The Trump administration expanded its assault on women’s rights this week, engineering the loss of birth control and other reproductive healthcare coverage for millions of low income women.
On Monday, the administration’s Title X gag rule went into effect, barring any provider who performs abortions or even provides referrals for them from receiving federal money from the Title X program, which funds birth control, cancer screenings, STD tests and other services for patients, many of whom make too much money to qualify for Medicaid coverage but too little to afford their own healthcare.
The gag rule would functionally require dishonesty from medical personnel at participating institutions, who would be forbidden from discussing abortion as a viable and available option for pregnant patients.
Though the move from the administration has been tied up in the courts for months, it was permitted to go into effect on Monday, prompting Planned Parenthood to withdraw from the Title X program and lose one of its most robust sources of funding. Title X clinics served 4 million patients in 2017, 40% of them through Planned Parenthood. They will lose their clinics. In many rural areas, Planned Parenthood is the only Title X provider. Patients there will lose their care. As is always the case with state-imposed cruelty, the change will disproportionately hurt young women and women of color.
When it was still functioning, Title X was an unmitigated success, filling a large gap in the healthcare system, catching cancers in their early and least threatening phases, and preventing thousands of unplanned pregnancies each year – 822,000 in 2015 alone, according to the Guttmacher Institute.
They exited the Title X program rather than comply with a rule that would require them to lie to and stigmatize the patients they are obligated to care for
Title X saved the federal government a tremendous amount of money, which you would think would please fiscally conservative Republicans, and it prevented hundreds of thousands of abortions, which you would think would please the religious conservatives who claim that abortion is an unparalleled evil. But these constituencies were not pleased with the program, because their aims have never been to balance the budget or to prevent abortions. Their aims have always been to restrict women’s freedoms, and to inflict as much suffering as possible.
In addition to withdrawing essential birth control, cancer, and STD screenings and ensuring that many people will become painfully and preventably sick, the Title X gag rule seems engineered to drive a wedge into the reproductive rights movement, forcing providers to choose between providing health care to Title X patients or providing abortions and information about abortions to everyone. It’s a move designed to force Planned Parenthood and other organizations to play by conservatives’ moral rules, engaging in a false and hateful rhetoric that positions patients who do not need abortions against those who do, and implying that one group is morally superior to the other.
Sadly, there are those in the reproductive rights movement who seem willing to take the bait. The women’s rights group NARAL drew criticism last month after an internal email was sent instructing staff and volunteers to back away from the group’s abortion rights messaging. “Do not say/write ‘Abortion should be/is safe and legal,’” the email read. “Do not say/write ‘Abortion is healthcare.’ Do not say/write ‘Abortion is normal.’ Do not say/write ‘Abortion rights are human rights.’”
The email, sent by NARAL deputy field director Travis Ballie, was not concerned with the fact that all of these forbidden statements are true: abortion is healthcare; abortion is normal; abortion rights are human rights; abortion is safe; and abortion is, for the time being, legal. Women’s rights are one of the rapidly multiplying areas of American public life in which stating fact has become an unacceptably controversial act, and it seems that some organizations that are nominally dedicated to reproductive freedom would rather avoid offense than stand up for women’s dignity.
A similar conflict arose at Planned Parenthood this summer, when its president, Leana Wen, came into conflict with staff over the organization’s strong political stance. Wen wrote in an op-ed that she wanted to be a medical provider, not a political activist. It was a cowardly stance – ultimately uninterested in giving patients the advocacy they needed and too willing to capitulate to the demands of bad actors who want to inflict harm. To be a reproductive healthcare provider in the United States is to be a political activist, and Wen and her allies were naïve to think that they could choose.
It is to the organization’s credit that Planned Parenthood was unwilling to tolerate this stance from their leadership, and pushed Wen out in July. It is to their credit, too, that they exited the Title X program rather than complying with a rule that would require them to lie to and stigmatize the patients they are obligated to care for.
The Trump administration responded to Planned Parenthood’s exit with sneering glee, attempting to blame the healthcare provider for the restrictions on care that it was imposing. You can practically hear HHS officials giggling in their statement to news organizations: “Some grantees are now blaming the government for their own actions – having chosen to accept the grant while failing to comply with the regulations that accompany it – and they are abandoning their obligations to serve their patients under the program.”
This effort by the Trump administration to blame Planned Parenthood for the same loss of healthcare coverage that the administration engineered has echoes of a schoolyard bully, his hand clenched around a little girl’s wrist, forcing her to slap her own face. “Stop hitting yourself,” the HHS officials can almost be heard taunting. “Stop hitting yourself.”
The way to deal with bullies is not to give them what they want, not to surrender to their terms, not to negotiate, and not to slink whimpering into submission. The way to deal with bullies is to fight back. Planned Parenthood has refused to cede the principle that patients deserve a full range of care, that medical providers should not have to lie to the people they serve, and that women must be free. These principles are increasingly under assault and increasingly maligned. We are lucky that Planned Parenthood has chosen to stand up for them anyway.
Moira Donegan is a Guardian US columnist