NYT Editorial: Birth Control Gets Caught Up in the Abortion Wars


Birth Control Gets Caught Up in the Abortion Wars

The Trump administration’s cruel new family planning rule threatens access to contraception and other health care for poor women.

By The Editorial Board, New York Times

The editorial board represents the opinions of the board, its editor and the publisher. It is separate from the newsroom and the Op-Ed section.

< ![if !supportLists]>·        < ![endif]>Feb. 26, 2019

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In its continuing assault on reproductive rights, the Trump administration has issued potentially devastating changes to the nation’s nearly 50-year-old family planning program, Title X, which allows millions of women each year to afford contraception, cancer screenings and other critical health services.

Health clinics have long been barred from using Title X money, or any federal funds, to pay for abortions, but they have been able to provide abortions and other family planning services under one roof. Under the new rule, unveiled last week by the Department of Health and Human Services after being floated last year, a clinic that provides abortions will have to jump through an absurd series of hoops to continue receiving Title X funding. For instance, it will have to create a separate entrance to the facility for patients seeking abortions, hire separate personnel and establish a separate electronic health records system. Title X facilities will also be barred from referring patients for abortions. The rule gives discretion to the department to decide on a case-by-case basis whether facilities are in compliance.

This will sound familiar to anyone who has followed the proliferation of state anti-abortion laws over the past decade. Some of those laws have required abortion clinics to widen their hallways, revamp janitor’s closets and make other expensive changes that had little to do with their patients’ well-being. This latest move comes from the same playbook: impose unnecessary regulations for reproductive health clinics to impede women’s access to care.

The bad news doesn’t stop there. The new Title X rule also removes the longstanding requirement that health care providers inform pregnant patients about their full range of options — prenatal care, termination, adoption. Critics of the rule worry that this will open the door to participation in the program by groups that are opposed to abortion or that emphasize abstinence over contraceptive use. The department acknowledges in the rule that it would allow funds to go to “entities that offer a single method [of family planning] or limited methods — including providers that might do so for reasons of conscience.”

This element of the “domestic gag rule,” as many reproductive rights advocates have called the rule, isn’t just medically unnecessary — it’s unethical. It undermines the notion of informed consent, a core tenet of medical ethics that says patients must be made aware of the risks and benefits of all options before them. Under the new rule, staff members at Title X facilities who are morally opposed to abortion can effectively pretend that the procedure doesn’t exist — a lie by omission that no one would find acceptable in the context of any other form of health care.

That’s not an accident. The anti-abortion movement has spent decades trying to make abortion seem separate from “regular” health care. The new Title X rule is just another example of that effort, brought about by a department that under President Trump has become stocked with anti-abortion and anti-contraception ideologues.

Planned Parenthood already has said that if the rule is enacted — it will begin going into effect in about 60 days, barring litigation — then it will stop participating in the Title X program. It’s not clear how the nation’s many independent clinics would cope with the new rule, but some of them most likely would follow suit, and those that remain grantees of the program could become overwhelmed.

As Dr. Leana Wen, the new president of Planned Parenthood, told The Times’s editorial board on Monday, “There will be many providers that will face an impossible decision: to participate in Title X and be forced to compromise their medical ethics, or to stop participating in that program.”

Either of these options would amount to a huge loss for women around the country, many of whom rely on Title X as their sole source of health care. Planned Parenthood alone serves 1.6 million Title X patients each year — more than 40 percent of the women who receive care in the entire program — and stands to lose $50 million to $60 million annually. But ceasing to participate in a compromised Title X program is understandable, given that the new rule seems intended to make it all but impossible for many clinics to comply.

Dr. Wen noted, rightly, that the new rule isn’t just about Planned Parenthood. “The harm isn’t to one organization; it’s to people’s health care,” she said. It’s clear, however, that the goal of the rule change is to satisfy Mr. Trump’s supporters by at least partly defunding Planned Parenthood — the boogeyman of the anti-abortion cause.

It’s ironic that a rule change clearly rooted in anti-abortion sentiment will threaten access to contraception — the very thing that prevents unintended pregnancies. But it’s not surprising. The Trump administration has quietly been chipping away at contraception access for two years now — all the while pushing anti-abortion policies and with the president spreading lies about what abortion entails.

With many medical groups, including the American Medical Association and the American College of Physicians, opposing the Title X rule change, it’s clear that the administration is not on the side of science or public health. Women across the nation will pay for it.


Source:  www.nytimes.com/2019/02/26/opinion/title-x-rule.html?action=click&module=Opinion&pgtype=Homepage