CHICAGO — For nearly five decades, the Title X family planning program has provided much needed funding for reproductive health care for millions of uninsured and underinsured people, covering basic services from cancer screenings to contraception to treatment for sexually transmitted infections.
Now, the Trump administration is proposing a so-called domestic gag rule that would strictly limit how clinics that get this funding can refer patients for safe, legal abortions. Under the proposal, clinics will face a choice: either adhere to unacceptable restrictions on how they practice medicine or be cut off from funding that allows them to provide for millions of patients. As a board-certified obstetrician-gynecologist, I can attest that this proposal is bad medicine; as a medical ethicist, I can also affirm it is an assault on both the patient-provider relationship and the autonomy of patients and health care providers.
The consequences of the proposed rule, which is open for public comment through July 31, go beyond abortion access: It would greatly restrict patient access to effective and necessary services, from contraception to preventive care. The rule demands physical and financial separation requirements between areas that use Title X funding and those that use nonfederal funds to provide abortion services — separate physical spaces, accounting records, health records, phone numbers and more — demands that seem intended to make it impossible for clinics to operate effectively. The proposed rule is clearly an attack on Planned Parenthood, which cares for over 40 percent of Title X patients.
But it also violates a more fundamental tenet of medical care: that providers be able to counsel patients about their medical options free from external interference by politically motivated rules that aren’t based on evidence.
For several years, I worked at a Title X-funded clinic on the West Side of Chicago, caring primarily for patients who lacked insurance. I saw firsthand what it meant for people to have access to both preventive care and providers who were able to counsel them effectively — and what it meant when they didn’t.
I remember one patient in particular. She was in her late 30s, and uninsured. She came to our clinic with an unintended pregnancy. She had been told, inaccurately, that because of a medical condition, no method of hormonal birth control was safe, so she relied on condoms alone; in other words, she had received the sort of misinformation that Title X-funded clinics can help to combat.
She also had a history of heart disease. She knew that, for her, a pregnancy presented significant health risks.
At our clinic, I was able to counsel this patient on all of her options: These included continuing her pregnancy with dedicated care to address her cardiac risks, and abortion. After careful consideration, she opted for an abortion, and I was able to help her obtain one. Thanks to Title X funding, afterward, she was able to get a safe, effective method of contraception. The availability of these options, and the ability to obtain care, provided this woman with the autonomy to make informed decisions that were best for her. A ban that would have prevented me from counseling and helping her get the care that she needed would have forced me to violate my oath to do what is in the best medical interest of my patients.
Everyone deserves the best medical care and access to complete and accurate medical information — including information about safe, legal abortion — regardless of insurance status, income, race or where they live. Leading professional medical organizations strongly oppose the proposed domestic gag rule, including the American Medical Association, the American College of Obstetricians and Gynecologists and the American College of Physicians.
Title X has helped millions of patients obtain essential reproductive health care. Instead of trying to cripple Title X, the Trump administration would be wise to support it. To do otherwise undermines the practice of medicine and does a grave disservice to patients.
Julie Chor is an assistant professor of obstetrics and gynecology and an assistant director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, and a fellow with Physicians for Reproductive Health.