Title X Changes Hurt Low-Income and Vulnerable Women Most

May 08, 2019

By: Megan Hunt, Johns Hopkins School of Medicine and

Keanan McGonigle, AMSA Education and Advocacy Fellow, 2019—2020


In our high-risk pregnancy clinic, I was introduced to a young woman in the eighth month of her second pregnancy. The woman had a number of mental health disorders which complicated care due to her cocktail of psychiatric medications, but what made this pregnancy particularly high-risk was that the woman was carrying twins. Throughout her pregnancy, the woman was insured under the state’s Medicaid program, but I found myself wondering what would happen to her after delivery. This pregnancy had strained her physical and mental health – she needed access to effective, long-term contraception for a significant period of time following delivery.


Thankfully Title X, the federal program that provides for comprehensive reproductive and preventive health services, exists to serve women just like her. Since its adoption in 1970, Title X has funded birth control, testing for sexually transmitted infections, and other crucial preventive care services for millions and currently serves over 4 million Americans. However changes introduced by the Trump administration threaten patients’ access to these services and doctors’ ability to provide them. [highlight]The administration’s changes extend far beyond existing federal policy that prevents public funds from paying for abortions to include a ‘gag rule’ preventing providers from even discussing the service for fear of losing federal funding and would require providers to maintain separate facilities to provide abortion services.[/highlight][highlight] These changes will disproportionately affect low income women and those who already struggle to access preventive and family planning services.[/highlight]


To date, over 75 healthcare organizations, including the American Medical Student Association, strongly oppose the Title X gag rule. With complete disregard for the input of medical practitioners, this administration is instead moving forward with policy that will directly hurt the women who need care most, and who have little voice to advocate for themselves. It finalized these changes in February, with a May 3 deadline for implementation. However, a federal judge in Oregon declared the administration’s changes a “ham-fisted approach to public policy.” The court issued a preliminary injunction that will delay the implementation date. As The Washington Post reported, “The decisions do not resolve the legal merits of the cases, but are based on the judges’ determination that the challengers are likely to prevail on the merits after a trial and that, in the meantime, allowing the restrictions to take effect would cause “irreparable harm” to the programs and those they serve.”


As future healthcare providers, we wholeheartedly agree with this assessment. Preventing providers from even discussing the comprehensive array of safe, effective reproductive care options is counter to everything we are taught from day one of medical school. Counseling patients on all options available to them is a key tenet of compassionate, quality healthcare. The intrusion of non-medical bureaucrats into the patient-provider relationship is a wanton violation of the trust inherent in the medical profession. At its core, this rule subverts patients’ rights to healthcare – without receiving full information concerning healthcare options, women will not be able to elect which care would be optimal for them.


We, along with thousands of other medical trainees every year, went into medicine to provide the best care possible to our patients. Medicine mandates a singular trust between patient and provider. By ‘gagging’ doctors from speaking the truth to our patients and creating an onerous burden on healthcare organizations that serve our country’s most vulnerable, the Title X attack strikes a blow to this profound relationship. Like so many in our nation, we believe access to healthcare, for men and women both, should not be a political issue but rather a human right. We stand with our patients and in opposition to these policies.


House Democrats have now introduced language that would protect Title X from the Trump administration’s machinations. Now is the time for every person that takes care of, cares for, or cares about women to take a stand. Call your representatives to support this new language in the House’s annual spending bill and then hold them accountable throughout the appropriations process! Reach out to AMSA’s AIDS Advocacy Network or Gender & Sexuality team for help and support!

Learn more about Title X Services


Source: https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/fpar-2017/index.html
Source: https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/fpar-2017/index.html