by Nicole Einbinder

The Trump administration has proposed sweeping changes to its national family planning program that, if implemented, would prohibit clinics from receiving federal funds if they provide abortion services for patients.

The proposed rule from the Department of Health and Human Services, released on May 22, comes amidst a series of actions from the White House intended to curtail abortion services and shift the government’s stance on teen pregnancy prevention. The moves have been heralded by the anti-abortion movement. But women’s health advocates and providers are concerned about what the funding changes will mean for access to comprehensive reproductive healthcare and family planning services.

Under the rule, which is being reviewed by the Office of Management and Budget, health care providers will not be allowed to perform abortions or refer patients to clinics if they want to continue to receive federal family planning money, known as Title X funds. These entities were already barred from using government funds for abortion, but can currently use those dollars to subsidize other health services.

The new rule would require health care providers to have a, “bright line of physical as well as financial separation” from programs or facilities “where abortion is performed, supported, or referred for as a method of family planning,” a White House official told FRONTLINE in an emailed statement.

“Title X programs may not directly or indirectly facilitate, promote, or encourage abortion in any way,” the rule said. It defines family planning services as including, “preconceptional counseling, education, and general reproductive and fertility health care to improve maternal and infant outcomes.”

“Family planning does not include post-conception care (including obstetric or prenatal care) or abortion as a method of family planning. Family planning… should reduce the incidence of abortion,” the document adds.

Title X funds served more than 4 million people in 2016, with 80 percent of those patients accessing contraceptives through the program. In 2017, Congress provided over $286 million in Title X grants for services including birth control, screenings for cancer and sexually transmitted diseases, pregnancy tests, and other reproductive services for low-income women.

As much as $60 million of that money annually goes to Planned Parenthood, the nonprofit organization that offers a range of reproductive health services, including abortions — making it a lightning rod for the anti-abortion movement.

The rule would effectively fulfill a campaign promise by President Donald Trump to defund Planned Parenthood — a longtime goal for anti-abortion advocates. President Ronald Reagan had proposed a similar rule, but it was never implemented. Last year, Congressional leaders unsuccessfully attempted to slash funding for the organization as part of a failed attempt to repeal the Affordable Care Act.

The White House official pushed back against the suggestion that the rule would defund Planned Parenthood, saying: “Any grantees that perform, support, or refer for abortion have a choice — disentangle themselves from abortion or fund their activities with privately raised funds.” The official added that unlike Reagan’s policy, the proposal will not prohibit organizations from counseling clients about abortion.

“A doctor would be permitted to provide nondirective counseling on abortion,” the proposed rule states. “Such nondirective counseling would not be considered encouragement, promotion, or advocacy of abortion as a method of family planning.”

Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America, said the proposed rule was an attempt to take away women’s basic rights. “Planned Parenthood will not stop fighting for our patients,” she said in a statement. “We will not stand by while our basic health and rights are stripped away.”

The proposal is the latest effort by the White House to restrict abortion access domestically and abroad, and fulfills the president’s promise to, “ensure that federal funds are not used to fund the abortion industry in violation of the law,” according to a statement from the White House Office of the Press Secretary.

“There’s been a ton of pro-life victories thus far from the Trump administration, and he really is the most pro-life president our nation has ever seen,” said Mallory Quigley, a spokesperson for the Susan B. Anthony List, which supports anti-abortion candidates. “This new regulation affecting the Title X funding is really President Trump keeping his promise, and really picking up the baton where Congress wasn’t able to get the job done.”

Three days into his presidency, Trump expanded the Mexico City policy, a Reagan-era policy that restricts foreign NGOs from receiving U.S. family planning dollars if they perform or promote abortions, to apply to all U.S. global health dollars, which totals $10 billion.

It’s strictly partisan: Republicans implement it, and Democrats roll it back. Trump’s expansion, however, has health workers in some impoverished countries concerned. In Uganda, a country that already has restrictive abortion laws, health providers told FRONTLINE that the policy has reduced access to other critical health services that had been provided by international groups like the International Planned Parenthood Federation and Marie Stopes International, which refused to sign onto the policy. Ugandan health providers worry that the policy will lead to a spike in unsafe abortions and increased maternal mortality.

Trump has also nominated federal judges and appointed officials in the Department of Health and Human Services who oppose abortion, including Valerie Huber, who was appointed as chief of staff for the Office of the Assistant Secretary of Health last June. In January, she was appointed as acting deputy assistant secretary for the Office of Population Affairs, which oversees the Title X National Family Planning Program. Her former position remains vacant.

Huber is a major advocate of abstinence-only programming, and formerly led a national abstinence education group. Last summer, the Office of Adolescent Health, which is administered by the Office of the Assistant Secretary of Health, prematurely cut funding for more than 80 grantees focused on teen pregnancy prevention because their programs did not align with the vision of the new administration, according to legal documents.

In April, the Office of Adolescent Health also announced that the pregnancy prevention program would favor grantees that teach abstinence and sexual risk avoidance, as opposed to the comprehensive sex education supported by the Obama administration.

That abstinence-only focus is now visible in the administration’s attempts to reshape the Title X program. In February, HHS released new criteria for how they will review and distribute federal family planning funding. The funding changes promote abstinence before marriage and cooperation with faith-based organizations, and omits any mention of contraception.

Some abortion-rights supporters have begun to fight back in court against these changes.

Several of the groups who lost funding from the teen pregnancy prevention program have sued, arguing their grants had been unfairly terminated.

In April, a federal judge ruled in response to one lawsuit that those funding cuts were unlawful. “Because HHS terminated plaintiffs’ grants without any explanation whatsoever… the Court concludes that HHS acted arbitrarily and capriciously, and in violation of the law,” wrote Judge Ketanji Brown Jackson of the United States District Court for the District of Columbia.

The National Family Planning & Reproductive Health Association, represented by the ACLU, and Planned Parenthood Affiliates in Wisconsin, Ohio, and Utah recently filed a lawsuit challenging the administration’s funding changes for Title X.

Karrie Galloway, CEO of Planned Parenthood Association of Utah, said the various attempts to change Title X funding would be devastating for women there.

The Planned Parenthood Affiliate of Utah is the only Utah organization to receive Title X dollars, and $2 million of their annual $11 million budget comes from those funds. In 2017, 80 percent of their more than 45,000 patients, many who were uninsured, relied on Title X to receive healthcare services.

“To use the issue of abortion to cut off the women who use the national family planning program from getting their healthcare from experts to help them manage their reproductive healthcare seems crazy to me,” Galloway said. “This gag rule is not meant to hurt Planned Parenthood; it’s meant to hurt women.”