The initial fight over the Trump administration’s abortion gag rule will take place in Oregon.

A coalition of national and state health care organizations and 21 state attorneys general filed a pair of lawsuits in U.S. District Court in Eugene on Tuesday seeking to block implementation of a rule that would prevent doctors and nurses at clinics receiving federal funds for reproductive health services from discussing abortion.

“The Title X gag rule is an astonishing step backward from providing quality health care and information to millions of our most vulnerable Americans,” said Oregon Attorney General Ellen Rosenblum. “To force Title X clinics to make the decision to refuse funds or cave to the requirements of this rule is not good for women or families who need these clinics for basic preventive health care.”

Title X clinics in Oregon served more than 37,000 patients in 2017, two-thirds of whom were low-income. Such clinics exist in nearly every county in Oregon, and in many rural areas they are the only place offering birth control, screening for cancer and sexually transmitted diseases, and well-woman exams.

The Title X program, created by Congress in 1970 and signed into law by President Richard Nixon, was designed to provide access to reproductive health services to low income men and women. Federal rules prevent those funds from being used for abortions, but many clinics that provide abortions rely on the funds to provide other family planning and health services.

Under the new rule, those clinics would have to physically separate their abortion services from the rest of the clinic, building separate entrances and exits for abortions, hiring separate staff and maintaining separate electronic health records.

“None of these requirements have any basis in medicine or science,” said Dr. Leana Wen, president of Planned Parenthood Federation of America. “Its only purpose is to restrict patients’ access to health care.”

The anti-abortion group Oregon Right to Life praised the rule when it was released, saying it would not cut family-planning funding.

“It ensures that Title X facilities do not perform or promote abortion under the guise of family planning,” said Lois Anderson, executive director of the group. “Abortion is not birth control, nor is it family planning. It is not the prevention of new humans being created. It is the destruction of those already living.”

Planned Parenthood and its state affiliates in Oregon, joined the American Medical Association and the Oregon Medical Association to file a lawsuit mirroring the one brought by the state attorneys general. Planned Parenthood accounts for about 41 percent of the Title X funding nationwide, and a similar percentage in Oregon.

Anne Udall, president and CEO of Planned Parenthood Columbia Willamette, said the rule would have a disproportionate impact on residents in Deschutes County and Eastern Oregon.

“Rural people have a hard time getting access to health care generally, and all this does is make it more difficult and punitive,” she said.

Through its Bend Health Center, Planned Parenthood serves 13 times more family-planning clients in Deschutes than any other clinic. The group estimated that other clinics in the county would have to increase their volumes by 69 percent if Planned Parenthood were unable to see them.

“If you take it away from Planned Parenthood, you put so much strain on the rest of the system,” Udall said. “That just creates an incredible demand that other providers are just not going to be able to meet.”

Udall stressed that the Bend Health Center would continue to provide its full range of reproductive health services, including abortions, regardless of what happens with the rule.

“The hope is that there is some type of very quick ruling that says we can continue to offer services under the Title X regulation as this plays out through the courts,” she said, but acknowledged: “We always have contingency plans.”

Gov. Kate Brown has been a vocal critic of the gag rule since it was first proposed and last year threatened to pull Oregon from the Title X program rather than adhere to its limitations. It’s unclear, however, how the state, facing significant budgetary challenges, would replace the $3 million in Title X funding it received in its last fiscal year.

“We will not stand by as the Trump Administration delivers yet another roadblock to accessing health care services that patients need to thrive,” Brown said in statement on the lawsuits. “I am committed to protecting access to family planning, reproductive and preventive health care for low-income and underserved Oregonians.”

The gag rule has been widely criticized by national and state provider groups. Leaders from more than 100 different medical organizations have written letters in opposition to the rule, and last week groups representing 4.3 million health care professionals issued a joint statement in opposition.

Officials from the Oregon Medical Association said the rule intrudes on the doctor-patient relationship and sets a dangerous precedent that puts vulnerable patients at risk.

“Title X has allowed the provision of quality contraceptive and pregnancy care to millions of women who are financially struggling,” said Dr. Fred Williams, president of the Oregon Medical Association. “An irreplaceable part of this care consists of providing competent and complete medical information about all of their options available.”

Under the rule, doctors could not talk about abortion even when their patients ask about it, and would be required to refer women for prenatal care even if the woman intended to terminate her pregnancy.

“If we lose this funding in my area, it will limit access for our most vulnerable populations,” said Dr. Heidi Beery, a Roseburg doctor and member of the OMA Executive Committee. “Patients deserve to access care in the communities were they live.”

The U.S. is experiencing a 30-year low in unintended pregnancies, while the birth rate for teens has dropped by 65 percent from 1991 to 2015, reaching an all-time low in 2017. The federal Centers for Disease Control and Prevention released data last fall showing the U.S. abortion rate had hit its lowest point in a decade.

While the Trump administration’s rule is seen as another attempt to limit access to abortion in the U.S., critics say it could lead to more abortion. According to the AMA, without Title X the rates of unintended pregnancy and abortion would be 31 percent higher.

— Reporter: 541-633-2162, mhawryluk@bendbulletin.com

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