On July 15, the Trump Administration’s proposed changes to the Title X family planning program went into effect – and one month later, Planned Parenthood clinics, which together serve about 40 percent of all Title X patients, withdrew from the program en masse. The new rules prohibit providers and staff in Title X-funded clinics like Planned Parenthood from performing some of their core functions: referring patients for abortion, and receiving funds to provide services like cancer and STI screenings while using non-federal funds to finance abortion. Instead, the rule mandates referral for prenatal care and social services like infant or foster care or adoption – effectively denying patients comprehensive counseling about pregnancy options.
This “domestic gag rule” is being implemented now even though pending lawsuits have yet to be decided. Some might take this uncertainty as reason to watch and wait: Will the 40 percent of Title X recipients find the care they need elsewhere? Will there be a decrease in abortions overall if low-income women have access to fewer clinics that will serve their needs?
We are researchers who have looked at the effects of the rule’s prototype – the global gag rule – over many years in various countries where U.S. funding contributes to reproductive health initiatives. The evidence is clear as to how the global gag rule has played out: abortion rates have increased. Like its global counterpart, the domestic rule is unlikely to decrease abortion because it will reduce women’s access to a broad spectrum of reproductive health services including contraception. More unwanted pregnancies mean more, not fewer, abortions.
First implemented by President Reagan in 1984, the global gag rule eliminates U.S. aid for family planning and reproductive health to foreign nongovernmental organizations that perform abortions or discuss the option of abortion with patients. Over the last 35 years, every Democratic president has rescinded the policy and every Republican president has reinstated it. Not only did Trump reinstate this restrictive policy, he expanded it to cover all global health funding, so even funding for health services such as maternal and child health and HIV/AIDS prevention and treatment is subject to the terms of the global gag rule.
We know, based on analyses of the years of the George W. Bush Administration when the global gag rule was in effect, that these restrictions simply do not reduce abortions. From 2001 to 2008, the odds of women terminating their pregnancy increased threefold in Latin America and the Caribbean and doubled in Sub-Saharan Africa. Our statistical research suggests that the domestic global gag rule is likely to result in more, not fewer, abortions.
No study has found evidence that restricting women’s access to abortion has a measurable impact on reducing abortion rates, nor is there a systematic relationship between the restrictiveness of abortion legislation and the odds of women seeking an abortion. Rather, restrictive legislation is associated with more unsafe abortions. Abortion remains common across developing countries, even those 66 where it is legally banned.
Women living in countries with restrictive national laws face a double blow to their reproductive health wherever the global gag rule is imposed: they have fewer options to access contraceptive methods and even fewer chances to access safe abortions. Countries with restrictive national legislation have higher rates of unsafe abortion and more need for post-abortion care. A substantial percentage of maternal mortality is attributed to unsafe abortions.
Title X, when allowed to function as intended, is an effective program that low-income families and people lacking health insurance use to access comprehensive family planning and preventive health services like screening for cancer and sexually transmitted infections. First enacted under Richard Nixon in 1970, it has operated for 50 years and serves 4 million people annually, at a cost of 28 million dollars – much less than the cost of unwanted pregnancies and untreated reproductive health disorders.
Notably, Title X funding already does not cover abortion services. Since the passage of the Hyde Amendment in 1976, it has been illegal to use federal funds to provide abortions except to save the life of the woman, or if the pregnancy arises from incest or rape.
If Title X dollars are already barred from paying for an abortion, and research shows that forcing Title X clinics to stop speaking about or giving referrals for abortion doesn’t keep women from seeking and accessing abortion, then what issues exactly are the new rules meant to address?
In the long term, Americans may yet avoid this assault against their ability to obtain high-quality family planning care that respects their sexual and reproductive health and rights, pending the results of at least two lawsuits from Planned Parenthood clinics and independent clinics in Maine. But in the short term, things are looking dire. If harming low-income women and curtailing the freedom of speech of health care providers who serve them is the goal, the domestic gag rule is going to deliver – just like its global counterpart has done for decades. Without this insidious amendment, the Title X program is a model of effective, bipartisan public policy. We can only hope the courts will agree.
Meredeth Turshen is Professor Emerita in the Edward J. Bloustein School of Planning and Public Policy at Rutgers University, and author of Women’s Health Movements: A Global Force for Change. Yana van der Meulen Rodgers is a Professor in the Women’s and Gender Studies department at Rutgers University, and the author of The Global Gag Rule and Women’s Reproductive Health: Rhetoric versus Reality.