WASHINGTON -- Changes to the Title X law proposed by the Trump administration would severely hurt women's access to family planning and other preventive health services, several women's healthcare provider organizations said here Monday.
"We are at a historic low for unintended pregnancy among teens and this is something we should celebrate, not reverse," Lisa Hollier, MD, president of the American College of Obstetricians and Gynecologists (ACOG), said at a briefing featuring eight women's healthcare groups at ACOG's headquarters here. "Unintended pregnancy can have serious health consequences for women."
"The goal of contraception is not only to reduce unintended pregnancies, but also to empower women to make decisions that are most appropriate for them," she continued. "Together [these groups] represent more than 700,000 providers caring for women in our communities. We are all here to say the government has no place in our exam rooms. Our bottom line is simple: we must not turn back the clock on women's health."
Changes Proposed
The Title X law that Hollier was talking about provides federally funded grants to "assist in the establishment and operation of voluntary family planning projects which provide a broad range of acceptable and effective family planning methods and related preventive health services," according to the .
These services include "natural family planning methods, infertility services, and services for adolescents; highly effective contraceptive methods; breast and cervical cancer screening and prevention services that correspond with nationally recognized standards of care; STD [sexually transmitted disease] and HIV prevention education, counseling, testing, and referral; adolescent abstinence counseling; and other preventive health services," the site continued.
In May, HHS announced proposed changes to the law, which was enacted in 1970. Among other things, HHS's states that "Title X [recipients] may not perform, promote, refer for, or support, abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion."
"If asked, a medical doctor may provide a list of licensed, qualified, comprehensive health service providers (some, but not all, of which also provide abortion, in addition to comprehensive prenatal care), but only if a woman who is currently pregnant clearly states that she has already decided to have an abortion," the rule continues. "This list is only to be provided to a woman who, of her own accord, makes such a request. The list shall not identify the providers who perform abortion as such." Comments on the proposed rule are due to HHS by July 31.
Restrictions on Doctor-Patient Conversations
Shari Erickson, vice president of governmental affairs and medical practice at the American College of Physicians, objected to such provisions that restrict what physicians can tell their patients.
"The proposed rule regulates how providers talk to their patients and restricts a provider's ability to offer the patient his or her best medical judgment," she said. "It would prohibit any Title X funds from going to an entity that provides even basic information about all legal and evidence-based options available to pregnant women."
"When a patient comes to any health professional seeking care, they need to be able to trust that they're going to be counseled and treated with the full breadth of the professional's medical knowledge," she continued. "That should be case whether funds come from Title X, Medicaid reimbursements or any other source ... The government should not mandate the content of what physicians say to patients."
Some of the other proposed changes to the $287 million Title X program include:
- Requiring clear financial and physical separation between Title X funded projects and programs or facilities where abortion is a method of family planning. "This separation will ensure adherence to statutory restrictions and provide clarity about permissible and impermissible activities for Title X projects," an said.
- Requiring clinics to encourage meaningful parent/child communication and, as required by federal law, encourage family participation in a minor's decision to seek family planning services, giving practical ways to begin -- and maintain -- such communication.
- Permitting individuals to qualify for Title X services if they are unable to obtain employer-sponsored insurance coverage for certain contraceptive services due to their employer's religious beliefs or moral convictions.
Contraception Access Concerns
One particularly disturbing aspect of the proposed rule is that it would allow family planning clinics to offer only certain types of birth control, which could curtail access to more effective -- and sometimes more expensive -- methods, said Tom Dardarian, DO, president-elect, of the American College of Osteopathic Obstetricians & Gynecologists.
"The abortion rate is down, and the teen pregnancy rate is down; we can directly link these to the increased availability of IUDs," he said. "Unfortunately, IUDs are a little more expensive, so by pulling them away from patients who need them the most, we are doing them a huge disservice ... Also, there are some women who have certain medical conditions that preclude them from taking the standard oral contraceptive, so we need these women to have access to [other methods] like progestin-only [pills] or IUDs."
The proposed changes to the rule will disproportionately affect minority women, said Mark Shahin, MD, a gynecologic oncologist in Abington, Pennsylvania, who was speaking for the Society for Gynecologic Oncology. The changes "will exacerbate social and economic disparities in access to care ... by leaving Title X patients, who are disproportionately black and Latino, without a source of care," he said.
"African-American women have higher mortality rates from breast and cervical cancer than any other group, so the proposed changes in Title X funding will adversely affect this population and take cancer screening away from women in our country who actually need it the most ... The women of America deserve better."
The proposed rule comes at the same time that HHS is ramping up its new division of Conscience and Religious Freedom, which is aimed at more strictly enforcing "conscience clauses" allowing clinicians to refuse to provide healthcare services that they have religious or moral objections to. "We're not exactly sure how [that new office] is playing into this ... but it's interesting that it was even felt that it was necessary," said Hal Lawrence, MD, ACOG executive vice president and CEO, during a question-and-answer session.
"Healthcare is healthcare, and it really is not religious based, it's healthcare-based, it's science-based and we have to be very careful when we start mixing those things," he said. "The founders of this country said we need to have separation of church and state; in healthcare, there is no question we need to have separation. We should all work to empower women to make decisions in their best interest and that are based on science."