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SALT LAKE CITY — The Planned Parenthood Association of Utah will rejoin Title X to receive federal family planning funding after its 2019 withdrawal over a Trump administration rule placed on the program.
The return comes after President Joe Biden rolled back the 2019 rule that prohibited Title X grantees from referring patients for abortion, except in cases of rape, incest or medical emergency. The Title X program provides low-income women with contraceptives, STD screenings and other services.
Prior to the rule and the nonprofit's withdrawal, the Planned Parenthood Association of Utah was the sole Title X grantee for 35 years. Over the years it provided over 37,000 people with reproductive health care and family planning services. When the provider removed itself from the program it left gaps in services not only statewide but nationwide.
"Once the new rules had been implemented in 2019, the program deflated to be perfectly honest. There were six states without Title X funding, Utah being one of them. The other states pieced together some programs, but many fewer women were served. It was a sad day for the women and families of the United States," said Karrie Galloway, president and CEO of the Planned Parenthood Association of Utah.
The funding accounted for 16% of the organization's revenue, according to the organization's 2018 annual report. The departure from the Title X program accounted for $2 million in funding that benefited 71% of its patients that were without insurance. Nationally, Planned Parenthood served 40% of patients who get services through the Title X program.
The organization's departure drew mixed reviews across the state.
"Planned Parenthood has made a choice that reflects their priorities," said Mary Taylor, president of Pro-Life Utah, in an email to the Deseret News at the time. "If Planned Parenthood's allegiance to abortion is greater than their desire to help disadvantaged women with real health care, there's no doubt in my mind that other clinics or organizations will step in to provide those services."
While other states were able to find funding or apply for the grant through other programs — Utah was unable to access the funding but not for lack of trying.
In 2020, the state legislature passed a law requiring the Utah Department of Health to apply for the Title X grant. Included in the application was a request for a waiver that would exempt federal restrictions regarding minors requesting contraceptives. Utah state law requires a parent or guardian to receive notice before a health provider can supply them.
The grant required the department to enter a new mindset towards direct services, said Lynne Nilson, director of Maternal and Child Health at the Utah Department of Health. In researching and writing the grant application the department observed where services were lacking or needed.
"There's a there's a definite need with low-income families for family planning services and contraceptive services and there's definitely a need in rural areas — where you may not even have an OB/GYN in that community," said Nilson. "You could call it, for lack of a better word, a contraception desert."
The waiver was rejected by the U.S. Department of Health and Human Services due to the Age Discrimination Act, which prohibits discrimination on the basis of age in federal health and human service-funded programs and activities.
Under the Age Act, recipients may not exclude, deny, or limit services to, or otherwise discriminate against, persons on the basis of age which directly conflicts with Utah state code. The conflict and rejection of the waiver resulted in the Utah Department of Health turning down approximately $3 million in Title X funding.
"Family planning in Utah is tricky and it shouldn't be," said Nilson. "So that's where the kind of the catch-22 falls."
Without Title X funding to provide subsidized care, there was a gap in services and a decline in patients accessing care, according to the Planned Parenthood Association of Utah.
"If you're a woman on a modest income you may have to decide between food, rent, transportation, maybe a little entertainment in your life, or your health care. It's just so frustrating to think that for two years Utah went without those services for the people of Utah," said Galloway.
She continued, "We know from statistics, women of color, Indigenous people, people who are marginalized at every step in life and need help had to forgo this help and to be able to serve them again, without any stigma, any embarrassment of saying 'Don't you have $5?' is a comforting feeling."
Whether due to COVID-19 or the lack of funding the number of patients served dropped from over 46,000 in 2018 to just under 42,000 in 2020. Patients served without insurance dropped from 71% in 2018 to 60% in 2020, according to the annual reports.
Other notable declines included between the two years include pap smears, testicular and breast examinations, and contraceptive services.
At the time of the organization's departure, Alexis McGill Johnson, the acting president and CEO of national Planned Parenthood, said lack of funding would have significant impacts on low-income women.
"It will simply be impossible for other health centers to fill the gap," McGill Johnson said. "Wait times for appointments will skyrocket."
The gaps observed in the statistics could be a variety of factors including the COVID-19 pandemic and the lack of Title X funding, although clinics in Utah remained open and operating during the pandemic. Specific data or statistics pertaining to the withdrawal from funding and impacts across the state hasn't been pulled, according to Nilson.
"We have worked extremely diligently to make sure that the basic family planning services that people need to live a fulfilled life have been available," said Galloway. "This just adds another wonderful aspect to easing out of the pandemic is that Planned Parenthood again, has subsidized services with no ramifications for the women and their families."
The return of federal family planning funding is a point of celebration for both agencies.
"Here's the bottom line, it's really good to have the funding back in the state, no matter who does it," said Nilson.
