New Rule Eases Trump-Era Restrictions on Title X Family Planning Program

A final rule issued by the U.S. Department of Health and Human Services (HHS) and published in the federal register on Thursday revises the regulations governing the program. The changes, in large part a reversion to the year 2000 rule, remove restrictions on “nondirective options counselling” and referrals for abortion services. They also eliminate requirements mandating the “strict physical and financial separation between abortion-related activities and Title X project activities.”

HHS explains that the Title X program is implemented through competitively awarded grants to state and local public health departments and other non-profit family planning and community health agencies. HHS further states that while Title X prohibits the expenditure of federal funds “in programs where abortion is a method of family planning,” the new rule aims to increase affordable family planning program access.

In addition, the revisions seek to curb the controversy and negative public health impacts that resulted from the 2019 rule change. Allegedly, the 2019 rule’s substantial revisions of longstanding polices and interpretations defining what abortion-related activities were permissible under the program gave rise to concerns that it imposed undue and improper restrictions on grantees.

Courts were split on the ultimate legality of the 2019 rule, but evidence of its adverse public health consequences quickly emerged, HHS claims. Allegedly, after the implementation of the rule, 19 of 90 Title X grantees withdrew from the program, including 11 State Departments of Health and independent Family Planning Associations and eight Planned Parenthood organizations.

Comments fielded from those organizations reportedly yielded a common thread, with one emblematically stating that the 2019 rule “‘makes it impossible for us to provide healthcare and information to patients consistent with medical ethics and evidence-based standards of care.’” According to HHS, the fact that so many providers withdrew from the program necessitated reconsideration of the rule.

As such, the 2021 final rule revokes the requirements of the 2019 regulations. It reportedly more freely allows nondirective counselling to pregnant women and sets aside the strict separations between abortion-related activities and Title X project activities. The new rule also revises the 2000 regulations to “increase access to equitable, affordable, client-centered, quality family planning services.”

Prior to its publication, HHS undertook study of over 30 reports involving the Title X program from 1975 to 2021. It also solicited and responded to public comment. The 2021 rule is set to take effect 30 days from its publication in the federal register.