Image via Reproductive Health Supplies Coalition/Unsplash Image via Reproductive Health Supplies Coalition/Unsplash

Reproductive health advocates call the new rule “coercive and a clear violation of patients’ rights.”

Last week, four Arizona mayors took a public stand on what they call the “Trump administration’s attacks on birth control and reproductive health care.”

In a statement released by Planned Parenthood Advocates of Arizona, mayors Kate Gallego, Regina Romero, Coral Evans, and Anna Tovar, who represent Phoenix, Tucson, Flagstaff, and Tolleson, respectively, called on Congress to “stand up for Arizona” and block what’s been dubbed the “domestic gag rule.” A new change to the Title X family planning program prohibits Title X healthcare providers from talking to patients about abortion. 

“This is a dangerous intrusion into the patient-provider relationship; violates the fundamental belief that ethical health care is based on providing complete, accurate, and unbiased information, and widens the gap between who does and doesn’t have health care in Arizona and in this country,” the mayors wrote. 

More than 31,000 Arizona women access reproductive health care through Title X, they said. 

Earlier this year, the U.S. Department of Health and Human Services finalized new regulations for the Title X grant program, the only federal program specifically dedicated to supporting family planning. Title X, which was enacted in 1970, ensures approximately 4 million low-income Americans have access to preventative care at low or no cost each year. 

Providers have always been banned from using Title X money to cover abortions; now, they can’t get the funding at all unless they agree not to offer abortion services or even referrals for the procedure.

The new provisions include a rule that “prohibits the use of Title X funds to perform, promote, refer for, or support abortion as a method of family planning.” Providers have always been banned from using Title X money to cover abortions; now, they can’t get the funding at all unless they agree not to offer abortion services or even referrals for the procedure.

Additionally, the new regulations require that providers in the program separate, both physically and financially, abortion-related activities from Title X services. They also no longer mandate that grantees offer the full range of family planning methods, instead encouraging “diverse and non-traditional Title X partners.”

Reproductive health advocates say these new regulations will hurt the people Title X is intended to help by reducing access to family planning care. “The domestic gag rule is coercive and a clear violation of patients’ rights. Censoring medical professionals and prohibiting them from sharing complete information with their patients is unacceptable and blatantly unethical,” said Dr. Herminia Palacio, president and CEO at the Guttmacher Institute, in an emailed statement. “The gag rule amplifies health inequities for people with low incomes and for people of color, and it forces providers to make harmful compromises.”

In fact, major medical associations representing more than 700,000 women’s and adolescents’ healthcare providers have come out against these changes to Title X. Shortly after the new regulations were finalized by HHS, 23 states, several major family planning organizations, and the American Medical Association filed legal challenges seeking to block the new rule. 

District courts in Washington, Oregon, California, and Maryland issued preliminary injunctions stalling implementation, but the Court of Appeals ultimately overturned those injunctions. The rules went into effect July 15, pending the outcome of litigation. 

As a result, several providers, including Planned Parenthood, have since withdrawn from the program. Five states—Maine, Oregon, Utah, Vermont, and Washington—now lack Title X clinics. A recent report from Power to Decide, a nonprofit working to prevent unplanned pregnancies, found that approximately 900 family planning clinics have opted out of Title X in response to the new rule.

“We believe that providing people with all of the information that they need in order to make decisions that are best for them, their lives and their families is part of our mandate as a healthcare provider.”

Maine Family Planning—which supports 50 health centers, including 18 of its own, statewide—is one of those recipients that decided it could not comply with the new rules. In a letter sent to HHS in August, CEO George Hill said his group is leaving “more in sorrow than in anger.”

Ultimately, it came down to being able to offer the best care possible for patients, Deidre Fulton-McDonough, the communications director of Maine Family Planning, told COURIER in an interview. The organization serves nearly 23,000 women, men, and teens each year; the majority of patients come seeking help to prevent pregnancy. 

“The relationship between our patients and our expert providers is one based on trust. Our patients come to us knowing that they are going to receive comprehensive, evidence-based, unbiased care,” Fulton-McDonough explained. “Because of its provisions specifically around abortion referrals, the gag rule really undermines that trust between patients and providers. We believe that providing people with all of the information that they need in order to make decisions that are best for them, their lives and their families is part of our mandate as a healthcare provider.”

Maine Family Planning has been the Title X grantee for Maine for 50 years. Opting out of the program meant rejecting nearly $2 million in federal funding, Fulton-McDonough said. They’ve managed to replace the gap in their budget with private donations and foundation grants, but they’re still looking for a more sustainable solution, potentially through the state legislature. 

“On a nuts and bolts level, Title X funding makes it possible for clinics like ours to offer a sliding fee scale,” she said. “If someone comes to us and they are uninsured or under-insured and don’t have access to another form of health coverage, we can still ensure that the care that we deliver to them on that day is affordable.”

In fact, approximately 80 percent of the organization’s patients are low-income. Those individuals, Fulton-McDonough and others say, will be impacted the most by these changes to Title X—especially if and when clinics are forced to cut back on services or close altogether.

“Studies have shown that for a significant percentage of Title X patients, these family planning clinics are their only regular source of health care,” Fulton-McDonough said. “If you’re undercutting the relationship between patients and their only source of medically accurate healthcare information, it’s really problematic. It’s going to lead people to not accessing health care period.”

It’s a point the four Arizona mayors brought up in their recent letter. Outlining the barriers to care that have already risen in their state since the Title X rules were implemented, they point out that residents who live in the city of Flagstaff have to travel more than 62 miles to access Title X care. 

“This has resulted in patients having nowhere to turn for care,” they write.