Trump administration plan means fewer Americans will have access to family planning

Like thousands of our physician colleagues, we entered the medical profession to care for our patients when they are sick and to advocate for their needs. We feel compelled to raise serious concerns about proposed changes by the Trump administration to the Title X Family Planning program as they stand to reverse important public health progress and harm many low-income patients.

Title X is the only federal program dedicated solely to providing family planning and related health and screening services. It improves the lives of 4 million people a year in all 50 states by funding breast cancer and cervical cancer screening, sexually transmitted disease testing and affordable birth control. Of note, its funds have already been prohibited from being used for abortion services.

Established under a Republican president nearly half a century ago, Title X has enjoyed bipartisan support for most of its history.

The proposed changes to Title X would have several harmful consequences:

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First, in an abrupt break from current policy, it eliminates the emphasis on ensuring women have access to the full range of contraception methods approved by the Food and Drug Administration. Instead, it opens the door to shifting funds to organizations that exclusively provide and educate about abstinence-only and other less effective strategies for family planning.

Scientific studies have demonstrated that women have lower rates of unintended pregnancies, improved health outcomes and reduced abortion rates when they have access to more effective contraception such as intrauterine devices (IUDs). By allowing Title X to fund clinics that do not offer the most effective options for women, the proposed rule disregards a key principle: Health policies are most effective when guided by science.

Second, the proposed rule would lead many safety net clinics to shut down by requiring facilities that provide abortion services outside of the Title X program to hire separate staff, build separate waiting rooms and exam rooms, and even maintain a separate electronic medical record.

These new requirements have no basis in medical need. The people who would be hurt most by these developments are the patients who depend on these clinics. In many communities, Title X clinics are the sole provider of contraception to low-income residents. In many others, existing safety net clinics would not be able to readily replace the lost services. The result would be that fewer people could access the basic reproductive health care they need.

Third, under the new rule, if a woman specifically asked her doctor where she could go for abortion services, her doctor would be prohibited from making that referral. As the American Medical Association states in its Code of Medical Ethics, “withholding information without the patient’s knowledge or consent is ethically unacceptable.”

The American College of Obstetricians and Gynecologists recently reiterated this standard, advising that even those who personally object to abortion “must provide the patient with accurate and unbiased information about her medical options and make appropriate referrals.”

The AMA and ACOG are among a growing number of medical and public health organizations that have stated their opposition to the proposed Title X changes based on the harmful impact they'd have on patients.

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As physicians, we were trained to provide patients with all relevant information about their options so they can make informed decisions based on their values and priorities — not ours.

We know that our fellow Americans have differing views about abortion. This makes it even more important for doctors to be vigilant about providing objective and comprehensive information rather than imposing their own moral or political views on their patients. Policymakers should hold themselves to a similar standard. Instead, the proposed rules place restrictions on doctor-patient communication that are based not on science but on personal views many patients do not share.

Title X has been a driving force behind increasing contraception availability, giving generations of women the freedom to plan their pregnancies as they pursue family, education and career goals. Today, the rate of unintended pregnancy in our country is at a 30-year low. The rate of pregnancy among teens is at an all-time low.

The Trump administration’s proposed rules take a step backward and threaten this progress. The true moral test of government authority is whether it is used to improve the lives of people it serves. By that measure and in this instance, the Trump administration has fallen short.

Regardless of one’s views on any particular health service, including abortion, we should all be able to agree on the importance of making scientifically proven treatments more available to those who would benefit from them, ensuring that patients get complete information to make informed decisions, and protecting the integrity of the doctor-patient relationship. For the sake of our nation’s health, we urge the Trump administration to reconsider these harmful changes.

Dr. Vivek H. Murthy was U.S. surgeon general in the Obama administration. Dr. Alice T. Chen is the former executive director of Doctors for America. They are both internal medicine physicians.