A newly unveiled Trump administration proposal would not just block groups like Planned Parenthood from receiving Title X funds. It also could pave the way for a host of previously ineligible organizations — some of which oppose contraception — to receive funds through the federal government's family planning program.
While introducing President Trump at a fundraiser on Tuesday for her anti-abortion-rights group, Marjorie Dannenfelser painted a picture of what the country might look like had abortion opponents and other social conservatives not rallied around Trump in 2016.
"We would be grieving the loss of support for women and children as pregnancy centers get forced to close down their businesses," Dannenfelser said, "not looking for ways in the federal government to support their beautiful work."
Dannenfelser, president of the Susan B. Anthony List, imagined a nation where government policies discourage the work of crisis pregnancy centers, where women are counseled against abortion. She praised Trump for being a "man of his word" and opposing abortion rights.
Under the rules unveiled by the Trump administration in recent days, crisis pregnancy centers and other organizations that do not provide standard contraceptive options, like birth control pills or IUDs, could find it easier to apply for Title X funds. The $260 million federal family planning program currently provides services like contraception, STD screenings and well-woman exams to about 4 million low-income patients.
The proposed regulation, released by the U.S. Department of Health and Human Services on Tuesday ahead of its formal publication in the Federal Register, blocks organizations that perform or refer patients for abortions from receiving Title X dollars. It also removes a requirement that recipients offer "medically approved" family planning services, and it states explicitly that recipients would not have to provide all forms of effective contraception approved by the Food and Drug Administration.
"Not every grantee or sub-recipient can provide—or should be required to provide—all services," the document says. A few lines later, it notes that some patients may prefer organizations that offer only methods known as fertility awareness or natural family planning, an approach that generally focuses on understanding a woman's menstrual cycle. With those methods, patients wanting to avoid pregnancy are taught to abstain from sexual intercourse when a woman is likely to conceive, or for those trying to achieve pregnancy, to time sexual activity around a woman's fertile days. When used perfectly, these methods can approach the effectiveness of contraceptives, though studies suggest that such methods may, in reality, fail to prevent pregnancy as much as 25 percent of the time.
Several organizations that promote abstinence-only education or natural family planning have told NPR that in response to the proposed changes, they are preparing to apply, or considering applying, for Title X funds for the first time.
"We are giving some consideration, because we believe it is good money to be given to good people," said Lori Kuykendall, executive director of Aim for Success, a Texas-based nonprofit that provides abstinence education classes in public and private schools.
Kuykendall said her group hasn't typically sought direct federal funding but is considering applying for Title X funds under Trump administration rules, including a set of guidelines issued earlier this year that appear to encourage applications from abstinence-based education programs. Whether or not her organization decides to apply, Kuykendall said, she believes the administration is opening the door to other groups around the country that share her point of view.
"I hope that others will give it a good look and that the good groups will go for the good money," Kuykendall said. "You don't want an opportunity to be missed for the movement as a whole."
Mario Dickerson, executive director of the Catholic Medical Association, said his group has not applied for Title X funds in the past because of requirements that recipients provide patients with information about a full range of reproductive health services including abortion and contraception, which the Catholic Church opposes.
"We've been asking that these requirements — these roadblocks and obstacles — be removed," Dickerson said. "So we're excited to be able to participate in these funds now."
Dickerson said the group most likely will apply for several million dollars to cover educational programs focused on natural family planning.
The Couple to Couple League, a Catholic organization that promotes natural family planning methods and abstinence until marriage, is partnering with Dickerson's group to apply for the funds. In an interview with NPR, Executive Director Chris Reynolds said he would like to use the funds to "reach more women" with information about a variety of approaches based on fertility awareness. He said the group is developing programming focused on low-income people and Spanish speakers.
"We believe it's a woman's right to learn about their bodies and how it works; it's a matter of female health," Reynolds said.
Reproductive rights advocates say the proposal will harm low-income patients by making it harder for them to get information about abortion and contraceptive services and undermining the federal program set up to provide them with reproductive health care.
"We have limited federal dollars for health care generally and limited federal dollars for family planning," said Nancy Northup of the Center for Reproductive Rights. "They should go to programs that have a full range of planning, that are scientifically based, and that women are making the decisions based on their full range of options."
Emily Stewart, vice president of public policy at Planned Parenthood, said in a conference call with reporters that the administration's proposal would "undermine access to contraception" and bring organizations into the Title X program "who don't even believe in birth control."
Planned Parenthood has long been a target of criticism from abortion-rights opponents because about 1 in 3 abortions in the United States is performed at a Planned Parenthood center. The organization serves more than 40 percent of all Title X recipients, or about 1.5 million people, according to Planned Parenthood officials.
The final proposal has yet to be released and would have to go through a standard rulemaking process before it could take effect. So far, the Department of Health and Human Services has issued a version of the document that officials say will be submitted to the Federal Register for public comment.