The Public Health Implications of Current Title X Funding Restrictions

Abortion Barriers to healthcare Healthcare Equity HIV Epidemic politics and health Public health Policy Reproductive Rights Sexual Health

Last Monday August 19th 2019 the Planned Parenthood Federation of America made a decision to withdraw from Title X funding. This program which is older than most of us was enacted by President Richard Nixon as Public Health Law 91-572 a part of the Public Health Services Act in 1970. The law passed the Senate unanimously and the house voted 298 to 32 to send this Bill on to President Nixon for his signature.

Judging by the voting record this law was very popular in 1970 so why would Planned Parenthood decide to  withdraw from such a popular funding arrangement which is said to provide high quality culturally sensitive Family Planning and Related Services for more than 1.5 million low income Americans.

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Washington state Attorney General Ferguson announcing a lawsuit in Feb. 2019 challenging the Trump administration’s Title X changes

The Trump Administration Final Rule which was published in the Federal Register in March 2018 has made significant changes to this program. Most analyst believe this rule if maintained would eventually change the nature of organizations receiving Title X funding. Below are some problems that practitioners in the field have complained about.

  1. The final rule eliminates Title X’s long-standing requirement that Title X projects provide nondirective counseling on all of a pregnant patient’s options (prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination) upon request.
  2. The rule is allowing organizations to offer only a limited range of such family planning services thereby limiting care options for pregnant women.
  3. The rule requires antenatal referrals for all pregnant women irrespective of their wishes.
  4. The rule prohibits Title X projects from abortion referral, even upon a patient’s request. The rule states that Title X projects are prohibited from providing, promoting, referring for, or supporting abortion as a method of family planning.
  5. The rule arbitrarily limits the optional delivery of pregnancy counseling to doctors and advanced practice providers.
  6. Requires sexual abuse screening and documentation for minors who require family planning or STD services.

These requirements have been described by many grant recipients to be directed towards eliminating providers of abortion services from Title X funding Programs. Also it appears to be moving the focus of Title X from low income uninsured and underinsured individuals to providing family planning services for insured patients whose employers do not provide family planning care in their insurance programs.

What Planned Parenthood Really Does

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Patient care provided by Planned Parenthood affiliate health centers from October 1, 2016 – September 30, 2017 – Source Planned Parenthood 2017-18 Annual Report

The requirement for documentation for sexual abuse screening for teens seeking services for STD and family planning is important but could be a major barrier for teens seeking care. Whilst some of these rules may appear well meaning one will need to consider their potential impact on the health system as a whole.

  1. Changing well developed systems of care could increase cost and make navigating the health system more challenging for individuals seeking services.
  2. Possibility of shifting services to different providers would mean many provider with several years of experience and developed networks for integrating family planning, sexual health and reproductive system cancer prevention care would provide less of the care within their areas of core competencies. This could cause disruptions in care delivery.
  3. Faith based programs whilst effective  in limited areas of family planning care would be most useful for individuals who have a defined reproductive health need and would not allow a more balanced assessment by those who are undecided and only exploring their health care options.

The changes in Title X funding by the Final Rule reaches into the provision of health care by US practitioners in a manner similar to the Bush era abstinence only programs for PEPFAR Programs internationally. The prior stipulation made HIV preventions efforts depending on PEPFAR funding in international settings cumbersome. Some experts believe that those misguided requirements related to HIV prevention cost sub-Saharan Africa significantly in their HIV  Prevention Efforts.

At this time if Planned Parenthood refuses Title X funding and is unable to replace this with alternate funding sources 49% of their services which contributes significantly to STD screening could be in jeopardy. The Trump Administration must realise that Ending The HIV Epidemic requires essential partners. In 2017, Planned Parenthood centers provided 4.7 million STI testing and treatment and performed 741,352 HIV tests. This makes Planned Parenthood a key partner in the administration’s HIV eliminations efforts. The administration would need to reconsider these restrictive regulations if they are really seeking to end the HIV Epidemic. Those who build up their partners always go far in their endeavors.

 

 

 

 

 

Dr. Leonard Sowah is an Internal Medicine Physician in Baltimore, Maryland

 

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