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An activist holds a rosary while ralling against abortion outside City Hall in Los Angeles

Trump’s proposed changes to Title X could limit access to abortion

Days after President Trump’s 2017 inauguration, Vice President Mike Pence stood in the cold before thousands of March for Life demonstrators and highlighted his commitment to restricting access to abortion.

“We will not rest until we restore a culture of life in America for ourselves and our posterity,” Pence said.

Since that day, the White House has held true to that promise by supporting restrictions on reproductive services in many forms. Over the last seven years, states have enacted more than 400 abortion restrictions, said Elizabeth Nash, senior state issues manager for the Guttmacher Institute, a research organization that supports access to abortion. These restrictions include Mississippi’s ban on abortion at 15 weeks, and Iowa’s “heartbeat” bill, which was signed into law in May before a judge halted the rule from going into effect the following month.

Also in May, the administration proposed changes to a set of programs known as Title X, which governs federal family planning funding. Public comment on these proposed changes ends today.

Nationwide, a majority of Americans support abortion access, according to years of nationally representative polls.

Here’s a look at these Title X programs, how the government wants to change them and what advocates plan to do next.

Title X and family planning

In 1970, President Richard Nixon signed into law the Title X Family Planning program as part of the Public Health Services Act passed by Congress.

Three years before the Supreme Court ruled on Roe v. Wade, this law encouraged public and nonprofit groups to develop comprehensive family planning services, but the law explicitly forbade using federal funds to pay for abortion: “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.”

This law allowed Title X programs to use federal grant dollars for comprehensive family planning services, including “contraceptive services, supplies and information to all who want and need them,” according to the Office of Population Affairs, along with preventive health care. And the law gave people from low-income households and their families priority in receiving such services. Initially, Congress appropriated $6 million for Title X programs. By 2017, after decades of expansion and inflation, that number had climbed to $286.5 million.

Proposed changes to Title X

Pointing to language in the 1970 law, the Trump administration said the proposed changes would “refocus” Title X programs to “voluntary, preventive family planning services specifically designed to enable individuals to determine the number and spacing of their children.” If the rule becomes law, staff at Title X clinics could no longer counsel, refer or give information to a patient about abortion, even upon request. Critics say this amounts to a “gag rule” between physicians and patients, a label the White House has rejected. The federal government argued that those services fall outside the scope of Title X’s core mission of family planning.

Title X funds will instead be used to monitor and enforce both the funding and operation of family planning services. Title X funds should not be used “for publicity and propaganda,” according to the proposed rule.

Also in the proposal: If an organization receives Title X funds while offering abortion services, it must maintain two separate facilities — one for Title X-qualifying services and another separate facility that would offer abortion, delivered by separate staff, under a different name, receiving no federal dollars.

Faith-based organizations have been encouraged to apply for these funds, and a qualifying clinic could offer “natural family planning,” such as tracking a woman’s ovulation cycle to determine fertile and infertile days, a method the American College of Obstetrics and Gynecology says is less reliable than birth control pills, IUDs, implants or condoms.

The rule would also protect employers who, in accordance with their “religious beliefs and moral convictions,” do not offer employees health insurance plans that cover contraception.

Since the administration opened public comments June 1, more than 115,000 have been submitted. Many comments included identical language and appeared to have been submitted from automatically generated petition forms.

How significant are these changes?

Changes to Title X would be as game-changing as securing a like-minded Supreme Court nominee, said Tom McCluskey, president of March for Life Action, who has worked for two decades to tighten restrictions on abortion.

“As we become more of a pro-life nation, this could be very well a turning point to help educate people on the difference between health care and abortion, and exactly what Roe v. Wade does as opposed to what people think Roe v. Wade does,” he said.

But unless these rules undergo dramatic changes before going into effect, Jessica Marcella, vice president of advocacy and communications for the National Family Planning and Reproductive Health Association, said she expects dire consequences for access to family planning and basic health care services – and a long legal battle ahead.

For four out of 10 women who receive care at Title X health centers, these facilities represent “their sole source of care for the year,” and these latest moves jeopardize health care for people who can afford few options, Marcella said.

The regulation is vague and “riddled with ideology,” Marcella added, permitting physicians to withhold information, even if a patient asks for answers (“You go in and say, “I’d love to get an IUD,” and you’re encouraged to use the rhythm method.”)

She views the proposed changes as another step in a series of actions the Trump administration has taken to dismantle the nation’s health care system.

“There’s a long road ahead before this is the law of the land,” she said. “We are going to rely on every lever — congressional supporters, the judicial system and the American public.”

What’s next?

After the public comment period ends July 31, the Department of Health and Human Services must go through thousands of submitted comments. This will take time, McCluskey said.

Depending on how the Department of Health and Human Services updates the proposed regulation to reflect those public comments, advocates, including Marcella, Planned Parenthood for America and others, are expected to mount a major legal fight.

The department did not provide comment about this proposed regulation, its significance or timing after multiple questions from the NewsHour.