Ad­min­is­tra­tion tar­gets fam­ily plan­ning pro­grams

The Denver Post - - PERSPECTIV­E - By Amanda Steven­son and Sara Yeat­man Amanda Steven­son is as­sis­tant pro­fes­sor of so­ci­ol­ogy at CU Boul­der. Sara Yeat­man is as­so­ci­ate pro­fes­sor of health and be­hav­ioral sciences at CU Den­ver.

On May 22, the Trump Ad­min­is­tra­tion an­nounced rules re­viv­ing a Rea­gan­era pol­icy known as the Do­mes­tic Gag Rule that is de­signed to re­duce ac­cess to abor­tion and con­tra­cep­tion. The rule, which gov­erns a key so­cial safety net pro­gram (Ti­tle X), lim­its how clin­i­cians can dis­cuss abor­tion with their pa­tients, ex­cludes all providers who of­fer abor­tion ser­vices, in­tro­duces ad­min­is­tra­tive bur­dens, and con­strains teens’ ac­cess to con­tra­cep­tion. The pol­icy is not about stop­ping the use of fed­eral funds for abor­tion. For over 40 years, it has been fed­eral pol­icy that fed­eral funds can­not be used for abor­tion care. In Colorado, our state con­sti­tu­tion bars state money from fund­ing abor­tion care.

The Do­mes­tic Gag Rule will have re­ver­ber­at­ing con­se­quences for women, es­pe­cially those with lim­ited eco­nomic re­sources, teenagers, and women of color. The rule has been firmly de­nounced by the Amer­i­can Col­lege of Ob­ste­tri­cians and Gyne­col­o­gists and the na­tional or­ga­ni­za­tion of Ti­tle X providers.

Cur­rently, the fed­eral fam­ily plan­ning pro­gram (called Ti­tle X) sup­ports 4,000 clin­ics na­tion­wide, pro­vid­ing sex­ual and re­pro­duc­tive health ser­vices for roughly 4 mil­lion women, and pre­vent­ing ap­prox­i­mately 1.9 mil­lion un­in­tended preg­nan­cies ev­ery year. Colorado’s Ti­tle X pro­gram, ad­min­is­tered by the Colorado Depart­ment of Pub­lic Health and En­vi­ron­ment, has been stud­ied by health care ex­perts and providers na­tion­wide be­cause of its high-qual­ity care and ex­cel­lent out­comes. Now, the Trump ad­min­is­tra­tion is telling CDPHE who it can and can­not choose to de­liver its pro­grams.

The Ti­tle X pro­gram, started in 1970 by Congress and signed into law by Pres­i­dent Richard Nixon, was de­signed to as­sure that all women, re­gard­less of in­come, have ac­cess to high­qual­ity and freely-cho­sen re­pro­duc­tive health ser­vices. Un­til re­cently, the Ti­tle X pro­gram had been un­con­tro­ver­sial, sup­ported by Democrats and Repub­li­cans alike.

The gag rule is part of a broader ef­fort some­times re­ferred to as “de­fund­ing Planned Par­ent­hood,” It started in Texas, and when we stud­ied its im­pacts there, we found that when Planned Par­ent­hood was ex­cluded from a Texas fam­ily plan­ning fund­ing pro­gram, one-third fewer women got the most ef­fec­tive meth­ods of con­tra­cep­tion, and there was a 27 per­cent in­crease in Med­i­caid-funded births among women who used birth con­trol meth­ods that re­quired reg­u­lar vis­its to a health care provider.

Even though the cuts in Texas tar­geted Planned Par­ent­hood, other smaller providers in non-ur­ban ar­eas bore the big­gest im­pacts. And at least 82 fam­ily plan­ning clin­ics closed. Here in Colorado, things will surely be sim­i­lar. The more than 70 Ti­tle X clin­ics in Colorado pro­vide cancer screen­ings, con­tra­cep­tion and other ba­sic health care, whether or not they pro­vide abor­tion care and coun­sel­ing us­ing non-gov­ern­ment funds. Some may be forced to close or re­duce ser­vices.

In try­ing to an­tic­i­pate the im­pacts of the Do­mes­tic Gag Rule, we can also turn to the Global Gag Rule, which re­stricts U.S. for­eign aid to non­govern­men­tal or­ga­ni­za­tions that per­form or pro­vide in­for­ma­tion about abor­tion. Stud­ies have shown that the Global Gag Rule in­creases abor­tion in the coun­tries that rely most on U.S. aid. Just like in Texas, the Global Gag Rule tar­gets the providers of abor­tion in­for­ma­tion or ser­vices but it ends up hurt­ing women.

CDPHE has demon­strated what hap­pens when gov­ern­ment makes it eas­ier to pro­vide fam­ily plan­ning ser­vices. Af­ter a pro­gram be­gan in 2009 en­sur­ing that Ti­tle X fam­ily plan­ning providers through­out Colorado could of­fer the full range of con­tra­cep­tives to all women, Colorado saw a 50 per­cent re­duc­tion in the teen fer­til­ity rate and a 50 per­cent re­duc­tion in the teen abor­tion rate. Colorado is now on the lead­ing edge of pro­vid­ing high­qual­ity fam­ily plan­ning for our cit­i­zens. The Do­mes­tic Gag Rule would jeop­ar­dize our ex­cel­lent pro­grams by dic­tat­ing what Colorado health of­fi­cials and health care providers can and can­not do.

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