Title X restrictions deny patients full range of health care options

Opinion editor's note: The following article was submitted as a statement from Minnesota doctors and public health educators. Signatories are listed below.

Family planning services have been part of the U.S. public health infrastructure for 50 years. Still, most Americans have never heard of Title X. That's a dilemma for a lot of public health services — when it's working, it's largely invisible. But now, the Trump administration is imposing unprecedented restrictive new rules on Title X funds, prohibiting health care providers from sharing information about abortion with patients.

This is a new form of a "gag" rule, putting restrictions on clinicians' conversations with their patients. Denying patients' the full range of health care options is alarming and of great concern to public health professionals. That is why we join the many medical and public health professionals in speaking out against these new rules.

The Title X section of the Public Health Service Act authorizes the federal Department of Health and Human Services to provide grants to clinics that provide family planning and preventive health services to low-income Americans. The program was established in 1970 under President Richard Nixon, and has enjoyed decades of bipartisan congressional support.

Planned Parenthood is the largest Title X provider in the nation and has used these funds to provide family planning services to over 4 million people each year in its health centers nationwide. In Minnesota alone, nearly 1 million people have received health care through Title X over the five decades the program has been in place.

Title X funding is used for a wide range of health care and family planning services, including cervical and breast cancer screenings, contraception, sexually transmitted infection screening and treatment, and annual exams. To be clear — no federal Title X funding is or has ever been used for abortion. Longstanding, strict criteria and annual audits ensure that grantees follow these rules.

However, the new "gag" rule imposed by the Trump Administration forbids Title X-funded providers from even discussing abortion with patients. This "gag" rule — so-called because it stifles the speech of health care providers — dictates how clinicians at facilities that receive Title X funding practice, including restricting the information they can provide to patients. This regulation is unprecedented interference in the patient-provider relationship and a further attempt by the Trump administration to restrict women's access to the full range of legal, evidence-based reproductive health services.

The gag rule has forced high-quality reproductive health providers, like Planned Parenthood, to leave the Title X program because they refuse to comply with this rule that would compromise their ethics and standards of care by withholding information from patients. Nationally, Planned Parenthood health centers serve 40% of all Title X patients. In Minnesota, that proportion is even larger, with Planned Parenthood serving more than 90% of Title X patients across the state.

Planned Parenthood's forced exit from the Title X program will have a devastating impact on many patients and families here in Minnesota and nationwide, especially low-income and rural women who rely on Planned Parenthood for basic health care needs.

Reproductive health care services are critical to our nation's public health infrastructure-whose mission is to protect, promote and advance the health and safety of our nation. For many low-income people, Planned Parenthood is one of the few places they can access affordable preventive care, especially in Greater Minnesota. And we know the program works. Title X has contributed to reduced teen pregnancy, reduced infertility and decreased cervical cancer rates. It has reduced disparities in access to care by providing crucial health services to low-income women who are uninsured or underinsured.

We are not alone in opposing this politically motivated and onerous new regulation that will disrupt public health throughout the country: the American Public Health Association, the American Medical Association, the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American College of Physicians and others have all expressed serious concern about the ethics and impact of this gag rule. Twenty-one state attorneys general have also filed lawsuits arguing it would undermine patient-provider relationships and endanger the health of millions of women.

This gag rule, and the resulting exit of expert reproductive health care organizations like Planned Parenthood from Title X, will disrupt an important access point for needed public health services. Clinicians must be able to practice free from government interference with the information they share with their patients.

We urge the Trump administration to put public health above ideology and revoke this unnecessary and unethical rule. We oppose this rule and the attempts of this administration to restrict reproductive autonomy and people's rights to make the health care choices that are best for them and their families.

This article was submitted on behalf of faculty members Lynn A. Blewett, Kathleen T. Call, Eva Enns, Sarah Gollust, Rachel R. Hardeman, Katy B Kozhimannil and Donna McAlpine at the University of Minnesota School of Public Health; on behalf of leaders of Minnesota physician organizations including Michael Aylward, president, Minnesota Doctors for Health Equity; Siri Fiebiger, vice/legislative chair, Minnesota Section, American College of Obstetricians and Gynecologists (ACOG); Ryan Greiner, president, Twin Cities Medical Society; David Hilden, governor, American College of Physicians, Minnesota chapter; and Douglas L Wood, president, Minnesota Medical Association; and on behalf of Eduardo Miguel Medina, a physician at Park Nicollet Clinic and the University of Minnesota Department of Family Medicine and Community Health.