The Title X family planning program provides high quality, culturally sensitive, confidential birth control and other reproductive health services to over four million people every year. But this summer the Trump-Pence Administration proposed to change the rules of the program in ways that would fundamentally change it into something completely unrecognizable and harmful to people who rely on it for care. Earlier this week, the Law Center submitted comments to the Department of Health and Human Services on its proposed new rules, telling the Administration that not only are the changes it proposes outside the lines of what Congress intended the program to be, but they violate federal law. In particular, we pointed out that there was no way the Department of Health and Human Services could have possibly done a real analysis of the impact their rules on family well-being, as required under federal law. If they had, they would have inevitably found that the rules would have a negative impact and wouldn’t have proposed the rules in the first place.
Current Title X rules require neutral, factual information and nondirective counseling on all pregnancy options. This centers patients’ own stated needs, their reproductive choices, and their requested referrals. The requirements currently in place ensure that a person visiting a Title X clinic will receive the care that he or she needs – from contraceptive counseling and the range of methods, including the most effective ones available, to non-directive counseling about her options if she is pregnant. And all of these services are provided on a sliding scale to those most in need. In many cases, the Title X program is the only source of health care women use.
Yet the Trump-Pence Administration proposed rule would effectively destroy the program, undermining the high-quality family planning care provided to patients across the country. The proposed rule would allow entities to participate even if they refuse to provide the broad range of contraceptive methods. It removes the requirements that ensure patients’ own health needs are at the center of Title X-funded care. It violates the essential legal and ethical principle of voluntary, non-coercive counseling in all Title X services. It undermines trust in the program and jeopardizes the provider-patient relationship. It threatens patient confidentiality, particularly for minors, in ways that could cause many patients to avoid seeking care.
There are several legal “checks” on an Administration going so far astray from what a program is intended to be (spoiler alert: the Trump-Pence Administration violated most of them). One important check on the Department of Health and Human Services is Public Law 105-277, which requires the Administration to present adequate rationale for the implementation of any rule that may negatively affect family well-being. The Department of Health and Human Services, however, gave no details of its assessment of the proposed rule, merely stating that the rule would not negatively impact family well-being. But when we took a look at the proposed rule and existing research on family planning we found many places where there would be a negative impact on family well-being:
- Restricting access to family planning information and services has an economic impact. Birth control access is directly linked to a dramatic increase both in women’s participation in the workforce and families’ reliance on women’s earnings. Decreasing access to birth control– which will be a result of the proposed changes in the NPRM – will make it more difficult for women to access the health care they need that will help them achieve and maintain economic stability.
- The family planning methods being prioritized by the Department are not appropriate for many people. All individuals should have access to the family planning method of their choice that fits their lifestyle and needs without coercion. Yet the Department seeks to prioritize birth control methods that are not medically approved – such as fertility awareness based methods (FABM) and natural family planning – and are not an appropriate contraceptive option for many individuals. For example, people whose menstrual cycle is shorter or longer than 26-32 days are not recommended to use FABMs, transmen often use contraception to control their reproductive health and FABMs cannot provide the same medical results, and people experiencing domestic and interpersonal violence often prefer certain medically-approved family planning methods, like the copper IUD, that are not detectable by and/or cannot be interfered with by partners. But the Departments provide no analysis to show the impact on these groups of people or their families if they cannot access the medically-approved birth control they need.
- Delayed or denied access to abortion negatively impacts women’s financial well-being. Restricting Title X clinics from referring for abortion, and only referring for prenatal counseling and social services as proposed in the NPRM, would leave women on their own to find abortion care, inevitably delaying that care. Yet, abortion is a health care service that people need, and, like any other health care service, one for which people need unbiased counseling and referral. Ultimately, the Department clearly has failed to consider the impact of full and accurate information during time sensitive decisions about whether to continue a pregnancy. The delays that would result from the NPRM could increase the cost of an abortion, which ultimately can make it inaccessible for some women and have long-term impacts on their ability to make ends meet.
The impact of these negative changes will be especially harsh on communities that are already marginalized from the health care system and disproportionately rely on Title X-funded clinics, like Black women, Latina women, and the LGBTQ community. The Title X program provides critical services to people in these communities. For example, LGBTQ people already face negative economic impacts because of discrimination, and current Title X rules require clinics to provide high-quality, medically-accurate, confidential care that centers patients’ own stated needs, all of which combats the inherent challenges LGBTQ people can face in the health care system. Should the Trump-Pence rules for Title X go into effect, significant harm will be caused to the health and economic well-being of LGBTQ people and their families.
Some at HHS may see the family well-being assessment as just a process point, a box that needs to be checked to get a job done. But Congress requires it for good reason: to ensure everything any Administration does, at a minimum, doesn’t hurt families. And the evidence showing that the Trump-Pence rules for Title X would have a negative impact on family economic well-being is overwhelming. We won’t let this Administration get away with skipping this important step because family planning is the foundation for family economic well-being.