Intended for healthcare professionals

News

Planned Parenthood rejects restrictive US government funding and “gag rule”

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5227 (Published 20 August 2019) Cite this as: BMJ 2019;366:l5227
  1. Janice Hopkins Tanne
  1. New York

Planned Parenthood, the largest provider of reproductive healthcare to low income women in the US, pulled out of the government funded Title X program on 19 August because new rules from the Trump administration prohibited it from referring for abortions or providing them—the so called “gag rule.”

Alexis McGill Johnson, acting president of Planned Parenthood, said, “We believe that the Trump administration is doing this as an attack on reproductive healthcare and to keep providers like Planned Parenthood from serving our patients.” She said that the organization would continue to serve patients.

“Our patients come to us because they expect the best information and healthcare available. And we have a commitment to provide that to them. But the gag rule would make it impossible for us to provide that,” she said.

Planned Parenthood executives would not say how much the organization was rejecting, but it has been estimated at $60m (£49.6m; €54.1m) a year. The government spends about $286m a year on Title X programs.

Title X, established nearly 50 years ago, is the only federally funded program that provides family planning, pregnancy tests, birth control, screening for cervical and breast cancer, and testing and treatment for sexually transmitted diseases to about four million women and men with low incomes. The program helps to fund about 4000 health centers nationwide. Planned Parenthood serves 40% of Title X patients—about 1.6 million people. Most of its patients are African-American or Hispanic women, and its services are low cost or sometimes free.1

Fighting the rule

Title X funds cannot be used to provide abortions. Until now Planned Parenthood clinics were allowed to discuss all options with pregnant patients—providing pregnancy care, adoption, or referrals for abortion. Some Planned Parenthood clinics provide abortion.

The federal Department of Health and Human Services, after promises in Donald Trump’s campaign to end abortion, issued rules forbidding organizations that receive Title X funds from referring for or providing abortions—the gag rule.

Planned Parenthood, the American Medical Association, the Oregon Medical Association, and 22 state attorneys general sued to block the regulation. A lower panel of the court blocked the regulation, but on 16 August a higher panel of the court allowed the restriction to take effect. The Department of Health and Human Services asked Planned Parenthood and other organizations to submit letters agreeing to the rule.

Planned Parenthood, seven states, and several other reproductive healthcare providers refused to sign such letters and withdrew from the Title X program. Planned Parenthood said it would continue to fight against the gag rule in the courts. The next hearing will be in the week of 23 September.

Family planning

The Department of Health and Human Services denied that the “final rule” was a “gag rule.” It said that health professionals may not refer for abortion as a method of family planning but that referral for abortion “because of an emergency medical situation” was not prohibited.2

It added, “There are 4000 Title X service sites across the nation, with Planned Parenthood representing fewer than 400 . . . In addition, the Final Rule encourages diverse and new organizations to serve patients in the Title X program.”

The Trump administration is directing Title X funds toward organizations such as Obria, which received $1.7m in Title X grants this year.

McGill Johnson of Planned Parenthood called Obria “a network of anti-abortion counseling centers,” and Obria offers abortion pill reversal on its website. She added, “Do you know what Obria does not provide? Contraception. This means that patients who go to Obria seeking birth control will not be able to access methods like the pill, an IUD [intrauterine device], and emergency contraception.

“In Utah, where Planned Parenthood is the only Title X grantee—or Minnesota, where Planned Parenthood serves 90% of the Title X patients—it will simply be impossible for other health centers to fill the gap.”

She said that Planned Parenthood would continue to serve its patients by using emergency funds but that delays and perhaps increased costs for services would be likely.

She hoped that Congress would correct the funding problem, she said. A spending bill that would block the gag rule has already passed the House of Representatives, but it would require approval by the Republican controlled Senate.

Footnotes

  • Correction: We amended the author details in reference 1 on 21 August 2019.

References

Log in

Log in through your institution

Subscribe

* For online subscription