Eliminating the Domestic Gag Rule
For more than fifty years, people with limited means have relied on health clinics supported by Title X funds to get affordable birth control, gynecological exams, and testing for sexually transmitted infections, cancer screenings, and more. But in 2019, the Trump administration implemented the ‘domestic gag rule,’ which forced health centers that receive Title X funds to withhold some information from patients about abortion services and care. In addition, health centers were also required to cease providing abortion care with non-Title X funds unless they did so at a physically separate site. As a result, more than 900 health centers were forced out of the program. Thankfully, HHS recently released a new Title X rule that undoes the harmful Trump Administration policy.
The gag rule’s impact on birth control access has been nothing short of catastrophic for people struggling to make ends meet. Many who have long relied on the program have experienced higher out of pocket costs for health care and birth control because their clinics no longer had the funds to support them. People already counting every penny and struggling amidst a pandemic had to travel longer distances to find a clinic offering services, take more time off work if employed, or pay for additional childcare costs. Many simply did not get care at all.
The full ramifications of the domestic gag rule will take years to assess and remedy, but already some of its consequences can be seen. The Department of Health and Human Services (HHS) recently reported that between 2018 and 2020, 2.4 million fewer people were served by Title X clinics. Of that amount, HHS estimates that 63% or (1.5 million) of the decline was the direct result of the gag rule.
When people are struggling economically, they will often forgo things such as diagnostic testing and contraceptive care in favor of paying for something they deem more of a necessity. Without access to these critical preventive services provided at free or low cost by Title X, people are left without basic reproductive health care.
The new final rule for the Title X Family Planning Program eliminates the domestic gag rule and paves the way for health centers forced out of the program to apply to rejoin the network of Title X clinics when the next round of grants are awarded early next year. The rule will take effect November 8, 2021.
The new rule is a critical part of rebuilding Title X and ensuring that people who face the greatest barriers to care have access to quality family planning services. In addition to eliminating the domestic gag rule, it affirms the Title X Program’s commitment to patient confidentiality protections and adolescent-friendly care. It also allows for services to be delivered through telehealth (including audio only), sets a strong standard for Title X grantees’ commitment to health equity and ensures that pregnant patients can receive non-directive counseling.
The Title X Family Planning Program is essential to ensuring all people have access to the full range of contraceptive options, screenings for sexually transmitted diseases, cervical and breast cancer as well as Pap tests and so much more. The new rule came at a time when access to quality and affordable contraceptive services and more are desperately needed. We look forward to health clinics being able to rejoin the Title X network, although we know it will not be back to full capacity overnight.
As this new rule takes effect it is more important than ever that Congress build on this step by providing a significant increase in Title X funding for FY 2022. Increasing the funding for this critical program will help to expand access to the contraceptive care and other services and information that all people—regardless of who they are and where they live—need to live their best life. Contact your members of Congress today to urge them to fund the high-quality sex ed and contraceptive care young people need to live their best lives!