Title X changes could hurt poorest residents

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BRATTLEBORO — Last year, 72 percent of the patients who visited the Brattleboro office of Planned Parenthood of Northern New England had incomes of $24,120 or less.

According to Lucy Leriche, Vice President of Public Policy for PPNNE Vermont, these are the people that will be hurt the most if the Trump Administration's proposed Title X changes are put into effect.

"What Title X does is provide resources so that low-income people have access to basic and essential health care services," said Leriche. About 40 percent of PPNNE's funding comes from Title X, a federal program that funds family planning and related health services.

Under the direction of the Trump administration, the federal Department of Health and Human Services plans to transition its funding to programs that teach abstinence-only and natural family planning (also known as the rhythm method).

"We weren't incredibly surprised but we were disappointed to see the administration moving in this direction," said Leriche. "These changes are dangerous and cruel and would take health care away from poor people."

Impact on birth control access

Leriche said the administration's policy would eliminate PPNNE's ability to offer full-spectrum counseling that includes advice on the 18 recommended and FDA approved birth control methods that have been proven effective in reducing teen pregnancy and brought unwanted pregnancies to record low levels.

"Abstinence-only and natural planning education is not very reliable," she said. "It doesn't work well because human beings aren't perfect."

According to the Guttmacher Institute, teen pregnancy, birth and abortion rates in the United States have reached historic lows over the past four decades. And according to the Centers for Disease Control and Prevention, abortion rates in the United States have also fallen to a historic low.

"We have been making great strides through education and contraceptive practices," said Leriche. "The data clearly proves that abstinence only education does not work."

The Trump administration's proposed changes to

Title X rules would do three main things: Make it illegal for doctors, nurses, hospitals, and community health centers to refer their patients for safe, legal abortion; impose new restrictions designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood; and remove the guarantee that people are getting full and accurate information about their health care from their doctors.

Conservatives and anti-abortion activists welcomed the move when Trump announced it last month.

"For decades, American taxpayers have been wrongfully forced to subsidize the abortion industry through Title X federal funding," Trump said May 23 at a gala hosted by the Susan B. Anthony List, an anti-abortion group. "So today, we have kept another promise."

According to Planned Parenthood, since taking office, the Trump administration has "pushed policy after policy to take away basic rights and health care," issuing a rule to allow employers to deny birth control coverage to their employees; ending protections for sexual assault survivors on campus; and an attempt to eliminate the Teen Pregnancy Prevention Program.

Many critics of the administration's proposal say the ultimate goal is to eliminate abortion services in the United States.

'It would be impossible'

While health centers such as those operated by PPNNE cannot use Title X funds to pay for abortions, said Leriche, the proposed rule would also mandate a physical separation between health care services and abortion services.

"We would have to build, rent or acquire a physically separate space to provide abortion care," she said. "Because abortion care is a very small percentage of the care we provide, it would be impossible for us logistically and financially to provide a separate space."

Leriche said the changes to Title X would also sabotage Planned Parenthood's very real successes in preventing the need for abortions by providing birth control counseling.

"No one is looking forward to having an abortion," she said. "And no one wants an unwanted pregnancy. Everyone would much prefer the resources and the empowerment to do what they can to avoid something they don't want, including a pregnancy."

And accepting the changes goes deeper than eliminating PPNNE's programs, said Leriche.

"If we choose to take Title X funding under the proposed rule, we would be compromising our medical standards and ethics," she said. "We would have to essentially lie to our patients or withhold critical, potentially life-saving, information from our patients. We would be putting our patients at risk and betraying their trust because the new rule would prevent us from explicitly referring a patient seeking an abortion for abortion care. The implications are pretty severe and could be life-threatening."

"I do not see how any health care provider that follows nationally accredited standards and medical ethics could comply with the rule as proposed," said Lerich. "The funding will no longer be available to Planned Parenthood in Vermont. I would speculate that might mean that Title X would not be available to any credible, reputable health care provider in the state."

Support offered

"Brattleboro Memorial Hospital values the right for all women to have access to essential health services," wrote Gina Pattison, Director of Development and Marketing at BMH, in an email to the Reformer. "Federal Title X funding helps ensure that every person, regardless of income or health care coverage, has access to these services. We will continue to work with our community partners to ensure that gaps in care are avoided."

A spokeswoman from Grace Cottage Hospital in Townshend declined comment on the controversy.

On May 2, Planned Parenthood affiliates in Wisconsin, Ohio, and Utah filed suit against the Trump administration, contending the changes would violate federal law as mandated in Title X.

"We know that the plaintiffs are asking for an injunction so that Title X programs continue operating in their current form as this is playing out in the courts," said Leriche.

Representatives around the country, including in Vermont, are working with their congressional delegations to find a way to make up any shortfall if the administration pushes through the changes, said Leriche.

"We have already joined more than 200 of our colleagues in telling the administration we will fight this change to the Title X program, and we will work to find ways to ensure Vermonters get the care they need from the provider of their choosing," Sen. Patrick Leahy, D-Vt., Sen. Bernie Sanders, I-Vt., and Rep. Peter Welch, D-Vt., said in a joint statement.

Leriche said legislators within the state of Vermont, as well as the governor's office, have also been supportive of Planned Parenthood's mission in the state.

"The public needs to know this is happening. When they do find out, they are pushing back and standing with us."

Those wishing to comment on the proposed changes can email Alex Azar, the Secretary of the Department of Health and Human Services, at Secretary@HHS.gov, or call his office at 202-690-7000. Comments to the DHHS can also be submitted at https://www.plannedparenthoodaction.org and concernedwomen.org.

Bob Audette can be contacted at 802-254-2311, ext. 151, or raudette@reformer.com.

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