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Care can’t be gagged

Imagine you’re a health care provider and you know exactly how to help your patient. You’ve got the information they need and there’s a safe, legal medical procedure they want. Now, imagine you can’t tell them about it. You can’t give them all the facts and you can’t tell them where they can get care they need. How would you feel?

I can tell you—you’d feel heartbroken. And frustrated. And you’d feel like you’re lying to your patients, even though you’ve sworn to help them.

A year ago, the Trump-Pence administration began enforcing a “gag rule” for any provider who receives federal funding from Title X—the nation’s only program for affordable family planning. The rule prohibits clinicians like me from telling our patients how and where to access abortion, although the procedure remains legal in all 50 states. It asks that, at best, we fail to provide our patients with all their available options; at worst, it requires us to mislead or lie to our patients about their care.

The “gag rule” forced health care providers across the country, including Planned Parenthood, out of the Title X program. As a Physician Assistant and health center manager at Planned Parenthood of Southern New England, I am proud to say that I won’t be gagged, and I won’t stop providing the information and care my patients need.

Title X isn’t even about abortion. Title X is meant to keep sexual and reproductive health care like birth control, annual exams, lifesaving cancer screenings, and STD testing and treatment accessible and affordable to people who might otherwise be unable to pay. These are preventive, fundamental services every patient deserves.

The Title X program has had bipartisan support since its inception 50 years ago because it’s a remarkably effective public health program that helps ensure everyone can get the essential care they need, regardless of how much money they have or whether they have health insurance.

Sexual and reproductive health care is incredibly important to your overall health. During a wellness exam, we conduct tests for high blood pressure and perform screenings to ensure early detection of breast or cervical cancer, catching issues before they become more serious and more dangerous. A routine STD test can prevent an easily curable infection from advancing into long-term complications that become more severe, and more expensive, to treat. Keeping birth control affordable doesn’t just prevent unintended pregnancies—it has a range of proven medical, economic, and social benefits.

The Title X “gag rule” makes health care even harder to access. This was a crisis one year ago when the rule came into effect, and it’s only gotten worse as the COVID-19 pandemic widens the gap between people who can access health care and people who can’t. The gag rule especially harms people of color, people with low incomes, immigrants, and LGBTQ+ people—those who face multiple barriers to care due to systemic inequity and racism and who are more likely to contract COVID-19 and experience worse outcomes.

During all this uncertainty I’ve seen my patients defer or delay their preventive care, putting themselves at risk in the future. Economic uncertainty means more people are worried about how to pay for routine medical expenses—creating another very real barrier to care. The “gag rule” forces people to consider postponing their appointments at a time when people need more health care, not less.

Recently, a young woman came to a Planned Parenthood health center after experiencing irregular bleeding for years. We had prescribed her birth control, but she was uninsured and had delayed a visit for her bleeding because she was worried about the cost. Before coming to us, her previous doctors had told her the bleeding would probably clear up—but it hadn’t.

After our exam, an ultrasound was performed and we were able to see she was suffering from a cyst that could cause problems down the line, including infertility or possibly ovarian cancer. We were able to connect her to an affordable surgical option in the area and followed her care every step of the way. Without programs like Title X to keep preventive care accessible, this could have become very serious very quickly.

Most alarmingly, and most personal to me, the “gag rule” sets a terrifying precedent by allowing the government to tell providers what we can and cannot say to our patients. I can’t truly take care of someone if I withhold important information about their care or if I can’t give them all their options. Being “gagged” prevents my patients from making informed decisions about their bodies, their health, and their lives.

The “gag rule” runs counter to every value I’ve sworn to uphold as a medical professional to first do no harm. Politicians need to get out of our exam rooms and let providers do what we do best: provide uncompromising, honest, ethical, and comprehensive care. It’s what we owe every patient.

Amina Carter is Physician Assistant and Health Center Manager with Planned Parenthood of Southern New England.

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