A Catch-22 for Clinicians. state bans abortion counseling. This is required by federal Title X rules.

Abortion bans in Tennessee and beyond that limit women’s health care have put family planning clinics at risk of losing federal funding.

The dispute involves the Title X family planning program, which provides services to low-income people, including minors. As of 2021, more than 3,200 clinics have used federal grants to provide free or low-cost birth control, sexually transmitted infection testing, breast and cervical cancer screening, and pregnancy counseling.

Federal regulations for the program, which was created more than 50 years ago to reduce unintended pregnancies, say participating clinics must offer pregnant women with requests for terminations and abortion referrals. But following those rules puts medical providers at odds with state abortion laws, some of which threaten prison terms, fines or the loss of medical licenses if they help someone terminate a pregnancy.

President Joe Biden’s administration cut off Tennessee’s Title X funds in late March after ruling that the state health department, which oversees its clinics and received $7.1 million last year, violated federal rules to provide patients not recommending abortion. “Continued funding is not in the government’s best interest,” two Department of Health and Human Services officials wrote to Tennessee officials on March 20. As of March, the state had more than 100 Title X clinics, according to the HHS directory.

In 2022, the federal government awarded Title X grants to approximately 90 organizations, a mix of state and local governments and private organizations. Those grantees distribute funds to public or private clinics.

Federal law prohibits clinics from using Title X money to pay for abortions. However, HHS requires clinics to provide information to pregnant women about prenatal care and delivery, newborn care, foster care, adoption, and termination of pregnancy.

In states where abortion is largely illegal, this may mean referring patients to providers in other states. But Tennessee told family planning clinics they could only discuss services that were legal in the state, effectively shutting down any conversation about abortion.

Tennessee allows abortion only in limited circumstances, including to save the life of a pregnant person. The state Department of Health’s policy on family planning is “consistent with state law,” said Jade Byers, a spokeswoman for Republican Gov. Bill Lee. Tennessee has allocated state funds to replace federal money.

Whitney Rice, director of the Southeastern Reproductive Health Research Center at Emory University, said that not providing timely abortion information and referrals “may contribute to further delays in people’s access to that care,” especially because women may have to travel long distances. for that.

The standoff over federally funded clinics is part of the widening fallout from the Supreme Court’s June 2022 decision. Dobbs v. Jackson Women’s Health Org ending the constitutional right to abortion.

In Idaho, which has a near-total abortion ban, two Title X-funded Planned Parenthood clinics recently stopped providing abortion information to patients and stopped out-of-state referrals, according to Planned Parenthood and the American Civil Liberties Union. in a lawsuit filed in April. v. Attorney General of Idaho.

State law prohibits providers from assisting with or attempting abortions, and violators risk having their medical licenses suspended.

The clinics’ decision comes after Idaho Attorney General Raul Labrador said in a March 27 letter that Idaho law prohibits providers from “referring a woman across state lines to obtain abortion services.”

That interpretation “prevents medical professionals from providing full information to their patients,” said Mac Smith, director of Planned Parenthood Great Northwest, Hawaii, Alaska, Indiana, Kentucky.

Although Labrador later retracted the letter, Planned Parenthood clinics still do not refer patients for out-of-state abortions, Smith said.

Before Labrador’s letter, the suit says, Planned Parenthood employees will provide general information about pregnancy options, a list of abortion providers in other states and organizations that help pay for patients’ abortions and related costs, and a flyer about Idaho’s abortion law. The staff also occasionally helps patients schedule care outside of Idaho. Now “Planned Parenthood Providers Don’t Do It Anymore.”

“When my patients request abortions, I now have to tell them that I’m not in a position to help them and that I can’t tell them anything about abortion options in other states,” Caitlin Gustafson, a physician who worked at Planned Parenthood of Idaho in the clinic. , said the legal statement.

Kimberly Harris, a visiting assistant professor at Texas Tech University School of Law, said doctors in states with strong bans worry about referring patients to other states because prosecutors could interpret it as “aiding and abetting abortion.”

Facilitating medical abortion, in particular, could “present a potential risk to health care providers,” Harris said, because a patient they refer to get pills out of state could then pick them up in a state where abortion is illegal. Medication abortion is the cause of most abortions in the United States and involves taking a series of pills during the first 10 weeks of pregnancy.

“Federal regulation may require me to provide advice and information,” Harris said of the clinicians. “But if you tell the providers they can lose their license, or they can go to jail, or they can face a huge fine. Rightfully so, they will be worried.”

As top HHS officials travel the country, they are listening to the problem.

HHS spokeswoman Tara Broido said increasingly “providers and patients are raising concerns about the impact of the Dobbs decision” on access to pregnancy counseling and referrals.

KFF Health News asked Broido which grantees did not follow the counseling and referral requirements. He refused to say.

People who use Title X services are disproportionately women. A report from the HHS Office of Population Affairs said that in 2021, approximately two-thirds of the 1.7 million patients had family incomes at or below the poverty line. Thirty-six percent were uninsured, twice the national uninsured rate for adults.

The Office of Population Affairs and the Centers for Disease Control and Prevention jointly recommend the family planning services that clinics are expected to follow. These include pregnancy testing and counseling.

The Title X program has been tested before.

In 2019, the Trump administration banned Title X clinics from making abortion referrals. And the administration said abortion providers cannot share physical space with Title X clinics. The number of participating clinics subsequently dropped sharply, from 3,825 in 2019 to 3,031 the following year. With fewer clinics, the number of people receiving free or low-cost family planning services through the program fell from 3.1 million in 2019 to 1.5 million in 2020.

The Biden administration overturned many of Trump’s policies in 2021. Biden’s rules remain in place, but several states have sued to block them. That trial is ongoing.

Sarah Parshall Perry, a senior staff attorney at the conservative Heritage Foundation think tank, expects additional challenges to Title X rules because “states have an interest in protecting their laws and their ability to enforce their own laws.”

In Texas, which bans abortion with few exceptions, the nonprofit Every Body Texas oversees 154 Title X family planning clinics.

Its providers still advise pregnant women about options, but “that doesn’t mean it hasn’t been very, very difficult,” said Stephanie LeBleu, director of the group’s Title X.

LeBleu said the counseling approach “may look different” from clinic to clinic. For example, clinics in rural Texas “need to be much more careful about how they share information with their clients,” LeBleu said. Sometimes this means making “referrals”, such as referring patients to organizations such as All-Options, which operates a national pregnancy options hotline.

Other Title X grantees also say they are in full compliance with federal regulations. In Alabama, if patients ask for information about pregnancy options, “our clinic refers clients to other resources,” said Karen M. In Landers’ statement. The department declined to say what those resources are and whether clinicians are concerned about being prosecuted under Alabama law for providing abortion counseling or referrals.

“Consumers are further informed about the legality of abortion in the state,” Landers wrote.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of KFF’s core operating programs, an independent source of health policy research, polling and journalism. Learn more about KFF.


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