Trump’s rule gagging doctors is a threat to women’s lives

By Dr. Karen Meckstroth, Special to CALmatters

At my university hospital clinics, I see patients with unplanned pregnancies every week. Some have decided to embrace the pregnancy, but some are still deciding and wish to discuss pregnancy options.

They, like all patients seeking medical care, expect that I will provide open, honest, ethical communication not directed by politicians. They need to know I am providing them the full picture about their options, including options I cannot directly provide.

Even in California, where we have a third of the nation’s abortion providers, I frequently see women who have experienced weeks of delay in accessing a desired abortion because they could not get an appropriate referral. Sometimes relatively minor medical issues can severely limit where a person can access an abortion.

A patient with a prior c-section seeking abortion recently described her many-week path to find a provider, a path through two other clinical offices that led to her having to seek an abortion that required more cost, time and travel.

A new rule from the Trump administration’s Department of Health and Human Services would undermine the patient-provider relationship, with dire consequences for millions of people.

The Title X family planning program provides reproductive health care services to over 4 million people—almost a quarter of them in California. The program began in 1970 with bipartisan support. It ensures that anyone can access birth control, cancer screening and other essential services, no matter how much money they make or whether they have insurance. The majority of Title X patients are people of color, young and low-income.

Despite massive opposition, the Trump administration released new coercive and unethical regulations governing the program. The administration’s anti-abortion agenda has seeped into Title X, a program that doesn’t pay for or provide abortion services.

The new rule will prohibit abortion referrals by Title X providers. Under these rules, I would not be able to tell patients where they can get an abortion, even if they ask. The best I could do is give a patient a list of healthcare providers, some of whom provide abortions. I wouldn’t be allowed to tell the patient which ones offer the abortion services they’re seeking. It’s impossible to imagine any other medical procedure where the government would force doctors to obfuscate time-sensitive information critical to honoring a patient’s stated wishes. Navigating healthcare is already challenging, and it’s unbelievable our government wishes to block clinicians from giving accurate information to patients.

This interference flies in the face of medical ethics and principles of providing respectful, evidence-based care. Every major medical association has denounced this rule, with the American Medical Association arguing it would “jeopardize public health.”

Providers would have to choose between violating medical ethics or turning down funding that allows them to serve patients who need quality reproductive health care.

This would leave Title X patients unable to afford health care from doctors who are guided by ethics and science. Government funding could be siphoned to organizations that have no commitment to best practices, medical ethics or evidence-based care.

The new regulation no longer requires enrolled providers to offer a range of medically-approved birth control methods. This opens it up to places like anti-abortion crisis pregnancy centers that have a long history of spreading myths about abortion and deceiving women. Rather than supporting a range of birth control methods and honest counseling, your tax dollars could be spent giving patients medical misinformation and delaying access to quality care.

Blocking or delaying care can have serious consequences. Not being able to get birth control of your choice can lead to unwanted pregnancy. Having to jump through hoops to find an abortion provider means care will be delayed, making it more costly and difficult. Carrying an unwanted pregnancy to term is much riskier for a person’s health than having an early abortion. It also impacts financial health. Women denied a wanted abortion are four times as likely to have their household income fall under the federal poverty level.

My patients—and the women in this country—deserve better. Even without this gag rule, people have difficulty navigating the complicated medical landscape and face delays in care. Allowing politicians to block accurate information is unconscionable.

There are lawsuits to block the rule, including on behalf of the more than one million Californians who would be impacted. Every provider who understands the consequences of decimating Title X needs to speak out.

It’s no exaggeration to say that women’s lives are at stake.


Dr. Karen Meckstroth is a professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, the medical director of the UCSF Women’s Options Center, and gynecology medical director of the Women’s Community Clinic, [email protected]. She wrote this commentary for CALmatters.

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