On Friday, news broke that the Trump administration was expected to announce a new ruling which would eliminate federal funding to any health facilities that also provide abortions. The ruling would be similar to the so-called “global gag rule,” by which funding is withheld from international organizations and NGOs which provide abortion counseling and/or services. This “domestic gag rule” has been compared to a 1988 ruling made by President Reagan, which was met with immediate legal challenges and was ultimately prevented from being carried out. President Clinton rescinded that ruling in 1994. One Trump official told the Times that the rule would neither prohibit nor require abortion counseling, but how that would work in a clinical setting has yet to be detailed.
The Cut spoke to Jenn Conti, an OB/GYN and a fellow with Physicians for Reproductive Health, about what this ruling would mean for medical professionals and their patients.
What’s your reaction to news of the impending gag rule the Trump administration has announced?
First, I’ll just say that this news is shocking and horrifying. We already know that there is a global gag rule in place with this administration, where federal funding is withheld from NGOs or international organizations [that provide abortion counseling and services], but this is unprecedented. There’s never been a domestic gag rule that essentially bars or prohibits providers from relaying full and comprehensive information about pregnancy and reproductive health care, including abortion, to patients. They haven’t released the full ruling, but what it sounds like is going to happen is that whereas you might still be able to mention that abortion is an option, you won’t be able to provide patients or women with information about where to get one. Which is still essentially a gag rule, because if you can’t provide complete information about all of your choices in pregnancy — including abortion — you’re essentially providing them with incomplete or inaccurate and biased medical information, which is completely unethical.
It seems that if you’re able to say abortion is an option but not advise patients where to go, more women will be at risk of going to a crisis pregnancy center instead of an actual clinic, where they’ll get further discouraged from getting an abortion.
Absolutely. Any ruling that chips away at freely accessible reproductive health care and abortion access, we know from research in different countries and different times in history, it increases maternal mortality, with pregnancies that are forced to continue. It increases the rate of unsafe or dangerous illegal abortion procedure; it increases the rates of at-home procedures. So it’s completely fighting against everything that we in the medical community want for our female patients.
Wasn’t it already the case that no federal funding was allowed to be used to subsidize abortion services at Planned Parenthood? Is this a symbolic move?
I do think it is an attack on Planned Parenthood directly, because Planned Parenthood does account for a large amount of Title X funding — I want to say it’s more than 40 percent. So I do think it’s directly targeting Planned Parenthood. They’re creating a situation where Planned Parenthood will be forced to make a decision between providing abortions, or accepting Title X money.
Title X funding floats a huge proportion of what Planned Parenthood is able to offer people: cancer screenings, STD screenings, contraception, basic well woman exams — all of that is funded or at least subsidized through Title X funding. So if you take away that money, you’re taking away the ability for this organization to provide health care for a huge proportion of American women. A lot of people have this misconception that Planned Parenthood uses federal dollars to fund abortion. And that’s absolutely not true. Title X money has never, ever been allocated for abortion. This is something that’s very, very closely monitored. Providers obey the laws. No federal dollars are used for abortion. But this is making this incredibly strict ruling saying that if you want to even accept this money to do any other medical care for women outside of abortion, you won’t be able to because you’re housed within a facility that also provides abortions.
What are the ramifications beyond Planned Parenthood itself?
In many counties in the U.S., Planned Parenthood is the only provider of health care for low-income women, and in these counties, providers have been clear that if Planned Parenthood were to lose its funding or not be able to provide care, they would not be able to fill the gap. So we’re talking about negatively impacting a large proportion of American women.
This news reminded me of something else—
The Handmaid’s Tale?
That, too, but I was thinking about how some medications are prescribed off-label, and whether that might have to be a workaround here, too — might doctors prescribe medical abortion drugs for another reason?
I hope not. One of the medications used in medication abortion, misoprostol, is not FDA-approved for abortion. It’s only FDA-approved for, like, stomach ulcers. But we use it all the time for reasons that are off-label. We use it during labor and delivery to help bring on contractions. So it’s not uncommon to use medications for reasons that are off-label. But I think the main point is that we shouldn’t have to live in a society where we’re trying to get around the truth and trying to find creative ways to provide health care to women they are legally owed. This is a normal health-care service, and a right, and we shouldn’t have to be sneaky about it.
What’s your sense of the predominant feeling about this ruling among the medical field right now?
You know it’s funny — I was talking to another one of my colleagues who performs abortions, and his response was, “Well, it took them long enough!” I think he had been waiting for this shoe to drop. You know, “This guy is two years into his presidency, why did it take so long to do something like this?” Not like it should have been, but we knew this was on their mind. Here’s a president that does not know the difference between HIV and HPV. And he’s making the ruling out about STD screenings. He clearly is not qualified to make these decisions.