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The White House has announced changes to Title X intended to remove funding for abortion services.
Peter Jesserer Smith
WASHINGTON — The Trump administration has launched a multipart attack to free Title X family-planning programs from the grip of the abortion industry — particularly the nation’s largest abortion provider, Planned Parenthood.

The new Protect Life Rule issued by the Department of Health and Human Services follows in the wake of other substantial changes to the Title X grant-making process, designed to invite pro-life alternatives as the federal government’s new partners in family planning and replace Planned Parenthood.

The White House announced May 18 that President Donald Trump supported a forthcoming HHS regulation on Title X that requires organizations receiving funding to have physical and financial separation from organizations providing abortion. The forthcoming rule revives a Reagan-era regulation, with the difference that Title X recipients will continue to be allowed to counsel patients about abortion but would be prohibited from referring or providing abortions.

White House Press Secretary Sarah Huckabee Sanders stated the HHS rule will align the Title X family-planning program with the Title X statute’s requirements and “ensure that taxpayers do not indirectly fund abortions.”

“This important proposal would ensure compliance with the program’s existing statutory prohibition on funding programs in which abortion is a method of family planning,” she said.

The new regulation drew praise from the U.S. Conference of Catholic Bishops, which welcomed the administration’s decision to separate abortion providers from the Title X family-planning program, which primarily serves low-income persons. Cardinal Timothy Dolan, the head of the USCCB’s Pro-Life Secretariat, said in a May 18 statement that the changes were “greatly needed.”

“We need to draw a bright line between what happens before a pregnancy begins and what happens after a child has been created,” Cardinal Dolan stated, noting that abortion takes the life of a child and leaves lasting effects on the mother, her family and friends.

Poor and low-income women account for 75% of all abortions, according to the Guttmacher Institute, which provides research for the abortion industry. The Title X program is primarily aimed at supporting this demographic’s access to materials and resources — typically in the form of contraception.

Reverses the Clinton Rule

Title X regulations put in place since President Bill Clinton’s administration had required Title X grantees to refer for abortion. This eliminated health centers that objected to abortion and contributed to the proliferation of abortion providers in the Title X program, which was first enacted in 1970 during the presidency of Richard Nixon.

“Planned Parenthood now has to choose: Are they for abortion or are they for family planning?” Rep. Chris Smith, R-N.J., told the Register. Smith, a Catholic and the co-chairman of the bipartisan House Pro-Life Caucus, said the “Clinton rule” — which pro-life advocates tried in vain to get George W. Bush to reverse — allowed abortion providers like Planned Parenthood to dominate the family-planning field, underwrite some general clinic expenses like salaries and advertising, and funnel Title X patients to their solution for unplanned pregnancy: abortion.

According to Planned Parenthood’s most recent annual report, up to 13% of its patients obtained abortion services in the 2017 fiscal year. The organization also claims to serve 41% of Title X patients.

Planned Parenthood has 226 centers where abortion providers and family-planning programs are under the same roof. Smith added all abortion providers among the 4,000 Title X grantees and subgrantees will be disqualified under the Reagan-Trump rule.

Title X accounts for approximately $60 million of Planned Parenthood’s income, but the financial gain from poor and low-income women is much greater through abortion. The Register’s conservative estimate puts Planned Parenthood’s abortion related income at $175 million. Title X does not directly pay for abortion, so the money for abortion comes from the pockets of women or is subsidized by Planned Parenthood’s wealthy donors.

Planned Parenthood’s Pushback

Because Planned Parenthood mandated all 56 regional affiliates provide abortion as an essential service by 2013, the organization will essentially be disqualified from competing for this year’s $260 million in Title X funding absent major changes.

Planned Parenthood Federation of America has launched fundraising and advocacy campaigns to push back against the new HHS rule.

Affiliates have already sued the Trump administration over Title X grant rules HHS issued in February that emphasize natural family planning methods and abstinence education, and therefore away from Planned Parenthood and its services. The organization is expected to sue again when the HHS rule banning abortion providers from Title X is published.

“This is an attempt to take away women’s basic rights, period,” Dawn Laguens, Planned Parenthood Federation of America’s executive vice president, said in a May 18 statement. “Under this rule, people will not get the health care they need. They won’t get birth control, cancer screenings, STD testing and treatment, or even general women’s health exams.”

But Autumn Christensen, the policy director for the Susan B. Anthony List, told the Register that women looking for Title X services will be able to get far more comprehensive health services, as well as family planning assistance, at the 11,000 community health centers already funded by the federal government than they would at Planned Parenthood affiliates.

The Protect Life Rule, Christensen added, prohibits abortion referrals but is not the “gag rule” described by opponents.

She explained the U.S. Supreme Court already upheld its predecessor, the 1988 Reagan-rule, in the Rust v. Sullivan (1991) case.

The Trump rule’s major difference with its predecessor is Title X providers may counsel their patients about abortion — the previous Reagan rule forbid any discussion of abortion.

In theory, this would allow pro-life Title X providers to discuss with patients the effects of abortion on a woman and her unborn child and explore life-affirming alternatives in counseling, such as keeping the baby or adoption.

Multistep Process

The Trump administration’s changes to the Title X program have been a multistep process. In late February, HHS made its announcement that it would revise the Title X grant-making process to make the bidding process more competitive with the inclusion of natural family planning and abstinence-education providers. It would also allow grantees to seek grants directly from HHS, rather than from the states, and bypass state Title X mandates, which may require abortion referrals.

Then in April, Trump signed into law a congressional repeal of an Obama-era HHS rule — passed with Vice President Mike Pence’s tie-breaking vote — that prevented states from redirecting Title X funding away from abortion providers like Planned Parenthood to other health providers.

Christensen explained the Trump administration has not simply sought to cut off a funding stream for abortion providers, but has opened the door for pro-life organizations to step forward and help Title X recipients who have long been targeted by the abortion industry.

But the challenge for many pro-life organizations is the long-standing “Clinton rule” abortion mandate was not their only obstacle — Title X’s statutory provisions call HHS to fund family-planning projects that “offer a broad range of acceptable and effective family-planning methods and services (including natural family planning methods, infertility services and services for adolescents).” So long as HHS regulations have interpreted the statute’s provisions to require the provision or referral for artificial contraceptive services, they have posed a roadblock to Catholic organizations and many other pro-life groups that would be willing to submit family-planning grant proposals aligned with Humanae Vitae.

Kathleen Eaton Bravo, the founder and president of the Obria Group, which has established Obria Medical Clinics to provide professional life-affirming, holistic care as an alternative to Planned Parenthood, told the Register she has been in conversations with Vice President Mike Pence’s office, which has told her Pence is concerned that, despite the Trump rule changes, HHS so far has received “very few pro-life applications.”

The main challenge is there are two routes available for Title X partnership — as a direct grantee or as a sub-grantee on a larger pass-through grant. Title X requires grant applicants “offer a broad range of acceptable and effective family-planning methods and services,” but allows subgrantees to offer just one component in a larger grant proposal. During a March 22 technical webinar, HHS officials encouraged groups that offer natural family planning or abstinence education to become sub-grantees on a larger grant proposal.

According to HHS’ own information, most states have one or two direct grant recipients, such as state health departments or medical consortiums. States that have relied upon a Planned Parenthood regional affiliate as a direct grantee will have to find alternatives.

The Pro-Life Response

Greg Schleppenbach, the associate director of the U.S. bishops’ Pro-Life Secretariat, told the Register the USCCB has encouraged pro-life partners to become Title X sub-grantees, “so they can provide natural family planning or chastity education programming without having to get involved in promoting contraception.”

However, Christensen explained it is an “open question” whether HHS would be able to stretch the interpretation of Title X far enough to allow organizations that provide only natural, fertility-based awareness methods of family planning and abstinence education, which is also characterized as “sexual risk avoidance,” to become the main grant recipients.

Abby Johnson, a former Planned Parenthood facility manager who is now a board member of the Guiding Star network of pro-life health centers, told the Register that Guiding Star made a “conscious decision” not to apply for a Title X grant until the Title X statutes were changed to state clearly that “fertility-based methods are acceptable and allowable” to fulfill the requirements of Title X.

Bravo, however, said Obria submitted an application for a $15-$17 million pass-through grant to HHS for its partners to provide holistic fertility education and sexual risk-avoidance education, without referring for contraception. Obria Medical Clinics will not budge on contraception, Bravo explained, because they are not going to recommend services to their patients that harm women’s health. Bravo said Obria is enlisting the support of Pence and members of Congress to assist in winning HHS approval of the grant.

“These changes really open the door for pro-life individuals to get involved and share our message with young women,” she said.

Critical Tests Ahead

The new Title X changes have yet to be published in the federal register. Once that happens, HHS will have a comment period — generally 60 days — where it will receive feedback on the rule change before finalizing it. The USCCB is calling upon Catholics and pro-life organizations to submit comments in support of the change.

Rep. Smith explained the Protect Life Rule will face three critical tests: litigation from Planned Parenthood, regulatory changes by HHS in response to comments and congressional review. He said some in Congress will push to repeal the rule.

He said, “I anticipate a huge fight — and it will be an illuminating fight.”

Peter Jesserer Smith is a Register staff writer