US Global Assault on Women’s Health Goes Domestic

During their race for the White House, the Trump-Pence campaign promised to defund Planned Parenthood, a crucial women’s health services provider in the United States. Today, the Trump administration is one step closer to fulfilling that promise.

The administration recently increased its efforts by officially proposing a rule targeting health care providers, like Planned Parenthood, who receive US government funding to provide low-income women with annual preventative exams, STI treatment, cancer screenings, and birth control prescriptions among other essential services.

The proposed rule, which revives a policy last seen under the Reagan administration, would prohibit organizations under the US federal funding program for affordable reproductive health care, known as Title X, from providing or referring women for abortion-related services. The rule would apply even when organizations cover these services with their own funding or if women pay directly. This policy, already being referred to as the Domestic Gag Rule, also requires the physical and administrative removal of space, staff, and finances for abortion services from Title X facilities, interrupting the provision of integrated health services.

This is not the administration’s first effort to restrict women’s access to healthcare. On his third day in office, President Trump reinstated and expanded another Reagan-era policy, the Global Gag Rule, which, similarly to the domestic version, prohibits foreign NGOs from engaging in a range of abortion-related work, even with the use of their own funding. The Trump administration is bringing home a deadly policy that denies patients the comprehensive, quality medical care to which they are entitled.

In addition to the ban on abortion provision or referrals, under the Domestic Gag Rule providers will be free to deny patients information about their full range of reproductive options, including abortion. This differs from the Reagan-era version, because it does not explicitly ban providers from counseling patients on abortion. However, the new rule would remove their obligation to do so, leaving providers with full discretion on whether to provide medical information based solely on their personal wishes. If implemented, this policy will endanger the lives of many, such as sexual assault victims and young people who depend on comprehensive and non-judgmental health services.

“Medical ethics teaches us, and the results of some medical malpractice lawsuits require, that patients receive a comprehensive conversation about risks, benefits, and alternatives. Counseling must be patient-centered, discussing all options including where to obtain an abortion,” Dr. Sara Imershein of Planned Parenthood Metropolitan Washington, DC, told the International Women’s Health Coalition (IWHC). “The purpose of Title X is to specifically provide SRHR [sexual and reproductive health and rights] funding where it is needed and a Gag Rule will only hurt poor women.”

In 2016 alone, Title X providers served over 4 million patients, 88 percent were low-income people who qualified for subsidized or no-cost services. Thirty-two percent of Title X patients identified as Hispanic or Latino, 21 percent as black or African American, and 66 percent were under the age of 30. Planned Parenthood serves 41 percent of all Title X patients in the US. Any policy that limits the availability of Title X services, like the Domestic Gag Rule, is a direct attack on the health and rights of the most marginalized women in America.

Federal law already prohibits the use of Title X funding for abortion. The new Trump rule would erect additional barriers to health services for women. This policy would force patients seeking abortion services or referrals to make separate trips to another providera hardship that would disproportionately hinder low-income women who would likely struggle to arrange for travel, days off work, childcare, and other costs associated with seeking medical attention. In its attempt to target Planned Parenthood, the administration’s proposed policy will also hurt community health centers, health departments, and hospitals that depend on Title X funding for services, forcing some to close their doors. It will also create a greater demand for services from abortion providers, which could result in critical delays in accessing abortion care.

For a rule whose stated intention is to save lives, evidence shows it does the exact opposite. The Reagan-era domestic gag rule was never fully implemented in the US because of legal challenges. But its global damage is unquestionable.

In a recent report following a year documenting the effects of the Global Gag Rule in Kenya, Nigeria, and South Africa, IWHC has found that the policy is already limiting services, sowing confusion and threatening to halt progress to integrate health care systems in those countries. These findings underline evidence from previous versions of the policy, demonstrating a negative impact on women’s health, including an increase in unintended pregnancies and maternal deaths. When access to safe abortion care is limited, patients risk their lives seeking services from clandestine providers.

“Unsafe abortion is a very silent killer in Kenya…It’s likely, that we are going to have another rise in maternal mortality, which we have really seen going down,” says Monica Oguttu of Kismu Medical and Education Trust (KMET), an IWHC grantee partner in Kenya. Last month, Oguttu shared her experiences with the Global Gag Rule with policymakers in Washington, DC and warned about the dire consequences the policy is already having in rural Kenya.

The effects go well beyond access to abortion. Sally Shackleton, an activist from South Africa, told IWHC, “Women are disproportionately affected by HIV [and] this program will disproportionately affect women who are HIV positive and poorer women who need public health services…Many of these people are people who desperately need birth control, they need access to family planning services, and they do need abortions.” Policies like the Global Gag Ruleand its new domestic counterpartthreaten decades of investment in integrated health systems and make it harder for the most marginalized women to access necessary services.

Just as the Global Gag Rule forces NGOs to choose between receiving US funds and providing comprehensive and medically accurate healthcare, domestic Title X providers will now be faced with a similar dilemma. The deadly and ideologically driven Domestic and Global Gag Rules, taken together with the defunding of agencies working to advance reproductive health in the United States and abroad, endangers all the progress women have achieved in the past decade.

Women’s health advocates have until July 31 to submit comments to the Department of Health and Human Services (HHS) to stop the Domestic Gag Rule. IWHC has previously submitted comments in addition to a report on the impact of the Global Gag Rule. Making our voices heard makes clear to the Trump administration that women’s lives matter.

Photo: Larissa Puro

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