{"id":42417,"date":"2018-06-20T16:03:30","date_gmt":"2018-06-20T15:03:30","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=42417"},"modified":"2018-06-25T14:29:44","modified_gmt":"2018-06-25T13:29:44","slug":"kinsey-hasstedt-trump-administration-looks-to-impose-domestic-gag-rule-continuing-its-assault-on-reproductive-health-and-rights","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/20\/kinsey-hasstedt-trump-administration-looks-to-impose-domestic-gag-rule-continuing-its-assault-on-reproductive-health-and-rights\/","title":{"rendered":"Kinsey Hasstedt: Trump administration looks to impose \u201cDomestic Gag Rule,\u201d continuing its assault on reproductive health and rights"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Kinsey_Hasstedt.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-42418\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Kinsey_Hasstedt.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Kinsey_Hasstedt.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/06\/Kinsey_Hasstedt-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>In late May, the Trump administration unveiled its latest attack on affordable birth control access, part of a much larger campaign to undermine reproductive health and rights in the United States and globally. The administration\u2019s latest target is the only US government program <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2017\/01\/why-we-cannot-afford-undercut-title-x-national-family-planning-program\"><span style=\"font-weight: 400\">dedicated to helping low-income and otherwise disadvantaged US women obtain high-quality birth control and related services<\/span><\/a><span style=\"font-weight: 400\">. Known as Title X (pronounced \u201cTitle Ten\u201d), the $286 million program makes grants available to 4,000 diverse healthcare providers, who in turn provide contraceptive care to just under four million women.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Among other programmatic changes, the administration\u2019s <\/span><a href=\"https:\/\/s3.amazonaws.com\/public-inspection.federalregister.gov\/2018-11673.pdf\"><span style=\"font-weight: 400\">proposed new regulations<\/span><\/a><span style=\"font-weight: 400\"> for Title X would impose a version of what is called the \u201cdomestic gag rule\u201d on all US service providers receiving Title X funds. A version of this proposal was first advanced in 1988 under President Reagan, but never fully implemented. While the details of this policy differ from the <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2017\/06\/when-antiabortion-ideology-turns-foreign-policy-how-global-gag-rule-erodes-health-ethics\"><span style=\"font-weight: 400\">global gag rule<\/span><\/a><span style=\"font-weight: 400\"> imposed last year on recipients of US global health assistance, the Trump administration\u2019s overarching intent is the same: To stifle health care providers, impede people\u2019s access to family planning care, stigmatize abortion, and exclude providers that offer it or otherwise help women obtain it, and\u2014above all\u2014to coerce pregnant patients toward childbearing, regardless of their own wishes.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The policy is called a gag rule because it severely restricts what information healthcare professionals are allowed to share with their patients. Specifically, the proposed rule would take away the long-standing guarantee that all Title X patients who are pregnant receive comprehensive, unbiased counseling on all their options, in addition to prohibiting referrals for abortion.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Enabling providers to deny patients nondirective pregnancy options counseling contradicts <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2018\/01\/unbiased-information-and-referral-all-pregnancy-options-are-essential-informed-consent\"><span style=\"font-weight: 400\">fundamental tenets of informed consent<\/span><\/a><span style=\"font-weight: 400\">. It\u2019s especially alarming when paired with the administration\u2019s intent\u2014reflected in both the proposed gag rule and elsewhere\u2014to extend Title X support to ideologically motivated entities like anti-abortion counseling centers that also explicitly oppose many forms of contraception and whose staff would likely seek to impose their views on patients, denying many individuals needed and wanted care.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Furthermore, thwarting Title X patients from getting information on where they can obtain abortions constitutes a <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2018\/01\/unbiased-information-and-referral-all-pregnancy-options-are-essential-informed-consent\"><span style=\"font-weight: 400\">major violation of medical ethics<\/span><\/a><span style=\"font-weight: 400\">.<\/span><span style=\"font-weight: 400\"> Indeed, denying or delaying services for patients who have decided to terminate their pregnancies jeopardizes their health and wellbeing. It\u2019s little wonder the administration\u2019s proposed gag rule has provoked the ire of many leading professional associations, including the <\/span><a href=\"https:\/\/twitter.com\/AmerMedicalAssn\/status\/999366987477331968\"><span style=\"font-weight: 400\">American Medical Association<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.acog.org\/About-ACOG\/News-Room\/Statements\/2018\/Health-Providers-Oppose-Efforts-to-Exclude-Qualified-Providers-from-Federally-Funded-Programs\"><span style=\"font-weight: 400\">the American College of Obstetricians and Gynecologists<\/span><\/a><span style=\"font-weight: 400\">, as well as <\/span><a href=\"http:\/\/thehill.com\/opinion\/healthcare\/390244-cutting-title-x-funding-promotes-unethical-medical-practices\"><span style=\"font-weight: 400\">leading experts in law and bioethics<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The domestic gag rule would also exclude health centers that legally use separate, non-federal funds to provide abortions from Title X support. (Title X funds have always been prohibited from going toward abortion services.) This political move targets Planned Parenthood, which serves <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2017\/08\/beyond-rhetoric-real-world-impact-attacks-planned-parenthood-and-title-x\"><span style=\"font-weight: 400\">more than 4 in 10 women who receive Title X-supported care<\/span><\/a><span style=\"font-weight: 400\">. In effect, the administration is looking to tell the 1.6 million women who obtain contraceptive care from Title X\u2212funded Planned Parenthood sites each year that they cannot see their trusted provider\u2014and in many cases, the <\/span><a href=\"https:\/\/www.whijournal.com\/article\/S1049-3867(12)00073-4\/pdf\"><span style=\"font-weight: 400\">only source of care they have<\/span><\/a><span style=\"font-weight: 400\">. Importantly, however, this provision and the domestic gag rule as a whole would impact the entire Title X network of providers and the communities they serve.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ultimately, it is Title X patients who would pay the price of the Trump administration\u2019s <\/span><a href=\"https:\/\/www.guttmacher.org\/gpr\/2018\/02\/coercion-heart-social-conservatives-reproductive-health-agenda\"><span style=\"font-weight: 400\">coercive edicts<\/span><\/a><span style=\"font-weight: 400\">. This is particularly offensive as many who rely on Title X\u2212funded providers and services are already marginalized. The gag rule would force subpar care on individuals who often face other obstacles to obtaining care or have historically experienced coercive treatment in the context of reproductive healthcare\u2014including people who have low incomes, people who are uninsured, and people of colour.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In the words of former US Senate Majority Leader George Mitchell, who opposed the domestic gag rule when it was first advanced 30 years ago: \u201cA society like ours, based upon the fundamental principle of equality, ought not tolerate, let alone encourage, even less insist upon a system in which there are two standards of care: One for the wealthy, the affluent, the powerful; and another, lower standard, for the poor.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">The proposed rule is just one of the many ways in which the Trump administration and its allies\u2014many of whom have long histories of undermining people\u2019s ability to obtain comprehensive reproductive health care\u2014are now seeking to undermine the Title X program. Indeed, the <\/span><a href=\"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2017.304124\"><span style=\"font-weight: 400\">U.S. family planning safety net has never been under such threat as it is today<\/span><\/a><span style=\"font-weight: 400\">. The Title X gag rule must be seen for what it is: part of social conservatives\u2019 broader and relentless assault on affordable birth control access and reproductive rights.<\/span><\/p>\n<p><a href=\"https:\/\/www.guttmacher.org\/about\/staff\/kinsey-hasstedt\"><i><span style=\"font-weight: 400\"><strong>Kinsey Hasstedt<\/strong><\/span><\/i><\/a><i><span style=\"font-weight: 400\"> is a senior policy manager at the Guttmacher Institute.<\/span><\/i><\/p>\n<p><strong>Competing interests<\/strong>: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In late May, the Trump administration unveiled its latest attack on affordable birth control access, part of a much larger campaign to undermine reproductive health and rights in the United [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/06\/20\/kinsey-hasstedt-trump-administration-looks-to-impose-domestic-gag-rule-continuing-its-assault-on-reproductive-health-and-rights\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":42350,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-42417","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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