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Trump’s Title X Restrictions Are Nothing Short of Coercion

The administration's gag rule could force reproductive health clinics to function more like anti-abortion “pregnancy centers.”

David McNew/Getty

Planned Parenthood announced Monday it was being “forced out” of a federal family planning funding program. Rather than obey a new anti-abortion restriction attached to those federal funds, the reproductive health organization is rejecting that money. That new restriction on Title X, the federal family planning program, comes under the direction of Dr. Diane Foley, a deputy assistant secretary in the Department of Health and Human Services and an anti-choice advocate.

None of this should come as a surprise. When President Donald Trump installed Alex Azar, a friend of the Family Research Council, an anti-choice and anti-LGBTQ group, as head of the Department of Health and Human Services, he put Foley—who has compared abortion to slavery and the Holocaust—in charge of the only dedicated federal program for family planning.

“We do not fight against flesh and blood,” Foley warned an audience at Claris Bible College in 2016. The fight against abortion, she said, is “a battle that is happening in the heavenly realms that Satan doesn’t want to lose.” (All this was detailed in a 2018 Senate memo on Foley, obtained by Tonic.)

Before her appointment, Foley was the head of two “crisis pregnancy centers.” These faux clinics, numbering around 4,000 nationwide, are designed to attract pregnant people seeking abortions and stop them from having the procedure through manipulation and misleading “counseling” about health consequences. Now, thanks to this administration’s new Title X restrictions, health care providers must prove they do not “support abortion as a method of family planning” or be denied federal funds. In essence, to get money from the program Foley oversees, real reproductive health centers must run their clinics like the fake ones Foley once headed.

This amounts to an abortion gag rule, restricting what Title X recipients can say about abortion to their patients. Reproductive health care providers have been bracing for this for months. At one Planned Parenthood clinic on the East coast, medications purchased with Title X funds “have been either thrown out or put in purgatory,” a clinic staffer told me, and “nobody here has any hope of getting them used before their expiration dates.”

The administration announced their new strictures back in May 2018, just ahead of Foley’s appointment. They claim this isn’t a gag rule, but given how broadly the new Title X guidelines are written—“A Title X project may not perform, promote, refer for, or support abortion as a method of family planning”—most providers consider themselves gagged because they can’t risk losing their federal funding over any discussion of abortion.

The new rules aren’t limited to abortions, alone: Providers are required to tell patients that their family members should participate in their sexual and reproductive health care, like when making choices about contraception or getting STI counseling and treatment. On top of that, now providers that don’t offer any contraceptives and instead promote “fertility awareness” (the rhythm method) are eligible for Title X. So, as publicly funded clinics face closure, Title X funded crisis pregnancy centers could see a windfall.

Monday represented the first deadline for Title X recipients to demonstrate they are in compliance with what the HHS Office of Population Affairs has termed the “Final Rule.” Several legal challenges to the funding restrictions are still ongoing, but a federal appeals court said Friday the rule will not be suspended while those suits play out. As a result, Planned Parenthood has said it will withdraw from Title X, potentially losing $60 million in funding. Nationally, Planned Parenthood serves about one third of all women who get contraception at publicly funded clinics.

“This is designed to force doctors and nurses to lie to their patients,” Dawn Laguens, the executive vice president of Planned Parenthood Federation of America, told The New York Times in May 2018, when the new restrictions were first made public. For the administration, the gag rule’s primary purpose appears clear. According to the New York Times, “[o]ne Trump official said the rule would give Planned Parenthood and other groups that receive federal family planning money a choice: Disentangle themselves from abortion or lose government funding.”

Planned Parenthood might be the largest and most visible target of Trump’s religious-right, anti-choice base. But all told, there are nearly 4000 Title X-funded family planning programs, according to the Kaiser Family Foundation, and they served more than 4 million people in the last fiscal year. Losing Title X, for the average clinic, means losing 19 percent of their funding, leaving people in need of family planning services with fewer choices. A 2019 report from the Guttmacher Institute put it bluntly: “The Trump administration is seeking to transform Title X from an agent of reproductive autonomy to a tool of government-sponsored reproductive coercion.”

This isn’t just supposition; Texas provides a disturbing preview. After imposition of a state law restricting family planning funding in 2011, long-acting, reversible contraceptive use went down by 35 percent, according to a 2016 study published in the New England Journal of Medicine. At the same time, births covered by Medicaid increased by 27 percent in the state.

Across the country, it will be people who relied on Title X-covered clinics—not just for family planning services, but for a full spectrum of reproductive and sexual health care—who will be most abandoned. A study, funded in part by HHS, showed that in 2016, for 60 percent of women seeking contraception at Title X-funded facilities, that visit would be their only healthcare for that entire year. Foley, Azar, and perhaps even Trump know what they are doing. The fake choices the Trump administration has given health care providers are a form of reproductive coercion, outsourced to medical professionals, to be carried out lest Satan have his win.