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Four Governors Refuse to Participate in Unethical Title X

Washington, DC —  Fifteen governors have put the interests of patients and providers ahead of politics, and rejected the Trump-Pence administration’s proposed unethical gag rule on Title X  — the nation’s only program for affordable birth control and reproductive health care.

Four of the 15 governors, whose states are direct grantees of Title X, have already announced that they’d refuse to participate in the program if Trump’s gag rule were finalized. Since it would make providing ethical and professional care impossible, the governors of Hawaii, New York, Oregon, and Washington announced they would have no choice but refuse to participate in an unethical Title X program.

Statement from Dawn Laguens, Executive Vice President, Planned Parenthood Federation of America:

Planned Parenthood applauds the many governors who are standing up for people’s health and rights by rejecting Trump’s unethical gag rule. It’s no wonder Hawaii, New York, Oregon, and Washington announced they could no longer participate in the Title X program, if the gag rule takes effect. This gag rule is so unethical, it is forcing quality health care providers to withdraw from the Title X program. President Trump and HHS Secretary Azar must listen to the health care community and withdraw this harmful rule, before it’s too late.

In rejecting the Trump gag rule, Hawaii Governor David Ige said:

“The State of Hawai‘i will explore all options available to ensure that the proposed rules do not threaten the health and wellbeing of our women, and the integrity of the state’s family planning program. Hawai‘i will not accept federal funds for these programs if the proposed rules are implemented.”

In rejecting the Trump gag rule, New York Governor Andrew Cuomo said:

“New York will explore all legal avenues available to us to ensure that the proposed rules' attack does not threaten the health and wellbeing of New Yorkers and the integrity of New York's Family Planning Program. If the rules are enacted as proposed, it will be impossible for New York to continue its comprehensive Title X program.”   

In rejecting the Trump gag rule, Oregon Governor Kate Brown said:

“If the Trump gag rule is adopted and legal challenges are unsuccessful, it would leave me no choice but to act in the best interests of the citizens of Oregon and our state law, and withdraw our state's participation from an unethical, ineffective Title X program that reduces access to essential preventive health services.”

In rejecting the Trump gag rule, Washington Governor Jay Inslee said:

“The Trump Administration has given our state no choice but to explore all possible avenues, including legal options, to block this policy from harming the women of Washington. I believe the rule as written will not withstand legal challenge, and I'll do all I can to prevent it. If the Trump gag rule is finalized as written, and cannot be blocked in court, we would be left with no choice but to refuse to participate in an unethical Title X program.”

Additionally, Axis Community Health, a federally qualified health center in the San Francisco Bay area that has been a Title X provider for more than 30 years stated in their official comment that they they would refuse to participate in an unethical Title X program.

“This Proposed Rule could threaten the patient/provider relationship by hindering trust and shifting the provider role from caregiver to interrogator, and violate the privacy rights of Title X patients by requiring them to disclose personal and private information that must be recorded in electronic health records….The Proposed Rule's censorship on abortion referrals is not only against medical ethics and standards of care, it is unnecessary and inappropriate. No other safe and medically approved procedure faces the same level of government-sanctioned restrictions…If the proposed regulations go into effect, Axis Community Health will no longer participate in the Title X program.”

Other governors have also expressed strong opposition to the Trump gag rule in the closing days of the comment period.

Republican Governor Charlie Baker, from Massachusetts, submitted official comments to HHS stating that the “proposed rule should be rescinded in its entirety.” The comments go on to say that it “would enact unnecessary barriers to a woman's right to choose, to be offered a comprehensive set of family health planning options, and to be provided with the information necessary to make an informed and non-coerced decision that best meets the needs of her individual or family circumstance. Patients deserved to be treated with dignity and respect and to receive comprehensive, medically accurate information.”

Governor John Hickenlooper, from Colorado, submitted a letter stating, “Perhaps most troubling, this new rule interferes with the trusted relationship between women and their doctors….Every woman in Colorado deserves to speak openly with their doctor and make the health care decisions that are best for them. This rule puts politicians in the exam room, limiting the information a doctor can provide to his or her patients. This rule will undermine the success that Colorado has achieved in reducing unintended pregnancy, promoting self-sufficiency, and reducing the costs of Medicaid and public assistance. All Coloradans deserve the opportunity to succeed. Starting a family on their own terms is a key part of ensuring economic security for many women. As such, we urge you with withdraw this rule.”

Governor Tom Wolf, from Pennsylvania, stated, “President Trump’s plan to implement a Title X gag rule will cut women off from critical health care services like birth control and preventive care, including cancer screenings, and will censor doctors and strip federal funding from certain health care providers for discussing legal health care procedures with their patients.”

These statements further reinforce the strong opposition by 14 governors in a letter sent to HHS Secretary Azar immediately after the Trump gag rule was proposed. That letter stated, “We stand with women and men in our states by rejecting this Administration’s efforts to interfere in the doctor-patient relationship, gut women’s access to family planning services, and force medical professionals to knowingly withhold information from their patients. If the federal government breaks its commitment to states in the Title X program, we will react in kind and do what is necessary to protect the health of our constituents...And if this reckless policy is finalized as written, we will have no choice but to explore all possible avenues, including legal options, to block it from harming the women in our states.”

The gag rule has also been met with widespread opposition from the health care community. Major medical associations, like the American College of Obstetricians and Gynecologists, the American College of Physicians, and others oppose this rule. The American Medical Association stated that they are “particularly alarmed” by Trump’s domestic gag rule and the American Nurses Association declared that it “violates basic ethics of the [nursing] profession.” The National Association of Community Health Centers opposes the gag rule, as do 110 public health organizations, and public health experts such as former U.S. surgeon general Dr. Vivek H. Murthy, and many others.  

A number of bioethicists and public health experts have declared the gag rule unethical.

  • R. Alto Charo, bioethicist at the University of Wisconsin, wrote in an editorial: “To require a provider to withhold information, and to actively mislead a patient through a lie of omission, is unethical. It flies in the face of fundamental medical ethics and standard of care — full stop.”

  • Julie Chor, an obstetrician-gynecologist and clinical medical ethicist at the University of Chicago wrote in The New York Times: “As a board-certified obstetrician-gynecologist, I can attest that this proposal is bad medicine; as a medical ethicist, I can also affirm it is an assault on both the patient-provider relationship and the autonomy of patients and health care providers….A ban that would have prevented me from counseling and helping her get the care that she needed would have forced me to violate my oath to do what is in the best medical interest of my patients.”  

  • Dr. Jody Steinauer and Dr. Philip Darney, from the University of California, San Francisco Bixby Center for Global Reproductive Health, wrote in The Lancet: “The potential violations of medical ethics go beyond withholding information and making unethical referrals. Delaying access to abortion care has serious health risks.”

National opinion polls show that 73 percent of Americans oppose administration actions, like the domestic gag rule that block access to care for millions of women and violate the trust they  have in their doctors. A new Kaiser poll released this week shows that 70 percent  of women, aged 18-44, and 60 percent of Republican women oppose the Trump gag rule. More than 200 members of Congress (Senate letter and House letter) and over 110 public health organizations have come out in opposition to a gag policy, as well as 80 mayors and 274 state legislators.

In May, the Trump-Pence administration introduced a proposed gag rule on Title X — the decades-old national program for affordable birth control and reproductive health care that four million people rely on each year. The gag rule would make it illegal for doctors and nurses in the Title X program across the country to tell their patients how and where they can access safe, legal abortion. It would also impose new restrictions designed to make it impossible for patients to get birth control or preventive care from reproductive health care providers like Planned Parenthood. Additionally, it would drastically undercut access to birth control across the country, removing the requirement that Title X providers offer their patients a full range of FDA-approved birth control, or even that they offer birth control that is “medically approved.” It also opens the door to allowing deceptive anti-abortion counseling centers to take the place of comprehensive women’s health care providers in the program.

The Title X program is meant to help those who have the least access to basic health care, like birth control and cancer screenings. Instead, the Trump-Pence administration is set on dismantling it — and using it to keep people from the care they need and deserve. It is clear that the Trump gag rule is unethical, unworkable, and would cause unthinkable harm to women across the country, said Laguens.


Planned Parenthood is the nation’s leading provider and advocate of high-quality, affordable health care for women, men, and young people, as well as the nation’s largest provider of sex education. With more than 600 health centers across the country, Planned Parenthood organizations serve all patients with care and compassion, with respect and without judgment. Through health centers, programs in schools and communities, and online resources, Planned Parenthood is a trusted source of reliable health information that allows people to make informed health decisions. We do all this because we care passionately about helping people lead healthier lives.