Dangerous and Coercive Title X Gag Rule Released

Kinsey Hasstedt
The time is now. Will you stand up for reproductive health and rights?

First published online:

Updated on April 15, 2021: 

On April 14, 2021, the Biden-Harris administration released a notice of proposed rulemaking to overhaul restrictive Trump-era regulations, collectively known as the "domestic gag rule," that have had a devastating impact on the Title X national family planning program. Asserting that the Trump-era regulations "have undermined the public health of the population the program is meant to serve," the U.S. Department of Health and Human Services intends to restore Title X back to its pre-Trump regulatory framework, with "several modifications needed to strengthen the program and ensure access to equitable, affordable, client-centered, quality family planning services for all clients, especially for low-income clients." The rule is open to comments through May 17, and the Trump-era regulations remain in effect for now. 

Updated on January 28, 2021: 

On January 28, 2021, the Biden-Harris administration took its first step toward rescinding the "domestic gag rule"—the destructive Trump-Pence administration overhaul of regulations governing the Title X national family planning program. President Biden signed a presidential memorandum directing the U.S. Department of Health and Human Services to review those regulations and consider whether to suspend, revise or rescind them; it may take several months to complete this action and restore funding to family planning clinics that were forced out of the Title X program. 

First published February 27, 2019:

On February 26, the Trump administration posted its final rule imposing sweeping and destructive changes to the Title X national family planning program to the Federal Register, four days after the text was initially released on the Office of Population Affairs’ website. Often referred to as the Title X gag rule, the administration’s changes threaten the integrity of the program, the qualified providers it supports and the well-being of people who rely on Title X–supported care.

Implementation would not begin until 60 days after the rule is officially published in the Federal Register, slated for March 4. However, several lawsuits seeking to halt the rule’s implementation have already been announced.

What is the Title X gag rule?

The Title X gag rule is a blatantly coercive and unethical violation of individuals’ right to high-quality sexual and reproductive health care. Among other threats, the rule would:

Deny patients information on and referral for abortion

  • The rule eliminates the Title X program’s long-standing guarantee that all pregnant patients receive neutral, factual and nondirective information on all their pregnancy options (including parenting, adoption and abortion). Moreover, the rule promotes enough confusion that it could have a significant "chilling effect" on the provision of abortion counseling, even among sites committed to providing high-quality care.
  • The rule prohibits abortion referrals. Pregnant patients who ask for an abortion referral could be flatly denied or given an intentionally misleading list of primary care providers that may or may not include some who also offer abortion—though sites offering abortion could in no way be identified as such. Moreover, the rule requires that all pregnant patients be referred for prenatal care, regardless of their own wishes. 
  • These restrictions flout medical ethics, dismiss clinical guidelines of leading medical organizations and undermine patients’ right to provide informed consent to their reproductive health care.

Reduce access to high-quality contraceptive care by reshaping the network of providers

  • The rule seeks to force providers that offer abortion using non–Title X funds out of the program by imposing unnecessary and stringent requirements for the physical and financial separation of Title X–funded activities from abortion-related activities. This would affect approximately one in 10 Title X sites.
  • The rule favors primary care–focused providers, despite the fact that reproductive health–focused providers deliver high-quality, timely contraceptive care to particularly high volumes of patients.
  • The rule also discourages providers committed to offering comprehensive pregnancy options counseling and referral, while encouraging participation by sites offering an inadequate package of services. This includes entities that refuse to offer abortion counseling and referral, and single-method sites, such as those offering only fertility awareness–based methods.
  • Taken together, these changes threaten Title X patients’ meaningful choice of contraceptive methods and their ability to obtain whatever methods will work best for them. 

Advance the Trump administration’s overarching ideological agenda

  • The rule stigmatizes sexually active minors, threatening adolescents’ ability to obtain confidential care. For instance, clinicians would be required to document efforts to encourage patients to involve their parents or guardians, or document why such involvement was not encouraged. And minors who are pregnant or have an STI would be subject to "preliminary screening to rule out victimization," a step far beyond providers’ obligations to report suspected abuse and assault.
  • The rule would also divert scarce Title X funds away from the individuals the program was designed to serve in an attempt to address gaps in contraceptive access that the administration itself created by undermining the Affordable Care Act’s contraceptive coverage guarantee.

What is at stake?

For nearly 50 years, Title X has been the sole federal grant program dedicated to advancing people’s access to comprehensive contraceptive and related services in the United States. Title X–supported providers deliver patient-centered, voluntary, confidential and affordable care to approximately four million people each year—most of whom have incomes at or below the federal poverty level, or face other systemic barriers to care. The Title X gag rule represents an all-out assault on these patients’ right to obtain the reproductive health care they want and need.