SoHo used to be one of the few places in New York City that Clara Williams felt safe walking through. But as she neared the Planned Parenthood clinic on Bleecker Street one Saturday morning in 2016, the hot pink letters of her safe oasis disappeared behind a kaleidoscope of anti-abortion signs and pamphlets swirling in front of her eyes.
She was nervous and afraid — not for what lied on the other side of Planned Parenthood’s doors, but because her once safe haven had been transformed into a war zone.
Three years later, Williams, 36, is unshaken by her decision to get an abortion. What disturbs her is the memory of the men and women protesting her decision.
“There is a separation of church and state for a reason,” she said. “Abortions are not awful. They’re not illegal. They’re safe. They’re a part of our health care decisions.”
On Feb. 22, the Trump administration announced any clinic providing information about, performing, or referring abortions will no longer be eligible for Title X program funding. Commonly called the “gag rule,” the change means clinics who do so will be unable to retain money from the only federal program that helps uninsured and low-income individuals receive sexual and reproductive health education and testing.
The program serves nearly 4 million people every year, according to the U.S. Department of Health and Human Services.
Under the new guidelines, grantees who wish to continue providing abortion services must do so under a physically and financially separate facility. They must also emphasize abstinence-based sexual education and the parents or guardian of patients who are minors must be included in sexual and family planning decisions.
“Promoting the dignity of human life from conception to natural death is one of the very top priorities of President Trump’s administration,” said HHS Secretary Alex Azar on Jan. 18. “This means not just protecting human life in the administration of our programs, but also respecting the conscience rights of those who participate in HHS-funded programs.”
Direct federal funding for abortion services has been illegal since the 1970s and the bulk of Title X funds provide screenings and treatments for sexually transmitted diseases and cancers. In the past, facilities that offer information about or perform abortions could still receive funding through Title X so long as they also provided other sexual and reproductive health services.
Planned Parenthood provides roughly 40 percent of all Title X-funded clinics throughout the U.S. and five out of nearly 60 clinics in New York City. Approximately 150,000 people in New York City rely on these services every year, according to Planned Parenthood.
Flatbush resident Raquel Friedman, 32, said she relies on Planned Parenthood for regular checkups, birth control, and cancer and STD screenings because she cannot afford to receive those services elsewhere. The organization, like other Title X clinics, offers patients a sliding scale for cost so that patients only have to pay what they can afford based on their income level and family size.
“When I first came to New York City, I was making slightly too much money to be on Medicaid but not enough to be able to afford my own health insurance,” she said. “Minute clinics have a walk-in-the-door price. As soon as you walk in, you incur some bill, regardless of whether or not you get medication or an x-ray or whatever the medical practice is that you need.”
Clinics’ abilities to receive federal funding has also become more difficult through the points system on the grant application, which now heavily favors new Title X priorities related to abstinence education.
With the change, facilities that support abortions are left with two options: Stop providing abortion information and procedures or lose Title X funding. Planned Parenthood of New York City will keep its doors open and forego the funding — a loss of $1.4 million a year. The organization’s vice president of communications and marketing Adrienne Verrilli said it’s a steep price to pay, but there really is no choice.
“It is something that is a disservice to any patient who gets medical services to say that the federal government and politicians can limit the information any patient gets,” she said.
Natural family planning facilities, such as Expectant Mother Care (EMC) Pregnancy Centers, will now have an advantage in obtaining federal funding. EMC founder and director Chris Slattery said federal funding could help natural family planning clinics advertise to more women and better provide birth control alternatives, such as fertility cycle monitoring.
Although his Bronx-based clinic provides STD testing and prenatal care, it discourages women from getting abortions, he said.
“We advise against [abortions] in all cases. … They’re morally wrong and they’re risky to a mother’s physical, emotional and spiritual health,” Slattery said. “We emphasize alternatives to abortion, which are single motherhood, marriage or adoption.”
Twenty-one states, including New York, and Washington, D.C., are challenging the changes in a lawsuit against the Trump administration. Although the National Institute for Reproductive Health (NIRH) is not party to the lawsuit, the organization is urging people to reach out to their representatives.
Andrea Miller, president of NIRH, said Title X has prevented approximately 60,000 unintended pregnancies a year and that pulling funding to ban abortions makes all health services more difficult to come by. The new regulations would eliminate federal funding for Planned Parenthood because abortions account for 3.4 percent of its total services provided in 2017, even though that service is not paid for by federal dollars. This leaves testing and treatment services for STDs and cancer, contraceptives, and other services — which make up roughly 97 percent of its services — federally unfunded and in the hands of donors.
“If you’re talking about less ability to screen and do Pap smears you’re talking about more rates of cervical cancer. If you’re talking about not being able to do screening for sexually transmitted infections … you’re talking about all the major health complications that come with undiagnosed and untreated STIs which can include sterility and infertility, sepsis, some can go blind,” Miller said. “Without these services people will be sicker and people will die.”
From 2014 to 2016, the Bronx had the highest rate of teenage pregnancies as well as the highest number of mothers on Medicaid, and the largest number of mothers in high to very high poverty situations, according to the city Department of Health. The Bronx also has the highest number of STDs. Without having access to Planned Parenthood and similar clinics, Miller said the situation will end with a “public health crisis.”