A federal rule change around family planning clinics being sought by the Trump administration could have a disproportionate effect on current and former foster youth. Advocates believe that the new rules could have a chilling effect on the likelihood for these young people to access birth control and screening for sexually transmitted diseases.
The rule change would impose stringent restrictions on the kind of services clinics receiving federal Title X funds could provide, preventing Title X providers from educating patients about abortion and possibly even limiting the number of clinics offering comprehensive contraception options. Title X is a provision of the federal Public Health Service Act enacted in 1944 to ensure family planning healthcare services to all Americans.
“I feel like it’s punishing us in a way, because a lot of us don’t have the money to go to a primary doctor. For a lot of us, Planned Parenthood is the primary doctor,” said Autumn Taylor, a former foster youth and now an advocate with the Los Angeles Reproductive Health Equity Program (LA RHEP). “There are a lot of barriers in our lives already and healthcare shouldn’t be one of them.”
The rule change was set to take effect May 3, but on April 25, a federal judge in Washington State issued an injunction that blocks the rule from going into effect while a number of legal challenges play out.
While a number of different clinics receive funding through Title X, the most well-known and largest Title X provider is Planned Parenthood, which has long been a defunding target of Republican lawmakers. The Trump administration — which is stacked with anti-abortion advocates — has been particularly active in attacking Planned Parenthood and minimizing access to birth control. In 2017, Vice President Mike Pence cast the deciding vote on a bill that allowed states to block Title X funds from being distributed to Planned Parenthood and other abortion providers. In his proposed 2018 budget, Trump tried to cut all federal funds to Planned Parenthood.
Established in 1970, federal grants through Title X fund family planning clinics that serve low-income and uninsured patients, providing a range of services including wellness exams, screenings for cancer and sexually transmitted infections, access to birth control and more. According to Planned Parenthood, more than 4 million people rely on Title X funding to access these health services across the country.
Title X clinics provide services and contraception free of charge to people living below the poverty line and evaluate teens receiving services based on their own income, not on that of their parents or guardians.
“We really do see them as a vital resource for vulnerable youth, including youth in foster care,” said Rebecca Gudeman, senior attorney and director of health issues at the National Center for Youth Law. “Access to local, safe, adolescent-friendly services is a big issue.”
According to Gudeman, the updated rules include a number of regulations that will work together to likely limit the number of clinics offering comprehensive contraception.
For example, a state could choose to use its Title X dollars to only fund clinics that instruct abstinence as their sole method of birth control. As long as one clinic in the state provides other forms of birth control, they’ll have met the standard for Title X funding. For a large state like California, such a situation could mean a teen being 10 hours away from a clinic that provides the products they need.
Access to these clinics can be especially critical for youth in foster care, who often don’t have control of or access to their own health insurance information, Taylor said. Plus, talking about subjects as personal and sensitive as sexual health is hard for any young person, but especially for those who are in tenuous living situations with caregivers they may not know well or trust, and those with strained relationships with their parents.
“I know a lot — a lot — of youth who want to keep it discreet,” Taylor said. “[Planned Parenthood] helps them be more comfortable.”
Taylor said she believes many youth in care will go without birth control and sexually transmitted infection screenings if Title X clinics near them shut down or stop offering those services. They’re unlikely to seek out other sources of family planning, she said, because of confidentiality concerns and challenges with health insurance.
The new rules, published in the Federal Register on March 4 and set to take effect 60 days later in May, would prevent Title X providers from discussing abortion with their patients or referring them to abortion services. It would also require Title X providers who do perform abortions to do so in a physically separate location from their Title X-funded services, though existing law already prevents providers from using federal dollars to fund abortions.
Any reduction in access to a full spectrum of sexual healthcare, medically accurate information and contraception could lead to higher rates of unplanned pregnancies and sexually transmitted diseases among foster youth, according to Gudeman.
“Particularly for young people who may not always have control over what happens to them, the ability to access quality sexual assault exams and contraception is really, really important,” Gudeman said.
She shared the story of one former client who was 14 years old and being molested regularly during court-ordered visitations with her birth family, but was empowered by her ability to obtain birth control. “I can’t stop him from molesting me, but I can stop myself from getting pregnant if he does,” the client told her.
Foster youth already as a group experience higher rates of unplanned pregnancies in their teenage and young adult years compared with their peers. Youth who give birth in foster care also have a higher risk of having their child taken into protective custody, too.
Foster youth are also disproportionately affected by sex trafficking, and Gudeman worries that reducing access to Title X clinics could worsen this bleak reality. Title X programs require staff to be trained on identifying child abuse and sex trafficking, and most have specific, adolescent-friendly protocols for asking questions around these issues, she said.
“Sad to say, in most states, that’s not required by regular providers,” Gudeman said. “If that door gets closed, we’re going to have a lot more young people who we don’t identify and who will end up getting victimized even more.”
A coalition of more than 20 states as well as medical organizations and advocacy groups are filing lawsuits to prevent the rule change, and a number of states in addition to Washington have filed preliminary injunctions to block the rule from taking effect while legal challenges play out. Some states are passing legislation that would fill the funding gaps created for providers who choose to forgo Title X money in lieu of bending to the restrictive new rules.
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