Trump's White House has birth control access in its crosshairs

Trump's White House has birth control access in its crosshairs
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The war on birth control is not just unrelenting. It’s escalating. The next target will be Title X, a joint federal-state program that has been supporting — for nearly half a century — family planning clinics serving low-income families. Unable to defund the program through the Congressional appropriations process, the Trump administration is determined to push it off the rails by putting administrative obstacles on the track.

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The Office of Population Affairs at the Department of Health and Human Service, which administers Title X, has stalled the process for applying for new family planning grants. Typically the funding application is released in November with states required to complete their applications by early January, but HHS has yet to make any announcement for fiscal year 2018. Many existing grantees are concerned that their funding may lapse in 2018.

Even if the administration does ultimately invite grantees to make application for funding, there are growing fears that it will seek, through administrative maneuvering, to prevent Planned Parenthood affiliates and other family planning providers from obtaining funding. The administration may attempt to do so by imposing some form of domestic gag rule that would preclude Title X clinics from counseling patients on abortion or referring them to abortion clinics. The administration could also change the eligibility requirements in order to favor clinics seeking to promote “natural” family planning instead of modern contraceptives.

These fears are founded, in part, on the Trump administration’s appointment of Teresa Manning to run the Office of Population Affairs at HHS. Manning, who previously worked for anti-abortion groups like the Family Research Council and National Right to Life, had been highly critical of modern methods of contraception. She resigned her HHS post last week, replaced temporarily by Valerie Huber, a social conservative who has actively supported abstinence sex education programs in schools.

Reproductive health advocates are ratcheting up scrutiny of HHS decisions, and a new group, Equity Forward, announced it will watchdog HHS decision-makers whom it called "anti-contraception political activists."

Termination of Title X grants, by whatever means, would be a serious blow to reproductive health. The Guttmacher Institute reports that the contraceptive services delivered by Title X providers in 2015 helped women avoid 822,000 unintended pregnancies, which would have resulted in 387,000 unplanned births and 278,000 abortions. Without the contraceptive care provided by these health centers, Guttmacher estimates that the U.S. rates of unintended pregnancy and abortion would have been more than 30 percent higher, and the rate of teen pregnancy would have been more than 40 percent higher.

The effort to gut Title X is part of a much larger campaign aimed at restricting access to birth control services. Last year, the Trump administration was successful in persuading Congress to block an Obama administration ruling stopping governments in Texas and other states from preventing Planned Parenthood affiliates in their state from receiving Title X funds.

This past fall, the Trump administration passed new rules that significantly weakens the Affordable Care Act’s so-called “contraceptive mandate”. Under the new rules, employers or insurers could drop coverage of contraceptive services in health insurance policies on the basis of moral or religious objections. While a federal court has temporarily blocked the implementation of those new rules, the administration is determined to weaken the ACA’s birth control mandate by any means possible, including the dismantling of the ACA itself.

The Trump administration and its allies in Congress act as if they have a public mandate to terminate any federal support for improving access to contraception. No such mandate exists, of course, as there is widespread popular support for family planning programs.

The Trump administration’s attempt to hamstring the administration of Title X funds is contemptuous of:

  1. The women who rely upon a Title X clinic for family planning services;
  2. Congress, which has consistently funded the program; and
  3. The statute establishing Title X, which was signed into law by President Richard Nixon in 1970.

Administration appointees, including Teresa Manning, the administrator of Title X, take a sworn oath to “faithfully discharge” the duties of their office. They should uphold that oath. 

Robert Walker is the president of the Population Institute, a Washington-based organization promoting family planning and the reproductive health of women at home and abroad.