The Trump Administration Is Trying Yet Again To Defund Planned Parenthood

Update: Just in time for President Trump to speak at a major anti-choice fundraiser tonight, his Office of Population Affairs has released the full text of a proposed rule to block Planned Parenthood and other clinics that provide or even mention abortion from receiving certain federal family planning grants, known as Title X.

The proposal is 129-pages long and is just as draconian as reproductive rights advocates feared. The new rule mandates that any participating clinic receiving Title X funds: "Not provide, promote, refer for, support, or present abortion as a method of family planning." It later clarifies that doctors can provide referrals for abortion, if a pregnant woman in their care "clearly states" she has already decided to end the pregnancy.

Already federal law prevents taxpayer dollars from going to abortion services, but the new rule mandates that taxpayer-funded birth control services and abortion cannot occur in the same building. "The Department believes that [the requirement to keep taxpayer dollars from funding abortion] is most clearly met where there is a clear separation between Title X programs and programs in which abortion is presented or provided as a method of family planning," the document reads. Refinery29 reached out to the Office of Population Affairs for comment and will update if we hear back.

The Trump Administration is expected to announce a decision as early as Friday to block federal family planning grants from going to clinics that provide or refer patients for abortions.

According to reproductive rights activists and some major medical groups, the policy represents a “domestic gag rule” — an extension of the “global gag rule” that blocks U.S. foreign aid dollars from going to health clinics in other countries that even mention abortion as an option — because it essentially applies the same rules to providers who receive federal funds through a program known as Title X. They say the rule could force reproductive health providers to choose between providing abortions or referring for abortion, or losing these crucial Title X funds, which are dedicated to helping low-income people access birth control and other services like STI testing and treatment.

The rule, which is a pet project of social conservatives, is another step in what appears to be a strategy to broadly attack access to birth control and abortion via executive orders and the federal agency rule-making process. It is also a clear attack on Planned Parenthood, the largest provider nationwide of Title X-funded care. Title X, which was originally a bipartisan project made law in 1970, serves about 4 million women a year through clinics. An estimated 41% of those patients are seen at a Planned Parenthood clinic.

Although Republican attempts to defund Planned Parenthood via legislation have failed repeatedly, the Trump Administration has issued multiple rules or executive orders that undermine women’s rights: This includes the reversal of the birth control insurance coverage mandate that came down in October of last year (which was blocked by a judge in December and is tied up in the courts); the blockage or reversal of many teen pregnancy prevention grants (which was blocked by a Federal judge last month); the multiple attempts by director of the Office of Refugee Resettlement Scott Lloyd to block detained migrant women from abortion care; the stacking of federal court benches with virulent anti-choice, anti-women’s rights judges; and of course this also includes the Global Gag Rule, which Trump reinstated as one of his first acts in office.

“This is a far-reaching attack and attempt to take away women’s basic rights and reproductive rights, period,” Dawn Laguens, Executive Vice President of Parenthood Federation of America, said of the administration’s latest proposal, in a call with reporters this morning.

An analysis by the Guttmacher Institute found that if Planned Parenthood was excluded from the Title X program, other reproductive health clinics would have to increase their patient caseloads by 70%. “For many women, losing Planned Parenthood would mean losing their trusted provider, and in many cases the only source of care they have,” Kinsey Hasstedt, senior policy manager for Guttmacher Institute, said in a release emailed to Refinery29.

Earlier this week 110 separate public health organizations signed a letter to Alex Azar, Trump’s secretary of Health and Human Services, in opposition to the policy, which they argued was “nothing less than an effort to eviscerate access to care and information for people with low incomes and underserved populations.”

“Title X family planning health centers are a place of trust and confidentiality for millions of people across the country,” said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, in a statement emailed to Refinery29. “Censoring health providers and robbing patients of comprehensive family planning care and information is counter to the mission of Title X family planning program and bad for public health.”

If the domestic gag rule becomes official policy (which could take months and will include a public comment period) it will likely trigger immediate lawsuits — just like it did when Ronald Reagan’s administration first implemented a version of it in 1988.

Back then, the rule completely barred family planning clinics that receive federal grants from even discussing abortion with women. That rule never went into effect because it got tied up in the courts. Although the Supreme Court ruled in favor of the Reagan administration, by the time that happened President Bill Clinton was in office. His administration ultimately replaced Regan’s gag rule with its opposite: a requirement that providers receiving federal funds provide appropriate "nondirective" counseling that includes the full range of options for pregnant women, from prenatal care to adoption to abortion.

According to The Chicago Tribune, which reviewed a Trump administration summary, the new proposal only rolls back the Clinton requirement that abortion be discussed, making it a slightly less severe version of the original policy.

What remains troubling to reproductive rights advocates, however, is that the new rule still seeks to create an actual physical barrier between abortion services and other reproductive healthcare. Federal law already blocks taxpayer money from funding abortions. But the new rule would make it so that any clinic where federally-funded reproductive-health services are offered must be completely separate from abortion services. “It’s really inconceivable and unwarranted that a safe, legal medical procedure that is part of the full scale of reproductive health care would have to be stigmatized and put aside, separate from where people go to get their healthcare,” Laguens said.

Medical experts echoed the sentiment. “This ‘gag rule’ is not only unconscionable, but it undermines medical ethics by forcing health care professionals to withhold accurate and timely medical information from patients,” says Jenn Conti, M.D., a fellow with Physicians for Reproductive Health. “As a provider of comprehensive reproductive health care, it is my number one priority to keep my patients safe and honor the trust they give me. If I can’t mention the word ‘abortion,’ then I am not providing my pregnant patients who want to know all of their options with complete, accurate, unbiased medical information.”

The American College of Obstetrics and Gynecologists warned that this could have dire consequences for women’s health. “While much of the media coverage has accurately captured the harms of these changes, I’m concerned that the narrative is losing sight of the deeper implications these changes have for routine and necessary women’s preventive health care and for the patient-provider relationship,” said Hal Lawrence, M.D., executive vice president and CEO of ACOG, in an emailed statement. “For the many health centers and patients that rely on this program for their contraceptive care, these changes will leave them with no alternatives."