By Maura Winkler
My mission as a midwife is to disrupt the long-existing power differential between women and their health care providers. Even in the most progressive circles, women live and work in a world steeped with the philosophy that they are ill-equipped to make decisions about their own bodies.
Midwifery model care upholds the principles of informed consent, shared decision making and open access to information.
President Trump’s proposed domestic “gag rule,” which would place significant limits on Title X family planning funding, directly opposes everything I do as a provider of women’s health-care services. Clinics funded by Title X are able to provide birth control, pap smears, and testing and treatment of sexually transmitted infections, including HIV, to 4 million patients each year. For each dollar invested in publicly funded family planning programs like Title X, the government saves more than $7 in Medicaid-related costs. Annually, Title X funding can save taxpayers $7 billion by preventing unintended pregnancies.
Trump’s proposed changes to Title X would restrict providers’ ability to discuss abortion as an option – even if patients directly ask about it. Additionally, the changes would require abortion to be done in a facility separate from that receiving Title X funding, despite the fact that Title X has never funded abortion services. And instead of receiving unbiased counseling and informed consent about contraceptive options, patients will be steered toward providers and facilities focused on abstinence and fertility awareness.
Reproductive and sexual health care services are already deeply segregated – socioeconomic status, race and geographic location deeply influence access to quality care.
If Trump’s domestic “gag rule” takes effect, disparities in health care will only worsen, as exhibited by the fact that past non-domestic gag rules have only increased rates of unplanned pregnancy and abortion. Furthermore, two thirds of recipients of health care services provided by clinics funded by Title X live at or below the poverty line.
The American College of Nurse Midwives (ACNM), American Congress of Obstetricians-Gynecologists (ACOG), and American Medical Association (AMA) are in agreement that the changes to Title X are purely politically and ideologically motivated and do not reflect current evidence-based practice.
Let’s be clear: A domestic “gag rule” would deeply undercut access to Title X funded services for patients and will increase the nation’s rate of unintended pregnancy. Trump’s proposed changes to Title X undermine the relationship between patients and their health care providers, inserting political motives into a relationship that should be free of coercion and based on the principles of trust and informed consent.
Maura Winkler is a midwife at Fika Wellness and Midwifery in Buffalo.