Domestic Gag Rule: Impact on Maine's Title X Program

1. DOMESTIC GAG RULE: WHAT DOES THIS MEAN FOR MAINE?Presented by: Maine Family Planning

2. What Will We Cover Today? What is the “Domestic Gag Rule”? What does it seek to do? 1 Who is MFP? What is Title X? What does the Title X landscape of care network in Maine look like? 2 4 How is MFP fighting back? How would implementation of the Gag Rule impact access & public health outcomes in Maine? 3 5 Questions & Answers 6 What can YOU do to defend Title X?

3. TITLE X IN MAINE

4. TITLE X: OUR FEDERAL FAMILY PLANNING PROGRAM • Enacted in 1970with bipartisan support, the Title X program provides high-quality family planning services and other preventive health care to predominantly low-income, under-insured, and uninsured people. • The program serves roughly 4 million people nationwide each year. • It is administered by the Office of Population Affairs (OPA) within the Department of Health and Human Services (HHS).

5. How does Title X work in Maine? • Maine Family Planning was established in 1971 to serve as the statewide grantee for Title X funds. • MFP has been the sole Title X grantee for the state of Maine ever since. • In FY 2018, MFP administered $2,035,670 in federal family planning funds. • Those funds were utilized to operate MFP’s 18 clinic sites & distributed to sub-recipients—like Planned Parenthood of Northern New England & FQHCs. • More than 40 sites administer Title X-funded services to low-income Mainers.

6. Title X Patients & Their Care • From July 1, 2017 to June 30, 2018, those 40+ health centers provided care for23,811Mainers • 78% of total patients qualified for free or reduced fee services. • 18,709 of those patients were contraceptive clients. • We also administered 2,130 pregnancy tests. • During that period, we provided: • 21,736 tests for sexually transmitted infections • 1,389 breast cancer screenings • 2,683cervical cancer screenings • 3,277 HIV tests

7. THE GAG RULE

8. How would the Domestic Gag Rule change Title X? • Prohibit organizations like MFP from providing abortion services and federally funded family planning services at the same location; • Strictly curtail counseling on and referrals to abortion services by Title X-funded providers; • Eliminate current requirements that Title X sites offer a full range of medically approved family planning methods and non-directive pregnancy options counseling.

9. Physical Separation of Services • In addition to family planning services, MFP currently offers abortion care at our 18clinic sites. We provide aspiration & medication abortion at our Augusta clinic & medication abortion via our telemedicine network at the remaining 17 sites; • As required by law, MFP already does not use any federal family planning funds for abortion care; • MFP cannot comply with the physical separation requirement while continuing to provide abortion services as we currently do.

10. Changes to Counseling & Referrals • This rule eliminates Title X’s long-standing legal and ethical requirement for nondirective pregnancy options counseling; • Betrays the trust so critical between provider and patient by prohibiting discussion of & clear referrals for abortion care, even if a patient explicitly requests it; • In the Title X program, patients’ values and unique health care needs come first. This rule intentionally upends what has been a guiding principle for nearly 50years to advance an ideological agenda.

11. Limiting Family Planning Services • The Gag Rule eliminates the requirement that Title X grantees provide a full range of medically-proven contraceptive methods; • Organizations applying for Title X funds are only required to provide one method of birth control, and its effectiveness does not have to be vetted; • The rule will destroy the guarantee that our patients will be able to access a robust set of family planning and sexual health services that have been the hallmark of the federal family planning program for 50 years.

12. How would the Gag Rule impact Maine’s Title X network? • Clinic closures • Lack of unweighted, comprehensive options counseling for patients with unplanned pregnancies • Devastating elimination of abortion access up to 10 weeks across rural Maine • Violation of medical provider ethics • Negative effects on the family planning network across the state • Potential for non-licensed, biased Crisis Pregnancy Centers to apply for Title X funding

13. What does this mean for our patients? • Many low-income Mainers could lose their only health care provider • Rural Mainers will face more travel & higher associated costs to access abortion • More difficulty identifying abortion providers • Less birth control access & options for low-income Mainers who rely on Title X • Diminishing trust & confidence in providers • Further institutionalizing of abortion stigma

14. A RIGHT IN NAME ONLY The Domestic Gag Rule would effectively push the right to abortion out of reach for everyone except those with the most privilege & resources, while also transforming our state’s family planning network beyond recognition. This is not about what is best for patients. It is an ideological attack.

15. NOW WHAT??

16. On March 6th, 2019the Center for Reproductive Rights filed a lawsuit against the Trump-Pence administration on behalf of Maine Family Planning. The Center for Reproductive Rights uses the power of law to advance reproductive rights as fundamental human rights around the world. The Center is arguing that the Gag Rule violates: • The 5thAmendment • The 1stAmendment Free Speech Clause, and • The Administrative Procedure Act (APA).

17. Questions??

18. How can YOU fight with us? TAKE ACTION TODAY!