Biden-Harris Administration Takes First Steps to Strengthen Both Title X and Medication Abortion Access

 Last week the Biden took two actions to expand access to reproductive health care: the FDA lightening restrictions to medication abortion access during the pandemic and the Biden administration beginning its rollback of Trump’s harmful Title X program rules. Deepika Srivastava, Policy Analyst at Planned Parenthood Federation of America and Nina Serriane, Legislative Affairs Manager at Planned Parenthood Federation of America, celebrate the recent changes in access to medication abortion and the lifting of restrictions on the national Title X program with us.

On April 12th, 2021, the Food and Drug Administration suspended a medically unnecessary barrier to medication abortion—requiring patients to access medication abortion pills in person at a hospital, doctor’s office, or clinic—for the remainder of the COVID-19 pandemic. This means that people will not need to expose themselves to COVID to get the basic care that they need in states that permit it. It also allows patients in some states to access abortion care in a way that is safe, effective, and ensures privacy. It is important to remember that restrictions to medication abortion care existed before the pandemic, and after the pandemic is over we need to fight to ensure these unnecessary barriers to abortion access are eliminated permanently.

In 2019, the Trump-Pence administration instituted a “domestic gag rule” on the Title X family planning program, which prohibited grants from going to providers where clinicians divulged to their patients how to safely access abortion care. This prevented providers from being able to disclose a full range of information to their patients and severely limited the comprehensive care that patients were able to receive. On April 14th, 2021, the Department of Health and Human Services proposed the rescinding of this rule. This Trump rule resulted in the Title X network’s capacity being slashed in half, and the health needs of people around the U.S. have only increased during the pandemic. Since this is a proposed rule, there will now be a public comment process, which you can find more information about in the Take Action section. The comment deadline is May 17th, 2021.

Links from this episode

Planned Parenthood Federation of America on Facebook
Planned Parenthood Federation of America on Twitter
Title X is Under Attack rePROs Fight Back podcast episode
Medication Abortion Shouldn’t Require an In-Person Visit (Especially During a Pandemic!)
2021: A New Year, A New Administration, A Blueprint for Reproductive Freedom

transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

Read More

Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So yeah, I'm really excited for this week's episode. We are talking about some good news that happened last week and not just one piece of good news, two pieces of good news. And you know, it was so energizing to have victories. Like so often we were talking about the next terrible thing or so many other things that have happened that we don't get a chance to take a second and celebrate the good news. So, we're taking a second in this week's episode to celebrate the good news. So, I'm going to bring that vibe to my intro as well. Um, instead of focusing on all the other things that are happening, let's talk good news. So first, my piece of good news is I have gotten my vaccine. I thought it was going to be waiting a really long time to be able to get an appointment. Things were a little slow in DC, but I had friends who called me out of the blue and she had found an appointment for me. And she's like, “Jennie, I will take you. I will drive you there. We will go.” So not only did I go get my vaccine, I got to see a friend that I haven't seen in over a year. And y'all, it was, you know, that, that we're just like living in crisis mode for so much that you don't get a chance to think about or process or any of those things. And so, I, I thought I was doing fine. Like no big deal. Like if I have to keep waiting no big deal, I'm fine. I'm staying home. Like I'm not worried about not getting the vaccine right away. Like, it's fine. But man, when she called and told me she got an appointment and had an appointment for me and I was going to get to see her, I cried, I didn't realize the weight I was carrying of, um, not being able to see friends and, um, not being able to go out and do things. So, it was really exciting. I got Johnson & Johnson, so I got one-in-done. So, you know, of all the things I thought were going to happen that Friday when I woke up getting vaccinated and being fully vaccinated were just absolutely not on my radar. So that was really exciting and nice. And it's nice to have it done. I was really lucky and had no really major side effects my arm really the next day, but I knew to expect that, and I was a little tired, but other than that, like it was, it was not bad. I have no complaints. Um, and it was actually really nice to be one-and-done and not have to worry about trying to find another appointment. So that was really exciting. And I'm really close to being able to see other friends soon because I'm almost through my two-week window.

Jennie: So that is super exciting. So, I think Friday, it will be two weeks. So, that will be very nice to be able to see some people also, really exciting. Y'all got to meet Rachel on our ask me anything episode. So, she had moved to Atlanta for grad school a little over two years ago, now… it feels much longer, but anyway, she is moving back to DC this week. Y'all, I am so excited. I've been able to see her at a couple events, but obviously in the last year I haven't been able to see her at all. And I'm just so excited to be able to see her. And some other coworkers, hopefully soonish, uh, [once] we're all vaccinated. And as soon as I am through my two weeks, she will be here and I will be able to see some people and see friends. And it's super exciting and that's the kind of energy I want to take. Right? And they're just these little things that are just so exciting and it will be nice to see people and be able to get together and maybe have a picnic lunch or something. It sounds delightful. And it is getting me through all the things right now. So that's super exciting. And I think I said exciting a lot. Can you tell I'm excited? I, yeah, it's just, it's been a happy little week minus all the other things happening just personally. And so, let's just take that energy going forward. I'm excited to talk about the good news and have two wonderful guests on this week to talk about a couple of good administration actions that happened last week. So, I have Nina Serriane and Deepika Srivastava at Planned Parenthood with me to talk about the FDA requirements around medication abortion that changed last week for during the pandemic, and the proposed changes to Title X. So, with that, let's go to the interview with Nina and Dee. Hi, Dee, Nina. Thank you so much for being here today. I'm so excited to talk to you.

Dee: Thank you for having us.

Nina: Thank you. This is wonderful.

Jennie: Okay. So let's see. Who wants to go first? Nina, do you want to take a second and introduce yourself?

Nina: Sure. So my name is Nina Serriane my pronouns are she/her. I'm the Legislative Affairs Manager at Planned Parenthood Federation of America. And I'm thrilled to be here with you all today.

Jennie: Awesome. Dee?

Dee: My name is Dee Srivastava, I use she/her pronouns, and I’m a Policy Analyst at Planned Parenthood Federation of America.

Jennie: So I'm so excited to have both of you here today, not just as you, which is amazing, but because we're actually talking about good news, it's not that often that we get to talk about good news in repro. So I'm pretty stoked. So let's start with a couple of things that happened last week. There was some changes around medication abortion. Do you want to talk about what happened?

Nina: Yeah. So this was like you said, we, I feel like celebrating our wins is not something we get to do very often. And this was a really wonderful first step taken by the FDA following the science. This was also a really important step forward for access to abortion care and health equity. So, what is this important first step? Let me, let me say what that is. Last Monday, the FDA suspended, [a] medically unnecessary barrier to medication abortion for the duration of the COVID-19 pandemic. So for those who aren't familiar, there's the risk evaluation and mitigation strategy restrictions, the REMS restrictions on mifepristone, which is one of two medications taken and a medication abortion. So right now, for the last 20 years, there's been barriers that aren't supported by science that include a mandate that patients pick up mifepristone or “mife” as you'll probably hear me call it the nickname for it. The mandate is that patients pick that medication up at the doctor's office hospital or health center rather than in a pharmacy or by mail as the FDA allows for equally safe medications. So, this is like I said, this was a wonderful first step. It recognizes that this is an unnecessary in-person risk to COVID, you know, people, whether it's with childcare or transportation or whatever it is that they're trying to get to the health center for. It's all these risks to COVID that are just not, not needed. So, I'll pause there in case you have other questions.

Jennie: Yeah. I mean, I think you started to touch on this, but like, what is this going to mean for patients and how they access care?

Nina: Yeah, so mifepristone has been used for over 20 years. It's safe, effective has a safety record of over 99%, and this restriction, it's the only restriction on this type of medication. One that the FDA requires to be dispensed in person but permits patients to self-administer at home. So, this means that people don't need to expose themselves to COVID to get the care that they need. We know that abortion is time sensitive, and we know that people need to be able to get the care they need when they need it. So, it's really about keeping people safe. These restrictions are medically unnecessary to begin with, but they're also a public safety issue when we're in the middle of a global pandemic.

Jennie: Yeah, no, it's great to like get rid of this unnecessary barrier. I think it's going to make it so much easier for patients to access care they need without having to jump through this extra hoop. So, like, that's it right? We're done. We don't have to worry about it anymore. It's gone forever?

Nina: If only. So, like I said, this is an important first step, both because it's part of, it's just a small part of the REMS restriction or small part…it's big for people that need to access care, but it's only part of the REMS restriction and it's only for the duration of the pandemic. So really what's needed next is that we're calling on the Biden administration and the FDA to take that step, to continue following the science and do a review of the full REMS restrictions, not just for a pandemic. We know that these restrictions and barriers to accessing abortion care existed long before the pandemic started and that they're going to continue after. So it's really critical that the Biden administration takes a look at the science and sees that this is medically unnecessary.

Jennie: Yeah.

Nina: Also, so with this call to action, this is something that we've been asking the FDA to take action on, but also we were joined with 55 reproductive health, rights, and justice partners last month in calling on the administration to make these changes. And we were joined by 200,000 supporters who also joined the call, asking the administration to take action. So, this is something that people know that, you know, is a decades old restriction and it's time for it to go.

Jennie: Yeah. I just can't imagine how much easier it will be for people to access care and be able to get abortion care in the way they want. Um, if we can get rid of these restrictions, not just now, but just completely.

Nina: Absolutely.

Jennie: This isn't the only victory we had, right? There was another, at least start of a victory that happened next week and that has to do with Title X. Um, so what happened last week? What did the administration do?

Dee: So, the administration, the Biden-Harris administration last week took yet another step, very exciting, to restore access to essential sexual and reproductive health care by taking a step to end the Title X gag rule. So, I'm actually going to start by explaining a little bit more about what the gag rule is and why getting rid of it is so critically important. So, in 2019, the Trump-Pence administration implemented a domestic gag rule on the Title X family planning program, which prohibited Title X grants from going to providers where, um, clinicians told their patients how they could safely and legally access abortion, even if they ask. So, it interferes with the communication regarding a full range of treatment and options between a patient and a provider, a very important relationship, the integrity of which is central to how healthy people can be. It also restricted the ability of providers to tell the truth, to disclose a full range of information to their patients. And thus, it is extremely unethical and it violates the ethical standards of, I would say most healthcare professionals and because of the type of restriction that was sort of, um, imposed, it forced a lot of providers to leave the program. In fact, it cuts the Title X network capacity nearly in half, and it's also had the effect of making it so that six states no longer have a single Title X provider at all. Before the gag rule was implemented by the Trump administration, Planned Parenthood health centers serve approximately 40% of the program’s 4 million patients. And after that gag rule began, patients receiving Title X services were, you know, maybe forced to find new providers or stop receiving critical care entirely. So, now we pivot to what happened last week, where following a months long review process, the Biden-Harris administration found that the gag rule undermines the public health of the populations that the Title X program is meant to serve. And so, on April 14th, the U.S. Department of Health and Human Services issued a notice of proposed rulemaking entitled “Ensuring Access to Equitable, Affordable Client Centered Quality Family Planning Services” to begin the process of formally ending this harmful Title X gag rule. The rule also includes some very important updates to Title X program requirements to meet the needs of the 21st century, meet a better and more understanding and wholesome definition of health equity, and inclusivity, and how access to sexual and reproductive healthcare is central to people's lives to their futures, to their freedom and to the nation's health. This new rule from the Biden-Harris administration, unequivocally states and quantifies the harms that the gag rule has imposed on patients over the past few years, the disparate impact of these harms to populations who've always faced systemic barriers. What we've long known that rules like this gag rule are entirely politically motivated and most undercut access for people who live in rural areas, medically underserved areas, people without insurance, people with low incomes. And as we've seen time and time again, these disproportionately affect Black, Latino, AAPI, indigenous communities.

Jennie: So, this is a really important step to bringing back to Title X and making sure that clients are able to access care. So, it is just a step in the process. So, what would it mean if the gag rule were repealed like, how would this impact patients?

Dee: Absolutely. So, like I said, just earlier, Title X disproportionately serves patients with low incomes, patients in rural areas, patients of color who have been facing centuries of disenfranchisement, systemic racism and health inequities. People from these communities have always faced daunting barriers to getting the care that they need. And this gag rule is no exception. We also have to remember that we're in the middle of a pandemic. And so, none of these things are happening in a vacuum and the COVID-19 pandemic has further exacerbated the harms that people are facing and the sort of barriers to access for healthcare, where people need accessible and affordable healthcare services. So, this gag rule essentially cut the Title X provider networks capacity in half. It made it so that six states don't have a provider to deliver Title X services at all. And on top of that, we've also seen that it's not just about Planned Parenthood health centers. It slashed the ability for providers in several states where they were forced out of the program and not able to see patients. And so, the impact is huge, and it has been further exacerbated by the pandemic. So, in spring 2020, 33% of women faced delays or were unable to access contraceptives or other care, which disproportionately affected women of color and women of low incomes who were more likely than white women and women with higher incomes to report these types of delays. We've also seen, you know, the economic impacts of the pandemic affecting access to care. We know that people of color make up the majority of low wage earners who were economically impacted by the pandemic and how women of color are more likely to hold jobs deemed essential than any other demographic. And so, they have accounted for most of the job losses due to COVID-19. And the last thing that people need to deal with is a further loss of access to care when people need it, because we know that the Title X program is there also for populations who are uninsured and un-insurance disproportionately affects women of color women with low incomes, and a lot of people who still don't have a path to coverage at all. Before the pandemic STI rates were already at a record high for the fifth consecutive year, which has a bearing on future health outcomes for all sorts of communities. And the pandemic has continued to also limit the availability of testing and treatment services, where even more STIs are going undetected and untreated. But a good thing about this new NPRM, or notice of proposed rulemaking, is the fact that the modifications it makes to strengthen the Title X program center health equity for what I believe is the very first time. And I think that, you know, it will be really hard to repair the harms that have occurred over the past two years without also making sure that investments in care are meaningful and congruent with the need that continues to grow. But this effort to make the program more inclusive and expand its sort of ability to take care of people, to meet the need that is happening. It needs to include both, you know, more inclusive definitions and standards of care, but also the ability to invest in the program given it's been underfunded for so many years.

Dee: Restrictions like the gag rule, they are entirely politically motivated, and they are there to undercut access to healthcare. And because of what we've seen, which is that the majority of providers who are forced to leave the program due to gag were providers who specialize in sexual and reproductive health care, um, that impact is very disproportionate and very great. A lot of people, you know, it might be losing access to the contraceptive method of their choice or to the provider that they trust, or to, you know, it's just another thing to figure out in the midst of a lot of other things that are piling up for people right now, the health and economic devastation is so palpable. And when politically motivated attacks that frankly make it so that federal programs aren't able to serve their function, which is deliver health care to the communities that need it and happen, then what we see is that the people who are most harmed are people of color, people with low incomes, people who are queer, people with disabilities, people who are already facing disproportionate barriers to care, and frankly don't need any more, especially during a global health crisis. So, [the] gag rule has had a very significant impact on what health care means, what health care access means and all of this is happening while the need to be able to plan your future and be healthy is more important than ever.

Jennie: I think one of the things we're saying to the two of you talk about both of these changes is how both of them are going to impact how rural communities, how communities of color are accessing care. And it's such a great expansion for both of them. And that's a really important first step for the administration to be taking around sexual and reproductive healthcare.

Dee: Absolutely. And I'll just add, because I don't think I said this at the beginning, what Title X really is and what it means to people. So, Title X is a federal program that provides grants to health care providers so that people who are uninsured, under insured, have low incomes can access free and low cost sexual and reproductive health care services, which includes birth control, contraceptive education and counseling, STI testing and treatment, preventative screenings for breast and cervical cancer, and other kind of preconception care and preventative reproductive health care. So, these services are incredibly important also because they have additional protections in place such as patient confidentiality. So, services are put in reach in a way that they might not be through other efforts to expand healthcare. And these things are very tangible and tangibly affect what the face of health care and public health looks like in our country. The ability to access a preventive preconception screening, or the ability to catch a pre-cancer is the thing that is going to save a life and it's going to make it so that people who are already facing systemic racism and health inequities can prevent these things from happening. And the providers who are meant to serve them can keep them healthy. It also means, you know, if you're a survivor, you know, of maybe interpersonal or domestic violence, that if you are accessing an STI test that you don't need someone finding out about that, you can do that. And you can do that, you know, with a sliding scale, provided that your provider can provide that you, it also means, you know, you can access things like contraceptive care or other care that, you know, might not be something that you want, you know, people in your family to know about or something else entirely where you might need privacy. You're able to access those services in a way that's affordable. So, losing providers who have the ability to sustain that type of care is losing a very big chunk of our health care system in a way that markedly and tangibly affects a lot of the health outcomes that you hear so much about, you know, things like maternal health outcomes, things like outcomes from, you know, infertility or cancer, or, you know, just the ability to determine with autonomy, what it is that you want for your future. You know, the ability to plan your family, the right to parent, to not parent and to parent the children that you have in the way that you want to. Obviously, federal funding is just one piece of the puzzle and that sort of framework that we are working out of, you know, the reproductive justice framework that so many people, so many of our partners, and so many of the ways that Planned Parenthood has been held accountable and continues to be accountable. So much of that is also linked to this.

Dee: So, the rescission of this gag rule is just one priority that has been set by a coalition of more than a hundred fold, progressive organizations convened by Planned Parenthood Federation of America. And In our Own Voice, National Black Women's Reproductive Justice Agenda. These groups developed a document entitled “First Priorities for the Blueprint for Sexual and Reproductive Health, Rights and Justice”, which is a detailed list of executive and agency actions, including this one that we hope that this administration swiftly addresses. And it can't be emphasized enough that in order for any of our goals around healthcare, equity, and access, as well as the achievement of any of these lists of actions includes ending the Title X gag rule so that patients can get the care that they need during the pandemic and beyond.

Jennie: Yeah.

Nina: Jennie, I think that's something really important that you said about access in rural areas, especially with medication abortion. Planned Parenthood health centers know firsthand, just how safe and effective online abortion services can be, especially for patients who are in need of timely care. And especially like you said, for patients who are living in rural or remote, or as Dee was saying, medically underserved areas. So, we know that our health centers are already helping patients access safe and legal abortion care. And because of this announcement from the FDA on Mifepristone some Planned Parenthood health centers will be able to start providing direct to patient medication abortion in additional states, obviously in compliance with the laws and regulations of those states. But this really is a huge win for all patients accessing abortion care, but specifically those in rural and underserved communities like you were both saying.

Jennie: Yeah, that's one that hits close to home. I grew up in rural Wisconsin and I think the closest place that I could've gone to access care was in Madison. So, it was an hour drive away, but like it wasn't something that was going to be like easy to get to for me as a young person versus if it had been somewhere closer. So that is one that hits particularly close to home. And I know an hour to access care is much lower than it is in some places in the country to get to reach the closest clinic. So being able to get tele-health or being able to access abortion services online, being able to get medication abortion shipped to you would really be a game changer for those people. So the Title X is a proposed rule. So, what comes next?

Dee: Absolutely. So this is a proposed rule, which means that now there's a notice and comment process where the public can actually go in and tell the administration just how important it is to protect this program and right the wrongs of not just the last two years where providers were forced out of the program and unable to be able to participate in this critically important, frankly, lifeline for a lot of people where it's, you know, their one point of access for care, but also to right the wrongs of what has been happening in our health system, where there hasn't been a focus on inclusivity or health equity. This rule includes a lot of new definitions that, you know, make it so that providers need to prioritize the fact that a lot of communities have different needs. A lot of them have already been doing this. And a lot of them have not been, you know, fully recognized for just who they serve and what healthcare means to those populations. So, hopefully, you know, the ability to emphasize the fact that it's so important to save this program and to allow providers to participate again so that they can start serving patients again, but also to take the framing of this rule, this framing of health equity, and inclusivity and access and ensure that it is done with integrity and that a lot of the people who've been left out of the program in the past can, you know, access care in new and improved ways, I would hope. And so Planned Parenthood, of course, you know, we are going to be commenting on this role and working with partners, but we can't do this without hearing from, and the administration hearing from, who this truly matters to, whether that's patients or providers or advocates, supporters, or more. And so, if you would like to submit a comment, or if anybody listening would like to submit a comment, that comment deadline is May 17th, which will mark this sort of period where the administration will begin reviewing who they hear from reviewing the things that they've heard. So, if you want to submit a comment to the administration on the harms of the gag rule and on what access to this care means to you, you can text Title X, the Roman numeral. So Title X, um, with, or without a space to 22422, and you'll be connected with a comment collection form. You can go ahead and fill it out and then we'll take care of the rest and we'll submit it to regulations.gov for you. And so that way you can make your voice heard in a very easy way. Hopefully we can make it so that, you know, we have a strong showing so that the administration knows exactly how important this is. This next month is so critically important to building that case and to ensuring that they are hearing from who they need to hear from many of the people who they need to hear from all of you.

Jennie: So, that definitely is amazing to have a way for people to comment and make it easy. So, that definitely starts my next question, which is what can the audience do around these issues? So Dee, definitely shout out the text information again, and Nina, is there anything that the audience can do around medication abortion?

Nina: Really at this point, it's up to the FDA. The FDA needs to follow the science and take a look at these decades-old restrictions. As I said before, completely medically unnecessary. They're not rooted in what people need. So, it's up to the FDA now to take that next step and expand these lifting of restrictions um, far beyond the pandemic, like I said, these restrictions existed, or the barriers to care existed before the pandemic, they'll continue to exist after. So, it's up to the FDA to review the… review, the materials and with those barriers for folks.

Dee: Yeah, I mean, on Title X you know, it will take a lot to undo the harm, um, for the patients who have been denied critical care these past two years, we need to move as swiftly as possible to finalize this rule and make the case for this rule, as clear as possible to prevent more people from being hurt and further attacks to undercut the Title X program. So, for the next month or so until May 17th, the best thing that we can do is continue to collect comments and ensure that the administration is hearing from the people who this matters to. So folks who are interested in submitting a comment letter, text Title X that's the Roman numeral, Title X to 22422, and you'll be connected with a comment collection form where you can submit your comment and we'll take care of the rest.

Jennie: Awesome. And we'll make sure to include all that information in our show notes. So, it's easy to access if y'all, didn't get a chance to write down the number. Nina, Dee, thank you so much for being here today. It was wonderful to get to talk about good news with you.

Dee: It was wonderful to talk about good news for a change really is such a hopeful time. And I'm so grateful. I got to talk with you both, and I'm really excited for what's to come.

Nina: Thank you so much for having us on. It's always a pleasure to, to chat good news. So thank you so much.

Jennie: Okay. Y'all I hope you enjoyed my conversation with Dee and Nina. I had a great time talking to them. It was nice to take a minute to celebrate some victories, and there's obviously more work to be done. Both of these were just first steps, but with all of the heavy and the bad, it's really important to go ahead and take a minute and celebrate the victories. So I'm glad we were able to do that this week to take a minute and celebrate these two victories. And with that, I will see you all in two weeks.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

take action