Anti-abortion clinics caught in tumult over Trump family planning rules
A faith-based chain of clinics that won $5.1 million federal family planning funds by positioning itself as an alternative to Planned Parenthood now unexpectedly finds itself faced with the prospect of offering contraception and counseling that includes discussing abortion — activities antithetical to its very existence.
The nonprofit Obria Group received the Title X grant in Marchas a sweeping Trump administration revamp of the program was churning forward. New rules would, among other things, bar health providers in the program from offering or referring patients for abortions — a restriction critics call a “gag rule.” Since then, a series of federal court injunctions have frozen the changes, prompting abortion-rights groups to demand Obria comply with existing standards.
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“It’s clearly a violation of the rules and HHS’s job is to enforce the existing rule,” said Emily Nestler, senior staff attorney at the Center for Reproductive Rights. “If HHS doesn’t do so, who will hold them accountable?”
HHS officials told POLITICO the department doesn’t intend to force Obria, which is heavily funded by the Catholic Church, to go against its moral principles.
“The Department has acknowledged that it cannot enforce the current requirement for nondirective abortion counseling and abortion referral with respect to Title X grantees, clinics, or providers that object to providing such services, as a result of certain federal conscience protection statutes,” a spokesperson said.
The watchdog Campaign for Accountability, which already is suing HHS over access to documents connected to the policy changes, is considering asking the agency’s inspector general office to investigate how the money is being used — and trying to rally Congress to get involved.
“Congress appropriates the money and sets out rules governing how that money should be spent,” said Alice Huling, the group’s counsel. “Obria, from what we can tell and from what they’ve said, is not complying with the rules, and that becomes a misuse of taxpayer money.”
The House Oversight Committee under Chairman Elijah Cummings (D-Md.) is looking into the matter, a Democratic aide said. “The Trump Administration’s decision to direct funds to grantees that refuse to provide access to contraceptives contradicts the goal of the Title X program … This is not what Congress intended,” the aide wrote in an email.
The committee requested documents about the Title X rulemaking in February but hasn’t received anything to date, the aide said.
The Title X program distributes about $250 million annually to providers who serve low-income women. HHS has the discretion to pick grant recipients.
Obria officials declined to directly address the matter. The group, which opposes both abortion and contraception in all forms — including condoms — other than fertility awareness methods, is one of California’s two main grant recipients of 2019 Title X funds. The other, Essential Access Health, which sued over the administration’s rule change, received $21 million to fund more than 350 clinics statewide for the year.
Based in Orange County, Calif., Obria promotes itself as a health network offering an alternative approach to family planning and has grown from three centers and a mobile van into a chain with 30 clinics in five states. It aims to reach 200 sites by 2021, relying mostly on private donations and funding from sources like Title X. Obria was turned down for Title X funding in 2018 because it didn’t provide birth control other than natural family planning and abstinence. The organization had previously discussed partnering with other providers that cover contraception in order to qualify for program dollars.
Faith-based groups have accused the organization of compromising its principles on contraception in a bid to win federal funds.
That’s because under both the current and proposed Trump rules, Title X grantees must offer a “broad” range of birth control options, including hormonal contraception. The Trump administration’s rule change simply removes the requirement that these options have to be “medically approved.”
An HHS spokesperson said grant recipients have to provide a broad range of family planning servicesbut added that not every provider connected to the grantee is subject to the requirement. “Grantees who fail to follow this requirement would be out of compliance with the conditions of the grant,” the spokesperson said.
Obria, as a main grant recipient, won $1.7 million a year for the next three years to distribute to six subrecipients. The three Obria clinic networks receiving the grants — located in the Bay Area and in Southern California — don’t offer birth control beyond fertility awareness methods. But Obria confirmed two other subrecipients — Hurtt Family Health Clinic and Share Our Selves — are federally qualified health centers that both offer contraception.
Kathleen Eaton Bravo, the group’s founder and CEO, said in a statement that “Obria clinics have never distributed or referred for contraceptives and have no plans to do so.” But that still doesn’t sit well with other faith-based providers.
“They applied for it, so it would be a cash grab [that] would continue to pay their salaries,” Abby Johnson, a former Planned Parenthood director-turned-anti-abortion activist, told POLITICO. Johnson said she worked for Obria for nine months but left last year due to her concerns over the group seeking Title X funds.
The requirement to offer contraceptionwas enough to convince Christine Accurso, executive director of Pro Women’s Healthcare Centers, another faith-based provider, to steer clear of seeking Title X funding.
“I think the Obria in a rough place because Title X is written for contraception,” Accurso said. She said she was open to the possibly “they found their way around” the requirement, but there’s no evidence of that.
Abortion-rights groups say they’re determined not to let Obria out of program requirements as the challenges to the rule changes churn through the courts.
“The awarding of funding to Obria is just one piece of the clear agenda by the Trump-Pence administration to strip funding from certain health care providers, like Planned Parenthood, and shift funds to ideological organizations, further restricting access to abortion care,” said Crystal Strait, president and CEO of Planned Parenthood Affiliates of California, in a statement. “We will use every avenue possible to fight back and protect access to comprehensive reproductive health care.”