A cornerstone of professional responsibility for healthcare providers is the provision of complete, unbiased medical information. I provide that standard of care in our Title X clinic every week, seeing mostly young women seeking care for sexual health, birth control, or cancer screenings. Last week, I saw Alice, a 22-year-old mother of a 4-month-old son, who, after considering her options, decided to start the birth control shot. Megan, a 17-year-old young woman, came in to discuss options to help her heavy menstrual periods.
Thanks to the Title X federal family planning funding program, these women were able to receive care consistent with their desires and values, and leave our clinic with medically accurate information on their health. Unfortunately, the Trump-Pence administration is decimating the program that supports these patients by reinstating a "domestic gag rule," which cuts off this funding to any healthcare provider who provides, refers for, or so much as mentions abortion care.
This egregious effort to silence healthcare providers puts ideology above sound medicine, with the clear intent to block women from obtaining complete and unbiased information to make informed decisions about their own health care. As with so many Trump-Pence administration policies, the communities facing the greatest barriers to accessing quality health care — people with low income, people of colour, youth, immigrants, transgender and gender-nonconforming people, and those who are uninsured — will pay the price for this display of allegiance to abortion opponents.
Over four million people rely on Title X clinics for access to reproductive health care. Title X allows us to serve people regardless of where they live, how much money they make, or their insurance status. Eighty percent of these patients fall below 150 percent of the federal poverty level, and more than half are women of colour.
This administration is taking this opportunity to galvanize their base at the cost of women's access to medically accurate care.
The Trump-Pence administration's new rule will effectively dismantle the Title X program. Proponents of this regressive policy, like Trump adviser Kellyanne Conway, claim that other clinics could pick up the slack. But their inflated numbers of "clinics" include everything from homeless shelters to dental offices, none of which are equipped to provide quality reproductive health care. Research following a similar defunding experiment in Texas showed that primary care providers trying to fill the gap for prior Planned Parenthood patients lacked training and struggled to meet their patients' primary care and family planning needs. To fill the gaps created by the loss of this program with providers lacking training in reproductive health care will only deepen the inequities that exist for underserved communities.
The remaining healthcare providers serving Title X patients will be silenced by the government. No matter their patients' needs or desires, they would be forbidden from discussing abortion — a safe, effective procedure that one in four American women will have in their lifetimes. People who need abortion care would be on their own, without accurate information about their options or guidance on how to seek care. Restrictive laws already make accessing abortion care challenging in much of the country, leading to delayed and more expensive procedures. This restriction limiting counseling will only add to the burden of people seeking reproductive health care, particularly where Title X clinics are the only source of care in a given community.
This politicization of health care sets up a system where accurate health information is a privilege reserved for people with the most economic resources. The members of Congress and anti-abortion groups who urged the administration to make this move demonstrate a shocking disregard for the lives and autonomy of women of colour and low-income women, despite claiming "pro-life" values. Our country is facing a crisis in maternal mortality right now, where black women are three to four times more likely to die in pregnancy and childbirth than their white counterparts. Instead of taking up this cause, and ensuring that all women have access to comprehensive and equitable reproductive health care and pregnancy care, this administration is taking this opportunity to galvanize their base at the cost of women's access to medically accurate care.
Every person deserves access to quality, evidence-based, full-spectrum reproductive health care, including abortion. Ideologically motivated government interference flies in the face of medical ethics, tying the hands of healthcare providers and threatening the bodily autonomy of our patients. Women of colour and women who receive a low income, who already face significant inequities in our healthcare system, will bear the burden of this callous and unjust policy.
Dr. Sanithia Williams [1] is a fellow in family planning with the Bixby centre for Global Reproductive Health at the University of California, San Francisco. She is an obstetrician and gynecologist with specialist training in complex contraception and abortion care services and serves Title X patients at Zuckerberg San Francisco General Hospital.