A photo of an entrance sign that says "Planned Parenthood. Care. No Matter what."

Access Denied

Trump’s Domestic Gag Rule Silences Doctors and Hurts Women

The goal of the administration isn't just to end Planned Parenthood; it's to completely change the country’s relationship to abortion and birth control.

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If you think about it, it probably comes as little surprise to learn that Donald Trump is really into gags. Between the allegations of affairs with adult film stars and Playboy playmates, the more spurious rumors of the “pee tape,” and his obsession with leaks—leaks from White House officials, leaks from former staff, leaks from ex-wives and ex-employees and ex-television co-stars—gags would have to be at the top of the president’s mind in a variety of situations.

But now he’s coming for doctors, too.

On Friday, the Trump administration announced a new proposal it is calling the “Protect Life Rule,” which would eliminate federal Title X funding for any medical facility that either provides or refers for abortion services. These grants are used to promote and offer family-planning methods like hormonal and non-hormonal contraceptives, sexual health testing and treatments, and other reproductive health services, especially to the poor or uninsured. This rule, if it goes into effect, could leave as many as 4 million people without access to reproductive health care services—especially birth control—by cutting off clinics that either offer abortion or work in networks that offer abortions from being Title X providers. As imagined, it is assumed to be a domestic version of the “Mexico City Policy,” which forbids U.S. aid to any foreign organization that offers or mentions abortion—a Global Gag Rule that is implemented whenever a Republican is in the White House and then rescinded each time a Democrat gets elected. The only difference would be no complete ban on mentioning abortion, just referrals.

Abortion opponents argue that the new U.S. gag rule is needed to “disentangle” taxpayer dollars from any form of abortion provision or promotion—a vague and potentially endless definition of “taxpayer funding of abortion” that continues to expand as the far right becomes even more extreme. At this point, the draft rule seems to have only been shared with anti-abortion groups and right-wing media, who state that no amount of family-planning funding will be cut, it will only be blocked from going to any entity that offers or refers for abortions.

It’s exactly the manner in which the funding will be blocked that is the biggest cause for alarm. Due to the Hyde Amendment, which bans public funds from being used to provide abortions except in the cases of sexual assault or to save the life of the pregnant person, this new rule allegedly will eliminate any clinic that offers abortion services in any location from participating in the Title X funding pool. According to the Christian Broadcasting Network (CBN)—a close Trump administration media ally—“The Department of Health and Human Services is announcing abortion is not considered family planning, therefore requiring a ‘bright line of physical and financial separation between Title X programs and any program (or facility) where abortion is performed, supported, or referred for as a method of family planning.’”

Anti-abortion movement leaders argue that this isn’t a “gag” rule and is actually less extreme than the Reagan Era restriction that was similarly introduced for the U.S., one which wouldn’t allow clinics receiving Title X funding to so much as mention abortion. That Reagan policy wasn’t allowed to fully go into effect due to the Supreme Court ruling that it limited free speech. By not banning counseling, the administration is hoping to slide this new version through without a potential court injunction.

But the truth is, this new version is even gaggier than the old one. It’s not often that I will ever say “Go read the National Review” but, they have an incredible explainer that gets deep in the wonky weeds of the Reagan rule and its history. But in summary, the Reagan gag rule stated that to be sure that no Title X funding was inadvertently funding abortions, no participant could offer abortion, refer for it, or provide counseling that even mentions the fact abortion exists as a means to resolve an unwanted pregnancy. It was found to be so over the top restrictive that it was first held up in the court for years, and then next by congressional politicians who didn’t want to be tied to such unpopular legislation. It finally went into effect only to be reversed when President Bill Clinton was sworn into office.

It is the final portion that banned abortion counseling that has been revamped by the Trump administration. The new rule is “allowing” counseling solely to avoid being called a “gag rule” in order to garner more public support and give Republicans cover so they can support it and not be harmed in upcoming elections. But without the ability to refer for an abortion, the medical clinics remain just as silenced as before.

“The Trump Gag,” as I’ve chosen to call it, is still working its way through the system before it will be released for public comment. But sources say it will forbid any funding for birth control, STI testing, sex education, or other reproductive health-care needs from going to a clinic that offers abortion on site, is part of an organization that offers it, or to any medical clinic that gives a referral to one of these organizations. In addition, to maintain complete separation, any entity that wants Title X funding cannot refer or discuss abortion on their websites, a modern twist to the Reagan rule for today’s internet age. In other words, the administration is cutting off contraception access to the poor and uninsured to be absolutely positive that a clinic that provides abortion isn’t somehow using taxpayer dollars to pay a portion of their electrical bill or the internet hosting fee for their appointment scheduling page.

As we head into the battle over this new Trump Gag—and let me assure you, there is definitely going be a legal as well as a public relations one—Republicans are going to scream as loudly as they can that this isn’t a “gag.” They will try to claim they are simply defunding Planned Parenthood, despite the fact that a large percentage of clinics that will be affected by the rule are not part of the Planned Parenthood network, and of those many don’t even offer abortions in their physical settings, but would likely be stripped of funds just because they offer referrals. They will say that they are eliminating any potential for “indirect funding of abortion” even though ever since the implementation of the Hyde Amendment in 1976 entities that offer abortions have been forced to offer strict accounting to prove that their funds are not somehow intermingling. They will try to hide behind the statistic that 60 percent of Americans say they don’t want their tax dollars to “support abortion,” while refusing to note that the polling was done by the Knights of Columbus, a Catholic-based fraternal organization, or that 75 percent of Americans—including a majority of Republicans—support Planned Parenthood and public funding of contraception.

Unfortunately for us, it is that other 25 percent who appear to have the president’s ear right now, and are desperate to get their agenda into action while they still have control over the government. Led by Vice-President Mike Pence—the man who literally spent his entire congressional and gubernatorial career trying to defund Planned Parenthood even if it meant enabling a public health crisis, they don’t see patients losing access to hormonal contraception or a potential rise in unintended pregancies as a flaw in their battle against legal abortion, but rather an added benefit.

Because right now their actual goal isn’t to end Planned Parenthood, or stop “indirect” funding of abortion. It’s to completely change the country’s relationship to abortion and birth control. With the Health and Human Services Department rewriting policies to state that a person exists at the moment of conception, and now that abortion is neither family planning nor even health care, it’s becoming clearer every day that our government is in the process of dismantling all forms of pregnancy prevention brick by brick, leaving those who can get pregnant with no means to avoid it. In the end, “family-planning” funds will be allocated to only allow creating more family members, not creating a family the size you want at the time in which you want it.

That’s exactly what anti-abortion movement leaders want. “These changes are long overdue as abortion is not health care or birth control and many women want natural health-care choices rather than hormone-induced changes,” Students for Life President, Kristan Hawkins told NPR. “The Trump administration has every right to require that Title X programs focus on health care, not abortion, and to keep such programs aimed at helping women make a plan for a family outside of the facilities designed to making sure women don’t have a family at all.”

The Trump Gag won’t just potentially eliminate hundreds of clinics from the family-planning network, potentially blocking as many as 4 million patients from receiving the treatments or contraception they need to have families when—and yes, if—they choose. The reality is that this is a gag not just on doctors or clinics, but on the entire U.S. population as the anti-abortion movement once more lays down rules that force us to agree to their personal definition of abortion and birth control. They want us to only call abortion the “taking of a human life.” They want hormonal contraception to be accepted as harming those who use it, physically and mentally, and embrace their belief that pregnancy is the inevitable potential result of any sexual encounter. They are using the White House to make their own religious views federal law, and the federal budget as the cudgel to force any dissenters to accept their position.

The Trump Gag isn’t just gagging Planned Parenthood, or even family-planning providers in general. It is gagging all Americans into accepting their far-right view that women are created primarily and foremost for the purpose of giving birth. And that is the thought that has me gagging the most.

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