Abortion is a legal medical procedure. It sometimes appears that’s no longer the case, based on the policies being promulgated, for example, by some states that are restricting access to abortions.
But the principal concern, because the impact is national, are the moves by the federal government to constrain the information a patient can receive at clinics subsidized by Title X, a long-established statute.
The latest initiative by the Trump administration seeks to regulate more strictly not only what procedures federal dollars can fund, but also what the health practitioner can say to the patient. Despite insistence to the contrary by the Department of Health and Human Services, this does amount to a gag order and should not be implemented.
Under the proposed rule, clinicians could provide “nondirective” counseling about options to pregnant women benefiting from Title X funds. However, they would have to stop short of a referral or advocacy that has the effect of promoting abortion as a method of family planning.
It is hard to see where the line can be drawn between directive and nondirective advice, and easy to see how this could have a chilling effect on all references to terminating a pregnancy by a clinic that relies on federal support.
The bottom line is that someone who needs the Title X financial assist would receive less comprehensive information about medical care than would a patient who can afford a private doctor. This seems patently unfair, and counter-intuitive for a program aimed at serving the medical needs of poorer citizens.
The routes to overcoming the gag order, however, are uncertain. The legal history suggests the way forward is murky.
Planned Parenthood, the nonprofit agency providing family planning and other health care to lower-income patients, sees more of the Title X patients than any other single provider.
In Hawaii, 4,988 Title X patients were seen at Planned Parenthood between July 1, 2017, and March 31 of this year, said Katie Rogers, spokeswoman for Planned Parenthood of the Great Northwest and the Hawaiian Islands.
Its services include abortion procedures, but long-established statutes have precluded use of federal funds for abortion.
Regardless, the agency remains a target of the anti-abortion advocacy groups and socially conservative lawmakers. They argue that funding is fungible and thus have opposed any federal resources for an entity because such grants free up its private funding sources to enable abortion procedures.
For its part, Planned Parenthood argues that the rule would go beyond barring referrals for abortions. It also would prohibit funding birth control or other services from any provider that also offers abortion — including Planned Parenthood, which for many women is the only affordable birth control or pregnancy care source available.
This administration is proposing a rule similar to one put forward by the Reagan administration. It was never fully implemented because lower courts ruled against it. Years later, the U.S. Supreme Court upheld it as a permissible application of executive discretion in interpreting Title X which, according to the decision, was ambiguous about abortion counseling being a purpose of the law.
The proposed rule will need to follow a process involving public notice and a comment period, which can take three to six months to complete, Rogers said, adding that the organization is also looking into legal options to stop it from becoming effective.
Those who benefit from the federal program directly, as well as all who believe unfettered access to good information is crucial to ensuring public health, should speak up in opposition to the rule. The government should not curb doctor-patient communication; doing so to women in need is simply unconscionable.
