Nearly 900 women's health clinics nationwide have lost federal funds after the Trump administration implemented a "domestic gag rule" to a federal family planning program known as Title X, according to an estimate by Power to Decide, an organization that works to prevent unplanned pregnancies.
Women of color make up more than half and Latinas over a third of all Title X patients, according to the National Latina Institute for Reproductive Health.
The lack of funding could affect access to reproductive health services, including breast cancer screenings, HIV tests and birth control for over 8.7 million women living in 390 counties in the U.S.
Paloma Zuleta, director of media relations at Power to Decide, told NBC that any changes in the way reproductive health clinics do business will mainly affect low-income women of color — defeating the purpose of the family planning program known as Title X, which was created to help low-income women.
“If clinics can no longer open early anymore or they can no longer keep late hours because their funding is so different or if they have to lay people off,” Zuleta said, “it's a deterrent for women to be able to access the health care that they need."
The Trump administration instituted the gag rule two months ago, stating that health clinics can’t receive funds under Title X if abortions are performed at the facility or if specialists refer patients to centers where they can get an abortion. The administration issued the ruling despite the fact that since 1976, federal funds cannot be used to directly pay for abortions under the Hyde Amendment, which excludes abortion from the health care services provided to low-income people by the federal government.
Ginny Ehrlich, chief executive of Power to Decide, said the gag rule imposed an “ethical dilemma” on clinics providing quality care, leaving some counties "with no clinic that has Title X funds to support women's needs.”
Clinics had to choose between halting family planning consultations or services that include abortion as a viable option and keep receiving Title X funds or, like Planned Parenthood, withdraw from the federal family planning program and continue to offer full services at their facilities while looking for alternate sources of funding such as donations or private grants.
All clinics receiving Title X funding in Vermont, Maine, Utah, Oregon and Washington walked away from the federal program, according to data from the Kaiser Family Foundation and Power to Decide. The five states currently lack Title X clinics.
Impact on services, contraceptive use
Reproductive justice advocate Estefany Londoño worries that cuts resulting in fewer preventive services such as cervical cancer screenings could be detrimental to Latinas, who have the highest rate of cervical cancer, according to the Centers for Disease Control and Prevention.
Another ripple effect Londoño anticipates is that costs for services may go up as health centers have to make up for the lost federal funds. “Clinics will become more expensive for low-income women," she said, and women may face longer waits for appointments if clinics contract services.
While the administration seeks to reduce access to abortion, reproductive health experts have found that one of the main factors driving a steep decline in abortions from 2008 to 2011 was the expansion of women’s access to better birth control and contraceptive services under programs like Title X.
According to a CDC analysis, the use of effective, long-term contraception such as IUDs and implants went up from 0.4 percent in 2005 to 7.1 percent in 2013 among the roughly 600,000 low-income teens who accessed family planning services through Title X clinics.
Ehrlich said that if the gag rule is not repealed, more women could end up living in “contraceptive deserts,” or areas that lack reasonable access to a health center offering a full range of contraceptive methods. This means more women could be facing unintended pregnancies.
About 19.5 million women were already living in “contraceptive deserts” before the gag rule was even put in place, according to Power to Decide.
Londoño slammed the administration's stance, saying that “not talking about abortion doesn’t make it less legal."
“This is not a pro-family piece of legislation," Londoño added. "It’s about sending a message about ‘putting women in their place’ — starting by not being able to go to a health care provider of their choice."
The Department of Health and Human Services said they would award supplemental funds to clinics that remained in Title X to try “fill service gaps.” But the Kaiser Family Foundation found that nearly 80 percent of the funding went to states that "are not addressing gaps" left by clinics that left the Title X program.
As clinics grapple with the gag rule, several reproductive health care organizations have recently announced new resources.
Planned Parenthood and Power to Decide have put in place services to help women get birth control delivered to their door and find emergency contraception. Other interactive tools help women find clinics across the country that offer family planning and reproductive health care services.