At a West Virginia Planned Parenthood clinic, multiple boxes containing birth control pills are marked with neon-colored signs reading “DO NOT USE." Providers at the clinic might have to destroy or return this medication, depending on how a court case against the Trump administration plays out. But for now, they can't give it to any patients; it sits untouched on a shelf. Thousands of miles away, the CEO of Maine Family Planning is facing the same prospect: Soon, the network of clinics may have to dispose of $100,000 worth of medication.
These clinics are just two of the many that have dropped out of Title X, a program established in 1970 that provides millions of dollars in federal funding to clinics and organizations providing comprehensive, evidence-based reproductive healthcare to 4 million people without insurance or low incomes.
But a mandate from the Trump administration earlier this month makes clinics that refer patients for abortions ineligible for the funds—even though Title X grants can't be used for abortion services to begin with. Additionally, faith-based, anti-abortion organizations that don't provide birth control can now apply for these funds instead. The roughly 4,000 clinics that currently receive Title X funds have until September to prove to the Trump administration that they’re not violating the program’s new stipulations, but many of them have already begun to feel their effects.
Clinics like Maine Family Planning have decided to leave the program in order to continue offering the full range of care they offered before—a choice the Trump rules have forced healthcare providers to make. The medication they purchased with Title X funds remains in limbo. Meanwhile, some patients without insurance are bearing the full costs for basic services. According to the New York Times, the price for a Pap smear at Planned Parenthood’s West Virginia location is $264; a breast exam, $160; and an IUD, more than $1,000. All were once free for low-income patients.
As these services become more difficult to access, others are becoming easier. Empowered by an influx in federal cash, groups like Obria—which calls itself a “pro-life” health clinic—have the capacity to dramatically scale up their infrastructure. Obria plans on serving 12,000 Title X patients across 21 offices in California, where it will promote abstinence and fertility tracking as patients’ primary methods of contraception; 13 of its offices don’t provide birth control pills, IUDs, or condoms in accordance with their religious orientation. (Obria did not return VICE’s request for comment.)
Advocates for reproductive health say the strain on what they call “legitimate” clinics, and the emboldening of “fake” ones (known for dissuading women from getting abortions), amounts to a seismic shift in the landscape of birth control access. In this new environment, some evidence-based clinics may close, having depleted the limited emergency funding many will rely on in lieu of Title X. Low-income patients—for whom the Title X program was specifically designed to serve when it was established—who can manage to get to a clinic offering comprehensive reproductive care may end up walking out without receiving the care they need, because it's now too expensive.
Others might find themselves in the waiting room of a health center providing them with false information, or flat-out denying them the care they’re seeking.
Debra Hauser, the president of Advocates for Youth, an organization dedicated to improving young people’s sexual health, said she worries that making the Title X funds available to religious organizations gives them the appearance of legitimacy. Obria clinics, for example, offer “abortion pill reversals,” a supposed method for reversing a medication abortion that has no basis in science or medicine. And while abstinence and fertility awareness-based methods can figure into the spectrum of contraceptive options health providers present to patients, Hauser says it’s just that—a spectrum, intended to empower patients to decide for themselves which is right for them.
“These organizations use misinformation and stigma to shame people into adhering to their own religious ideology,” Hauser said. “It’s malpractice, frankly.”
For decades, reproductive rights advocates have been trying to thwart the estimated thousands of faith-based organizations in the United States that purport to offer the full range of birth control options and abortion care, when they don't in reality. Advocates call them “crisis pregnancy centers” or simply “fake clinics.” Many of these clinics advertise “abortion information” on their websites—that's the first “service” that appears beside Obria’s name in Google search results—and use similar branding as their abortion- and birth control-providing counterparts. Providers and advocates worry that now it will become even harder to identify crisis pregnancy centers under the new Title X policies.
“What is most troubling to me as a doctor is that to the average person, these fake women's clinics are incredibly difficult to distinguish from real health clinics,” said Jennifer Conti, an OB/GYN and fellow with Physicians for Reproductive Health. “My job is to give medically accurate care and information and help patients make the decision that is best for their health, life, and well-being.”
“It’s really predatory,” added Amanda Thayer, the deputy national communications director at NARAL Pro-Choice America. “These facilities market themselves to give the impression that they’re the kind of place someone can go if they’re seeking healthcare or medical information. Being able to receive federal funds enables them to mislead people more.”
Thayer says every other move from the Trump administration has led up to this one, beginning with the administration’s promise to defund Planned Parenthood and leading up to the precarious position Roe v. Wade currently occupies. In between, Trump has filled his administration with anti-choice activists, rolled back the Affordable Care Act’s birth control mandate, given states the OK to withhold funds from abortion providers, and supported state legislatures in their efforts to repeal federal abortion rights.
“From a 10,000 foot view, this is not a drill in any way,” Thayer said. “The anti-choice movement has infiltrated the Trump administration over the course of the last few years, and now the stars are aligning in their fight. The devastating consequences for women and families has really come into focus.”
“The entire gamut of reproductive healthcare is crumbling down,” Hauser said. “When you pull funds from traditional family planning providers it becomes a question of who can survive. And there’s a good chance many of them will not be able to make it without those funds.”
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