Planned Parenthood said Monday that it would withdraw from the federal family planning program that provides birth control and reproductive health care to low-income patients around the country rather than comply with the Trump administration’s decision to ban clinics from providing abortion referrals.

The organization’s decision means that it stands to lose $60 million in federal funding each year – money that has allowed the group to provide more than 1.5 million low-income women with services such as wellness exams, cervical and breast cancer screenings, birth control and STD testing. 

Title X does not include funding for abortions, but the Department of Health and Human Services (HHS) informed clinics in July that it would begin enforcing its so-called “gag rule,” banning those involved in the Title X program from providing abortion referrals and requiring that clinics maintain separate finances from facilities that provide abortions. 

The decision was widely viewed as an attack on womens’ reproductive rights and healthcare, as Planned Parenthood is the largest provider of Title X services in the nation, serving 40% of all Title X patients.

The Department of Health and Human Services said in a statement Monday that groups that refused to comply with the rule “are now blaming the government for their own actions,” and “are abandoning their obligations to serve their patients under the program.”

Alexis McGill Johnson, acting president of Planned Parenthood, defended the organization’s decision. “When you have an unethical rule that will limit what providers can tell our patients, it becomes really important that we not agree to be in the program,” Johnson said.

The Trump administration’s latest attack on women’s reproductive healthcare was roundly criticized by Virginia Democrats.

The “gag rule” is the subject of ongoing lawsuits by Planned Parenthood and other organizations and could still be struck down in court, but if it’s not, the consequences could be devastating for Virginia.

The Virginia Department of Health (VDH) and Planned Parenthood South Atlantic are Title X grantees in the Commonwealth.

In 2017, the VDH received the majority of the state’s Title X funding – nearly $3.7 million – while Planned Parenthood received roughly $800,000, according to HHS. Combined, this $4.5 million helped provide family planning and sexual health care services to an estimated 50,575 Virginians at 139 different service sites, according to the National Family Planning and Reproductive Health Association.

While Planned Parenthood and its affiliate clinics will suffer, it’s the clinics that receive funding from the VDH that will bear the brunt of “gag rule” in Virginia, should it be upheld. In 2016, the VDH treated 86% of patients and was responsible for 91% of service sites receiving this funding in the Commonwealth.

If the rule is upheld and the VDH abides by it, VDH-funded clinics will no longer be able to help patients secure abortions and will no longer be required to share information about prenatal care and adoption with women. 

If it opts not to comply, the VDH will lose millions in federal funding, which would significantly impact the care it provides to lower-income Virginians; sixty-five percent of those who received care through Title X in Virginia in 2017 were uninsured and 56% were below the federal poverty line.

The fallout would also be worse in certain areas, as 38% of Virginia localities do not have a public healthcare provider that is unaffiliated with the Title X program.

Virginia Attorney General Mark Herring is also fighting the “gag rule”; joining 20 other states who have filed suit against the Trump administration, arguing that it’s pushing “illegal and misguided policies that put the health of women across the country in danger and jeopardize the important relationship between a patient and her doctor.”

Planned Parenthood has made the stakes of the suit very clear. If the states and advocates lose, “the resulting exodus would cause major gaps in access to care, harm public health, and produce significant, unnecessary cost,” the organization said in their lawsuit.