Until family planning clinics stop performing abortions or referring women to abortion providers, those health-care facilities won't collect a penny from the U.S. government under a new proposal issued by the Trump administration on Friday.

While the White House billed its proposal targeting abortion providers as something that would "improve women's health," pro-choice advocates say the plan to strip funding from some family planning clinics only serves to harm the most marginalized women in the U.S.

Under the new plan from the Department of Health and Human Services (HHS), family planning clinics would be denied federal funding if they perform abortions or refer women to abortion providers. It also requires such clinics to be physically separate from sites providing abortion services.

Trump's proposal — seen as a fulfilment of his campaign vows to defund Planned Parenthood — would amend the federal grant program known as Title X, which is dedicated to subsidizing birth control and reproductive health care.

Title X funding cannot be used to provide abortion procedures, but anti-abortion advocates have long complained the money also subsidizes Planned Parenthood and similar organizations.

A cyclist rides past a Planned Parenthood clinic in Chicago on Friday. The Trump administration has announced a proposal to bar government-funded family planning clinics from referring women for abortions. (Scott Olson/Getty Images)

The proposed changes will pull funding for family planning clinics that treat abortion as a family planning method, echoing a 1980s rule decried by reproductive-health advocates as a "gag rule."

Since Title X was established in 1970, the program has been a cornerstone of publicly funded family planning in the United States. Without those federal dollars, contraception and access to abortion would be out of reach for the poorest women in the country, many of whom are also people of colour.

Reproductive-rights groups contend that the plan inhibits a woman's power to make her own decisions — including whether abortion feels like the right family planning method — and will disproportionately hurt low-income women, people of colour and the uninsured.

"A patient should be able to know all their health-care options. And in this country, abortion is a legal health-care option," said Melissa Torres-Montoya, the policy director for the National Network of Abortion Funds.

"This is an issue of trying to restrict people's access to full health-care services."

Pro-choice groups said late Friday they were still awaiting the full language of the proposed rule to understand the scope of the restrictions.

In a brief statement, the White House denied it was introducing any so-called "gag rule" prohibiting "counselling" women about abortions — an attempt to distinguish it from a Reagan-era rule that banned counselling and referrals altogether for clinics that receive federal money. The policy wasn't fully implemented and became stuck in the U.S. court system.

However, reproductive-health activists continued to describe the policy as a "gag rule" due to action prohibiting referrals for abortions and a requirement that abortion providers must be physically separated from other family planning facilities.

'Two classes of health care'

Torres-Montoya worries that the rule would "devastate the reproductive health needs" of women, particularly "those who are most marginalized."

Doctors in Title X-funded clinics would be banned from providing abortion referrals, even at a patient's request.

"Essentially we're making two classes of health care in this country," said Beth Lynk, a spokesperson for Planned Parenthood. "One where you have access to the full range of information, including information for safe, legal abortion, and one where you don't. That's reprehensible."

Women dressed as handmaids from the novel and television series The Handmaid's Tale demonstrate against cuts for Planned Parenthood in Washington in this June 2017 file photo. (Joshua Roberts/Reuters)

About four million Americans access subsidized family planning services funded through the Title X program, according to HHS, and the majority are women of colour. Planned Parenthood, which has about 650 affiliate health centres across the U.S., says its patients account for 41 per cent the women served by the Title X program.

"Plain and simple, this is an attempt to take away women's basic rights," Lynk said.

Joe Langfeld, executive director of the anti-abortion non-profit Human Life Alliance, said he fails to see how the policy change amounts to a "gag rule." He blasted Planned Parenthood as an abortion chain that tries to pass itself off as a reproductive health organization.

An anti-abortion campaigner holds up a model of a 12-week-old fetus during a protest outside a clinic in Belfast, Ireland, in October 2012. (Cathal McNaughton/Reuters)

"It's not a 'gag rule.' It doesn't stop [abortion providers] from talking to anybody," he said. "It just stops them from receiving money that's designated for health care, not just abortion."

He argued the Trump proposal gives money to more deserving facilities providing "real health care."

"It's a good move for women, a good move for kids, a great move for taxpayers."

Planned Parenthood points to Texas's 2013 crackdown on abortion clinics as a cautionary case. It resulted in 30,000 fewer women being covered by the state's family planning program, according to Texas's own data.

"The number of people accessing the most highly effective forms of birth control went down, while unintended pregnancies went up," Lynk said. "We know what happens when politicians target Planned Parenthood and access to people's reproductive health care: It harms people's health."

The potential knock-on effect that most concerns Melissa Grant is how the change will affect particularly low-income women's access to contraceptives. She is the co-founder of the Carafem abortion clinic, located just outside of Washington, D.C.

Melissa Grant, of Carafem, is shown from the abortion provider's flagship office in the Friendship Heights neighbourhood near Washington, D.C. The centre aims to 'de-medicalize' women's reproductive health. (Matt Kwong/CBC)

According to a 2016 study published in the New England Journal of Medicine, women living below the poverty line are five times more likely to have unintended pregnancies than women earning the most. The study also found poorer women are more likely to seek abortions.

"The reasons are apparent; financial stability is really important when people want to care for their families," Grant said. "But also in terms of health impact, we know that when women have less access to overall health care, as low-income women do, it can increase things like preterm births.

"It's good public health policy to allow people to plan more effectively when they're going to have children."

Court challenges already underway

Under the plan, Grant believes women who access facilities that were able to receive low-cost birth control under Title X "might no longer have access to the most effective methods." She said it puts abortion-care providers in the position of having to charge low-income women more for contraception when they need it most.

"They're always hit hardest. Maybe they don't have access to birth control or don't have enough information about birth control, and some of the best places to receive that information is through Title X facilities."

Grant said birth control pills can cost around $50 a month, and an intrauterine device (IUD) or implant might cost $1,000. That would be prohibitively expensive for an economically disadvantaged person seeking long-acting contraception.

"So what do they do? The abortion provider either has to charge the full cost of the contraceptive method because they don't receive funding that makes the contraceptive cost less," she said. "Or, they try to absorb the cost. But abortion care for low-income women is not covered by many insurance plans or Medicaid."

Changes to the program are already being challenged in court. Last week, Planned Parenthood, the National Family Planning & Reproductive Health Association, and the American Civil Liberties Union filed lawsuits to challenge the Trump administration.

The ACLU says it wants to block the government from diverting funds to "inexperienced providers that emphasize abstinence only" until marriage, and away from clinics providing "essential clinical care," including abortion-related services.

'Reprioritizing funding'

Texas anti-abortion activist Abby Johnson said she sees it simply as a "reprioritizing" of funding. Her organization, And Then There Were None, aims to assist workers in leaving abortion-related fields.

"We don't live in times where women don't know abortion is accessible to them," she said. "Women know that. The internet is everywhere. Women have phones."

Lynk said that misses the fundamental problem of restricting health-care providers from properly informing people about reproductive health-care options.

"This administration is chipping away people's health and rights, and their ability to control their bodies, their lives, and their futures," she said.