New guidelines for family planning centers mandate bad medicine

Patients expect to get accurate information about their health and options for care when they visit the doctor. If a patient needs services that their doctor cannot provide, patients should receive a referral to another qualified health professional who can provide the necessary care.

That is about to change for the 4 million patients that rely on the federal Title X program. And for predominantly low income, uninsured women who have few other options for family planning services, this change will hit especially hard.

ADVERTISEMENT

The Title X program has set the standard for family planning service delivery in the U.S., and the new guidelines threaten to undermine those standards by severely limiting providers’ abilities to provide medically appropriate information about women’s pregnancy options, including abortion. 

The Trump administration recently issued new guidelines for the program, which supports family planning services at nearly 4,000 health centers nationwide. The new regulations, which are set to go into effect in May, require health care providers at Title X-funded facilities to no longer offer information and counseling about abortion, even if their pregnant patients ask for it. 

The new guidelines also prohibit providers from referring patients considering abortion to facilities that provide that service. 

Instead, physicians and advanced practice clinicians must refer a pregnant patient to prenatal care, regardless of her desires to continue the pregnancy. Clinicians at Title X sites can offer patients a list of providers that offer abortion, prenatal care and other pregnancy-related services, but that list cannot indicate which providers offer abortion. Women will be left to figure that out on their own. This may be particularly difficult for the many low-income patients who rely on Title X-funded services and will have to overcome transportation barriers and find an appointment that can accommodate their childcare needs and work schedule.

The U.S. Department of Health and Human Services justifies the new guidelines by saying providers should not be required to choose between participating in the program and violating their own consciences. But, the long-standing guidelines for the Title X program do not allow providers’ referrals to include “promoting abortion” or scheduling an appointment for patients desiring abortion. Yet, by restricting what providers can and cannot say, the guidelines create a crisis of conscience for those clinicians who want to fully support their patients’ reproductive health choices.

This “domestic gag rule” is similar to a state-level policy implemented in Texas in 2013 that prohibited organizations from receiving state family planning funds if they “provide or promote elective abortions.” Like the new federal regulations, Texas’ policy was aimed at excluding Planned Parenthood from participating in publicly funded family planning programs. The guidelines for Texas’ state-funded programs did not prohibit participating providers from offering women impartial information about all her pregnancy options, including abortion, if requested.

In a recent study we conducted in Texas, we compared pregnancy counseling and referral practices at state-funded family planning organizations and compared them to federal Title X-funded family planning organizations after the state policy went into effect. We found that the policy had a chilling effect on providers’ counseling and referral practices, which adversely impacts the health care of pregnant women.

Providers at organizations that did not receive federal Title X funding were far less likely to offer women comprehensive counseling about their pregnancy options — prenatal care, adoption and abortion. They simply censored themselves from offering relevant information about available services. 

ADVERTISEMENT

A “domestic gag rule” that, in effect, leads health care provider to withhold medical information from their patients lies in stark contrast to initiatives elsewhere in medicine to provide patient-centered care. That is why health care providers and professional medical associations, such as the American Medical Association, have filed lawsuits challenging the new guidelines.

Pregnant patients should be able to expect that their providers will offer them unbiased, comprehensive information about all their healthcare options. Federal policies that force health care providers to do anything less are mandating substandard and unethical care. 

Kari White is an investigator with the Texas Policy Evaluation Project at The University of Texas at Austin and an associate professor in the Department of Health Care Organization and Policy at The University of Alabama at Birmingham.