SILENT OR SILENCED: THE IMPACT OF ABORTION GAG RULES ON TITLE X CLINICS AND REPRODUCTIVE HEALTH CARE ACCESS.

In 1970, Title X of the Public Health Service Act (Title X) established the National Family Planning Program (the Program) within the Department of Health and Human Services (HHS) to decrease the adverse effects of inadequately spaced childbearing by providing affordable reproductive health services, especially in low-income communities. Title X distributes grants to service sites that meet regulatory requirements set by the Secretary of HHS (the Secretary). In 2018, Title X had nearly 4,000 sites in the United States and provided invaluable health care to over 3.9 million people. From inception, Title X expressly prohibited grants from going to "programs where abortion is a method of family planning" but gave the Secretary discretion to interpret what activities "support" abortion. In 2019, the Trump Administration passed a gag rule that violated medical ethics obligations by prohibiting physicians from counseling patients on or referring for abortions. In response, nearly one-third of service sites left the Title X network by 2020, and the number of people served by the Program dropped to 1.5 million. The Biden Administration revoked the rule in 2021 and the Program began rebuilding one piece at a time; however, the network suffered serious losses and still has not recovered to its 2018 numbers. Nevertheless, the second Trump Administration has made clear its intent to further restrict reproductive rights, and it is likely another gag rule will be enacted. This Comment argues against the legality of gag rules and discusses the impact these regulations have on the Title X Program and public health in general. [ABSTRACT FROM AUTHOR]