The Centers for Disease Control and Prevention (CDC) describes contraception services as one of ten “great public health achievements” in the United States in the 20th century. Contraception access is associated with better health in women and their children and greater economic stability in families. Even so, recent legislation from the Trump administration threatens to stem nationwide access to contraceptives. An article by Diana J. Mason, PhD, RN, and Lisa David, MBA, published in the JAMA Forum discusses the public health impact of restricted access to contraception.
Title X of the Public Health Service Act was enacted in 1970 to ensure family planning access to all women. Title X provides nearly $300 million each year to health clinics and nonprofit organizations for family planning, sexual health, and contraceptive services. Recent Trump cabinet legislation permits non-governmental employers and universities to deny contraceptive coverage to women on “moral objectives,” including “services … [considered] abortifacient.” In lieu of coverage from employers, the Trump administration has suggested that women seek assistance from Title X-funded programs, but Title X services are financially overburdened, already exceeding the $286 million available annual funding.
The Trump administration also plans to throttle the legislative capabilities of Title X in a new rule that eliminates non-directive counseling on pregnancy options, prohibits abortion counseling and referrals, and limits funding eligibility for organizations providing abortions, among other directives. Precedent underscores the potentially devastating effects of this new rule: under 2011 Texas legislation restricting family planning centers, the number of women using the most effective birth control methods “plunged by one-third,” and births by poor women on Medicaid increased by 27%.
Under Trump’s new rule, Crisis Pregnancy Centers could receive funding from Title X, misappropriating resources from health clinics and damaging care access for women. Crisis Pregnancy Centers provide pregnancy testing and ultrasound scans to women but do not offer contraception and directly advocate against abortion. Crisis Pregnancy Centers have been described by the medical community as unethical; many advertise “well woman care” without providing necessary contraceptives access.
Under shifting Title X conditions, the Office of Population Affairs has encouraged religious organizations to contact existing grantees to be included in subsequent applications. As such, under this new rule Crisis Pregnancy Centers could receive Title X funding. Such a development would threaten already limited funds for contraceptive access and abortion services.
The erosion of contraceptive access under federal legislation is a public health crisis. Restricted access to family planning has deleterious health consequences for women and families alike. Although legal challenges have been filed by state attorneys, family planning groups, and providers since the new rule’s issuance, organizations that depend on Title X remain in a precarious position.
Mason DJ, David L. Title X: moving forward or backward on women’s health? JAMA. 2019;321(3):236-237.