Trump gag rule threatens patients

Trump administration restrictions would wreak havoc on health care across Illinois as offered by Planned Parenthood

Grecia Magdaleno first consulted Planned Parenthood under the federal Title X program: "It was easy. It was low-cost, and it was affirming the entire way through." (One Illinois/Zachary Sigelko)

By Ted Cox

Now that President Trump has agreed to stop separating children from detained immigrant families, he might want to reconsider separating Illinoisans from their health care.

In a bow to anti-abortion factions in his political base, Trump recently announced planned changes to Title X, a federal program on family planning that dates back to the Nixon administration. Trump proposed making it illegal for any agency receiving Title X funding to even discuss abortion, while imposing new restrictions on agencies that do, like Planned Parenthood, thus preventing doctors from discussing the full range of care with their patients.

That amounts to a "gag rule," according to Dr. Amy Whitaker, medical director and vice president of Planned Parenthood of Illinois.

"Prohibiting the speech, prohibiting the interaction between a patient and their doctor, is basically an egregious assault on medical ethics and undermines the standards of medical care," Whitaker said in a recent interview at Planned Parenthood's offices in downtown Chicago. "It's really an assault on the doctor-patient relationship. Patients have the right to expect that their doctors are going to give them the full range of options ... to make informed decisions about their own health." She called any limits on what can and should be discussed "a violation of that trust between a doctor and a patient."

"Prohibiting the interaction between a patient and their doctor is basically an egregious assault on medical ethics and undermines the standards of medical care."

Dr. Amy Whitaker of Planned Parenthood (One Illinois/Zachary Sigelko)

Planned Parenthood has 17 locations across Illinois. Local health departments and federally qualified health centers add up to more than four times that number, but nonetheless Planned Parenthood serves more patients in the Title X program, providing care to those who can't afford it, than any other agency in the state: more than 50,000 patients a year, according to a 2015 study, or 42 percent of the total in Illinois. According to Whitaker, current figures are that the organization treats 66,000 people a year.

Planned Parenthood estimates that it helped Illinois women prevent 25,700 unintended pregnancies and 8,700 abortions in 2015, and in treating more than 20,000 teenage women it prevented 5,600 unintended pregnancies and 1,600 abortions.

The U.S. Department of Health and Human Services posted the proposed changes online on June 1, initiating a 60-day period for public comment before they can be implemented. Trump touted the changes in a speech to an annual anti-abortion group's fundraiser in May.

What that ignored, however, is that Planned Parenthood is far more than an abortion agency. While not shying from that duty, Whitaker said, "The common misconception, the one we come across most frequently, is that's all we do." She pointed out that Planned Parenthood also does cancer screening and testing for sexually transmitted infections, and in some areas of Illinois it's the best and most convenient source of medical care of any kind.

"We do make the conscious decision to go to places that are underserved," Whitaker said. "We want to be in Englewood, we want to be in Pekin. We want to be in the places that other providers don't necessarily go to."

That's what initially drew Grecia Magdaleno to Planned Parenthood as a teenager growing up in Arizona. Now a University of Chicago student pursuing a master's degree in social-service administration, Magdaleno said, "Where I lived, primarily there were low-income, working-class people of color. My parents, specifically, they are undocumented immigrants and they are working-class, have their own small business, and in that area we didn't have community health centers, and if we did they were usually run by religious organizations or they were run by the county, but they were over capacity, and I wasn't able to ever fit in an appointment.

"And at the time I was closeted and was seeking services related to maybe coming out and talking about my sexuality with someone that I trusted. And I knew I couldn't do it at either of those other agencies because they didn't offer (those services) or  they were religiously affiliated, and I didn't feel comfortable going there.

"So I went to Planned Parenthood because it was not only in my neighborhood, but it was affordable too," Magdaleno added. "They provided services through the Title X program, so it was easy. It was low-cost, and it was affirming the entire way through.

"I went to Planned Parenthood, and they were able to sort of walk me through my feelings and then give me resources and give me affirmation that whatever I decided to do would be the right thing so long as it was my decision and I felt good about it."

The quality and confidentiality of the care led Magdaleno to remain a Planned Parenthood patient even as she moved to Tennessee and now Chicago, where she's also an intern at the organization. "In my experience in Arizona, Tennessee, there are a lot of people who understood that Planned Parenthood was the only health center that was available to them and that they could afford," Magdaleno said. "And they were OK with that. It wasn't something political to access care there. They just wanted care."

Magdaleno identifies as queer and prefers the pronoun "they," in part because it reflects the multiple people they are — as perhaps anyone is. "We're not one-dimensional people. I carry many different identities," they said. "So I'm someone who is the daughter of immigrants who are also undocumented. We're working-class. They didn't go to college, so I was the first college graduate in my family. I'll be the first person in my family to graduate with a master's degree. I'm queer, I'm brown, Latina. There's so many different aspects of me."

One of the key elements that drew them to Planned Parenthood is "you're not pigeonholed," Magdaleno said. "We're accepted as a whole person here. I think by coming to Planned Parenthood, they allow me to be my most authentic self."

Pointing out that 10 percent of Planned Parenthood's patients are men, Whitaker said that level of conscientious care is what attracts people to the organization across Illinois. She added that she's especially proud of Planned Parenthood's transgender care. "We've been providing transgender care for almost two years now," Whitaker said. "Our biggest population for our transgender services is in southern Illinois, in our downstate clinics, because there are so few options for getting transgender care in that area of the state."

Julie Lynn and Dr. Amy Whitaker stand in the Planned Parenthood of Illinois offices in Chicago.

(One Illinois/Zachary Sigelko)

"No one should be have to travel hundreds of miles or hours to get the care and information that they need," said Julie Lynn, manager of external affairs at Planned Parenthood of Illinois. "Everyone should be entitled to that."

Dr. Tabatha Wells is a Southern Illinois University graduate who returns to its Springfield medical campus next week to take a job with the university's Resident Department. She pointed out that Planned Parenthood is the only abortion provider in the area, and only began offering the service a couple of years ago. Before that, she added, patients "had to drive at least an hour and a half" to the nearest abortion clinic.

According to Wells, students, employees at the local Catholic hospital, and others employed by, say, Hobby Lobby have health plans "where they don't have birth-control coverage and the only option is Planned Parenthood."

Again, she emphasized how the organization offers a range of health care essential to area residents. "There are tons of doctors in the area, but not many who see the underserved patients," Wells said. If Trump's proposed Title X changes go through, she added, "I can't imagine what that's going to do to the community. So many patients go there for so many things besides abortion." 

Whitaker emphasized that, no matter what new rules are eventually implemented, Planned Parenthood will maintain its mission in public health. Lynn said it was already rallying its own considerable base of support to combat the new rules during the public-comment period. The organization recently reminded supporters that the period for public comment on the HHS website closes July 31.

"The administration is kind of trying to get their ducks in a row, and we just keep blocking their ducks," Lynn said. "We've already been generating comments from our supporters.

"It's very clear from this," Lynn added, "that the administration is attacking women's health care."

"It's a political move that I think is not at all rooted in the experience of everyday people," Magdaleno said. "It's not realistic to go to this policy, because it has helped so many people, including people like me. And I know it's controversial — Planned Parenthood comes with controversy because of some of the services that we provide — but those aren't the only services that we provide. And I'm testament to that. I've accessed all different kinds of services at Planned Parenthood, because I couldn't go anywhere else. And every single time it's been consistent. It's been professional, and it's been affordable. And again, Title X, it goes hand in hand. And I'm really grateful that people who work at Planned Parenthood support programs like the Title X program, because it reaches a lot of people that we couldn't otherwise."