Reproductive health clinics serving Latinas grapple with ‘domestic gag rule’

Latinas who provide reproductive services in areas with few options for low-income women and women of color are grappling with a new rule from the Trump administration that may limit clinics’ access to federal funding, making it more difficult to provide affordable care to women.

In Texas’ Rio Grande Valley, where 92% of the population is Hispanic and many are immigrants or don’t have health insurance, “our bodies and our health have become political pawns,” says Lucy Ceballos Félix , associate director of Texas field advocacy for the National Latina Institute for Reproductive Health.

At issue is the “Domestic Gag Rule” that went into effect at the end of August, stipulating that health clinics cannot receive specific federal funding — known as Title X — earmarked for family planning and other health care services. other reproductive health services if abortions are performed at the facility or if specialists refer patients to centers where they can have abortions.

Clinics now face a choice: stop family planning consultations or services that include abortion as a viable option and continue to receive Title X funds; or, like Planned Parenthood, opting out of the federal family planning program and continuing to offer comprehensive services at their facilities while seeking other sources of funding such as donations or private grants.

For centers such as Planned Parenthood, losing Title X money can mean “clinics will become more expensive and women will have to wait longer for appointments,” said Estefany Londoño, a master’s student at the University of Central Florida and longtime reproductive justice advocate. NBC News.

This would defeat the purpose of Title X, which was created to help low-income women.

Impact on contraceptive services

Nearly 4,000 health centers in the United States specializing in reproductive health care receive Title X funds, and about half are state, county, or local health departments.

More than 80% of Title X funds go to birth control services as well as preventative care such as breast cancer screenings and HIV testing, among other reproductive and preventative health care services.

Women of color make up more than half of all Title X patients, while Latinas make up about a third.

The regions of the Rio Grande Valley, where Ceballos Félix works, are considered a “contraceptive desert”, which means that they do not have reasonable access to a health center offering a “full range of contraceptive methods”. . According to the organization Power to Decide, which works to prevent unplanned pregnancies, around 19.5 million women live in these areas.

Many clinics in this area are “overwhelmed” and struggle to meet the needs of women living in the area, Ceballos Félix said, adding that women normally have to wait a year to get an appointment for a pap smear.

“With the new restrictions, that wait is going to get longer,” she said, adding that she fears more funding regulations could lead to clinics closing.

When clinics are scarce, “people are more likely to self-medicate”, rather than seeking medical advice or prescriptions. “It’s very dangerous,” Ceballos Félix said.

Federal funds cannot be used to directly pay for abortions since 1976 and the passage of the Hyde Amendment, which excluded abortion from health care services provided to low-income people by the federal government.

The Department of Health and Human Services argues that the new restrictions should not be seen as a “gag rule” because they do not prohibit health care providers from counseling patients about abortion.

But the rule explicitly states that if a Title X-funded center “encourages, promotes, advocates, supports, or assists in abortion,” the clinic would be considered one “where abortion is a method of family planning” — so ineligible for federal family planning funds.

Some critics of the changes say they would trigger the diversion of $286 million earmarked for federal family planning efforts away from organizations such as Planned Parenthood and toward faith-based providers, who are not necessarily required to provide medically accurate services.

Planned Parenthood president Dr. Leana Wen speaks during a protest outside the Supreme Court on May 21, 2019.File James Lawler Duggan / Reuters

“The household gag rule is tragic and its collateral damage would take years to repair,” Ginny Ehrlich, executive director of Power to Decide, told NBC News. “Nobody benefits when women can’t get information to get pregnant on their own terms. Families thrive when women are able to plan their families.

In recent years, unwanted pregnancies have dropped by 18% among women of all ages, incomes, races and ethnicities, largely due to better use of birth control. Sharp declines in unplanned pregnancies have led to lower abortions, showing “that supporting and expanding women’s access to contraceptive services leads to lower incidence of abortion,” according to the Institute. Guttmacher, a research group that supports abortion rights.

Even though abortions are legal, advocates say the Trump administration is using anti-abortion rhetoric to fund reproductive health services.

Most Latinos think it’s “not up to politicians to decide when a woman should become a parent,” according to a poll by the progressive group Equis Labs that found a majority of Latino voters think “women’s decisions in matters of health care, including abortion, should be done by her privately with her doctors, her family and her own beliefs.”

As clinics continue to grapple with the new rule, reproductive health care organizations are offering other resources to try to ensure women’s access to services.

Through the National Latina Institute for Reproductive Health, Ceballos Félix recently helped 25-30 women get “coupons” to afford Pap tests and cancer screening tests to detect breast and cervical cancer. of the uterus.

Planned Parenthood and Power to Decide have set up services to help women get contraceptives delivered to their doorstep and locate emergency contraception. Other interactive tools help women find clinics across the country that offer family planning and reproductive health care services.

“If I didn’t have access to this care, I don’t know if I could access education,” said Londoño, the master’s student. “That’s why we have birth control. This allows women to participate in society as they wish.

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