Trump-Era Family Planning Policy Resulted in About 180K Unintended Pregnancies, HHS Says

The Biden administration is working to reverse a Trump-era family policy directive that caused Planned Parenthood to leave the federal family planning program, a move that officials believe may have resulted in an estimated 180,000 unplanned pregnancies.

The U.S. Department of Health and Human Services (HHS) wrote in a proposal that since President Donald Trump's 2019 "gag" rule was issued—which bans federal family planning clinics from referring women for abortions—clinics have seen a 37 percent overall reduction in clients from the average caseload from 2016-18, or 1.5 million fewer women a year.

The federal family planning program, known as Title X, was first implemented in 1970, and is the only federal grant program that provides funding for comprehensive family planning and related preventative health services. It provides $286 million annually to clinics that serve mostly low-income patients, according to HHS, including Planned Parenthood and affiliates, which served about 40 percent of those patients before exiting the program in 2019.

"The impact of the 2019 Final Rule has been devastating to the hundreds of thousands of Title X clients who have lost access to critical family planning and related preventive health services due to service delivery gaps created by the 2019 Final Rule," HHS said in the proposal. "As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings for STIs. Adolescent services were also adversely affected."

The 2019 rule required federally funded clinics, which were already banned from using taxpayer funds for abortions, to financially and physically separate themselves from abortion providers. Abortion counseling became optional instead of standard practice, and pregnant women were supposed to receive referrals for prenatal counseling even if they did not want it, among other requirements.

Despite the blow to federal family planning clinics and their clients, the Biden administration is holding off on immediate suspension of the policy to increase the chances of the new proposed rule being upheld in court. The process can take months, according to the Biden administration, which means the existing regulation will remain in effect until then.

Planned Parenthood
ST LOUIS, MO - JUNE 04: A group of demonstrators gather during a pro-life rally outside the Planned Parenthood Reproductive Health Center on June 4, 2019 in St Louis, Missouri. The fate of Missouri's lone abortion clinic could be decided today in St. Louis Circuit Court after a restraining order prohibiting Missouri from letting the clinic's license lapse was granted last week. On Wednesday, the U.S. Department of Health and Human Services released a proposal for a reversal of a 2019 Title X directive that banned federally funded clinics from referring patients for abortions. Michael B. Thomas/Getty Images

For more reporting from the Associated Press, see below.

The proposed rule from the Department of Health and Human Services follows through on President Joe Biden's campaign promise to reverse his predecessor's family planning policy, branded a "gag rule" by women's groups and decried by medical associations as violating the doctor-patient relationship.

The 2019 Trump administration policy "abandoned (a) client centered approach over the objection of every major medical organization without any countervailing public health rationale," HHS wrote in the Biden proposal. "That approach cannot be squared with well-accepted public health principles."

Though by law federal family planning funds could not be used to pay for abortions, religious conservatives long regarded the program as a form of indirect subsidy to Planned Parenthood, the nation's largest provider of abortions. Former President Donald Trump counted on religious conservatives as a cornerstone of his political base and acceded to their demands on a range of women's health issues.

HHS said its proposed rule reversal will restore the program to how it ran in President Barack Obama's years, when clinics were able to refer women seeking abortions to a provider. The Biden rules will also put a greater emphasis on affordability and on eliminating racial and ethnic disparities, although many of the program's clients already are minority women.

"Ultimately, continued enforcement of the 2019 rule raises the possibility of a two-tiered health care system in which those with insurance and full access to health care receive full medical information and referrals, while low-income populations with fewer opportunities for care are relegated to inferior access," HHS said in a statement. "This situation creates a widespread public health concern."

The agency said it expects clinics that left the program will gradually return if the Biden policy goes into place, and Title X will again be serving about 4 million clients within a couple of years.

Release of the proposed regulations was the second blow to abortion opponents this week from the administration. On Tuesday, the Food and Drug Administration said women would not be required to visit a doctor's office to get a prescription for an abortion pill for the duration of the coronavirus pandemic and instead could safely rely on telehealth.

The rule reversal on family planning clinics is proceeding alongside litigation over the Trump administration policy, now before the Supreme Court. In that case, the justices agreed to hear a challenge to the rules that Biden is now trying to unravel. The Biden administration and medical groups that filed the challenge are asking the court to dismiss the case, but Republican state attorneys general want to proceed. The court has yet to say what it will do.

Abortion rights supporters and opponents have argued back and forth over decades, through Democratic and Republican administrations, whether counseling a patient about abortion or referring a patient to a different provider for an abortion violates that language. Abortion remains a legal medical procedure, though improved access to birth control in recent years has led to a significant decline.