Title X Has Never Paid for Abortions—But the Trump Administration Gutted It Anyway

Planned Parenthood announced last week that it would withdraw from Title X—a federal program that funds family planning for low-income households—over a new rule preventing abortion referrals. While anti-abortion activists cheered the move, what the new rule has achieved has little to nothing to do with abortion—Title X clinics have never been able to use those funds for abortion.

Instead, doctors and researchers say the change could severely limit low-income women’s access to both birth control and life-saving healthcare, including cervical cancer screenings, while increasing costs across the country.

“The current attacks on Title X constitute a direct assault on the human rights of not only Title X patients, but on the rights of low-income and otherwise marginalized individuals across the United States,” senior policy manager Kinsey Hasstedt of the Guttmacher Institute, a research group that supports reproductive rights, said in a statement shared with Fortune.

Title X currently serves approximately 4 million people, distributing $260 million to clinics across the country. Planned Parenthood treats more than 40% of those patients—some 1.6 million people—receiving between $50 and $60 million annually, according to the Associated Press. The program has always focused on poverty and serving low-income women. Some 42% of all of the people served by Title X in 2017 (the most recent available data) were uninsured, according to Office of Population Affairs, which administers the program. And 67% lived at or below the poverty level, according to the same report.

Former Republican President Richard Nixon’s administration put the Title X program into place in 1970 to ease the financial burden of family planning for low-income Americans. As Nixon said in 1969: “No American woman should be denied access to family planning assistance because of her economic condition.”

Reproductive health clinics outside of the Planned Parenthood network are taking a major hit, too. Maine Family Planning, an independent provider with 18 clinics in the state, is a perfect example of the type of community that Title X was created to serve—and who will now face additional obstacles to healthcare as a result. Maine Family Planning’s patient base includes more than 20,000 men, women, and adolescents, many of whom are low-income and live in rural areas. The clinic, which announced its withdrawal from the program Monday, is losing $2 million in federal funds.

Maine Family Planning is making every effort to keep its doors open through private donations. When similar changes have been made at the state level, however, the result has been longer wait-times, higher costs, and the closure of clinics, according to Emily Nestler, a lawyer from the Center for Reproductive Rights who is leading a case on Maine Family Planning’s behalf. A greater number of unplanned pregnancies, more sexually transmitted infections, and fewer people getting of vital cancer screenings, are also a risk. “The federal government has really pulled the rug out from under providers who serve millions of low-income women, and the results are going to be devastating,” she told Fortune.

Some women may even be forced to choose between putting food on the table and buying contraception, as patients who once were treated for free may now be charged a $15 to $20 co-pay, according to Planned Parenthood. For the 67% of Title X patients who earn $24,600 or less (for a household of four), that price constitutes as much as 20% of their weekly take-home pay. The change will also open funding up to religious groups and so-called “crisis pregnancy centers” that counsel women against abortion and often do not provide a full spectrum of contraceptive options.

Both the department of Health and Human Services and anti-abortion activist groups have claimed that the move simply separates abortion from family planning in Title X-funded facilities. In many clinics, however, compliance would have been physically impossible or would have cost tens of thousands of dollars in construction costs.

A spokesperson from Health and Human Services explained that Title X clinics would still be able to tell pregnant patients about their options (including abortion), but that counseling would have to remain “nondirective.” Or as she put it, Title X doctors could give a pregnant woman a list of primary care physicians—some who provide abortions and some who don’t—but that doctor would not be able to tell her which was which.

The assertion by anti-abortion activists that the program’s change is somehow a victory against abortion has no basis in fact, experts say, as Title X funds have always been prohibited from being used for abortion—the only people who are losing are low-income women looking for healthcare and family planning.

In fact, multiple sources in reproductive healthcare said they feared these restrictions on contraceptive access would result in more unplanned pregnancies and therefore potentially a greater need for abortions.

And the notion that the loss of Title X money is tantamount to defunding Planned Parenthood is similarly unfounded (Planned Parenthood will continue to receive $400 million from Medicaid). A report from the federally run National Institutes of Health in 2009 described the Title X program as a success, one that had expanded to tackle HIV, sexually transmitted infections, and cervical cancer, while providing gynecological services and even postpartum care. This program aimed at serving impoverished Americans actually saves money. For every dollar that federal programs spend on family planning, they save more than $7, according to The Guttmacher Institute.

The clinics themselves—as well as the American Medical Association, The American College of Obstetrics and Gynecologists, and the American College of Physicians—say that the rule violates medical ethics and does not serve patients.

“We are very concerned that the proposed changes, if implemented, would undermine patients’ access to high quality medical care and information, dangerously interfere with the patient-physician relationship and conflict with physicians’ ethical obligations,” Dr. James L. Madara, executive vice president of the American Medical Association, wrote in a letter to the U.S. Department of Health and Human Services, urging the department to reconsider.

Enforcement of the new rule is set to take place in September, ahead of legal challenges being led in 21 states across the country.