It’s deja vu all over again, as the current administration, borrowing a never-implemented move from the Reagan administration, attempts to gag physicians who provide reproductive care to women.
New proposed regs would forbid Title X funded providers from freely providing information about abortion to their patients, limiting such conversation to the provision of a list of names to women who have already decided to have an abortion.
Given that close to 50% of pregnancies in the United States are unplanned and that a significant proportion of women with unplanned pregnancy are unsure what they will do at the time of diagnosis or presentation to their doctor, the ruling is effectively a gag rule for any encounter around unplanned pregnancy. Or a planned pregnancy that goes wrong. Or that occurs in a woman with medical issues placing her health in danger during pregnancy. Or anytime when a pregnant woman is unsure what she wants to do regarding her pregnancy.
There’s more to the ruling that just the gag, much of it targeting Planned Parenthood, which provides reproductive health services to 41% of Title X clients.
By imposing extensive physical and financial separation requirements, the proposed rule effectively excludes from Title X any safety-net health center that provides abortion using non-federal funds. Specifically, Title X-funded entities would have to maintain separate accounting records, physical spaces (such as waiting and exam rooms, entrances, and exits), workstations, phone numbers, email addresses, staff, patient health records, educational programs, and signs.
The Ruling also lowers the bar and redefines family planning to allow Title X Funds to flow to programs that don’t actually offer medically approved contraception, but instead focus only on fertility awareness (rhythm), adoption or abstinence.
If you, as I do, oppose the proposed Title X changes, then I urge you to submit a formal comment and make your voice heard.
You’ll be joining the AMA, AAP, ACOG and ACP and almost 600 bipartisan elected officials in opposing this attempt to limit the free flow of healthcare information to women seeking to make choices among legal medical options. If you’re not great with words, head over to PRH Website for some more freely given text.
Here’s the comment I submitted today. Feel free to share, copy and paste.
Dear Secretary Azar, Senior Advisor Huber, and Deputy Assistant Secretary Foley:
I am writing you at this time to express my strong opposition to the proposed changes to Title X funding rules, which would limit Title X-funded providers in dispensing information or referrals for abortion services.
The proposed rule effectively gags both health care providers and their patients, limiting free speech within the patient-provider relationship.
Many, many women at the time of pregnancy diagnosis are unsure of their plans for that pregnancy, and wish to discuss their options with their provider. Limiting abortion discussion and referrals to women who have already decided to have an abortion is tantamount to malpractice, as women who are unsure of their options are not provided by their clinician with the critical health information they need to make a choice between the legal options available to them.
As a practicing physician I vehemently oppose this attempt to dictate medical care. Abortion is a legal medical procedure, safer than carrying pregnancy to term when performed by qualified providers, and information about it must be freely available to women, who need unbiased, factually correct, evidence-based information to make the choices that are safest and best for themselves and their families.
The proposed regulations unfairly and unconscionably impacts low income women, who frequently have no other options for reproductive health care other than that provided by Title X providers. The proposed rule changes create a two tiered system of reproductive education and care – one for women of means, who are given the information and counseling they need to make decisions about their reproductive health, and the other for poor women, from whom information about legal, safe reproductive options is deliberately withheld. If the legislation has its intended impact, women will lose trusted providers such as Planned Parenthood, which currently provides care to 41% of Title X patients.
Finally, the government cannot, though its funding mechanisms, require physicians to deliberately withhold information about completely legal health care options from our patients. This violates our free speech, promotes unethical behavior and violates the patient-physician relationship.
I urge you to withdraw the proposed changes
Thank you for allowing me to comment.
Margaret Polaneczky, MD
- Federal Register – Read the proposed ruling
- Top X on Title X – Top X Reasons Why America’s Women’s Health Care Providers Oppose Restrictions to Title X
- More than a Gag Rule – Atlantic Monthly
- Health Affairs explains the entirety of the ruling, which is indeed much more than just a gag rule
- Louisiana Weekly has a great article on how the gag rule disproportionately affects poor Southern women
- Kaiser Family Foundation – Implications of the proposed ruling for women and family planning providers