Let’s Call Trump’s Title X Gag Rule What It Is: Discrimination

By Fajer Saeed Ebrahim
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In this op-ed, Fajer Saeed Ebrahim, the If/When/How reproductive justice fellow at Legal Voice, explains how President Trump's Title X rule amounts to discrimination against marginalized communities.

The Trump administration instituted a new Title X gag rule to prohibit health care providers that share information about abortion from participating in the federal family planning program. There are big consequences of this new rule: Fewer people will be able to access reproductive health care, and the patients who do access care will not receive complete information or referrals about abortion. By dramatically limiting the care available, the gag rule will only worsen health inequities across the country.

Title X is the nation’s program for affordable reproductive health care and is meant to ensure that people who are struggling to make ends meet can still get birth control, STI testing, cancer screenings, and other essential care. Unless courts stop the gag rule from going into effect, millions of individuals will not be able to access critical health care and family planning services. The ACLU, the Center for Reproductive Rights, Planned Parenthood, 21 state attorney generals, and others have filed lawsuits against the rule.

By proposing and enacting this rule, the Trump administration makes it acceptable for marginalized communities to receive incomplete information about their health care or no health care at all. Here's what that could mean.

For LGBTQ People

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Title X is critical to meeting the unique sexual and reproductive health needs of LGBTQ people. Among other things, access to Pap tests is particularly important for lesbian and bisexual women, who studies show are less likely to get routine Pap tests for cervical cancer than their heterosexual counterparts. LGBTQ people also face a disproportionate STI burden, making access to STI prevention counseling, testing, and treatment vital. In 2016, Title X centers tested 2.1 million patients for chlamydia, 2.3 million patients for gonorrhea, and 635,000 patients for syphilis. Transgender women also bear a disproportionate HIV burden, and Title X centers provide HIV counseling, testing, diagnosis, and linkage to care.

LGBTQ people also frequently report lacking access to culturally appropriate care. Care delivered under Title X is governed by the CDC’s quality family planning guidelines, which, among other things, states that LGBTQ patients should be offered culturally competent care. Moreover, LGBTQ people are more likely to be economically disadvantaged, making safety-net programs like Title X a critical source of affordable care.

For People Of Color

Unsurprisingly, people of color will be disproportionately harmed by these cuts to care. Of Title X patients, 19 percent identify as Black and 24 percent as Hispanic or Latina. Research shows that the barriers to health care that many women of color face often result in delayed diagnoses, higher rates of cervical cancer, and increased mortality rates for breast and cervical cancer.

Latina women are more likely to be diagnosed with cervical cancer and more likely to die from breast cancer than white, non-Latina women. Black women are two to six times more likely to die from complications of pregnancy than white women, depending on where they live. Services provided through Title X like breast and cervical cancer screenings, birth control, and education and counseling are critical.

For Young People

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Title X guarantees confidentiality for all patients, including young people who are not required to notify or get consent from their parents or guardians to access care through the program. Research shows that without access to confidential care, many young people would not seek birth control, STI testing, or other needed health information even if they remain sexually active. For patients who may not be able to involve their caretakers, Title X service providers are essential for safe health care and informed decision-making when it comes to pregnancy and parenting.

For People With Low Incomes

People with low incomes, who lack insurance, or who may otherwise not have access to care will be disproportionately harmed, as they are by all anti-abortion restrictions. The vast majority of Title X patients are at or below the federal poverty line, which is around $12,000 a year for individuals and $25,100 for a family of four. There is already an immense divide between the “haves” and the “have nots” when it comes to health care in this country and this rule will only exacerbate this divide.

In the two years since Trump was elected, his administration has proposed a variety of policies that make it harder to get birth control and abortion care. All of them harm marginalized communities the most. This is not by accident and we should call it what it is: discrimination.

Each and every one of us — not just the white, the wealthy, and the insured — deserves accurate, quality reproductive health care and the ability to plan our futures.