Title X Change Would Threaten Evidence-based Care, AAFP Warns

Women's Health, Doctors' Ethics at Stake

July 30, 2018 04:09 pm News Staff

A change to Title X regulations that the administration is proposing would "force family physicians to omit important and accurate medical information necessary for our patients to make timely, fully informed decisions," the AAFP is warning.

[female physician talking with female patient]

"This encroaches on physicians' codes of ethics and responsibilities to our patients," AAFP President Michael Munger, M.D., of Overland Park, Kan., said in a July 26 statement.  

The statement highlights key issues that the Academy detailed in a July 25 letter(4 page PDF) to HHS Secretary Alex Azar ahead of a July 31 deadline for public comments on the proposed new rule.  

HHS notes that(www.hhs.gov) Title X is "the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services." It is intended to provide access to contraceptive services, supplies and information to everyone, especially those with low incomes.

As Munger pointed out, "More than 8.7 million women gained maternity care services thanks to this coverage, and 62 million women with private insurance now have access to vital preventive services."

According to the Title X Family Planning Report(www.hhs.gov) published by HHS in August 2017, "Title X providers continue to make important gains in delivering high-quality, evidence-based contraceptive and related preventive care to a vulnerable population." Further, the report notes the role of Title X in screening for cervical cancer, chlamydia and breast cancer that contributes to early detection and treatment.

The original Title X statute was sponsored by then-U.S. Rep. George H.W. Bush and signed by President Richard M. Nixon in 1970. "If family planning is anything," Bush said,(books.google.com) "it is a public health matter."

Importantly, Munger noted that Title X is the only federal grant program exclusively dedicated to enabling low-income and adolescent patients to access effective family planning and related preventive health services, and he said restricting the information patients receive will lead to adverse outcomes.

"The AAFP opposes legislative or regulatory restrictions on information that can be given to women, or policies that force physicians to provide women with inaccurate information," he added. "This could lead to increased rates of unplanned pregnancy, pregnancy complications and undiagnosed medical conditions. Research shows women who have unplanned pregnancies are more likely to delay prenatal care, increasing the risk of birth defects, low birth weight and poor mental and physical development in early childhood."

The statement echoes a May President's Message in which Munger noted that the AAFP opposes any intrusion on family physicians' relationships with their patients.

"This proposal does that by putting other concerns above our ethical obligations to patients," he wrote. "The Academy respects the right of physicians to decline to participate in health care services that they're morally opposed to. However, the AAFP also strongly supports a physician's ability to deliver legal medical services."

The new statement called on HHS "to maintain coverage of evidence-based essential health benefits, such as maternity coverage and women's preventive services, without cost-sharing," and supported over-the-counter access to oral contraception.

"The health of women is at stake," the statement concluded.

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