In March, the Trump administration released a final rule barring recipients of Title X family planning funds from offering information and referrals for abortion services. The rule, also referred to as the domestic gag rule, calls for all Title X funding recipients to be physically and financially separated from facilities that offer abortion—a requirement that specifically targets major women’s health care provider Planned Parenthood. The rule has been challenged in court in recent months. And just last week, Planned Parenthood issued a request for the Trump policy to be blocked by the U.S. Court of Appeals for the Ninth Circuit.

On August 16, that request was denied, forcing the Planned Parenthood out of the Title X Family Planning program, which is sure to be a blow to the millions of women who access care through Planned Parenthood health centers.

The Title X Family Planning Program has helped ensure access not only to reproductive health care, but also to basic health care for millions of women, for almost fifty years. For women at the margins, Title X providers often serve as their only access point for health care. To put it plainly, Title X providers are working on the front lines to ensure health care for hard to reach communities across the country. What this new rule does is force states and women’s health care providers to face a cruel choice: either fully divest from even just acknowledging that abortion should be part of a comprehensive approach to family planning and reproductive health care, or lose all federal funding for care for these women.

In the face of the ensuing challenges that implementation of the domestic gag rule will cause, some states have stepped up to protect women’s access to basic health care. This commentary first takes a quick look at the background of the Title X Family Planning Program and who it serves, and then looks at how states are responding in the short-term to the domestic gag rule.

What Is the Title X Family Planning Program?

Title X was established under the Family Planning Services and Population Research Act of 1970, an amendment to the Public Health Service Act. It was signed into law by President Richard Nixon. It is the only federal domestic program dedicated solely to providing family planning services, serving approximately four million people each year, of which 40 percent are supported by Planned Parenthood health centers.

Who Benefits from the Program?

Title X providers predominantly serve low-income people of color, many of whom lack health insurance and reliable access to family planning services. According to the Guttmacher Institute, Title X-funded clinics helped avert 822,300 unintended pregnancies in 2015, resulting in the prevention of 387,200 unplanned births and 277,800 abortions. All of this translates to savings in taxpayer dollars as well. Taxpayers save $7 for every $1 invested in publicly funded family planning programs, including Title X. The services offered at Title X clinics typically include preconception health, teen pregnancy prevention, contraception, testing and screening for sexually transmitted infections, cancer screenings, and education and counseling services—all for free or at reduced cost. No one is turned away due to an inability to pay.

Due to long-standing, draconian restrictions on federal funding for abortion, Title X providers already may not offer abortion “as a method of family planning.” However, information about abortion and referrals to this care have historically been permitted. Federal law has long held the requirement that all pregnant people receiving health care through the Title X Family Planning Program are offered information and non-directive counseling on all pregnancy-related options. Under the domestic gag rule, pregnant people now must be referred to prenatal services, regardless of whether they express the choice to terminate a pregnancy.

Who Is Filing Legal Challenges to the Domestic Gag Rule?

In July, the U.S. Court of Appeals for the Ninth Circuit allowed the domestic gag rule to take effect. This followed months of back and forth in court fights contesting the rule, culminating in a plea to block the rule by Planned Parenthood (and co-plaintiffs in the lawsuit) on August 14. Lawsuits have also been filed against the U.S. Department of Health and Human Services by other leading organizations, including the American Medical Association, the American Civil Liberties Union (ACLU), the National Family Planning and Reproductive Health Association, and the Center for Reproductive Rights. Twenty-one states, the District of Columbia, and state officials have also filed lawsuits against the federal government contesting the domestic gag rule.

How Are States Responding?

In addition to the twenty-one states and the District of Columbia citing legal challenges with the domestic gag rule, eight states have refused to accept federal funding under the Title X Family Planning Program as a response to the release of the rule. Here is a closer look at the profiles of Maryland, Maine, Illinois, and Massachusetts, and how each state is working to protect the integrity of family planning programs and affirm support for women in need of affordable reproductive health care. It should be noted that these state actions are short-term fixes.


In May, Maryland became the first state to withdraw from the Title X Family Planning Program after announcement of the domestic gag rule. Via legislative measure, state lawmakers approved a preemption that guarantees level funding for the next fiscal year for local family planning providers if the rule were to go into effect. Approximately 267,650 women in the state need subsidized family planning services, traditionally offered by programs including the Title X and Medicaid.


On July 16, Maine Family Planning announced its withdrawal from Title X due to the domestic gag rule, forfeiting $2 million in federal funding. However, clinics will continue operating and providing family planning services—a situation state officials acknowledge as untenable for the foreseeable future. The program serves almost 23,000 people in Maine, through forty-seven health centers. Services offered at the centers include basic care, such as cervical cancer screenings, testing for sexually transmitted infections, and contraception. Approximately 82 percent of Maine Family Planning’s clients are low-income, qualifying for free and reduced-cost health care services.


Governor J. B. Pritzker announced that the state of Illinois would be withdrawing from the Title X program on July 18. To help fill the gap in funding for twenty-eight grantees, the Illinois Department of Health plans to provide approximately $2.4 million. The Planned Parenthood affiliate serving the state, Planned Parenthood of Illinois, separately announced that it would forfeit $3 million in funding that would have come directly from the federal government, due to the domestic gag rule. State officials estimate that 773,000 women residing in Illinois need subsidized contraceptive services.


In April, Governor Charlie Baker signed a bill to protect access to family planning services for more than 75,000 people in the state of Massachusetts. In response to the domestic gag rule, the bill ensures supplemental state funding in order to maintain current levels for fiscal year 2019 for local health care providers that previously received federal funding through the Title X program. Title X providers in the state span ninety sites, including Planned Parenthood health centers, federally qualified health centers, hospitals, and other facilities.

The women predominantly served by Title X deserve to have quality health care—health care that will support them in leading healthy lives, and health care that will empower them to make the best decisions about their bodies and their futures. Implementation of the domestic gag rule will gravely compromise health care access for millions of low-income women. In order for these programs to run optimally and ensure that women have access to the comprehensive family planning and reproductive health care they deserve over the long-term, including non-biased counseling and education, federal funding needs to be sustained and the domestic gag rule needs to be struck down.

Protecting Title X, as well as other publicly funded health programs, is essential to broader efforts to ensure universal access to health care. Policies like the domestic gag rule perpetuate a system of inequality where quality health care access and the freedom to make informed health care decisions are reserved for only the privileged in American society.

Cover Photo: Pro-choice activists, politicians and others associated with Planned Parenthood gather for a news conference and demonstration at City Hall against the Trump administrations title X rule change in New York City. Source: Spencer Platt/Getty Images