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Excluding Qualified Family Planning Providers from Offering Care to Low-Income Women Will Restrict Access and Cause Harm

Update, February 22: This post has been updated to remove reference to a study. Problems with the data used in the study were discovered after its publication.

The Trump Administration has proposed a rule to exclude many qualified safety net family planning clinics from participating in the Title X family planning program, which would sharply reduce access to essential family planning and other health care services for low-income women and men: more than 18 million women (nearly 1 in 3 of reproductive age) say they’ve used a safety net family planning clinic, according to a new survey by the Urban Institute.

Created in 1970, Title X supports providers that offer family planning services to low-income individuals.  It has a broad reach: nearly 4,000 Title X-funded sites provided services to 4 million people in 2015.  Title X providers offer preventive health care, such as cancer screenings, along with family planning services.

Title X family planning services play a critical role in health care: almost half of all pregnancies in America are unintended, and unintended pregnancies are linked to negative health and economic consequences for families as well as for states and the federal government.  The proposed rule would exclude many current, qualified Title X providers from participating if they also offer abortion services.  (Federal funds already can’t be used for abortion except in cases of rape, incest, or danger to the life of the mother.) As we’ve written, excluding these providers would cause significant harm to the low-income women and men who rely on Title X for family planning and other essential care.

The proposed rule would have deeply harmful effects that we’ve already seen in the 13 states that, since 2011, have imposed restrictions similar to the proposed rule.  In 2011, for example, Texas slashed state funding for family planning services and changed its Title X sub-grant criteria to exclude family planning providers that offer abortions from participating.  The state’s Title X network fell from 48 to 36 providers, and the number of Title X clients served fell sharply from 259,600 in 2011 to 166,500 in 2015.

House Speaker Paul Ryan claims that federally qualified health centers could replace the services that excluded family planning providers now provide.  Some health centers do participate in Title X but, in a 2018 survey, most community health centers reported that they could not manage a major increase in new patients.

The proposed rule is likely to prevent Planned Parenthood from participating in Title X.  Planned Parenthood sites, however, serve at least half of all women receiving publicly funded contraceptive services in more than two-thirds of counties where they’re located, and health centers don’t have the capacity to meet their needs.  Planned Parenthood is also much likelier than other health centers to offer a full range of contraceptive methods and frequently performs better on critical indicators of health care quality. (Full disclosure: I’m on the board of Planned Parenthood of Metropolitan Washington.)

Title X providers are the main contact with the health care system for many women.  If the Trump Administration arbitrarily excludes qualified family planning providers from Title X, many of these women won’t have essential family planning and primary care.