Title X, a program that provides federal dollars to be used for family planning services, is under siege. The public comment period ended July 31, 2018, and now we wait to see how funding changes for Title X unfold.
Title X is a critical program that provides essential reproductive health services to women, created by the United States Congress in 1970 as part of the Public Health Service Act. Since that time, millions of women have accessed reproductive health care that benefited their lives, both through family planning and by preventing adverse outcomes arising from unintended pregnancies.
Historically, while there have been some efforts to make changes to Title X at the federal level, the main venue for creating restrictions on Title X has been at the state level. State governments — currently, 18 states — have successfully limited the ability of Planned Parenthood to receive Title X funds as a strategy for abortion restriction.
Now, Title X faces serious changes that have been proposed at the federal level. These changes are also focused on abortion and directly affect the ability of medical clinicians to provide comprehensive reproductive health care to their patients. The federal government is trying to control what can be said in the confidential conversation between a doctor and patient by only allowing Title X money to go to agencies who promise to not allow their medical staff to talk to patients about abortion.
In this country, abortion is a legal option that women can choose as part of their own reproductive health. The changes proposed for Title X would mean that medical staff can’t even bring up abortion as an option for a woman who might find herself with an unwanted pregnancy. This is the so-called “gag rule.”
Efforts to restrict conversations between patients and their healthcare provider around the full legal scope of reproductive health services are a substantial breach of the foundational structure of that relationship: honesty and full knowledge. A healthcare provider’s focus is their patient, the unique needs and expectations that are critical to that single encounter. Restricting the distribution of Title X funds, as proposed, will reduce access to reproductive health services. The population most in need of these services will be the population most affected. By enacting the Title X changes proposed in the announcement, further inequities will occur: women using Title X will not be provided with information about the full scope of reproductive health services that they might most want or need. Title X is a long-standing, extremely successful program. The proposed changes would be devastating to the millions of women who depend on Title X.
– Excerpt from Dr. Satterwhite’s public comment, July 2018
We are not alone in our concerns over these proposed changes. Every major medical and nursing association stands firmly with women, children, and families. Other Americans need to stand up, too. Here’s how we can all play a role:
- Advocates: We do not yet know the full fate of Title X programs, but advocates can stay engaged by following media coverage of the changes, calling their local and federal representatives about changes, and voting in primaries and general elections.
- Clinicians: If robust coverage for family planning services diminishes, clinicians will bear a responsibility to provide care for their patients and be resourceful. This could include direct outreach to pharmaceutical companies for patient assistance programs that cover contraceptives; identifying community partners that are still able to offer affordable contraceptive services; and staying on top of local resources to fill the gaps in coverage. In addition, clinicians should continue to be comprehensive and evidence-based when counseling their patients on their reproductive health options.
- Public health practitioners: Public health practitioners will also have to potentially work with pharmaceutical companies for patient assistance programs; work with their state health departments to get family planning resources in the case of local health departments; and possibly partner with university medical systems to provide easy access to patient care and referral for family planning needs. Community entities will have to be creative in mapping out plans to meet the needs of women, children, and families.
- Researchers: Researchers will have to keep their eyes on the ever-changing events related to federal funding for family planning. Consider new opportunities to conduct evidence-based research about the impact of loss of family planning services on women, children, and families. Write in the peer-reviewed academic press, as well as in other outlets — academic blogs, local media, and social media. Make science a public enterprise and continue to shed light on the evidence of how family planning services benefit society.
We all have a part to play. We hope that this post serves as inspiration.
Catherine Lindsey Satterwhite
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