The Biden administration increases access to mifepristone and moves toward reversing the Trump administration “gag” rule on federal abortion funding
The weekly, Feminist News Digest of the Feminist Majority Foundation (to which I am a donor) recently reported two significant moves of the Biden administration toward restoring some of the reproductive rights stripped away during the Trump administration.
Mail delivery of the “abortion pill” (mifepristone, brand name Mifeprex)
On April 12, 2021, the Biden administration lifted the Trump administration-imposed ban on women receiving mifepristone pills required for medication-induced abortion through the mail. Unfortunately, the new reprieve only applies for the duration of the pandemic, but it is still a significant victory for advocates of women’s right to choose.
As reported by CBS News, acting FDA commissioner Janet Woodcock said that the agency would stop enforcing the rule that requires patients to pick up the medication in person from a medical provider during the pandemic.
Based on the results of four recent medical studies, Woodcock wrote that “these studies do not appear to show increases in serious safety concerns… occurring with medical abortion as a result of modifying the in-person dispensing requirement during the COVID-19 pandemic.”
Representatives of several professional medical organizations and reproductive health advocacy groups voiced support for this decision.
“Mifepristone itself has demonstrated, through both clinical study and decades of use, to be a safe, effective medication,” said Maureen Phipps, the president, and chief executive of the American College of Obstetricians and Gynecologists. “Requiring the medicine to be dispensed in person, then taken elsewhere at the patients’ discretion, is arbitrary and does nothing to bolster the safety of an already-safe medicine.”
The action of the Biden administration contradicts a recent Supreme Court ruling which appealed a federal judge’s decision that suspended the ban. The judge ruled that the requirement endangered the health of pregnant people seeking medication abortion by requiring them to pick up the drug in person. The action of the FDA commissioner overrides the Supreme Court ruling since it comes from the FDA itself and not a lower court.
Shortly after the pandemic began, many heavily regulated medications such as methadone were given the green light to be dispensed through the mail. Abortion rights advocates used this to highlight the disparity in how mifepristone was regulated under the Trump administration despite the public health crisis.
Reversal of Trump’s Domestic Gag Rule
On April 13, 2021, the Biden Administration announced that they were taking steps to undo the Trump-era domestic “gag” rule, which prevented clinics that referred patients for abortions from receiving federal funding.
The proposed Department of Health and Human Services (HHS) rule would revoke the Trump restrictions eventually, but not immediately. If implemented, the rule will return the program to how it was run until 2019, before the Trump administration changed the rules.
A report in Newsweek states that officials believe this Trump-directed policy change may have resulted in an estimated 180,000 unplanned pregnancies.
The U.S. Department of Health and Human Services (HHS) wrote in a proposal that since President Trump’s 2019 “gag” rule was issued — which bans federal family planning clinics from referring women for abortions — clinics have seen a 37 percent overall reduction in clients from the average caseload from 2016–18, or 1.5 million fewer women a year.
Title X, the federal family planning program, was first implemented in 1970 and is the only federal grant program that provides funding for comprehensive family planning and related preventative health services. According to HHS, it provides $286 million annually to clinics that serve mostly low-income patients, including Planned Parenthood and affiliates, which served about 40 percent of those patients before exiting the program in 2019.
According to the Newsweek article: “Advancing equity for all, including people of color and others who have been historically underserved, marginalized, and adversely affected by persistent poverty and inequality, is a priority for OPA [the HHS Office of Population Affairs] and the Title X program,” HHS wrote in the proposal. “By focusing on advancing equity in the Title X program, we can create opportunities for the improvement of communities that have been historically underserved, which benefits everyone,” the agency wrote.
Title X funds thousands of providers offering contraception, cancer screening, and other reproductive health services to millions of low-income people of all genders throughout the country.
In 2019, when Trump issued the domestic gag rule, about one-quarter of the nearly 4,000 providers left the program, arguing that the rule was unethical. Because of this, several states had no Title X providers.
In California, 36% of its Title X service sites withdrew from the program, which resulted in over 700,000 patients losing access to Title X-funded care.
“As a result of the dramatic decline in Title X services provided, the 2019 Final Rule undermined the mission of the Title X program by helping fewer individuals in planning and spacing births, providing fewer preventive health services, and delivering fewer screenings” for sexually transmitted infections, HHS said in the proposal.
Biden’s reversal of Trump’s rule will particularly impact communities of color, especially Black patients. Fatima Goss Graves, president and CEO of National Women’s Law Center said in a statement that “This rule especially harmed people who already face barriers to care, including people of color, patients with a low income, and those who are uninsured. Everyone deserves quality health care, which includes receiving accurate information about abortion. That’s true now more than ever — in the midst of a public health and economic crisis, people need the important care that Title X health centers provide. We’re glad the Biden Administration is moving to restore this program, and we will continue to fight for quality care alongside the Biden-Harris administration, Title X family planning providers, and their patients.”
The rule reversal on family planning clinics is proceeding alongside previous litigation over the Trump administration policy now before the Supreme Court. In that case, the justices agreed to hear a challenge to Biden’s rules now trying to supersede. The Biden administration and medical groups that filed the challenge are asking the court to dismiss the case, but Republican state attorneys general want it to proceed. The court has yet to say what it will do.