Laura Kneedler
Abortion supporters in Portland, Oregon, January 2019. The Trump Administration’s attack on Title X promises to block health care access for some four million people—mostly poor, mostly women.
Four million people in 2017 benefited from Title X-funded services, ranging from cervical and breast cancer screening to contraception and STD testing. Two-thirds of these people, most of them women, were living at or below the poverty line. Last week, when Trump finalized a new rule on February 26 preventing clinics who receive Title X funds from performing abortions or referring patient to clinics that do, he in essence issued an ultimatum to family planning clinics: Abandon four million people who rely on you for non-abortion services or abandon reproductive rights.
It’s an ultimatum the administration has issued before, and at a global scale. One of Trump’s first acts after taking office was to reinstate the Global Gag Rule, which imposes the same abortion and referral restrictions as the new Title X guidelines on recipients of international family planning assistance. Then, in May 2017, he expanded the rule to apply to all global health assistance, increasing by sixteen times the amount of funding affected.
Some groups have stood their ground. Marie Stopes International, which works in thirty-seven countries to provide contraception and safe abortion, has refused to alter its mission, and as a result is now ineligible for U.S. funds. It has estimated that the Global Gag Rule left them with a funding gap of nearly $80 million in 2018, a deficit the organization predicts will result in as many as 2.5 million unintended pregnancies, 870,000 unsafe abortions, and 7,000 avoidable maternal deaths.
The outcome is no better when organizations abide by the Global Gag Rule, reducing access to safe abortions. The World Health Organization reports that in countries that completely ban abortion or only allow it in cases where the mother’s life of health is threatened, only one in four abortions is safe. And, the overall number of abortions doesn’t drop when tighter restrictions are put in place.
Similar patterns are evident in the United States. A 2017 Center for Reproductive Rights study found the more abortion restrictions a state imposes, the worse its indicators of women’s and children’s health. Women who don’t have access to abortion care are also more likely to experience poverty, physical health impairments, and intimate partner violence, according to the report.
Title X funding provides the most vulnerable people in the United States with health care.
Title X funding provides the most vulnerable people in the United States with health care. In 2017, most of the patients seen at Title X-funded clinics (community health centers and Planned Parenthood or other family planning clinics) were young women with low incomes. A full 90 percent of patients—3.6 million—qualified for subsidized or no-cost services. A third of U.S. women with low incomes depend on Title X clinics for their contraception.
Five states—California, Connecticut, New York, Oregon and Washington—have vowed to sue to block implementation of the rule. Seven others have expressed opposition, as have the American Medical Association, American College of Obstetricians and Gynecologists, Association of State and Territorial Health Officials, Association of American Medical Colleges and many other health, legal, and advocacy groups. The ACLU and Center for Reproductive Rights have announced their intention to sue.
The American Medical Association issued a statement warning about the new rule’s consequences: “Millions of women depend on the Title X program for access to much-needed healthcare including cancer screenings, birth control, STI testing and treatment, and other exams. This is the wrong prescription and threatens to compound a health equity deficit in this nation.”
The ACLU and Center for Reproductive Rights have announced their intention to sue, but while legal challenges work their way through the system, millions who can’t afford non-subsidized health care are left without recourse.
Anti-choice advocates claim the Trump Administration’s actions will help get women out of “dismal abortion clinics” and into “bustling, cheerful community health centers.”
But it will not be easy for non-Planned Parenthood centers to fill the gap. A Guttmacher Institute study reveals that in 103 counties, Planned Parenthood is the only facility supplying publicly funded contraceptives. And these clinics serve far more contraceptive clients each year on average than other types of health facilities—2,950 as opposed to the 330 served by federally qualified health centers and the 750 served by health departments.
The final say will lie with the courts, but it will take time for legal challenges to work their way through the system—time in which millions who can’t afford non-subsidized health care are left without recourse. Eventually, the decision may fall to a U.S. Supreme Court that has shifted further right under Trump. And that could mean the responsibility for ensuring adequate health care access for vulnerable populations—like other protections of reproductive rights—will eventually fall to the states.