Clinicians: Title X Proposal 'Prohibits' Discussion of Abortion

Alicia Ault

May 23, 2018

WASHINGTON — The Trump administration on Tuesday issued a proposed rule that would impose tight, new restrictions on how physicians who receive funds under the Title X family planning would be able to discuss abortion, and would take away all Title X money from clinicians and clinics that provide abortion services.

The proposal was lauded by prolife organizations, but many clinician groups and abortion providers said they were concerned about the impact on women's healthcare.

"The administration's proposed policy changes to the Title X Family Planning program would significantly limit access to care for millions of Americans," said Ana María López, MD, MPH, FACP, president of the American College of Physicians, in a statement. "By discriminating against clinics unless they agree to unacceptable intrusions on the patient-doctor relationship, many may be forced to close or curtail their services."

"The [American Medical Association (AMA)] objects strongly to the administration's plan to withhold federal family planning funding from Planned Parenthood and other entities," said AMA President David O. Barbe, MD, in a statement. "We are particularly alarmed about government interference with the patient-physician relationship in the exam room."

Women's healthcare specialists also expressed strong opposition to the proposal. "Under this proposed rule, more than 40 percent of Title X patients are at risk of losing access to critical primary and preventive care services," said the signatories of a joint statement issued by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American College of Physicians, the Association for Physician Assistants in Obstetrics and Gynecology, the National Association of Nurse Practitioners in Women's Health, Nurses for Sexual and Reproductive Health, and the Society for Adolescent Health and Medicine.

Those patients will also "lose access to meaningful health information," said the groups, adding, "The proposed rule dangerously intrudes on the patient-provider relationship."

Planned Changes

The US Department of Health and Human Services (HHS) said in a press release that the planned changes — which will be open for comment for 60 days after the proposal is published in the Federal Register — will require clear financial and physical separation between Title X-funded projects and "programs or facilities where abortion is a method of family planning."

The Title X rules have not been updated in 18 years, and many critics have said that, despite strict prohibitions against the practice, many Title X recipients are recommending abortion as a family planning method or providing abortion services.

President Donald J. Trump said the proposal represented a promise kept. "When I ran for office, I pledged to stand for life, and as president, that's exactly what I've done," said Trump, speaking on Tuesday night at an annual gala for the Susan B. Anthony (SBA) List, an organization that supports what it calls "pro-life leaders."

Added Trump, "For decades, American taxpayers have been wrongfully forced to subsidize the abortion industry through Title X federal funding. So today, we have kept another promise. My administration has proposed a new rule to prohibit title X funding from going to any clinic that performs abortions."

SBA List President Marjorie Dannenfelser said in a statement, "We thank President Trump for keeping his promise to disentangle taxpayers from the abortion business." Dannenfelser claimed that the proposal will redirect money away from Planned Parenthood, "the nation's largest abortion business," and instead funnel money to Title X centers that do not promote or perform abortions, "such as the growing number of community and rural health centers that far outnumber Planned Parenthood facilities."

Under current law, funds for Title X — a program established in 1970 to provide family planning and preventive healthcare to low-income Americans — cannot be used to provide abortion or promote abortion as a method of family planning. In practice, many clinics that receive the funds — such as Planned Parenthood facilities — provide abortion services. But those services are funded by private money.

HHS said the rule would also protect "Title X health providers so that they are not required to choose between the health of their patients and their own consciences, by eliminating the current requirement that they provide abortion counseling and referral."

A "Gag Rule"?

The federal health department said the proposal "would not bar non-directive counseling on abortion, but would prohibit referral for abortion as a method of family planning."

The proposal states that nondirective counseling would be defined to mean that it "would not be considered encouragement, promotion, or advocacy of abortion as a method of family planning." The clinician would be "permitted to provide a list of licensed, qualified, comprehensive health service providers, some (but not all) of which provide abortion in addition to comprehensive prenatal care."

However, according to the proposal, "Providing such a list would be permitted only if a woman who is currently pregnant clearly states that she has already decided to have an abortion."

That may not be exactly the same language as a 1988 Reagan administration-imposed "gag rule" that was later rescinded after legal challenges, but some women's health organizations say it's effectively a ban.

Planned Parenthood said in a statement emailed to Medscape Medical News, "The administration's own rule says it prohibits abortion referrals. That means doctors are blocked from giving information to patients. That's the definition of a gag rule. It also discourages providers from counseling on abortion."

In addition, said the organization, "The rule prohibits providers from telling patients where they can obtain access to safe, legal abortion, and coupled with the language discouraging counseling for abortion, means that the information that providers share with their patients will change dramatically."

Ilyse Hogue, president of NARAL Pro-Choice America, called the rule a "scorched earth approach to ban abortion," in a statement.

"With this rule, this administration is trying to instruct doctors about what they can or cannot say to their patients," Hogue added. "That should alarm anyone who ever wanted to know the facts about their own healthcare or feel the doctor-patient relationship is sacred and should be protected."

Energy and Commerce Ranking Member Frank Pallone Jr (D-NJ) also condemned the new rule. ''Under this proposal, low-income women will lose access to contraceptive services and related preventive health care, and providers will be forced to choose between giving their patients complete medical information or complying with a restriction on speech," he said in a statement.

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