Paralleling the judicial expansion of reproductive rights, in 1970 Congress enacted Title X of the Public Health Service Act. The Title X program established the only federal grant dedicated to providing individuals with comprehensive family planning and related preventive health services, including access to contraceptive services, supplies, and information, with priority given to low-income women. There was bipartisan consensus in the 1960s and early 1970s that access to family planning was a universal human right; the Senate passed the Act with a unanimous vote and only 32 members of the House dissented. For nearly 50 years Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and related preventive health services for millions of low-income and uninsured individuals.
Title X programs are jeopardized by recent legislative efforts such as the Title X “Gag Rule.” The proposed final rule would force a medical provider receiving federal assistance to refuse to promote, refer for, perform or support abortion as a method of family planning. This has led many family planning programs, such as Planned Parenthood, to drop out of participation in Title X rather than attempting to comply with these restrictive regulations. Those who are most vulnerable to the “Gag Rule” are minority women, lower socioeconomic status women, and adolescent girls who are disproportionately impacted by unintended pregnancy rates and subsequent abortion rates, and many rural and urban community health centers, particularly those serving poor women on Medicaid, are left with fewer options for family planning services. The result could be reversal of the 30-year drop in adolescent pregnancy rates and the lower rates of abortion that we have seen over the last quarter century.
Access to affordable and available contraception is the premise of the foundation for Title X and one of the guaranteed preventive women’s health services described under the Affordable Care Act. In 2018, ACOG along with at least 10 other health care organizations provided testimony opposing elimination of the contraceptive mandate proposed for Health and Human Services. Worldwide almost 25% of maternal deaths are due to an unmet need for contraception.
Current legal restrictions
More than a century since the Comstock Act, women’s access to reproductive health care including abortion and contraception is threatened through legislative backlash against reproductive choice, and abortion access is more vulnerable than ever due to legislative attempts at the state and national levels to disenfranchise women and marginalize rights to legal reproductive choices. States have enacted a growing number of abortion restrictions that the courts have found not to be “undue burdens,” including mandatory waiting periods, physician scripting, parental involvement, and specific facility requirements for abortion clinics. Since Roe v Wade, 1200 restrictions have been enacted; recently the pace of abortion restrictions has accelerated, and the nature of the restrictions more severely curtails access. An increasing number of states have passed extremely restrictive abortion laws intending to test the protections of Roe v Wade in the Supreme Court.
- 1. Jatlaoui TC, Boutot ME, Mandel MG, et al. Abortion surveillance – United States, 2015. MMWR Surveill Summ. 2018;67(No. SS-13):1-45.
- 2. Comstock Act (Law) History of Contraception, Anthony Comstock. https://case.edu/affil/skuyhistcontraception/online-2012/Comstock.htmlw. Accessed 10/24/2019.
- 3. Roe v Wade Law Case. Summary. Encyclopedia Britannica. www.britannica.com/event/Roe-v-Wade. Accessed 10/24/2019.