New restrictions on reproductive health care providers in the Title X program are once again on hold, thanks to an order by the Ninth U.S. Circuit Court of Appeals.
The domestic gag rule bans these providers from offering abortion care, referring patients to other providers who can provide abortion care, or even talking about abortion. The rule went into effect nationwide, except Maryland, for two weeks, as part of the ongoing effort of the Trump administration to silence doctors and attack access to health care through information.
It’s a lesson I learned back in high school when I read 1984: If you’re able to control language and information, you can control what people are able to think and do. It was an interesting thought experiment — until it wasn’t.
Information is an essential component to ensuring that we can make informed decisions about our health and lives. Controlling access to that information is a way to control people’s bodies and limit reproductive autonomy.
Title X provides critical funding to health care providers that offer birth control, sexually transmitted infection testing and cancer screenings to people struggling to make ends meet. The Trump administration is now forcing these providers to withhold information about abortion or lose funding.
That means that if a patient directly asks for a referral to an abortion provider, a doctor can only share a list of comprehensive primary care providers, which may or may not actually provide abortion care, and cannot indicate which, if any, offer abortion services. The rule also encourages Title X providers to withhold medically accurate information by eliminating a decades-old requirement that Title X providers offer non-directive counseling about all of the patient’s pregnancy options.
The Title X gag rule is the domestic corollary of the global gag rule, which stops foreign non-governmental organizations (NGOs) that receive U.S. health assistance from giving patients information about abortion, providing abortion services, or advocating for access to safe and legal abortion — even if they are using their own funds.
When Trump first took office, his administration reinstated and expanded the global gag rule. In late March, his administration announced another expansion: that the U.S. will withdraw funding from a foreign NGO if it gives any financial support — again, even its own non-U.S. funds — to an organization that would provide patients abortion-related information or services.
This adds another circle of foreign organizations blocked from counseling patients about or referring them to abortion services. It is not enough that the U.S. won’t pay for abortion care, but the administration is now going further than ever to deny people information about how they can safely find the care they need.
People cannot exercise rights they don’t know they have, or access services they don’t know they need. We know that Trump’s expanded global gag rule has resulted in less access to contraception and more unwanted pregnancies, unsafe abortions, and preventable deaths for women, girls, LBTQI and gender–nonconforming people around the world. It and the Title X gag rule prevent pregnant people from being able to make informed decisions about their health care options, with devastating consequences.
The Trump administration also used this technique of gatekeeping to stealthily and systematically narrow access to information about the Affordable Care Act (ACA). The Department of Health and Human Services has decimated its ACA consumer outreach funding, spending 90 percent less on advertising in 2018 than the previous year and reducing its funding for navigators, who provide in-person assistance and help underserved communities enroll in health plans, by $26 million.
The administration has removed references and links to the ACA from the Office of Minority Health, Title X, Medicare and Medicaid websites; removed and edited text in research related to the ACA to de-emphasize the positive impacts of the law; removed some of the ways to apply for coverage for the Health Insurance Marketplace; and removed an ACA marketplace outreach guide that specifically centered Latinx communities.
Unlike in 1984, this slow, methodical chipping away at access to information and education won’t affect everyone. People with resources have ways to get the health care they need. These changes will primarily harm people who are disproportionately likely to have low incomes because of longstanding structural oppression — people of color, immigrants, LGBTQ folks, people with disabilities, single moms.
This is no accident. The people behind these policies know this, and are actively building a world of haves and have-nots of information, health care and ultimately, good health. The only question is whether we will accept this dystopic world order by letting them.