OPINION: New Title X Birth Control Rule Bad for the Nation’s Health

“Domestic gag rule” will lead to more abortions, unintended pregnancies, and deaths, write Boston University professors

By Katharine O’Connell White and Aviva Lee-Parritz

Last month, Washington announced a new federal regulation that will damage the health of our nation. It’s a “domestic gag rule” for reproductive health providers who participate in Title X, the federal family planning program. It would impose new rules that are designed to make it impossible for millions of patients to get birth control or preventive care from healthcare providers like Planned Parenthood.

Title X law is clear: healthcare providers cannot withhold information from women about pregnancy options, and this gag rule removes that guarantee. Under the new rule, doctors, nurses, hospitals, and community health centers across the country could no longer provide or even refer their patients for a safe, legal abortion procedure that might save their lives.

This regulation disproportionately affects poor women and women of color. Planned Parenthood serves 41% of the 4 million women who receive federally subsidized family planning services. More than one-third of low-income women get birth control through Title X at a Planned Parenthood center. This regulation would essentially bar the organization, and clinics like it, from receiving Title X funding. Consequently, these health centers may have to stop providing non–abortion services or close altogether.

The loss of these healthcare providers will be especially painful in the 18 states that did not expand Medicaid under the Affordable Care Act, leaving their low-income residents with no other options to receive vital healthcare services. Planned Parenthood and other groups that perform abortions are the only federally funded healthcare providers in over 100 counties. There is no backup option; some women in those places may simply not receive reproductive healthcare at all. They won’t get birth control, cancer screenings, STD testing, and treatment, or even general women’s health exams.

Some people may blame Planned Parenthood for not just giving up abortion services. Yet this regulation represents a choice by the government, which already withholds federal funds from covering a woman’s abortion, to now withhold funding for contraceptive services. It is not just Planned Parenthood that is affected; the gag rule is wide-reaching and will affect community health centers and many hospital-based providers as well. If the goal is to further decrease abortions, we should be doubling down on improving access to contraception, not making it harder to obtain.

This regulation will have the consequence of reversing the gains made in reducing unintended pregnancy. Abortion rates are currently at near-record lows, and the adolescent pregnancy rate is at an historic low. The domestic gag rule will actually increase the number of abortions (from lack of contraception access) and will likely increase maternal and infant mortality rates (from mistimed and unwanted pregnancies). We already have the highest maternal mortality rate in the developed world — 17 to 28 per 100,000 live births, which is more than double the rate of 30 years ago — and black mothers die at three times the rate of white mothers.

Women have pregnancies they didn’t plan for so many reasons — misinformation, lack of access to birth control, using their method incorrectly. Women are often hindered by medical professionals who are uninformed about contraceptive options and expect women with chronic illness to just remain abstinent. Poverty, racism, misogyny all affect people’s ability to be proactive and plan, and lack of control over their fertility is yet another barrier for women to take control of their lives.

The problem of unintended pregnancy may feel far away, but what’s at stake is nothing less than the health of society. The domestic gag rule will directly lead to more unintended pregnancies and more women dying in childbirth from pregnancies they didn’t plan. And we can’t forget that “unintended” does not always mean unwanted. But when women have a mistimed pregnancy, even if that pregnancy is welcome, it may represent a threat to their health and well-being.

Lack of access to reproductive health services will lead to severe morbidity and mortality for pregnant women and more families without mothers, which means more communities torn apart. The health of our society — not only of women, but of their families — is dependent on access to both contraception and safe abortion. Especially if you don’t believe in abortion — don’t let providers be stopped from providing the care that prevents them. For the sake of women and mothers and children across this country, let the White House know how you feel about this regulation.

For additional commentary by Boston University experts, follow us on Twitter at @BUexperts and on Instagram at @buexperts.



Cutting-edge research and commentary out of Boston University, home to Nobel laureates, Pulitzer winners and Guggenheim Scholars. Find an expert: bu.edu/experts

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
BU Experts

Cutting-edge research and commentary out of Boston University, home to Nobel laureates, Pulitzer winners and Guggenheim Scholars. Find an expert: bu.edu/experts