Following the recent Title X revision issued by the United States Department of Health & Human Services (HHS), the Endocrine Society announced a public objection to the decision, calling it a “gag rule” and urging the administration to reconsider the new eligibility criteria for program funding.1 The final draft of the Title X rule was released on February 22, 2019, and prohibits funding programs that offer abortion as a method of family planning — a move that has been denounced by every major medical association, according to the Endocrine Society’s statement.1,2
Title X provides basic family planning and reproductive health services to approximately 4 million people every year, regardless of income or insurance status.1,2 When the administration first published the proposed changes in June 2018, the Endocrine Society was among 500,000 respondents to submit comments, expressing concern that changes to the Title X funding program would eliminate the right to easily accessible, affordable family planning services for many people who depend on Title X-funded facilities.3
The new Title X rule goes further than prohibiting funding programs that offer abortion services by also prohibiting the referral for abortion as a method of family planning altogether. “The final rule does not bar nondirective counseling on abortion, but eliminates the requirement that Title X providers offer abortion counseling and referral,” according to the HHS press release.2 More complete reporting on referral agencies by grant recipients is also required under the updated rule to ensure compliance with the funding requirements.
Concerns that clinicians may be prevented from speaking openly with patients about all options, including abortion, have led the Endocrine Society and other opponents to call this new regulation a “gag rule.” According to Dr Leana Wen, president of Planned Parenthood, withholding information about abortion from Title X patients is a violation of medical ethics.4 If forced to refuse Title X funds, Planned Parenthood may be required to make major changes that would compromise care for the 41% of Title X patients who currently use Planned Parenthood’s services nationwide.4
In a 2017 position statement on access to hormonal contraception, the Endocrine Society reported that “federally qualified health center sites in 27 states would need to at least double their contraceptive client caseloads if Title X funding is withheld from non-[federally qualified health centers]. Nine of these states would need to at least triple their case load. This would create an insurmountable access problem for women in need of contraceptive services.”5
Access to contraception has the potential to reduce the number of elected abortions, improve women’s health, and lower healthcare costs.5 Limiting access to preventative care will increase medical costs and force women to forgo treatment.1 “We urge the administration to eliminate these new eligibility criteria to ensure that all centers qualified to provide these services have equal opportunity to receive Title X grant funding,” stated the Endocrine Society.1
1. Endocrine Society. Endocrine Society Objects to Title X Gag Rule That Limits Women’s Access to Contraception. Endo News. https://endocrinenews.endocrine.org/endocrine-society-objects-to-title-x-gag-rule-that-limits-womens-access-to-contraception/. February 22, 2019. Accessed February 22, 2019.
2. US Department of Health & Human Services. HHS Releases Final Title X Rule Detailing Family Planning Grant Program. https://www.hhs.gov/about/news/2019/02/22/hhs-releases-final-title-x-rule-detailing-family-planning-grant-program.html. February 22, 2019. Accessed February 25, 2019.
3. Mandel S; Endocrine Society. Re: Compliance with Statutory Program Integrity Requirements [Docket NO.: HHS-OS-2018-0008]. https://www.endocrine.org/-/media/endosociety/files/advocacy-and-outreach/society-letters/2018/20180731-title-x-letter-to-sec-azar.pdf?la=en. July 31, 2018. Accessed February 22, 2018.
4. McCammon S. Trump Administration Announces Sweeping Changes to Federal Family Planning Program. NPR. https://www.npr.org/2019/02/22/690544297/trump-administration-proposes-sweeping-changes-to-federal-family-planning-progra. February 22, 2019. Accessed February 25, 2019.
5. Endocrine Society. Ensuring Affordable Access to Hormonal Contraception: An Endocrine Society Position Statement. https://www.endocrine.org/advocacy/priorities-and-positions/ensuring-affordable-access-to-hormonal-contraception. September 2017. Accessed February 22, 2019.