Title X grantees are told to stop abortion referrals immediately; Wen removed from Planned Parenthood



Effective immediately, recipients of federal family planning dollars under the Title X program can no longer provide referrals for abortion services.

The Health and Human Services department issued the email notification to Title X recipients late in the day on July 15, a day before a planned national Title X grantee meeting in Washington.

The HHS statement cited recent federal appellate court decisions that have declined to stay the ban on abortion referrals for Title X recipients contained in a March 2019 final rule. “Consistent with those rulings, HHS shall now require compliance with the Final Rule,” HHS said in the emailed statement.

Currently, no federal funds can be used to provide abortion services, but Title X recipients have been able to provide referrals for abortions or to perform non–federally funded abortions on the same premises where Title X–funded family planning services are provided. The implementation of the final rule would change this by barring referrals and by imposing physical separation requirements for health centers that offer abortions.

In an email accompanying the notification to Title X grantees, Diane Foley, MD, deputy assistant secretary of the HHS Office of Population Affairs, noted that, “We are aware that many of you have been frustrated with the lack of guidance given to you regarding the 2019 Title X Final Rule that was posted earlier this year.” She added that “The timing of the national grantee meeting will allow us to provide direction to you as well as hopefully answer your questions face to face.”

Providers of family planning and abortion services objected to what they are calling the Title X “gag rule.”

“As we have said all along, the Trump-Pence administration’s Title X gag rule is devastating for the millions of people who rely on this program for cancer screenings, HIV tests, affordable birth control and other critical primary and preventive care,” Leana Wen, MD, president and CEO of the Planned Parenthood Federation of America (PPFA), said in a statement. She went on to say that, “While we are incredibly concerned by this harmful rule, our doors are still open.”

Shortly after that statement was issued, Dr. Wen was removed from her position.

"We thank Dr. Leana Wen for her service to Planned Parenthood in such a pivotal time and extend our best wishes for her continued success," PPFA Board Chair Aimee Cunningham and Planned Parenthood Action Fund Board Chair Jennie Rosenthal said in a joint statement. Alexis McGill Johnson, a PPFA board member and former board chair, was named acting president.

"I am leaving the organization sooner than I'd hoped because of philosophical differences about the direction and future of Planned Parenthood," Dr. Wen said in a post on Twitter. "I came to Planned Parenthood to run a national health care organization and to advocate for the broad range of public health policies that affect our patients' health.... New board leadership has determined that the priorit for Planned Parenthood moving forward is to double down on abortion rights advocacy. Witht he landscape changing dramatically in the last several months and the right to safe, legal abortion care under attack as never before, I understand the shift in the board's prioritization."

The National Family Planning & Reproductive Health Association’s president and CEO Clare Coleman said that, “this rule will shatter the long-standing provider network – leaving hundreds of thousands of vulnerable patients without essential care. Last night’s notice will prompt grantees and other participating entities to withdraw from Title X, and we anticipate withdrawals beginning this week.”

An HHS spokeswoman said additional guidance will be provided to grantees during the meeting.

“While the final rule prohibits referral for abortion as a method of family planning, nondirective counseling on abortion is permitted,” the HHS spokeswoman said. “The final rule protects Title X health care providers so that they are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.”

The American Association of Pro-Life Obstetricians and Gynecologists applauded the implementation of the final rule and the “separation of Title X funds from the provision of abortion.”

Most recently, the federal Ninth Circuit Court of Appeals, in an en banc ruling, denied requests for an administrative stay of the final rule. Previous rulings by the Fourth Circuit, as well as a federal district court in Maine, also have denied requests for injunctions against the final rule.

An additional requirement for physical separation of abortion facilities from other Title X–funded family planning facilities will go into effect on March 4, 2020, according to the HHS communication.

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