By Valerie Ploumpis, National Policy Director
Funding from Title X — the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services — has long provided vital health care services in California, home to one in four Title X patients who receive care under Essential Access Health. Under the program last year, California received more than $20 billion to support access to high-quality family planning and sexual health care for low-income people — well-woman checks, birth control and reproductive services, cancer screenings, and testing and treatment for sexually-transmitted infections, including HIV and AIDS.
Current CDC guidelines require that health care providers provide culturally-competent care to their LGBTQ patients under Title X. But even with these protections, a toxic brew of bias, discrimination, indifference and ignorance means that, in reality, many LGBTQ people report they have experienced sub-par care. Widely-shared anecdotes about maltreatment by health care providers in turn cause others to avoid medical professionals until absolutely necessary.
That’s why Equality California quickly responded to a request for public comments by the Department of Health and Human Services to express our deep concerns that cuts to Title X funding would affect health care for low-income LGBTQ people including:
Lesbians, bisexual women, and gender-nonconforming people are much less likely than non-LGBTQ women to get routine Pap tests for cervical cancer. Other studies indicate that lesbians and bisexual women have higher rates of some risk factors for breast cancer.
Studies, including one conducted by the National Institute of Health, find that lesbians, bisexual women and gender-nonconforming people also experience unintended pregnancy at high rates (link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299536/). Equality California is extremely concerned that reducing access to Title X-funded contraceptive counseling and birth control will lead to higher rates of unwanted pregnancy – an unwelcome reversal in a 30-year low of unwanted pregnancies, especially for teenagers.
LGBTQ people, especially men who have sex with men, have disproportionately higher rates of STIs, including chlamydia, gonorrhea and syphilis. California has seen a 45% increase in STIs over the past five years, setting record highs in each of the last three years. This is clearly not the time for STI prevention counseling, testing, and treatment under Title X funding to be cut back.
The CDC finds that men who have sex with men account for the vast majority of people living with HIV and new HIV diagnoses in the U.S. CDC research also indicates that transgender women also bear a disproportionate HIV burden.
But beyond cutting Title X funding for these vital health care services, HHS’s proposed changes would also prohibit medical providers – including Planned Parenthood and other women’s health clinics, doctors, nurses, hospitals, and community health centers — from providing any information about or talking to patients about safe and legal abortion.
Federal law already prevents Title X funding from covering abortion services, so the intent of the “gag rule” is clearly to prevent medical providers from talking about abortion as a family planning option and to punish providers who do by pulling the funding they need to provide reproductive and sexual health services to people who could not otherwise afford them.
The proposed rules would also remove the requirement that family planning counseling be “medically appropriate” and encourages “natural family planning” and abstinence-only practices.
Equality California’s comments strongly urged the Secretary of HHS to abandon these proposed rule changes. Helping people who live at or below the Federal poverty rate to access birth control, avoid unwanted pregnancies, and detect and treat sexually transmitted infections, breast cancer and cervical cancer should be HHS’s primary concern – not find ways to restrict access or block it altogether. And requiring trusted health care providers to withhold full and accurate info to pregnant women about option to secure a safe and legal abortion is horrifying and unethical.
Equality California will continue to fight for robust, affordable, non-discriminatory health care for all.