The Trump administration announced this week that family planning clinics that receive taxpayer funding under the Title X program must stop referring women for abortions immediately.

In its latest salvo against reproductive rights, the Department of Health and Human Services (HHS) informed clinics that it will 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 “gag rule” is currently being challenged in federal court, but HHS said there was no legal restriction on enforcing the rule.

What is Title X and why does it matter?

Title X was established in 1970 and provides affordable birth control and reproductive health care to about 4 million low-income and uninsured patients around the country. This care includes wellness exams, cervical and breast cancer screenings, birth control and STD testing, but Title X does not include funding for abortions. 

What does this mean for Virginia?

In Virginia, the Virginia Department of Health (VDH) and Planned Parenthood South Atlantic are Title X grantees. 

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 also suffer, it’s the clinics that receive funding from the VDH that will bear the brunt of “gag rule” in Virginia. In 2016, the VDH treated 86% of patients and was responsible for 91% of service sites in the Commonwealth.

Ultimately, though, it’s lower-income Virginians that will be the most affected. 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.

Title X services also prevent hundreds of thousands of unintended pregnancies across the country, including an estimated 15,100 in Virginia in 2015.

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.

Backlash to the rule

The “gag rule” has been criticized by clinics and advocacy groups, who say it could disrupt basic healthcare for low-income women.

NARAL Pro-Choice Virginia says this “creates two classes of women – those who are well-off enough to get accurate medical information from their doctors and those who are not.”

Planned Parenthood says that the rule would also make it impossible for patients to get contraception at clinics and would “prohibit doctors from giving women full information about all of their sexual and reproductive health care options.”

The organization, which provides care for 40% of the patients in the United States who receive care thanks to Title X, has already said it will not abide by the ruling, risking its involvement in Title X and the tens of millions of dollars in federal funding that come with it.

“While we are incredibly concerned by this harmful rule, our doors are still open,” Planned Parenthood said in a statement.

Many lawmakers also criticized the rule, including Rep. Jenifer Wexton (D-Va).

What’s next?

The Virginia Department of Health will have to re-evaluate the services its clinics can provide. If it abides by the gag rule, 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. 

It’s still possible that the “gag rule” will be struck down by courts. That’s what groups like NARAL and Planned Parenthood are fighting for, and they’re not alone. 

Virginia Attorney General Mark Herring is part of a coalition of 21 states who have filed suit against the Trump administration, arguing that they are 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.”

If the states and advocates lose, many providers would be forced to withdraw from Title X entirely, which could have devastating consequences. Planned Parenthood made this point abundantly clear in their lawsuit.

“The resulting exodus would cause major gaps in access to care, harm public health, and produce significant, unnecessary cost.”