I didn’t have health insurance for most of my senior year in high school. My mom left her hospital job to focus on building a business, and consequently we lost her employer-sponsored coverage. We weren’t eligible for Medicaid and this was before the Affordable Care Act, a time when purchasing even crappy insurance on the open market cost a small fortune. So our generally healthy family took a calculated risk and went without.
During the time I was uninsured, I relied on the Planned Parenthood health center in our Ohio suburb for birth control. They charged me using a sliding fee scale based on the meager pay stubs from my after-school hostessing gig. For my first office visit and a three months’ supply of birth control pills, I paid just $45.
I didn’t know it then, but that low-cost visit was made possible by Title X (pronounced “title ten”), a Nixon-era family planning program that has ensured access to reproductive health and preventive care services to low-income and uninsured people for over 50 years. But new regulations released by the Trump-Pence Administration on February 22 undermine the very foundation of the program, threatening the availability and quality of care that 4 million Americans rely on each year.
Title X grants have historically enabled healthcare providers like Planned Parenthood and Maine Family Planning to offer a comprehensive range of sexual and reproductive health services to eligible patients at low or no cost. These services include contraception, testing and treatment for sexually transmitted infections (STIs), breast and cervical cancer screenings, pregnancy tests and options counseling, and referrals for further care.
Title X was passed with broad bipartisan support and signed into law by a Republican president. But publicly-funded family planning services once seen as common sense have since been rendered controversial by anti-abortion extremists.
Under the direction of anti-abortion lobbyists and fueled by Mike Pence’s terrifying zeal for using forced birth as a punishment for people whose sexual ethics differ from his own, new rules governing the Title X program are designed to strip funding from organizations that provide both sexual health services and abortion care, like Maine Family Planning and Planned Parenthood of Northern New England (PPNNE).
Federal law already prohibits the use of federal funds to pay for abortion care except in extremely narrow circumstances. While previously, the program required only financial separation between Title X services and abortion care, the new rules require grant recipients to demonstrate both financial and physical separation. This has the potential for wide-ranging implications, but here’s just one example: The same exam room could not be used for both contraceptive counseling and pregnancy options counseling that included a discussion of abortion — these two actions would have to take place in separate, designated spaces.
While cumbersome and unnecessary, the absurdity of that new rule pales in comparison to what many abortion rights advocates have dubbed a domestic “gag rule.” To remain eligible for Title X funds, participating providers must agree not to provide information or referrals about abortion services — even when patients specifically request them. In other words, healthcare providers would be required by law to withhold relevant health information from their patients.
At the same time that the proposed rules force providers of comprehensive sexual and reproductive health services to choose between violating medical ethics and sacrificing millions of dollars in grants that make care accessible to uninsured and low-income patients, they clear the way for crisis pregnancy centers (CPCs) to receive funds in their stead.
CPCs are organizations that work to convince pregnant people not to have abortions. They are often affiliated with religious groups and have a long, documented history of masquerading as legitimate health organizations offering free pregnancy tests, ultrasounds, and STI screenings to get unsuspecting people through their doors. CPCs promote abstinence until marriage and almost universally oppose the use of modern contraception.
Until now, Title X program regulations required neutral, nondirective counseling about abortion — basically, counseling that presented parenting, adoption, and abortion equally without pressuring the patient to choose one over the others. They also required providers to offer a full range of effective contraceptive methods. Thanks to these patient protections, CPCs have historically been ineligible for Title X funds. The new rules do away with both requirements, opening the door for biased and religiously-motivated abortion and contraceptive counseling to be paid for with federal dollars.
These changes have made me think back to the person I was at 18, when I relied on Title X providers for birth control. With their help, I learned about the importance of regular STI screening and avoided unintended pregnancy. But what if instead of a qualified health professional, I’d been met with a CPC volunteer? What if instead of receiving unbiased, factual information about my sexual health, I’d been shamed for having sex at all? What if instead of effective birth control, I’d been scolded towards abstinence or grudgingly taught the rhythm method and sent on my way? And what if the faith-based organization running that CPC received Title X funds for its trouble?
The wildly inconsistent periods of my adolescence would have put me at high risk for unintended pregnancy, even with the most meticulous menstrual tracking. And Title X, a program intended to reduce unintended pregnancy, would have funded that failure of its own mission.
Today, we’re on the edge of that alternate reality. Local and national healthcare organizations and abortion rights advocates have pledged to fight these changes with all they’ve got in an effort to protect access to care — real care — for millions of Americans. I hope you’ll join them, and me, in the hard work ahead.