Fighting to Save Title X

In February 2019, the Trump-Pence administration unveiled the Domestic Gag Rule, an attack on the Title X family planning program. The Gag Rule interferes in the patient-provider relationship; goes against science and medical ethics; and would erect barriers to care for more than 23,000 Mainers.

On August 19, 2019, after nearly 50 years as Maine’s grantee for the Title X National Family Planning Program, Maine Family Planning withdrew from the program rather than comply with the Trump-Pence Gag Rule.

What is Title X?

Enacted in 1970, the Title X family planning program provides high-quality family planning services and other preventive health care to predominantly low-income, under-insured, and uninsured individuals who may otherwise lack access to health care. The program serves roughly 4 million people nationwide each year. It is administered by the Office of Population Affairs (OPA) within the Department of Health and Human Services (HHS).

How does Title X work in Maine?

Maine Family Planning was established in 1971 to serve as the statewide grantee for Title X funds. MFP has been the sole Title X grantee for the state of Maine ever since.

In FY 2018, Maine Family Planning administered $2,035,670 in federal family planning funds. That money helped support:

  • 18 Maine Family Planning clinics: Augusta, Bangor, Belfast, Calais, Damariscotta, Dexter, Ellsworth, Farmington, Fort Kent, Houlton, Lewiston, Machias, Norway, Presque Isle, Rockland, Rumford, Skowhegan, Waterville
  • Title X sub-recipients:
    • Planned Parenthood of Northern New England (Biddeford, Portland, Sanford, Topsham)
    • Calais High School
    • DFD Russell Medical Center (Leeds, Monmouth, Turner)
    • Greater Portland Health (Portland, South Portland, Casco Bay, Deering H.S.)
    • HealthReach (Albion, Rangeley, Belgrade, Bethel, Bingham, Coopers Mills, Kingfield, Livermore Falls, Richmond, Madison, Strong)
    • Islands Community Medical Services, Inc. (Vinalhaven)
    • Maranacook Community School (Readfield)

Who are Title X patients? What services do they need?

From July 1, 2018 to June 30, 2019, our 47 health centers provided care for 22,727 Mainers; 20,070 of those patients were female contraceptive clients. Fully 82 percent of total patients qualified for free or reduced fee services.

During that period, we provided:

  • 22,200 tests for sexually transmitted infections
  • 2,602 cervical cancer screenings
  • 3,182 HIV tests

In addition to family planning services, Maine Family Planning separately offers abortion care at its 18 direct-service sites. As required by law, MFP does not use any federal family planning funds for abortion care, and we consistently and regularly confirm this through annual audits.

What is the Domestic Gag Rule?

The Domestic Gag Rule represents a set of sweeping changes to the tremendously successful Title X national family planning program. If it is allowed to go into effect, there will be a sudden disruption to how healthcare services have been delivered in Maine for decades.

The Domestic Gag Rule would:

  • Force MFP to stop offering abortion care at 17 of our 18 health centers, and to implement prohibitively expensive (and medically unnecessary) physical separation provisions at our flagship clinic in Augusta, Maine.
  • Prohibit clinicians at Title X facilities from making referrals to abortion providers, even when the patient requests a referral.
  • Force providers to give all pregnant patients prenatal referrals, even when the patient doesn’t want one.
  • Divert Title X funding to non-medical organizations known as “crisis pregnancy centers,” which are designed to look like medical clinics but aim to deter women from getting abortions.

For Maine Family Planning, the Domestic Gag Rule presented an impossible choice: Continue to accept Title X funding and violate our mission and medical ethics, or leave the program and sacrifice roughly $2 million in annual federal funds, which could force drastic cuts to services that would undermine the family planning network we’ve been honored to oversee for close to 50 years.

Want to learn more? Check out MFP’s Domestic Gag Rule webinar.

So, what is MFP doing to stop the Domestic Gag Rule?

Everything we can.

First, we took the Trump administration to court.

On March 6, 2019, on behalf of Maine Family Planning, the Center for Reproductive Rights and Covington & Burling, LLP filed a case in US District Court seeking to block the Domestic Gag Rule from going into effect.

That case is ongoing. We maintain the beliefs put forth in our motions, namely that the rule is unconstitutional and would inflict harm on Mainers by wreaking havoc on the statewide reproductive health network.

But while we pursue litigation, our patients are not protected from the Gag Rule’s harms. So on July 16, we announced our intent to withdraw from Title X.

We refuse to comply with the Gag Rule, but we are committed to preserving Maine’s robust and successful family planning network. Our top priority is our patients – those who need and deserve evidence-based, unbiased care in their communities.

That’s why we’re doing everything we can do fight the Gag Rule. We are committed to ensuring true reproductive freedom all Mainers, regardless of where they live or how much money they make.

What's the latest?

We requested a preliminary injunction to stop the Gag Rule from being implemented while our case goes through the courts. Our injunction hearing took place April 24 in Bangor, Maine.

On April 25, a federal judge in Washington state issued a preliminary injunction on the Gag Rule that applies nationally. Because Mainers were covered by this injunction, we filed a notice on April 26 to withdraw our motion for a preliminary injunction.

Subsequently, the nationwide injunction was stayed by a 3-judge panel in the Ninth Circuit. We refiled our motion for a preliminary injunction on an emergency basis — a request that was denied by Judge Lance Walker. On the same day Judge Walker refused to block the Gag Rule, the Ninth Circuit Court of Appeals granted the National Family Planning and Reproductive Health Care Association’s (NFPRHA) request for a rehearing. Since then, the Ninth Circuit has clarified that this decision does not reinstate the nationwide injunction. There will be further developments in the Ninth Circuit this fall.

MFP’s legal battle also goes on. We maintain the strong views set forth in our motion, including that the Gag Rule is an unlawful violation of Title X and the U.S. Constitution, and we will continue to pursue vindication of those claims and to permanently invalidate the Gag Rule in our case going forward.

Meanwhile, we are striving to ensure our patients experience no disruption in service. To them, we say: Our doors are open and we are here for you.

For now, MFP is supporting the system with funding from our limited reserves. This is only a short-term solution. Just as we pursued every avenue to block the Gag Rule, we are doing everything we can to maintain health care access for women and families in our state without any interruption in service or clinic closures.

That means working to secure alternative sources of public funding as well as urging state and federal lawmakers to protect reproductive health in Maine and nationwide. This is a public health imperative.

MFP to Withdraw from Title X Family Planning Program – July 16, 2019

9th Circuit Court Restores Nationwide Injunction on Gag Rule – July 3, 2019

Judge Refuses to Block Title X Rule in Maine – July 3, 2019

Maine Family Planning Responds to Nationwide Injunction on Gag Rule – April 26, 2019

Maine Family Planning to Fight Domestic Gag Rule – February 22, 2019


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Maine Family Planning is a proud independent provider battling an administration that is sabotaging women’s health and abortion access.

Will you support this fight? Help us defend Title X.