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Trump Administration Issues Final Title X "Gag" Rule
Action Alert

Trump Administration Issues Final Title X "Gag" Rule

February 23, 2019

Yesterday, the Department of Health and Human Services released its final Title X gag rule, prohibiting providers in the Title X program from giving patients evidence-based information about the full range of comprehensive sexual and reproductive health services, including abortion, and thereby making it impossible for patients to access Title X care at various health centers nationwide. Enacted in 1970, Title X of the Public Health Service Act is the nation’s only domestic federal program dedicated solely to providing individuals with family planning and related preventive health care services. The success of the program is dependent on funding that is awarded and available to the most qualified health care providers, including midwives. Without this assurance, family planning providers lose access to federal family planning resources and will have fewer resources to see patients, resulting in less access to care. ACNM has been a strong opponent against measures that seek to alter the existing Title X program and restrict access to care.

ACNM affirms that discrimination against any health care provider for reasons unrelated to medical evidence or best practices is wrong. Permitting such discrimination will further reduce patient access to maternal and women’s health care providers in a system that is already experiencing provider shortages. In response to the announcement, ACNM President Susan Stone, DNSc, CNM, FACNM, FAAN stated, “We are disheartened that the Trump Administration chose to move forward with implementation of the domestic gag rule and interfere with the relationship between midwives and the women, families and individuals we serve. The gag rule is a direct attack on patients who rely on Title X for care. It restricts access to crucial medical and health information, limits free speech, and impedes a women’s access to family planning, reproductive-health services and counseling.”


There are two main provisions in the gag rule that will put health care access at risk for millions of people:  

  1. THE GAG ITSELF: The gag rule prohibits health care providers in the Title X program from referring patients for abortion. Censoring and gagging these providers threatens the patient-provider relationship and prevents patients from having information about all of their options. Medical ethics and standards of care require providers to give patients complete information about their health care so patients can make meaningful, informed decisions about their own health. This bedrock principle is the foundation of the provider-patient relationship and critical to ensuring that patients trust the medical system. In addition, for decades, Title X law has been clear: health care providers cannot withhold information from patients about their pregnancy options.
  2. BLOCKS ACCESS TO PLANNED PARENTHOOD HEALTH CENTERS: This rule also includes onerous “physical separation” requirements specifically designed to block patients from coming to Planned Parenthood which serves 41 percent (1.6 million) of the 4 million people who rely on Title X health centers. This seems to mean a range of cost-prohibitive and unnecessary changes, from requiring health centers to build separate entrances and exits, to requiring the construction of whole new health centers, to requiring that health centers hire a whole second staff of doctors, midwives, and administrative staff. Given that Title X already bars federal funds from being used for abortion, the policy is clearly only intended to make it practically impossible for abortion providers to participate in the Title X program. Estimates indicate that implementation of this rule will strip $286 million in funding from Planned Parenthood health centers.

ACNM will continue to monitor the fallout from this policy decision. We encourage members, advocates and health care providers who oppose this policy decision to express their views with their respective networks and post on social media. Please contact with any questions.

Here is a link to several ACNM resources as they relate to the College’s position on access to comprehensive reproductive and sexual health services:

ACNM Regulatory Comments in Opposition to Domestic “Gag” Rule
ACNM Position Statement on Midwives as Abortion Providers
ACNM Press Release in Opposition to Proposed Domestic “Gag” Rule
ACNM Joint Statement in Opposition to Title X Changes
ACNM Position on Access to Comprehensive Reproductive Health Services
ACNM Position Statement on Conscientious Refusal and the Practice of Midwifery

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