Family planning services for millions of poor Americans is at risk

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The United States has supported the delivery of high quality, evidence-based family planning counseling to low income Americans for nearly a half century. It has done this with broad, bi-partisan support from Congress and from presidents of both political parties.

This family planning program, widely known as Title X, has been a phenomenal success. Since the late 1970’s, when the program was launched, the initiative has helped prevent over one million unintended pregnancies annually.

{mosads}Among adolescents, the impact has been particularly profound. Between 1981 and 2011, Title X programs averted over 2 million unintended pregnancies. Data also support Title X’s role in reducing low birth weights, sexually transmitted infections and preventable cancers.

Today family planning services for millions of poor Americans is at risk. The Trump administration has formally published a rule barring Title X family planning providers from advising pregnant patients that, one of the options they have, is terminating the pregnancy.  Unless enjoined by the courts or withdrawn by the administration, the rule takes effect May 3rd.

Trouble is, no medical provider — offering family planning advice or any other medical care — may ethically withhold important information from a patient.

A lie of omission by a health-care provider doctor is just as damning as any affirmative lie. It may well constitute malpractice, and that is what The Trump administration is mandating for any provider who accepts federal family planning funding.

For the most part, Title X has avoided the heated debate over abortion and a woman’s constitutionally protected right to choose. It has done so with prudent lawmaking which, on the one hand, insures that no federal funds are expended on abortion. That has been the unambiguous law of the land since 1976.

Title X mandates what is known as “nondirective” counseling for women who seek help in understanding their options when pregnant. “Nondirective” family planning counseling is no different than almost every other kind of ethical health care.

A doctor, a nurse, or a counselor should always tell a patient what choices they have in confronting a health issue — whether it be a sprained ankle, cancer, or pregnancy.

The job of a health-care provider is to be honest, to set aside his or her opinions and help a patient make the best, informed choice. Family planning under Title X carefully follows this basic rule, and has done so for decades.

Consider our patient, Melissa Green (not a real name, and a typical but composite patient). She is 18-years-old, a high school senior, and sexually active. Melissa comes to our neighborhood health center where she has received school vaccinations, annual check-ups, lessons in nutrition and wellness and basic health care for years. She knows and trusts her pediatrician, who has seen Melissa grow up.

Today she is scared. Melissa has missed two periods and is frightened that she is pregnant. She wants to be tested. The test comes back positive. After a checkup with a health center OB-GYN, Melissa learns that she is eight weeks pregnant. Today, we calmly discuss with Melissa her options— prenatal care, adoption and, yes, abortion. Our health centers, properly, are judgement-free zones and our Title X supported counseling is “nondirective,” as is ethical and legally required. Our job is to help Melissa make her own decision, with the information she needs.

Under the new federal rule, here is what would happen:

We advise Melissa that, yes, her test came back positive. When she asks, “Help me decide what to do,” our response is limited to telling her about prenatal care and adoption. Under the new rule, we are required to provide a referral for prenatal care regardless of Melissa’s own wishes. So Melissa, shaken with her news and uncertain where to turn, goes home with no inkling that she is constitutionally entitled to terminate her pregnancy — if that is her choice. It is not likely that she will ever trust that health center again — for any form of health care.

Under the new rule there is one, ludicrous, exception. If, and only if, a patient directly asks about abortion, may a Title X provider — but only an advanced practice clinician — share information with the patient. If affirmatively asked, the provider may give the patient a list of referrals for comprehensive primary care and some of which (but not the majority) may also provide abortion.  However, the list may not indicate which agencies provide abortions.

Besides being cruel, the new rule is counter-productive. Sabotaging responsible family planning and cutting poor women off from access to family planning only results in more unplanned pregnancies and more abortions — including dangerous, high risk abortions.

Health providers with a conscience will not accept these federal restrictions and will refuse Title X funds. Many will have no choice but to shut down, cutting access for poor women of a full range of women’s health services including contraception, cancer screenings, HIV and STI testing, health education, lactation counseling, prenatal and postpartum care and other basic health-care needs.

It is not too late for The Trump administration to understand just what they are directing, and pull this rule. Otherwise, poor Americans can only look again to the courts for protection.

Robert M. Hayes is the president of Community Healthcare Network, a non-profit providing integrated healthcare to underserved New Yorkers at 14 community health centers and a fleet of mobile units. He is a founder of the National Coalition for the Homeless and the attorney who established the right to shelter in New York for homeless men, women and children.

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