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Planned Parenthood warned Wednesday that, without intervention from a federal court, it will be forced out of the Title X Family Planning Program next week because of the Trump administration's ban on health clinics receiving federal tax dollars if they provide or refer patients for abortions.
"We refuse to let the Trump administration bully us into withholding abortion information from our patients."
--Alexis McGill Johnson, Planned Parenthood
The Health and Human Services Department declared last month it would immediately begin enforcing what critics call the Title X or domestic gag rule. Less than a week later, the agency announced that clinics would have until mid-August to submit written assurance that they don't provide the procedure or referrals, and are making "good-faith efforts to comply" with the rule.
Alan E. Schoenfeld, a Planned Parenthood attorney, wrote in a letter (pdf) to U.S. Court of Appeals for the Ninth Circuit Wednesday:
Planned Parenthood has long been firmly committed to its Title X patients and to the Title X program, which it has served for nearly 50 years. With deep regret, however, its direct grantees now have no option but to withdraw from the Title X program. Absent emergency judicial relief, they must do so by the close of business on Monday, August 19--less than a week away.
"This is a blatant assault on our health and rights, and we will not stand for it," Alexis McGill Johnson, Planned Parenthood Federation of America's acting president and CEO, said in a statement Wednesday. "We refuse to let the Trump administration bully us into withholding abortion information from our patients. The gag rule is unethical and dangerous, and we will not subject our patients to it."
"The Trump administration is targeting providers like Planned Parenthood in an attempt to end access to birth control and other reproductive healthcare," she added. "They are forcing qualified, expert healthcare providers out of our nation's decades-old program for affordable birth control--providing grants instead to an anti-abortion group that doesn't even offer birth control."
Without urgent action by the court, warned McGill Johnson, "this gag rule will destroy the Title X program--putting birth control, breast and cervical cancer screenings, and STI testing and treatment at risk for millions of people struggling to make ends meet."
The Washington Postreported on the anticipated consequences of Planned Parenthood's exit from the federal program, which mostly serves people with low incomes who face systemic barriers to healthcare:
The result of the agency's withdrawal--unless the court should rule against the administration before Aug. 19--will vary greatly by state, said Erica Sackin, a spokeswoman for the organization. Some states have pledged to make up the funds. But in others where that isn't the case, especially rural areas where providers can be many miles from one other, the effect is likely to be "chaos," she said.
In Ohio, a mobile health center that provides testing for sexually transmitted disease, birth control and education, will likely have to shut down, Sackin said. In Vermont, where Planned Parenthood is the only Title X provider in the entire state, women would be referred elsewhere. Some Planned Parenthood affiliates may waive fees or offer discounts on a sliding scale, she said.
"Planned Parenthood health centers are doing everything we can to make sure patients can still get care but it would be a mistake to think there won't be changes," Sackin said.
In a series of tweets, Planned Parenthood highlighted that its health clinics across the country serve 40 percent of all Title X patients, many of whom are people of color and under the age of 30. The group also urged critics of the administration's widely unpopular gag rule to contact their members of Congress.
\u201cNow, we need Congress more than ever to protect access to birth control and other essential care for MILLIONS. \n\nTell your senators to stand with Planned Parenthood and protect Title X: https://t.co/8cNL13CtlY #ProtectX #IStandWithPP\u201d— Planned Parenthood Action (@Planned Parenthood Action) 1565806554
The Democrat-controlled U.S. House passed a spending package in June that would block the administration's gag rule, but a similar measure has not yet passed the Republican-held Senate. There has also been pushback from some states.
"The Democratic governors of several states including Hawaii, Washington, and Illinois have said their state agencies will not participate while the rule is in effect," reportedNPR. "Maine Family Planning--the only Title X grantee in that state--recently announced it is also pulling out of the program."
After President Donald Trump's administration announced Monday that it would immediately begin enforcing a ban on abortion referrals at clinics that receive federal tax dollars, outraged reproductive rights advocates warned about the impact on healthcare nationwide and vowed to keep fighting against what they call the domestic gag rule.
"The Title X gag rule is part of a much broader agenda by the Trump administration and its allies to undermine people's reproductive health and rights, and to impose a socially conservative worldview within the U.S. healthcare system."
--Guttmacher Institute
Trump's Health and Human Services Department notified clinics of the move ahead of a conference in Washington, D.C. on Tuesday. The announcement followed a 7-4 vote Thursday by the U.S. Court of Appeals for the Ninth Circuit upholding an earlier ruling which lifted injunctions that prevented enforcement of the policy.
The administration's rule makes healthcare clinics ineligible for Title X Family Planning Program funding if they provide abortion referrals and requires them to keep finances separate from facilities that provide abortions. Though clinic staff can still discuss the procedure with patients, they are not required to do so.
The rule also stipulates that healthcare centers receiving Title X funds cannot be located in the same space as abortion providers, though that provision isn't set to take effect until next year. The decades-old Hyde Amendment, passed annually by Congress, already blocks federal funding for abortion services except in cases of rape, incest, or threat to a pregnant person's life.
\u201cThis prohibits #TitleX clinics from referring people to abortion providers IF the patient wants. Providers are not allowed to even counsel patients with medical info. They must also now be in separate facilities from abortion providers. (Funding abortion is already prohibited.)\u201d— Rebecca Kreitzer (@Rebecca Kreitzer) 1563286658
Services funded by the Title X program, which gives clinics about $260 million in grants annually, mostly serve patients with low incomes and those who face systemic barriers to care, including people of color and uninsured individuals. According to Planned Parenthood, a primary target of the new rule, "more than four million people rely on affordable birth control and reproductive healthcare services that are funded by Title X."
The organization operates clinics across the country, which would be effectively defunded by the gag rule--a longtime goal of the anti-choice movement and Republican politicians. Planned Parenthood Action responded to the administration's enforcement announcement on Twitter late Monday, denouncing the rule as "devastating, illegal, and unethical."
Promising to continue the ongoing legal challenge to the ban, Planned Parenthood Federation of America president Dr. Leana Wen said in a statement that "our doors are still open" and "we will not stop fighting for all those across the country in need of essential care."
\u201cBREAKING: Last night the Trump administration notified Title X providers that it will begin enforcing its unethical gag rule IMMEDIATELY\u2014endangering the healthcare of millions and effectively "defunding" Planned Parenthood nationwide. https://t.co/BlNnGT8OrO #ProtectX\u201d— NARAL (@NARAL) 1563287051
In a series of tweets Tuesday, the Guttmacher Institute, condemned the rule as "blatantly coercive and a violation of medical ethics and patients' rights," and cautioned that "the consequences could be severe."
"The Title X gag rule is part of a much broader agenda by the Trump administration and its allies to undermine people's reproductive health and rights, and to impose a socially conservative worldview within the U.S. healthcare system," tweeted the research and policy group, which works to advance reproductive health and rights globally.
Clare Coleman, president of the umbrella group National Family Planning & Reproductive Health Association, also tied the move to the Trump administration's and Republican lawmakers' other recent attacks on healthcare and reproductive rights. As she told The Associated Press, "The administration's actions show its intent is to further an ideological agenda."
\u201cLast night, @HHSGov notified Title X grantees that it will begin formally enforcing the final #TitleX rule. This is devastating for our members and for the 4 million people served by the program every year. The @AP reports more. https://t.co/VsCHiWie7p\u201d— NFPRHA (@NFPRHA) 1563286285
"Make no mistake, this is not about helping women--it's about preventing women from exercising their constitutional right to choose," Rep. Barabara Lee (D-Calif.) tweeted Tuesday. "Politicians have no place dictating patient care."
Sen. Elizabeth Warren (D-Mass.) was also among those who expressed alarm over the administration's policy. In a Monday night tweet, the 2020 presidential candidate wrote that she stands with Planned Parenthood Action in the fight to overturn the gag rule and highlighted how she would safeguard reproductive rights on a national scale if elected to the White House in 2020.
\u201cThis rule silences doctors and puts women's lives at risk. I stand with @PPact in their fight to overturn these punitive regulations. A Warren administration will protect the right to choose. Here's how: https://t.co/iBzvjDBCL4\u201d— Elizabeth Warren (@Elizabeth Warren) 1563234490
Nearly 80 organizations on Monday unveiled a sweeping policy agenda intended to improve sexual and reproductive healthcare and rights.
"We can do more than fight back--it's time to move forward," women's rights group UltraViolet said in a tweet about the plan.
Entitled Blueprint for Sexual and Reproductive Health, Rights, and Justice (pdf), the over 100-page document represents a far-reaching vision. It notes that "sexual and reproductive health and rights are inextricably linked to economic justice, voting rights, immigrants' rights, LGBTQ liberation, disability justice, and the right to community safety and racial equity."
Those intertwined issues are reflected in the diversity of endorsing organizations, which include the Center for Reproductive Rights, the National LGBTQ Task Force, People for the American Way, and Sierra Club.
Recent moves, say the organizations, have made clear that the nation is on a "dangerous trajectory."
"The last two years," reads the document, "have seen increasingly hostile attacks on reproductive autonomy and rights, creating a palpable urgency for action that demands a proactive and transformative agenda"
It notes, for example, the fact that in "seventeen states, abortion is simply a theoretical right for many individuals, as laws and policies have made it virtually impossible for people to access safe and legal abortion."
With areas of concern encompassing the state, federal and global levels, the new agenda focuses on five principles. They are, as noted in the document:
\u201cGuttmacher is joining nearly 80 SRHR organizations to collaborate on a proactive vision of how policymakers can better support sexual and reproductive health and rights! https://t.co/Y65WEEUTld #ReproBlueprint\u201d— Guttmacher Institute (@Guttmacher Institute) 1563205630
Flushed out within those principles are a number of specific policy recommendations to advance sexual and reproductive health and rights. Among them are for states to expand their Medicaid programs; full federal funding of USAID HIV programs; ending the anti-choice Hyde, Helms, and Weldon Amendments; and terminating the so-called domestic and global gag rules.
Advancing reproductive rights and bodily autonomy, the blueprint explains, also includes policymakers supporting the decriminalization of self-managed abortion, both in the U.S. and globally, as well as supporting families' economic opportunities with policies including paid family and medical leave.
Adding to the recommendations are a call for authorities to treat detained immigrants with respect, and to take quick action on the climate crisis because people have the right to a healthy environment.
"This blueprint represents the future we want to live in where each individual has sexual and reproductive autonomy over their own body," the organizations say. "It provides a playbook on how to get there. And it is drafted with the expectation that it will be implemented as soon as we have a supportive Congress and Administration."
"That future is coming," they write, "and we are ready."