The Trump Administration Uses the Domestic “Gag Rule” to Yank the Health Care Safety Net Away from Low-Income Women of Color

It was a long-time coming. Far right legislators and government officials long have pulled one lever or another to chip away at funding for Planned Parenthood. But it was the Trump-Pence Administration’s Domestic “Gag Rule” - which effectively silences all federally-funded family planning and health care providers on abortion referrals - that finally got the job done.

Despite facing legal challenges, mounted right after it introduced the Gag Rule in May 2018, the administration put the rule in effect on July 15, 2019, effectively forcing Planned Parenthood to choose between the federal funding it needs to serve its patients and providing those patients with appropriate care. The organization chose its patients.

While Planned Parenthood may be the largest health care provider forced into this position, it’s not the only one – by far. Maine Family Planning also refused to comply with the new Title X ideologically-based rule rather than deny its patients comprehensive reproductive care and withdrew from the program. So did the state health departments in Massachusetts, Oregon,Vermont and Washington. Others are likely to follow.

In all, the Trump Gag Rule is putting the health and lives of some four million low-income people at risk. And, if the health care providers who were forced to decline Title X funds because of the new restriction can’t come up with the funding they need to provide the low-income women who rely on the prenatal care, cervical cancer screenings, mammograms and sexually transmitted infection testing that Title X made possible, a very dangerous public health crisis will result.

At the heart of the Gag Rule is the Title X National Family Planning Program, which provides everything from birth control to HIV testing for low-income people, mostly women of color. If Title X recipients want to continue to receive the funding, they’ll have to comply with new restrictions, which prohibit them from making abortion referrals or even telling patients where they can receive the medical procedure. Medical experts say the rule interferes with the doctor-patient relationship, denies patients access to a full range of medical options and essentially forces doctors to withhold information from people under their care.

From the start, the rule was squarely aimed at Planned Parenthood, which meets the reproductive health care needs of more than 1.5 million people or 40 percent of Title X patients by requiring Title X recipients that perform abortions to do so with separate staff in separate facilities or else lose government funding. This despite the fact that Title X funding does not cover and has never covered abortion services. The move is eerily reminiscent of the 1970s Hyde Amendment which shut off Medicaid funding of abortions. But the Trump policy goes to another extreme. It’s designed to raise the costs of doing business for reproductive health care providers so they are eventually unable to provide any services at all.

In the end, the scheme worked. Determined to avoid such a direct hit at its impoverished, uninsured clients who need the services the organization provides, Planned Parenthood withdrew from the Title X National Family Planning Program in mid-August, choosing instead to raise the money it needs to treat its patients with evidence-based, scientifically-sound medicine.

Meanwhile, the government is lowering quality standards in order to open a door for Title X participation to previously unqualified providers and deceptive, so-called crisis pregnancy centers, which go to extreme lengths—even lying to women about their medical options—to promote their anti-abortion, anti-contraception agendas. (In another win for fake crisis pregnancy centers—and loss for women and medical facts—the Supreme Court in June 2018 ruled on free speech grounds that the state of California may not require these religiously-oriented, centers to provide women with information on how to terminate their pregnancies.)

This latest turn of events marks yet another win for religious extremists in the fight for reproductive rights.

The administration already had forced this Gag Rule on countries around the globe by prohibiting monetary assistance to international aid groups and governmental agencies that counsel about or perform abortions to disastrous results, including unwanted pregnancies, followed by unsafe abortions and tens of thousands of deaths. Will the rule have a similar effect on the United States?