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What Changes to Title X Could Mean for Local Health Options 

Trump Administration's rule changes mean Title X doctors can't discuss abortion with patients

In Central Oregon, Planned Parenthood’s Bend Health Center serves around 7,000 Central Oregonians a year, according to stats provided by the Center in 2017. That’s about 600 to 700 patients a month. According to the staff there, about 96 percent of the services the Bend clinic provides is preventative—including screenings and treatment for sexually transmitted infections, birth control, cancer screenings and annual well exams, as well as vasectomies and prenatal care. In that year, less than 4 percent of the services provided at the clinic were abortions, the staff said.

Yet it’s that small percentage of services that has put Planned Parenthood’s federal funding in peril.

click image CHARLOTTE COOPER
  • Charlotte Cooper

This week, our Women’s Issue hits stands. It’s a celebration of the strength, resilience and progress of women—but it’s also a chance to look at what still needs to change.



If you thought the assaults on women’s health were behind us decades ago, think again. Since the start of his presidency, President Trump has put women’s health in the crosshairs with his moves to withhold family planning funds from centers that also provide abortion services.

Planned Parenthood is one of many organizations that receives funding under Title X—the federal government’s only program offering federal funds for family planning services.

This month, the Trump administration released its revised Final Rule on the regulations governing Title X. The Rule, according to the document released Feb. 22 by the Department of Health and Human Services, will “require Title X providers to maintain physical and financial separation from locations which provide abortion as a method of family planning.”

In other words, places including Planned Parenthood’s Bend Health Center would have to completely separate their abortion services, financially and physically, from the rest of the center in order to continue receiving Title X funds.

Further, health care providers working at centers receiving Title X funds will not be able to discuss abortion with patients, nor refer patients to abortion centers—even if that’s something patients want, and even if an abortion is medically necessary. Groups including the American Medical Association, the American Nurses Association and the American College of Obstetricians and Gynecologists have come out against the rule change.

Planned Parenthood’s president, Leana Wen—who’s also a physician—told National Public Radio last week, “This is a gag rule because what President Trump is doing is to put a gag on doctors like me to prevent us from providing our patients with full and accurate medical information. So if you are a woman who goes to a health center that receives public funding, you cannot be referred to abortion care, even if your life depends on it. This gag rule is unethical and unconscionable.”

Wen said Planned Parenthood would not separate its abortion services from the rest of its services in order to comply with the rule, and further, wouldn’t take federal funds under the new rule. Wen, and others, say the rules will “disproportionately affect those who already face the greatest barriers to care. It's women of color and families of low income.”

According to Planned Parenthood Advocates of Oregon, PP health centers served four in 10 Title X patients in 2015—while only making up 13 percent of Title X centers.

Advocates of the change say the funds absorbed by Planned Parenthood can be directed to other community health centers instead.

During our interview with the staff at the Bend Health Center in 2017, however, I asked them about whether the patient population the center currently serves would be able to realistically go elsewhere, and to get appointments in a reasonable amount of time. (Staff were not immediately available for another interview at this time.)

“This community could not absorb the kind of patient volume that we're talking about. With the Affordable Care Act and how generous our state is with contraceptive care, we see the OHP patients, and many health care facilities limit those total patients. Five patients, 10 patients,” said Tricia Wilder, Bend’s Regional Health Center Manager. “We're talking about 7000 patient visits a year that we do here that currently could not be absorbed into other health centers. It would limit access to the most vulnerable population in Central Oregon.”

It’s not yet clear how Planned Parenthood would fill the gap in funding—but locally, private donations helped the center expand two years ago.

Oregon’s Attorney General Ellen Rosenblum announced Feb. 22 that she would be filing a lawsuit against the Trump Administration for the rule changes.

“Medical providers, no matter what kind of service they perform, must be able to have candid conversations with patients about all options for care, and without fear that if they say the word “abortion” their clinic could lose federal funds,” Rosenblum said. “This rule, if implemented, will mean that health clinics that serve so many Oregon women and families around our state may have to close. This is not acceptable, and I will do everything I can to prevent this from happening.” Rosenblum was among 19 attorneys general who wrote a friend-of-the-court brief challenging the gag rule in May 2018.

In July, Gov. Kate Brown threatened to pull the state out of the Title X program should the rule go into effect.

The new rule goes into effect at the end of April—60 days after it was published in the Federal Register.
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