On May 18, just six days after the White House celebrated National Women’s Health Week, the Trump administration proposed a new rule that would harm women’s health. This so-called “Domestic Gag Rule” would restrict medical advice and financially deplete organizations like Planned Parenthood, which provide women access to a whole range of health services—all in an attempt to restrict abortions.
The Rule and its Rationale
The rule, to be implemented through the Department of Health and Human Services, would change regulations currently in place for the Title X Family Planning Program for any organization that receives federal funds for family planning services, such as prenatal care or birth control, that also provides abortion services. Unless the organization was able to demonstrate “clear financial and physical separation” between Title X-funded programs and abortion services, they would lose Title X funding. The new rule would also eliminate the current Title X requirement mandating that health providers give patients abortion counseling and referral—it would not bar “non-directive counseling on abortion,” but would prohibit providers from referring their patients to centers providing safe and legal abortions. Dubbed the domestic “gag rule,” it harkens back to the 1988 Reagan policy that barred Title X-funded facilities from providing any information about abortions or referrals to patients.
The Trump administration claimed that the rule would ensure Title X funds would not be used to fund abortions, but under the Hyde Amendment, in effect since 1976, health care providers are already prohibited from using federal funds for abortions except in the cases of rape, incest, or when the woman’s life is endangered. The rule also states this change is “protecting Title X health providers so that they are not required to choose between the health of their patients and their own consciences.” Separate provider conscience rules exist as well, which the Trump administration is seeking to expand.
This Domestic Gag Rule follows Trump’s reinstatement of the Global Gag Rule just days after taking office.
Access to Family Planning Services and General Health Care
A Domestic Gag Rule will have similarly dire effects as its global counterpart on access to family planning services, including contraception. Planned Parenthood provides health care to 41 percent of all Title X participants. In 67 percent of U.S. counties with Planned Parenthood clinics, these clinics served as at least half of all safety-net family planning centers, which, using public funds, provide contraceptive care to the general public for a free or reduced price. In over one-fifth of these counties, Planned Parenthood centers are the only family planning centers of this type at all.
Planned Parenthood and similar clinics also offer their patients teen pregnancy prevention programs and sex education, birth control, mammograms, sexual assault care, LGBT services, and more. And in rural states and for low-income women, their health clinics serve as one of the only options for medical services.
But because Planned Parenthood is also the country’s leading abortion provider, under Trump’s new rule, patients who benefit from all their other health services would be at immediate risk, should these clinics be forced to scale back services or shut down.
Increasing Unsafe Abortions
Under this rule, medical professionals working for organizations that receive Title X funding would not only no longer be allowed to perform abortions in the same setting that they provide other family planning services, but also would no longer be allowed to refer patients elsewhere to receive safe and legal abortions—or even tell them all of their options for their pregnancies. The American Medical Association, in a statement on its strong objections to this proposed rule, said: “Gag orders that restrict the ability of physicians to explain all options to their patients and refer them—whatever their health care needs—compromise this relationship and force physicians and nurses to withhold information that their patients need to make decisions about their care.”
This rule change would actually contribute to the Trump administration’s stated concern that abortions cause harm to women. Restricting access to abortion simply does not reduce the amount of abortions that take place.
This rule change would actually contribute to the Trump administration’s stated concern that abortions cause harm to women. Restricting access to abortion simply does not reduce the amount of abortions that take place. Research from around the globe has demonstrated that in countries that ban abortion or have severe restrictions on the procedure, abortion occurs just as much as it does in countries where it is legal. Furthermore, in countries where abortions are banned or severely restricted, women turn to self-induced, dangerous methods. This has already been exhibited in Texas, where the vast majority of health clinics providing abortion services have been forced to shut down due to strict state-level abortion laws. The World Health Organization has found that in places with extensive abortion-restrictive laws, only a quarter of abortions are considered safe. Abortions performed in legal settings, by comparison, have a 90 percent safety rate.
Deepening Unequal Access to Medical—Including Abortion—Services
Americans already struggle with extremely disparate access to medical services based on physical proximity to readily available medical professionals, poverty and medical insurance coverage, and state abortion laws, among other factors. Should health care providers serving those with fewer medical options lose their Title X funding or be restricted in the kind of care they can provide, patients will be forced to travel to alternate providers, which is not a luxury many can afford. And should clinics be forced to shutter their abortion services in states with strict state-level abortion laws like Iowa and Oklahoma, women will be denied their constitutional right granted by Roe v. Wade, to an even greater extent than so many Americans already are.
Lessons from the Global Gag Rule
Since its establishment in 1984, the Global Gag Rule and its reinstatement by every Republican president has produced devastating effects. Marie Stopes International, a leading women’s health provider, lost almost one-fifth of its funding due to Trump’s reinstatement of the rule, affecting its ability to provide a myriad of health services. While Marie Stopes was still able to provide contraception to 26.9 million people in 2017, this number only increased by 6 percent from the previous year (which had seen a 20 percent increase from 2015 to 2016). Under the next year, Marie Stopes estimates that over 2 million women will lose contraception services, leading to 2.5 million unintended pregnancies, 870,000 unsafe abortions, and 6,900 avoidable maternal deaths. The Domestic Gag Rule risks similar consequences for Americans.
This new rule has some precedent: President Reagan introduced a Domestic Gag Rule in 1988, which barred doctors in clinics that received Title X funding from providing any information on abortion or referrals for where to undergo the procedure. It also required the physical and financial separation of a clinic’s abortion procedures from its Title X-funded family planning services. The Supreme Court backed the rule as a permissible exercise of executive power in Rust v. Sullivan (1991), providing Trump with legal precedent for his version of the Domestic Gag Rule. However, Reagan’s rule was never fully implemented due to court challenges and President Clinton’s promise to repeal it upon taking office.
While we know about the effects of the Global Gag Rule and already disparate access to reproductive health care across the United States, the extent of the impact of the Domestic Gag Rule—assuming it is implemented—is unknown. Experts suggest it will result in increasingly reduced and unequal access to health care across the United States. If the current effects of restricting abortions provide a true snapshot into the implications of Trump’s Domestic Gag Rule, the devastation it will bring to Americans—particularly American women—is sure to be unprecedented.