Title X gag rule is a dangerous attack on women’s health
The 9th U. S. Circuit Court of Appeals is weighing whether the Trump administration can continue to enforce its gag rule on Title X, which prohibits funding recipients from providing patients full information about family planning options and from referring patients to abortion services. While a court on the West Coast will ultimately make the decision, it will have repercussions throughout the country, including here in New York.
In theory, the Title X gag rule is designed to target abortions alone and limit access to this necessary, even life- saving procedure. That would have been bad enough. In actuality, the rule change will worsen a myriad of public health issues, including raising the rates of sexually transmitted infections and diseases and unplanned pregnancies.
After the Trump administration implemented the rule — while lawsuits continue in courts from New York to Washington — numerous family planning providers dropped out of the federal Title X program, refusing to comply with the egregious requirements it set forth. But funding losses may require these clinics and programs to reduce services in order to keep their doors open. This means fewer appointments and longer wait times, which can often be a deterrent to patients and exacerbate poor health outcomes.
For example, STD cases in the U. S. hit a record high in 2017, according to the Centers for Disease Control, with nearly 2.3 million cases of chlamydia,
gonorrhea and syphilis. Less funding for contraception, screening and treatment means these numbers will rise, especially among vulnerable communities and teens. When left undiagnosed or untreated, STIS and STDS can cause infertility, increased risk of HIV, birth defects and other severe outcomes.
The gag rule will also increase the rate of unintended pregnancies — already reaching a whopping 45 percent of all pregnancies in the U. S. — by limiting access to contraception and full information about family planning options. U. S. abortion rates are at a historic low, not because of growing abortion restrictions, but rather due to a decline in pregnancies linked to greater contraception use since the passage of the Affordable Care Act. Low- income women and teens are particularly at risk, as 95 percent of unintended pregnancies occur because women have not had effective education about contraception.
Publicly funded contraceptive services, such as Title X, are essential to preventing unplanned pregnancies. Without access to care, both mother and child face a higher risk of adverse health outcomes, which often result from unplanned pregnancies. According to the Guttmacher Institute, these services helped prevent 1.9 million unintended pregnancies in 2014. Without these services, the U. S. rates of unintended pregnancy, unplanned birth and abortion each would have been 68 percent higher, and the teen pregnancy rate would have been 73 percent higher.
While New York has often been a national leader on reproductive rights — most recently by passing the Reproductive Health Act — that doesn’t make our most vulnerable communities immune from the consequences of the Title X gag rule.
Unplanned pregnancy is already a critical issue in New York, with a statewide unplanned pregnancy rate that is approximately 10 percent higher than the national average as of 2010. As a result,
New York has the third highest public expenditures in the country related to unplanned pregnancies. Vulnerable women and teens will experience more unplanned pregnancies with the gag rule in place, which will further strain state resources and potentially worsen health outcomes.
New York’s STI rates will also be affected. According to the CDC, New York ranks among the top nine states with the highest chlamydia and syphilis rates as of 2017. In New York City, rates of several STIS are on the rise. With less funding for comprehensive reproductive health care, these already high rates will likely continue to rise.
The Trump administration is trying to make the Title X gag rule all about limiting abortion — but federal government money hasn’t been used to fund abortions in decades. Through the rule change, the Trump administration is deliberately worsening health outcomes for the most vulnerable communities.
We can’t sit idly by as we await a decision from the 9th Circuit. While the ruling will be significant, it likely won’t stop here, as many suspect this case will eventually wind up in the U. S. Supreme Court. Protecting reproductive health necessitates that we continue to build momentum. New York leaders are doing what they can to mitigate the effects of the gag rule.
But New Yorkers, too, need to recognize the far- reaching impact of the gag rule in their community. New York organizations and clinics that rejected Title X funds under the gag rule, including Public Health Solutions’ two Brooklyn- based reproductive and sexual health clinics, are now struggling to keep services free for the high- risk community members they serve. While the state stepped in to help, medications and health essentials such as pregnancy testing kits, contraception and HPV vaccines are no longer fully covered.
It is happening here in our backyard, making it important for New Yorkers to take up the fight against this flagrant attack on women’s health here and across the country.