July 17, 2018
4 min read

OB/GYN society: Changes to Title X ‘would turn back the clock on women’s health’

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With just 10 days remaining until the end of the comment period for the changes to Title X proposed by HHS, the American College of Obstetrics and Gynecology, or ACOG, held a press conference with several other major health care associations to raise awareness of the threats posed by the changes.

“[Title X] is a great health success story. Unfortunately, the proposed changes to the program ... would turn back the clock on women’s health,” Hal C. Lawrence III, MD, executive VP and CEO of ACOG, said at the press conference. “Title X is the only federal program dedicated to helping low-income women gain access contraceptive care. It also plays a vital role to ensuring timely access to lifesaving preventive services.”

Under the proposed rule, funding for programs and facilities offering abortion would be eliminated and health care providers would not be required to offer abortion counseling and would be prohibited from referring abortion as a method of family planning.

Reduced access to care

“The proposed rule threatens women’s lives by restricting access to medically accurate, preventive health care, putting more than 40% of Title X patients at risk of losing essential care,” Katie McHugh, MD, chair and junior fellow action committee of ACOG, said.

Photo of young woman at clinic
With just 10 days remaining until the end of the comment period for the changes to Title X proposed by HHS, the American College of Obstetrics and Gynecology, or ACOG, held a press conference with several other major health care associations to raise awareness of the threats posed by the changes.
Photo credit: Adobe Stock

Vulnerable populations without other sources of care including low-income patients who otherwise would not be able to afford care as well as blacks and Latinos, mainly seek care at Title X clinics, according to McHugh and Mark Shahin, MD, from the Society of Gynecologic Oncology.

They noted that the rule would decrease access to basic primary and preventive health care services such as wellness exams, cervical and breast cancer screenings, birth control, contraceptive counseling and testing and treatments for STDs and HIV testing among such populations.

Restrictions to Title X also “target qualified health care providers such as Planned Parenthood,” Gay Johnson, CEO of the Nurse Practitioners in Women’s Health, said.

“Title X is a lifeline to patients who have already faced tremendous barriers in their lives,” she added. “Without this safety net, millions of women would lose access to all sorts of health care including reproductive and preventive health care services.”

Regulations on patient-physician relationship

Shari Erickson, MPH, VP of governmental affairs and medical practice at ACP, noted that the proposed rule regulates how health care providers talk to their patients. Suzanne Berry, interim CEO of the Association of Women’s Health, Obstetric and Neonatal Nurses, added that proposed restrictions to Title X would force providers to omit crucial medical information required for patients to make fully informed decisions in a timely matter. These regulations also restrict physicians from offering their best medical judgement and violate their responsibilities to patients, they said.


Elizabeth Hill- Karbowski , PhD, CNM, director of midwifery practice, education and global outreach at the American College of Nurse Midwives, added that physicians are morally and ethically obligated to share information with patients that is relevant, accurate, truthful and individualized. However, the proposed rule uses medically inaccurate language and places political ideology over science, she said.

Concerns about access to abortion, contraception and adolescent care

“The rule undercuts a woman’s access to safe, legal, abortion by banning providers from referring their patients at any stage of pregnancy for safe, legal abortion,” Dana Block-Abraham, MD, from the Society for Maternal-Fetal Medicine, said.

Abortions may be necessary in high-risk pregnancies and taking away women’s right to a safe, legal abortion may force women to go to extreme measures such as self-inflicted trauma, self-medication or pursuit of a potentially unqualified pregnancy procedure, she said.

Additionally, confidentiality protections for adolescents would be undermined under the proposed rule, Brandi Ring, MD, practicing OB/GYN in Denver, said.

“Without these protections, adolescents, especially those without adult support systems, may be more likely to delay or not receive needed, sometimes lifesaving care,” she said.

Additionally, changes to Title X would reduce access to contraception, Thomas Dardarian, DO, president-elect of the American College of Osteopathic Obstetricians and Gynecologists, said.

“The proposed rule allows Title X grantees to exclude certain forms of FDA-approved contraceptives and removes the requirement that contraceptive methods provided by Title X grantees be ‘medically approved,’ restricting access to safe and effective contraception,” he said.

Lisa Hollier, MD, president of ACOG, noted that our nation is at a historic low of unintended pregnancies among adolescents.

“This is something that we must celebrate, not reverse,” she said, noting that more work still needs to be done, because 45% of the 6 million annual pregnancies in the United States are unintended. Unintended pregnancy can have serious maternal health consequences and neonatal outcomes, she said.

“Women, families and our nation all benefit from affordable access to contraception,” Hollier said. “The goal of contraception is not only to reduce pregnancy but also to empower women to make decisions that are most appropriate for them. We can prevent unintended pregnancy if women have access to the contraceptive care.”

“The government has no place in our exam rooms,” she said. “Our bottom line is simple, we cannot turn back the clock on women’s health.” – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.