Will Low-Income Women Lose Access to the Reproductive Health Care They Need?

Stories that caught our attention

The Trump administration’s recent changes to the Title X Family Planning Program are expected to severely reduce access to reproductive health services across the country. Title X is the $286 million federal program that ensures that low-income or uninsured women can obtain contraceptive and related services. Since the program was created in 1970, Congress has prohibited the use of Title X funds Essential Coveragefor abortion. The administration further distanced the program from abortion when it announced on July 15 that it had immediately cut off federal funding of health clinics that perform or refer patients for abortion. On July 20, the government gave clinics a two-month grace period to comply with the rule changes before facing penalties, the Washington Post reported. According to the Associated Press, “the latest timetable from the administration says clinics must submit a compliance plan next month, and by mid-September must show they are carrying out most of the new requirements.”

The rule changes are a huge setback for Planned Parenthood, the nation’s largest provider of reproductive health services (including abortion) and the largest recipient of Title X funding, at about $60 million. Planned Parenthood serves 41% of the four million Title X patients nationwide, providing basic primary and preventive services like wellness exams, breast and cervical cancer screenings, and testing and treatment for sexually transmitted diseases. In California, 26% of the more than 360 Title X clinics are no longer eligible for federal funding because they are Planned Parenthood clinics or because they provide abortions, according to KFF (Kaiser Family Foundation). Only Vermont, Utah, and Alaska have higher proportions of Title X clinics that are affected by the new rule.

Politco reported that Planned Parenthood will withdraw from the Title X program. To continue providing family planning services, it will tap emergency reserves while challenging the administration in court. “Since day one, the Trump-Pence administration has aggressively targeted the health, rights, and bodily autonomy of people of color, people with low incomes, and women,” said Emily Stewart, vice president of public policy for the Planned Parenthood Federation of America, in a statement. “We’re going to fight this rule through every possible avenue.”

These regulations put politics over quality patient care. They go against clinical best practices and medical ethics. — Julie Rabinovitz, Essential Access Health

Reproductive rights groups and nearly two dozen states, including California, have filed numerous lawsuits to block the Title X changes. In March, California Attorney General Xavier Becerra sued the Trump administration in the federal court for the Northern District of California. Oregon and Washington filed similar lawsuits. The challenges won temporary injunctions in April blocking implementation of the rule, but the Department of Health and Human Services appealed. On June 20, a three-judge panel of the US Court of Appeals for the Ninth Circuit in San Francisco ruled that the Trump administration’s Title X rule could go into effect immediately. Soon after, Becerra petitioned the Ninth Circuit to have all 27 of its judges reconsider the panel’s ruling.

Role of Reproductive Services in Reducing Poverty

Title X, passed with bipartisan support and signed into law by President Richard Nixon, provides a family planning safety net for millions of low-income women. Nearly 70% of patients who rely on Title X live in poverty, Jessica Mason Pieklo reported in Rewire.News. Additionally, “about one-third of Title X patients are Latinx and approximately 22% are Black, meaning a disproportionate number of Title X patients are people of color.”

Research shows that family planning plays a pivotal role in reducing poverty, in addition to numerous benefits, including “maternal and infant survival, nutrition, educational attainment, the status of girls and women at home and in society, human immunodeficiency virus (HIV) prevention, and environmental conservation efforts.”

It’s not surprising that a majority of Americans are concerned about access to reproductive health services under the new rule. A national poll conducted by KFF found that 69% of Americans and 76% of women ages 18 to 44 share this concern. Seventy-six percent say it is important for the federal government to fund reproductive health services, including family planning and birth control for women with low incomes. A national poll conducted by Morning Consult for the National Family Planning & Reproductive Health Association (NFPRHA) found 81% of Americans believe the public needs access to health care and health education — mainstays of the Title X program — to prevent unintended pregnancy. [Disclosure: Carlina Hansen, senior program officer for CHCF’s Improving Access team, serves on NFPRHA’s board of directors.]

California Not Immune to the Threat

In California, the nonprofit Essential Access Health is responsible for distributing Title X funds to over 360 health clinics in 38 counties. After the Trump administration released its final rule for Title X in March (implementation has been delayed by the legal challenges), Essential Access Health president Julie Rabinovitz said that she anticipated there would be clinic closures and 200 layoffs of federally funded positions under the rule, Sammy Caiola reported for Capital Public Radio.

In an email interview, Rabinovitz told me that “these regulations put politics over quality patient care. They go against clinical best practices and medical ethics. We are very disappointed that the Department of Health and Human Services decided to begin implementation of the regulations and jeopardize access to care while we are still in the early stages of the judicial process.” Essential Access Health has sued the Trump administration to block the Title X rule from taking effect.

The California Medical Association (CMA) also strongly opposed the final rule, saying in a statement, “These new regulations will limit access to critically needed care and services for millions of individuals who depend upon the Title X program for their care and will result in harm to patients and the public health.” CMA cited the finding by the Guttmacher Institute, a research organization committed to advancing reproductive health and rights, that $1.3 billion is saved annually in California due to public investment in family planning services at Title X–funded health clinics.

A Chaotic Time for Planned Parenthood

Roiled by the uncertainty and controversy surrounding the Title X changes, Planned Parenthood is also facing upheaval. After eight months at the organization’s helm, Leana Wen, MD, was ousted by the board of directors. On July 16, Wen announced via Twitter that the Planned Parenthood board had ended her employment because of “philosophical differences over the direction and future of Planned Parenthood.” Wen followed up with another tweet emphasizing her belief “that the best way to protect abortion care is to be clear that it is not a political issue but a health care one.”

Planned Parenthood appointed Alexis McGill Johnson as acting president. McGill Johnson, who co-founded the antibias research group Perception Institute, has served on Planned Parenthood’s board for nearly a decade. In a statement, Planned Parenthood described McGill Johnson as a “renowned social justice leader, lifelong political organizer, and a tireless advocate for reproductive rights and access to quality, affordable health care.”

At a time of growing threats to reproductive health services for women and families with low incomes, stable access to care is critical.

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