Title X Gag Rule Has Led to Increased Funding for Anti-Choice Clinics

Newly released federal grant applications for the Obria Group, a California-based anti-choice organization operating clinics nationally, show an inefficient distribution of Title X funds, including high patient costs and a six-figure salary for its medical director.

The Obria Group, which operates 48 anti-choice clinics, or crisis pregnancy centers was awarded up to $5.1 million over three years in Title X funds (though not every clinic receives funds) from the Trump administration last March to provide comprehensive family planning services in three California counties. According to a report from the Campaign for Accountability (CfA), a nonprofit watchdog group, Obria’s 2019 Title X application shows per-patient costs ranging from $292 to $970.

In contrast, Essential Access Health, another Title X recipient in California, has drastically lower per-patient costs — roughly $20 — which allows them to serve a much greater number of patients for the same amount of federal dollars, CfA Counsel Alice Huling told Rewire.News.

“If an organization is falling far short of what it said it is going to do or the project is being poorly implemented or inefficiently run, those might all be reasons you might start to question whether they are a good steward of the money they’ve been given,” Huling said.

It isn’t unusual for costs to vary among Title X recipients and sub-recipients, Huling said. Many factors affect the cost of providing services, such as rent and utilities for the clinic space, along with worker salaries. Providing services in rural locations can also increase costs, though the Obria clinics utilizing Title X funds are not in rural areas, Huling said. Obria didn’t respond to requests for comment.

Title X is operated by the U.S. Department of Health and Human Services, which has turned into a hub of anti-choice activity during President Trump’s first term. The Obria Group is among many anti-choice clinic networks that has received financial support from the federal government. The Trump administration’s domestic “gag rule” prohibits Title X recipients from referring patients for abortion care. It has led family planning providers to cease participation in Title X — the nation’s only federal funding program dedicated to family planning — which means more funds could go toward anti-choice clinics in the future, leaving patients with fewer options for services and information.

Huling called on congressional lawmakers to use their “oversight jurisdiction to ensure HHS anti-contraception ideologues can’t fritter away anymore hard-earned taxpayer funds on this futile project.”

The scope of Obria’s services is much more narrow than other Title X recipients, Huling said. Obria’s health centers do not offer contraception and instead counsel patients on so-called fertility awareness and natural family planning — ineffective contraceptive strategies pushed by anti-choice activists. In 2018, Obria founder and CEO Kathleen Bravo promised supporters the organization would “never provide hormonal birth control or abortion.”

According to Obria’s 2019 application, the group plans to spend $58,000 federal dollars on staff training for FEMM, a “natural family planning” app not approved by the Food and Drug Administration (FDA). Obria’s initial 2018 Title X application was denied; in 2019, Obria reapplied, asking for $5.9 million to serve 12,00 patients. Obria received $1.7 million, about a third of that request. The anti-choice organization is set to receive up to an additional $3.4 million over the next two years.

“If they are saying they need $6 million to serve 12,000 patients, and they are getting a third of that, how many patients are they really serving and is the better part of $2 million to serve 4,000 patients a good use of taxpayer money?” Huling said. “When the services being provided are so much more circumscribed [compared to other Title X recipients], that makes it even more stark of a comparison.”

Obria’s 2019 Title X application shows a salary of $165,000 for medical director Dr. Peter Anzaldo, without disclosing his unrelated full-time job maintaining a private medical practice. CfA obtained Obria’s applications through the Freedom of Information Act and eventually suing HHS.

“Limiting people’s options and cutting them off from the type of family planning services they would choose for themselves makes it more difficult for low-income individuals to engage in family planning,” Huling said. “It also means those individuals who are seeking those services may have to pay more for those services or look longer for less reliable sources.”

The Trump administration’s domestic gag rule has come under scrutiny from many family planning advocates and pro-choice politicians, including U.S. Sen. Patty Murray (D-WA), a vocal critic of the anti-choice HHS policy.

“It’s absolutely backwards that instead of supporting the health care providers millions of patients trust to get the care and information they need, the Trump-Pence Administration is gagging trusted providers, cutting them out of the Title X program, and welcoming in unscrupulous actors that promote unproven approaches over science-based ones,” Murray said in a statement.