Washington State

Office of the Attorney General

Attorney General

Bob Ferguson

Jul 31 2018

Proposed rule will severely diminish women’s access to family planning services

SEATTLE — Attorney General Bob Ferguson, joined by three other attorneys general, today urged the Trump Administration to withdraw a proposed rule that would reduce women’s family planning options, interfere in doctor-patient relationships and potentially leave many vulnerable women with no healthcare access at all.

In a letter to U.S. Health and Human Services Secretary Alex M. Azar II, Ferguson and the attorneys general from Massachusetts, Oregon and Vermont argue that the rule would allow the government to unnecessarily and unconstitutionally interfere in doctor-patient relationships and violate rights to free speech and women’s freedom protected by Roe v. Wade.

Congress designed Title X to benefit the most vulnerable populations: low-income and rural families and people of color. Providers already cannot use Title X funding for abortion services. Currently, all Title X-funded providers that also offer abortion services must separate these services financially from the Title X funding they receive.

On June 1, the Trump Administration proposed a rule that would eliminate funding to Title X family planning providers who, using non-Title X funds, also provide abortion services.

“The federal government has no place in the exam room,” said Ferguson. “Women should be able to count on their medical providers to give them complete, unbiased information on their healthcare options. This rule would undermine that relationship.”

“There is no doubt the Trump Administration’s damaging proposal would weaponize the Title X program, undermine women’s health, and deny patients comprehensive, medically accurate information about their medical care. It is nothing more than a domestic gag rule that has no place in Washington’s medical facilities,” said Gov. Jay Inslee. “Washington has been, and will continue to be, a state that stands with women and their right to safe and legal abortion and reproductive care. We will do all we can to block this reckless policy.”

Rule impacts

The Trump Administration’s proposed rule would block federal funds to providers that offer abortion services, even though providers already cannot perform these services using Title X funds. It would require facilities to physically separate their abortion services from services done with Title X funds. Ferguson and the states argue that forcing providers to find or create separate facilities to perform their abortion services and referrals from their Title X activities will jeopardize some clinics and force many providers to forgo Title X funding altogether.

It would also curtail any providers who receive any Title X funds from counseling and giving referrals to abortion services to their patients.

The rule would eliminate requirements that Title X-funded providers offer a broad range of non-directive, medically approved family planning methods. It would prevent any clinic that received any Title X funds from referring patients to abortion services, unless the patient uses “magic words” indicating she already has decided she would like an abortion. If the patient says she would like an abortion, the provider may only provide her with a list of clinics that do and do not offer that service. If the patient chooses any other option, the provider must assist the patient with setting up appointments.

Additionally, the proposed rule would direct new funds to faith-based and other organizations that promote less effective family planning methods, such as fertility awareness and abstinence, as opposed to the full range of medically approved options.

According to the letter, Title X programs serve an estimated 4 million women annually across the United States. More than two-thirds of these women have incomes at or below the federal poverty level.

In addition to family planning care, Title X providers also screen for high blood pressure, diabetes and depression. For the four out of 10 women who receive contraceptive care from Title X-funded and other similar facilities, this is their only source of healthcare. 

Washington impacts

In Washington, 91,284 patients received care through Title X in 2017 alone. More than half of these patients were at or below the federal poverty line. The Washington Department of Health estimates that services provided to these patients prevented 16,233 unintended pregnancies, resulting in savings for the state of more than $100 million.

The attorneys general argue that implementing this rule would cause the majority of Title X providers to stop providing Title X-funded services. This would keep thousands of vulnerable residents from reasonably accessing contraception, cancer and STI screening and other family planning care. The result would overburden remaining Title X facilities and increase the states’ costs substantially as a result of the foreseeable increase in unintended pregnancies and other preventable health consequences.

In 20 of Washington’s 39 counties, there is only one Title X provider, and that provider also performs abortions outside of its Title X-funded services. In today’s letter, Ferguson alleges that if Health and Human Services (HHS) implements the rule, it will leave these 20 counties and thousands of patients without a Title X-funded provider.

Around 11,000 patients in Washington received Title X-funded services from providers that also performed abortions without using Title X funds in 2017. These patients would be forced to find a new provider, if one is available.

“Thousands of patients will lose reasonable access to family planning services and other critical reproductive health services. The Title X providers that remain will be prevented from delivering the high-quality and complete medical care that they have always provided,” the attorneys general write.

“Studies have shown that access to family planning assistance makes it more likely that a teen will graduate high school, that a woman will achieve her educational and career goals, and that a woman will earn more money (positively impacting not only her life, but the lives of her family).  Access to family planning also leads to healthier relationships, better health outcomes, and better parenting.  Title X is critical in assuring that teens and low-income women can achieve these same positive outcomes.”

Attorney General Ferguson has previously taken on the Trump Administration in an effort to protect women’s reproductive rights. Last year, Ferguson filed a lawsuit to block the Administration’s rules undermining women’s access to contraception. Two federal judges temporarily halted the rules’ implementation in separate cases across the nation.


The Office of the Attorney General is the chief legal office for the state of Washington with attorneys and staff in 2z divisions across the state providing legal services to roughly 200 state agencies, boards and commissions. Visit www.atg.wa.gov to learn more.



Brionna Aho, Communications Director, (360) 753-2727; brionna.aho@atg.wa.gov