We cannot let changes to Title X put women’s health at risk

Barbara L. McAneny, MD , Former President

As physicians, we know that any law or regulation that interferes with or limits our obligation to talk openly with our patients about their health is antithetical to quality care and undermines the patient-physician relationship. That’s why the American Medical Association and leaders across medicine will fight to oppose efforts by government, or any other third party, to restrict open and free communication between patients and physicians. Any such attempts represent a fundamental threat to the nation’s health.

Today, the AMA filed a lawsuit to block the Administration’s rule that would decimate the Title X program and limit the medical advice physicians can give their patients. The Administration is putting physicians in an untenable situation, prohibiting us from having open, frank conversations with our patients about all their health care options—a violation of patients’ rights under the Code of Medical Ethics.

We will not stand idly by and allow this to happen.

The U.S. Department of Health and Human Services (HHS) issued changes that would withhold funding from some health organizations that receive support under Title X, the nation’s longstanding family planning program that provides health screenings, birth control and reproductive health services to people who could not otherwise afford this care. Title X serves an estimated 4 million people annually.

The new Title X rule represents a significant step backward by reducing access to breast and cervical cancer screenings, as well as testing and treatment for HIV and sexually transmitted diseases. Millions of lives have been saved by these services since Title X was launched in 1970.

In addition to endangering this potentially life-saving care, the rule takes aim at reproductive health, including limiting access to both contraception and comprehensive family planning services at clinics across the country.

Title X and related programs supporting family planning through affordable and accessible birth control are a major reason the nation is experiencing a 30-year low in the rate of unintended pregnancies. The birth rate among U.S. teens dropped by 64 percent from 1991 to 2015 and hit an all-time low in 2017, according to the Centers for Disease Control and Prevention (CDC). Fewer unwanted pregnancies mean fewer abortions; CDC figures released last fall showed the U.S. abortion rate had hit its lowest point in a decade.

The changes to Title X threaten to reverse this progress and could exacerbate health disparities based on income, geography, race, ethnicity, and other factors. Women should not lose access to breast cancer screenings and other needed services based on who they are, where they live, or how much money they earn. Imposing these unnecessary and unwarranted restrictions inflicts harm on the most vulnerable members of our communities.

The freedom of communication between patients and their physicians—and the trust upon which it is built—lies at the center of effective health care. Restricting what type of information physicians may share with those whom they are trying to heal is a clear violation of patients’ rights, not to mention physicians' First Amendment protections. Doing so impedes the journey to recovery and wellness.

Imagine the consequences if a nephrologist were forbidden to discuss transplant options with a patient struggling with kidney disease, or if a primary care physician couldn’t talk about insulin with a diabetic patient. The revisions to Title X block physicians from counseling their patients about the full range of health care options available to them.

These changes are the wrong prescription for America, and especially for the millions of women who rely on Title X funded clinics as their primary source of health care. Title X has enjoyed bipartisan support for decades because it saves lives and has played an important role in reducing teen pregnancy, abortion rates and sexually transmitted infections.

Access to affordable and comprehensive family planning services yields tremendous benefits not only to women, their children and families, but to our communities as well. We cannot reverse this progress, just as we cannot allow outside parties to insert themselves into the most personal conversations between patients and physicians.  

AMA intends to protect the patient-physician relationship anywhere it is threatened, including in the courts and we hope you’ll support us in this fight.