May 23, 2018 at 11:24AM
via Business Insider

• President Donald Trump announced a new "gag rule" policy to prohibit family planning clinics who provide abortion services or referrals from receiving federal funding under Title X.
• The gag rule could affect up to 4 million people nationwide, many of whom are uninsured and rely on Title X for reproductive healthcare. 
• By removing funding for contraception, the gag rule could have the affect of increasing unplanned pregnancies and STIs.

Speaking at a gala for the anti-abortion organization Susan B. Anthony's List on Tuesday night, President Trump formally announced a new rule that would prohibit family planning clinics that receive federal funding under Title X from providing privately-funded abortions or referring patients to abortion services.

This announcement reflects Trump's campaign promise to defund clinics that provide abortions, such as Planned Parenthood, and more broadly decrease access to abortion nationwide.

Here's everything you need to know about Title X, what this so-called "gag rule" means for patients, and what impacts it could have for women's health on a national scale. 

What Title X is

Established in 1970, Title X is the only federal statute that issues grants to clinics that provide family planning and health services to low-income and uninsured people who wouldn't otherwise be able to afford such services.

Title X grants are administered to health centers and family planning clinics, such as Planned Parenthood, through the Office of Population Affairs (OPA) within the Department of Health and Human Services (HHS). 

According to an April 2018 report from the Congressional Research Service, 4 million people received services funded by Title X in 2016. There are 4,000 Title X-funded health centers throughout the country, with Planned Parenthood serving 41% of Title X patients. 

Services Title X subsidizes

The main services funded by Title X grants are wellness exams, cervical and breast cancer screenings, birth control, contraception education, STI testing and treatment, and family planning counseling. A 2016 OPA report estimates that Title X funding allowed clinics to provide 700,000 pap smears, four million STD tests, and a million breast cancer screenings.

While Title X funding can pay for counseling in which patients are educated and informed about abortion, it cannot directly pay for abortion procedures. The Hyde Amendment of 1976 expressly prohibits any federal programs, including Title X and Medicaid, from funding an abortion procedure except in rare cases where pregnancy would endanger the life of a pregnant person. 

J. Scott Applewhite (Associated Press)

What the gag rule entails

According to a memo released by HHS last week, the new policy would bar clinics such as Planned Parenthood that provide abortions along with other family planning services from receiving any Title X funding at all, even though none of that funding directly goes toward abortions services.

Additionally, doctors at clinics that receive Title X funds but do not provide abortions would be largely prohibited from referring patients to clinics that do provide abortions. The new rule removes the requirement that providers counsel pregnant people on abortion as an option, and only permits doctors to make referrals to abortion services if the patient has already made up their mind to terminate the pregnancy.

Last January, Trump also re-instated a global gag rule known as the Mexico City Policy that prohibits global non-profits and NGOs that receive US government aid from providing information or referrals on abortion to patients in foreign countries. Originally enacted by President Ronald Reagan in 1984, the Mexico City Policy has since been consistently implemented by Republican presidents and revoked by Democratic ones to signal their positions on abortion.

Who is most affected

Health clinics and opponents of the policy argue this new gag rule would disproportionately affect the most disadvantaged populations and leave them with no where else to turn for referrals to abortion providers.

The 2016 OPA report found that 89% of patients who received care through Title X funding identified as female, 64% had family incomes at or below the poverty line, and 43% lacked health insurance coverage. 

This rule means that clinics that refuse to comply with the restrictions on abortion services and referrals would lose all federal funding, including funds that provide birth control and contraception education. The rule could also increase the prevalence of unplanned pregnancies and STIs.

 A 2011 study on the impact of the global gag rule during the George W. Bush administration found that this decreased availability of contraception services had the impact of nearly doubling unplanned pregnancies and abortions in sub-Saharan Africa. 

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