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HHS Blames Trump Policy for 180,000 Unplanned Pregnancies

HHS Blames Trump Policy for 180,000 Unplanned Pregnancies


Dubious assumptions underlie estimate of unplanned pregnancies caused by Trump policy. “The Biden administration is working to reverse a Trump-era family policy directive that…officials believe may have resulted in an estimated 180,000 unplanned pregnancies,” reports Newsweek. The startling estimate comes from a new proposal from the U.S. Department of Health and Human Services (HHS) to rescind the Trump-era rule. But to get this unintended pregnancy estimate, the health agency had to make some pretty big leaps in logic.

The biggest flaw with the HHS estimate is that it assumes a lot of people not receiving family-planning services subsidized by a particular federal government program in 2019 simply went without any birth control or family-planning measures at all.

The funding in question comes via Title X of the Public Health Service Act, under which the federal government can “make grants to and enter into contracts with public or nonprofit private entities to assist in the establishment and operation of voluntary family planning projects.”

In 2019, the Trump administration finalized a rule saying that no Title X funding could go to health clinics or programs that also referred women to abortion services or provided information about abortion. (The money was already barred from going toward the direct provision of abortions.) “Litigation over the 2019 rule immediately ensued,” notes the HHS proposal. “The Department was sued by 23 states, every major medical organization, Title X grantee organizations, and individual grantees.” But appeals courts upheld the Trump administration rule.

As a result, 19 out of 90 recipients of Title X grant funding dropped out of the program, according to HHS. “Overall, the Title X program lost more than 1,000 service sites. Those service sites represented approximately one quarter of all Title X-funded sites in 2019.”

With fewer groups getting Title X grants, fewer patients were serviced under the auspices of Title X money. “With the 2019 Final Rule only being in place for five and a half months, the remaining 71 Title X grantees served 844,083 fewer clients as compared to the previous year,” HHS reports.

HHS does not say these service sites—many of them Planned Parenthood clinics—shut down, and there was no news in 2019 of a wave of Planned Parenthood clinic closures or masses of people being turned away from Planned Parenthood services. (Searching Google for 2019, the only news of Planned Parenthood clinics closing is that two in Cincinnati, Ohio, closed after facing threats that included state rule changes. “These closures are the result of years attacks on our ability to provide reproductive health care,” Planned Parenthood said in a statement to ABC News.)

Presumably, Planned Parenthood—whose lobbying arm spent $45 million on the 2020 election—largely found other ways to cover budget deficits left by lack of Title X funds.

Planned Parenthood itself does not report serving fewer patients or helping prevent drastically fewer unintended pregnancies. Its annual reports say that for 2019–2020, it served 2.4 million patients and that an estimated “395,000 unintended pregnancies [were] averted by contraceptive services
” it provided. And for 2018–2019, it also served 2.4 million patients, and “approximately 393,000 unintended pregnancies [were] averted by Planned Parenthood contraceptive services.”

In addition, groups still receiving Title X money were given more of it in 2019, which should have enabled them to serve more patients. “Fifty existing grantees were awarded $33.7 million to expand Title X services” and seven states “had a meaningful increase in the number of Title X clinics in their states,” HHS says.

There’s no reason to suspect that patients whose visits were previously subsidized by Title X money at Planned Parenthood (or other clinics that left the grant program) simply gave up on birth control or other family-planning methods altogether. Yet that’s exactly what HHS assumes to get its unintended pregnancy increase estimate.

The new HHS proposal gives a lot of data on how many fewer people were served using Title X money: “Compared to 2018, 225,688 fewer clients received oral contraceptives; 49,803 fewer clients received hormonal implants; and 86,008 fewer clients received IUDs.” But we don’t know that people went without these things entirely, merely that clinics weren’t using Title X grant money to pay for them.

Nonetheless, the agency extrapolates from there that “as a result of the decrease in clients able to receive Title X services, it is estimated that the 2019 Final Rule may have led to up to 181,477 unintended pregnancies.”

It arrived at that number by “estimating that of the 844,083 fewer clients served by Title X in 2019 compared to 2018, 21.5% of those clients could have experienced an unintended pregnancy as a result of not receiving services.” HHS said it came to this number from a formula developed by the Guttmacher Institute, a reproductive rights research group.

The Guttmacher Institute said in a 2017 paper that “the formula for calculating pregnancies averted among general populations of publicly funded family planning clients is to multiply the number of clients by 21.5%, to get the number of unintended pregnancies averted.”

However, using this to estimate the number of unplanned pregnancies caused by fewer patients being served by Title X grants does not take into account that these patients may have been served by other publicly funded (or otherwise subsidized) planning programs.


Adam Toledo dropped gun, got killed by cops anyway. Body camera footage released by the Chicago Police Department on Thursday gives a fuller picture of the March 29 killing of Adam Toledo. The 13-year-old boy was fatally shot by police despite having his hands up. “Prosecutors initially suggested Toledo had a gun in his hand when the officer shot him, but the state’s attorney’s office walked that back today,” as Reason‘s Billy Binion reported yesterday. While Toledo did have a gun, “a slowly rendered version of the clip shows Toledo dropping a gun and raising both of his hands in the air, after which point he was shot in the chest.”


House Democrats approve antitrust bill targeting Big Tech. The House of Representatives Judiciary Committee has formally approved an antitrust report targeting Apple, Amazon, Facebook, and Google. The report, released last October, “was approved by a 24-17 vote that split along party lines,” notes Reuters. But Democrats aren’t alone in their antitrust fervor. For instance, Sen. Josh Hawley (R–Mo.) has just a dangerous new “trust-busting” bill. The measure “not only increases the opportunities for future officials to derail perfectly harmless business activities; it runs the risk of bogging down commerce in regulatory processes,” writes Katherine Revello.


• The defense in Derek Chauvin’s case rested yesterday, without having called Chauvin (who is on trial for killing George Floyd) to the stand. Closing arguments begin Monday.

• The American Civil Liberties Union of Ohio is suing the state’s prison system for seizing inmates’ COVID-19 stimulus checks.

• Mississippi will stop making purveyors of low-risk beauty services get special licenses:

• A psychedelics decriminalization bill is moving forward in California, having passed the Senate Health Committee by a 6–1 vote on Wednesday.

• A woman with dementia is suing the city of Loveland, Colorado, and three of its police officers after cops pushed her to the ground, arrested her, and jailed her for attempting to walk out of a Walmart with around $14 worth of goods she hadn’t paid for and promptly gave back when asked by store employees.

• Democratic reactions to the prospect of withdrawing troops from Afghanistan are different than they were last year…

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Elizabeth Nolan Brown

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