Maine Family Planning and the global Center for Reproductive Rights have sued the federal government over a new Trump administration rule they say will limit access to abortion services.

The rule from the U.S. Health and Human Services Department would ban family planning clinics that receive federal Title X funds from making abortion referrals — what critics are calling a “gag rule.” Those clinics would also be barred from providing abortion services in the same buildings where they provide other health services such as cancer and STD screening, a requirement that would increase costs for many providers.

That expense would force Maine Family Planning to stop offering abortion services at all but one of its family planning clinics in the state, the group says. Under that scenario, Mainers would have only three publicly accessible locations for abortion care across the state — the flagship Maine Family Planning Clinic in Augusta, the Mabel Wadsworth Center in Bangor and the Planned Parenthood location in Portland.

A spokeswoman said Maine Family Planning provides about 500 abortions each year.

“I don’t believe I’m overstating it when I say that the domestic ‘gag rule’ poses an unprecedented threat to our organization, to Maine’s Title X network and the 23,000 patients our network serves,” said George Hill, the president and CEO of Maine Family Planning. “The rule undercuts and upends all of the work that we’ve done to expand meaningful access to affordable reproductive health care, including abortion care, in Maine.”

The new rule is expected to face a myriad of challenges in court, of which the lawsuit in Maine is the latest. The American Medical Association and Planned Parenthood filed a similar lawsuit in federal court Tuesday, and Planned Parenthood has said it would forgo an estimated $60 million in Title X funding if the rule stands. So did a group of 21 state attorneys general, although Maine’s Attorney General Aaron Frey was not among them. Maine’s entire congressional delegation has also come out in opposition to the new rule.

The Title X program serves about 4 million people annually. The grants fund family planning services like contraception and STD screening to low-income individuals for free or at low cost. In 2017, the most recent year data is available, the program administered more than $280 million in federal grants to clinics. Federal laws prohibit the use of taxpayer funds to pay for abortions in most circumstances, so Title X grants do not pay for those services.

Still, anti-abortion activitsts have argued that organizations with any connection to abortion should not receive federal fund at all. A spokesperson for the Department of Health and Human Services declined to comment on pending litigation. A department press release announcing the new rule last month said it will “provide needed clarity” for the public and for clinics about what is allowed and not allowed by law.

“The final rule ensures compliance with statutory program integrity provisions governing the program and, in particular, the statutory prohibition on funding programs where abortion is a method of family planning,” the release stated.

Maine Family Planning receives $2 million annually in Title X funding. The agency operates its own 18 clinics and shares the federal funds with 29 other health centers across Maine. Attorneys from the Center for Reproductive Rights said they chose to mount a legal challenge in U.S. District Court in Portland because Maine Family Planning is the sole grantee in the largely rural state, and low-income patients here have few other options for those services.

“As an independent provider, they don’t have the benefit of a national support system,” said Emily Nestler, senior staff attorney at the Center for Reproductive Rights and the lead attorney on the case. “They are an organization that has stepped in to provide a public service for the people of Maine, to fill a void in health care that nobody else wants to offer.”

Hill said Maine Family Planning could not afford to create separate facilities for abortions at each of its scattered clinics, so it would consolidate those services in Augusta.

“The rule fails — we would argue, spectacularly — to take into account the realities of health care provision in our large and rural state, where many people grapple with poverty, lack transportation and otherwise struggle to access high quality care,” Hill said.

Evelyn Kieltyka, a nurse practitioner and the senior vice president of program services at Maine Family Planning, said the new rule would erode trust between patients and their health care providers. The previous rule required Title X providers to tell patients about all options for pregnancy — prenatal care, adoption and abortion. But Kieltyka said the new version would bar those providers from talking opening about the option of abortion.

“Our ability to provide comprehensive information is important because our patients often don’t know where abortion is available and whether it is legal in their circumstance,” Kieltyka said. “We are those patients’ only opportunity to learn about their pregnancy options. By banning abortion referral and forcing providers to obscure information about where to obtain abortion care, the ‘gag rule’ inserts politics into the exam room.”

In the lawsuit, the plaintiffs argue that the rule violates the constitutional rights of women and medical professionals, and that it was adopted without the justification required under the law.

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