Richard B. Karel is a freelance writer in Baltimore.
Maryland recently became the first state to formally opt out of Title X federal funding for family planning services in the wake of the Trump administration’s new family planning rule. The new rule would require Title X recipients to physically and financially separate clinical space used for reproductive counseling and contraceptive services from those used to perform abortions and prohibit in the former any mention that specific clinics perform abortion. Opponents have termed the provision the “gag rule.”
The new Maryland law is premised on the assumption that the federal rule will survive ongoing challenges, but should it be struck down, the state would continue to accept Title X funds.
The rule is facing numerous legal challenges and might eventually end up before the Supreme Court. It had been scheduled to go into effect the first week in May, but in late April, a federal judge issued a nationwide injunction, temporarily blocking its implementation. It is opposed by most major medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, which argued that it is an intrusion on the doctor-patient relationship.
Title X and other federal funds recipients have long been banned from using any federal money for abortions under the Hyde Amendment. But, because some family planning providers — Planned Parenthood, in particular — provide abortion services in addition to other reproductive care, abortion opponents have long argued that Title X funds facilitate abortion.
Four million patients nationwide get care under Title X.
Marjorie Dannenfelser, president of the antiabortion Susan B. Anthony List, said in a news release that “the Title X program was not intended to be a slush fund for abortion businesses like Planned Parenthood, which violently ends the lives of more than 332,000 unborn babies a year and receives almost $60 million a year in Title X taxpayer dollars.”
Maryland’s preemptive legislation guarantees that if the rule goes forward, all family planning centers in the state would continue to be funded at the same level as the prior fiscal year. According to a fiscal note provided by the state legislature, the new rule would have no impact this year but would result in a loss of $3.2 million in federal family planning money in fiscal 2020. At that point, the new Maryland law would require that funding for Maryland’s family planning program continue at the same level as total funding provided in the prior fiscal year.
The creation of obstacles to contraception and other family planning services in Maryland and elsewhere would disproportionately affect low-income and uninsured women. By making it more difficult for women to access family planning services, the consequence could be an increase in abortions, as more women fail to receive adequate counseling and contraception. As research by the Guttmacher Institute has shown, better access to contraception, which occurred in the United States following implementation of the Affordable Care Act, leads to a decline in abortion. The report, published in 2016, contradicted arguments from the antiabortion community that the decline resulted from more women carrying unplanned pregnancies to term because of state abortion restrictions or a change of heart.
It is clear that, for many low-income and rural women, Planned Parenthood is the only source of comprehensive family planning services. And while antiabortion and pro-choice advocates agree on very little, there is no disagreement that the best way to prevent abortion is to prevent unplanned pregnancies.
By being prepared to opt out of the federal program and stipulating that the state will continue fully funding family planning services, Maryland has demonstrated that the health of women and families comes first — and has led the way for the nation.