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Yesterday, Planned Parenthood Federation of America (PPFA) and the American Medical Association (AMA) filed suit in federal court to block the Trump administration’s Title X “domestic gag rule,” which places serious limitations on abortion providers and referring doctors. This filing follows on the heels of parallel action from a coalition of 21 attorneys general led by New York Attorney General Letitia James, Oregon Governor Kate Brown, and Oregon Attorney General Ellen Rosenblum. The suit names Alex Azar, current secretary of the Department of Health and Human Services (HHS), and alleges, “The Final Rule would impose burdensome and unnecessary restrictions that would reduce access to care, interfere with the patient-provider relationship, and undermine Congress’s intent in enacting Title X of the Public Health Service Act nearly five decades ago.”

Joining Oregon and New York in the lawsuit are Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin.

As Rewire.News explained last month after the final version of the gag rule was announced:

The gag rule would ban Title X family planning providers from making referrals for abortion services and require providers to physically separate their Title X practices from their abortion services. Physical separation could mean everything from building new entrances and exits, to opening completely new facilities and hiring more staff.

Calling the gag rule “unconscionable and unethical” in a statement following the administration’s February 22 announcement, PPFA president Leana Wen called reproductive health care a “basic human right.”

“This rule compromises the oath that I took to serve patients and help them with making the best decision for their own health,” said Wen. “Patients expect their doctors to speak honestly with them, to answer their questions, to help them in their time of need. Imagine if the Trump administration prevented doctors from talking to our patients with diabetes about insulin. It would never happen. Reproductive health care should be no different.”

Outspoken abortion advocate and board chair of Physicians for Reproductive Health Willie Parker issued a statement in support of the lawsuits, saying he is “deeply alarmed” and that the Title X rule change “flies in the face of ethical standards of care.”

“Title X family planning funding currently helps more than 4 million people — including people with low incomes or those who don’t have insurance. The good that Title X has done for Americans’ health and well-being is undeniable,” said Parker. “The new rule shortchanges patients who deserve accurate information about all of their options concerning pregnancy, and potentially deprives them of seeking care from trusted community health care providers like Planned Parenthood.”

Advocates emphasize that while abortion and contraception are crucial health services, a wider range of services are also at stake. As North Carolina Attorney General Josh Stein stated in the coalition press release from the Oregon Department of Justice, Title X is about more than contraception.

“Title X clinics screen for cancer, prevent unintended pregnancies, and reduce the spread of sexually transmitted infections,” said Stein. “These are critical health care services that change and save lives. This proposed gag rule would prevent women in North Carolina from making the healthcare decisions that allow them to lead happy, healthy lives.”

On a press call yesterday, the lead plaintiffs from both lawsuits stated similar concerns, pointing out that Title X is the only federal reproductive health care program. They stated that it has worked effectively since it was signed into law by Republican President Richard Nixon in 1970, making good on a campaign promise that “no American woman should be denied access to family planning assistance because of her economic condition.”

As Rewire.News reported, two-thirds of Title X center patients live in poverty and the proposed changes would disproportionately affect the already marginalized — rural residents, people of color, youth, the LGBTQ community. The Guttmacher Institute’s analysis of the new restrictions set to go into effect at the end of May reinforce this reporting, calling the gag rule “a blatantly coercive and unethical violation of individuals’ right to high-quality sexual and reproductive health care.”

“These restrictions flout medical ethics, dismiss clinical guidelines of leading medical organizations and undermine patients’ right to provide informed consent to their reproductive health care,” according to Guttmacher.

Legislators are also weighing in on the Title X changes. On February 28, U.S. Reps. Diana DeGette (D-Colorado), Frank Pallone, Jr. (D-New Jersey) and Anna G. Eshoo (D-California) sent a letter to Azar challenging the legality of the domestic gag rule.

“We have serious concerns regarding the final rule’s compliance with the Title X statute, the public health implications of this action, and the Administration’s rationale for these changes,” the lawmakers wrote. “Additionally, we have questions about the Department’s expansive claim of authority under this rule, HHS’s failure to account for the significant costs created as a result of the final rule, and the internal regulatory process used by the Department to review and finalize this rule.”

They have also asked several specific questions which have yet to be answered in any way by the administration, including: What evidence (if any) was used to allow only adoption as a post-conception option and justify requiring the physical separation of services? Has HHS considered the financial and public health implications of the new policy and did they consult “external organizations” as they formed the gag rule?

The Congress members stated that even temporary implementation of the gag rule could have wide-reaching effects.

“The success of Title X is largely due to the network of qualified family planning providers that have implemented the program’s goals since its creation,” the lawmakers wrote. “It is disturbing that the Administration has chosen to undermine the ongoing success of this program by finalizing this rule.”

The White House has thus far not publicly responded to legislators’ concerns or to the lawsuits.


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