All People Deserve Access to Quality Reproductive Health Services
This week the Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking (NPRM) that would, if implemented, eliminate the “domestic gag rule.” The gag rule prevented Title X funding from going to health centers that refer patients for abortion care or provide abortion care with non-Title X funds. As a result, millions of people with low incomes faced additional barriers to accessing critical reproductive health care. The recent action by the Biden-Harris administration to reverse the policy is a welcome relief to Title X providers and the people in our communities who rely on the family planning safety net system but the damage to the program will take more than a rule change to reverse.
People across the country have benefitted from high-quality and affordable contraceptive care and much more for 50 years. People in need can depend on a Title X clinic for the full range of contraceptive options, STI screenings, Pap tests and other cancer screenings. It’s important to understand that these centers often provide more than health care. They are committed to their patients and are often an integral part of the community serving mainly the uninsured and people with low incomes, who are disproportionately Black and brown people.
The Trump administration’s domestic gag rule devastated the Title X Family Planning Program and changed the way health centers could provide reproductive health care to people in our communities with low incomes. It undermined the integrity of the program, confused patients and caused chaos amongst health centers who struggled to meet the needs of their patients without the critical Title X funding they needed. The gag rule caused more than 900 health centers that offer high-quality affordable contraceptive care to leave the Title X program, resulting in large declines in the number of patients served by the program. In fact, between 2018 and 2019—when the gag rule went into effect—the Title X program served 844,000 fewer patients, a 21% decline in a single year.
This came at a time when the Title X Family Planning Program already struggled with inadequate funding to meet the needs of our communities. In 2010, Title X was funded at $317.5 million, and the program served 5.2 million people that year. But by 2014, funding was down to an annual level of $286.5 million where it has been ever since. Then the domestic gag rule took effect in 2019. In that year, the program served 3.1 million people, a decline of over 59% in just nine years. Yet despite the program being significantly underfunded and the harmful domestic gag rule, and now a global pandemic, Title X health centers have continued to diligently work to provide high-quality contraceptive care to their communities.
When Congress passed the American Rescue Plan, they included one-time additional funding of $50 million for Title X. This funding will help bring clinics forced out of the program back in once the domestic gag rule is eliminated. However, the Title X program still needs significantly more annual funding to adequately meet the need for family planning and other services for the people who rely on this program for care.
The new proposed rule released by HHS will help to restore critical and equitable access to high-quality reproductive health services, but a 2016 study in the American Journal of Public Health estimated that approximately $737 million is needed each year to fully meet the needs of people who depend on the Title X Program for their contraceptive care. Power to Decide urges Congress to provide at least $512 million for the Title X Family Planning Program in FY 2022. Coupled with the elimination of the domestic gag rule, this would not only restore the integrity of the program but also significantly expand equitable access to affordable and high-quality contraception for more people struggling to make ends meet.
I have been a gynecologist who provides reproductive care for nearly 20 years. As a health provider I am committed to ensuring all my patients have quality care regardless of who they are, where they live or their economic status. The Title X program has been critical in this effort, helping to not only keep people healthy but also to ensure all people have the power to decide if, when and under what circumstances to get pregnant and have a child. We have an opportunity to turn the page and ensure that such an important program is able to fully meet the needs of all people. In addition to removing the devastating domestic gag rule, we must ensure that the Title X Family Planning Program receives the level of funding it not only needs but also deserves. Only then will we be able to fully realize the promise of Title X.