The Ninth Circuit Court of Appeals recently ruled on the legality of the Title X Family Planning Program. In 2019, Colorado and about two dozen other states sued the federal government over changes the Trump administration made to the program. The court, which has jurisdiction over most of the West Coast, upheld the federal government's new regulations.
Colorado Edition co-host Erin O'Toole spoke to KUNC's Stephanie Daniel about what a new study can tell us about the impact this will have on Colorado.
Erin O'Toole: Before we talk about the study, remind us what Title X is?
Stephanie Daniel: Title X is a federal program that was created in 1970. It provides family planning services and affordable reproductive health care including birth control, STD testing and cancer screenings to 4 million uninsured or low-income people every year. Title X provided these services to nearly 4,000 clinics throughout the country last year. Title X has never funded abortions.
What changes did the Trump administration make in 2019?
There are several. Providers can't refer pregnant women to abortion services — even if the patient asks. On the other hand, they must refer pregnant women to prenatal care regardless of the patient's wishes. Clinics are also no longer required to provide pregnancy counseling options, which includes infant care, foster care or adoption. Title X now funds "non-traditional" organizations that may offer only one method of family planning, like fertility awareness instead of contraception.
The state of Colorado denounced the Title X changes after they were announced the joined a national lawsuit against the Trump administration. Why did these states take action?
The Colorado attorney general's office released a statement last March which said the lawsuit was challenging the constitutionality of the new Title X "Gag Rule," which would significantly restrict access to reproductive health services and information for women and families. The lawsuit alleged that the implementation of the new rule would erode the quality of reproductive health care and interfere with the provider patient relationship by limiting what the provider can say to a patient.
How much money does the state get from Title X funding?
The Colorado Department of Public Health and Environment receives about $3.8 million from the Title X program every year. This money, combined with more than $4 million from the state, funds the Colorado Family Planning Program. According to the department, the statewide program has helped cut teen birth and abortion rates in half over the last 10 years. This reduction in the number of births has saved the state close to $70 million in potential costs for state and federal programs that assist women and their infants.
As of last June, Colorado had 74 Title X clinics, which includes nonprofit, county and community health centers. But by the end of the year, two had opted out of the federal program. This is a trend that's going on across the country. According to data, about a quarter of Title X clinics nationwide have withdrawn from funding.
A Colorado-based researcher studied the effect of Title X changes in Texas. What did she find?
I talked with Kate Coleman-Minahan, an assistant professor at the University of Colorado College of Nursing. She co-authored a study looking at family planning organizations in Texas. In 2011, the Texas legislature reduced its family planning budget by two-thirds and redistributed Title X funding.
The study looked at data from 47 family planning organizations from 2012 to 2015. During this time period, 79% lost their Title X funding.
Texas requires parental consent for teens under 18 to access birth control unless they have Medicaid or receive care at Title X clinics. So, when those health care organizations were defunded, it impacted teens. Here's what Coleman-Minahan said about the study results:
COLEMAN-MINAHAN: We found that a loss of title 10 funding constructed organizations' ability to provide low cost confidential care to teens and other results, they saw a decrease in the number of teen clients served. So essentially teens lost access.
Did the study find a correlation with reduced access and teen birth rates?
I posed this question to Coleman-Minahan via email. They did not have the data to test for a link between access to care and teen birth rates. But her study did cite another 2017 study, which found family planning cuts correlated with a small increase in teen birth rates.
Coleman-Minahan acknowledged the importance of this question but said access to reproductive health care is also key. This access is crucial to teens' autonomy. Pregnant teens are often blamed and stigmatized for giving birth. This pulls attention away from the structural factors that increase the risk of teen pregnancy which includes lack of access to contraception and sex education, as well as political, economic and social oppression of marginalized communities.
How do these findings relate to reproductive health care here? One big difference is that, unlike Texas, Colorado does not require parental consent for people under 18 to access birth control.
Correct. I want to note the study did not look at all publicly funded providers in Texas. But Coleman-Minahan said the results serve as kind of a warning about what could happen in other states that receive Title X funding including Colorado. This is especially true when it comes to providing affordable and confidential health care to young people.
Coleman-Minahan is also a nurse practitioner and said the 2019 Title X changes are vague and confusing. And that's an issue.
COLEMAN-MINAHAN: So, an example of a local school nurse contacted our clinic asking if she could still refer young people for pregnancy options counseling. And although Title X now prohibits us from providing abortion referrals, we can still provide pregnancy options counseling. And so, this demonstrates not only confusion among staff about the new rules, but confusion in the community.
Coleman-Minahan said young people who want reproductive health care are actively seeking to avoid pregnancy and take control of their bodies, lives and futures.
COLEMAN-MINAHAN: They have to navigate school, jobs and responsibilities at home, find transportation and then make it to a clinic, so they shouldn't have to then experience on affordable unequitable or inconsistent access to care due to the goals of policymakers.
What does the court's ruling mean for Colorado now? Are we going to see big changes or perhaps another appeal?
I reached out to the Colorado Attorney General's office for an updated and received a written statement. Here's what it said:
Colorado will continue to fight the administration's Gag Rule in federal court so that women have access to critical healthcare services, and doctors and healthcare providers can give accurate medical information to their patients without the federal government telling them what they cannot say.
This interview is part of KUNC’s Colorado Edition for March 16. You can find the full episode here.