March 6, 2019; Rewire
For reproductive rights advocates, the political environment is an ever-changing theater of conflict, each of which is important.
Lawsuits have been filed by numerous state attorneys general and nonprofits across the US in response to the new Title X guidelines released by the Trump administration this week. The guidelines constitute a domestic gag rule that limits women’s access to sexual and reproductive health services.
Specifically, the guidelines state that grant-funded Title X services “[do] not include abortion as a method of family planning” and “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” This means that money for research and training and money that supports other health services such as cancer screenings, infertility treatment, and contraceptives cannot go to facilities that also provide abortion; they must be “physically and financially” separate. While health providers may mention abortion to their patients, they cannot provide any direct referrals for the service.
Planned Parenthood has already declared that if and when the rule goes into effect in May, they will simply forfeit their Title X funding rather than compromise care. However, many smaller providers rely much more heavily on federal funds and may not be able to make that choice.
“I don’t believe I’m overstating it when I say that the domestic ‘gag rule’ poses an unprecedented threat to our organization,” said George Hill, president and CEO of Maine Family Planning. Hill’s organization has joined with the global Center for Reproductive Rights to file one of the suits against the new rules. According to the 2017 Form 990, the majority of Maine Family Planning’s money comes from federal grants. Hill said, “The rule undercuts and upends all of the work that we’ve done to expand meaningful access to affordable reproductive health care, including abortion care, in Maine.” His organization faces an impossible choice: provide a lower standard of care for their patients or close their doors.
Twenty-one state attorneys general agreed with Hill and Planned Parenthood and announced they would “challenge the constitutionality” of the new rules in US District Court in Eugene, Oregon.
Advocates have seen this move coming. One of the new administration’s first acts in January 2017 was to reinstate the global gag rule, which prevents USAID (United States Agency for International Development) funds from going to any organization that provides information, referrals, advocacy, or services related to abortion. The president has been threatening to defund Planned Parenthood almost since he took office. This past May, over 100 healthcare organizations sent a letter to Health & Human Services Secretary Alex Azar, registering grave concerns about the possibility of a domestic gag rule; it would, they said, “contradict the primary purpose of Title X,” which provides healthcare to over four million Americans.
Planned Parenthood president Leana Wen wrote, “This rule has nothing to do with medicine and everything to do with politics.” She’s absolutely right.
The head of the Office of Population Affairs (a creepy name for the department tasked with distributing Title X funds) is Diane Foley, a prior president of the anti-abortion Life Network, which has ties to Focus on the Family. In November, anti-abortion groups convened at the White House to convey their disappointment that despite threats made on Twitter, little progress had been made to defund abortion clinics. Students for Life of America President Kristan Hawkins said, “We did express some disappointment that things haven’t moved faster and that there were things that they’ve promised that they haven’t done yet.”
Women who have lower incomes, women who live in rural areas, and women of color, all of whom generally have a harder time accessing decent health services, will be heavily impacted by this rule. Their bodies—the bodies of women, particularly women of color—have become the battleground in a war for ideological turf, their rights collateral damage sacrificed at the altar of dominant patriarchal narratives about morality and gender norms.
Aziza Ahmed wrote in 2005,
Conservative forces and nations…are able to merge their own agendas with that of the US government’s; ironically, they are allies in the war against women. The rise of conservativism, bolstered by…cooptation of human rights language, has led to a more specific assault on sexual and reproductive health rights.
The press release from HHS claims this rule “protects Title X healthcare providers so that they are not required to choose between participating in the program and violating their own consciences.” But removing the choice from the purview of healthcare providers does not eliminate it; the policy merely reassigns the choice to politicians, who by definition are more likely to make the decision based on politics rather than medicine. The choice to save the “consciences” of healthcare providers rather than health of their patients is the one being fought by Planned Parenthood, Maine Family Planning, the attorneys general, and several others.—Erin Rubin