The rule is an attack on good family planning care, reproductive health advocates say.

On Friday, the Trump administration announced that it will impose a domestic gag rule for health care providers that aims to defund Planned Parenthood and restrict people’s access to quality reproductive health care.

This rule would upend Title X, a federal grant program administered by the Department of Health and Human Services (HHS) and the country’s only federal family planning program. Planning services funded through Title X support testing and treatment for sexually transmitted infections, cervical and breast cancer screenings, birth control, and contraception education.

The rule does not allow abortion referral and does not allow agencies that receive Title X funds to provide abortion, even though they are using nonfederal funds to do so. Regardless of what pregnant patients say they want from their reproductive health care, the rule would mandate that physicians refer those patients for social services and prenatal services. The rule also requires the financial and physical separation of Title X projects and facilities “from programs and facilities where abortion is a method of family planning.”

Earlier this month, Emily Stewart, vice president of public policy at Planned Parenthood Federation of America/Planned Parenthood Action Fund, said the rule will harm the 4 million people the program serves, the majority of whom have an income at or below the federal poverty level.

“This is a program that is designed to make sure that people who are struggling to make ends meet are able to get not only birth control but STD screenings and cancer screenings and well woman exams. For a lot of people receiving care under this program, this program is the difference for them in terms of whether they have access to health care or not,” she said.

The rule is set to take effect gradually 60 days after it is published in the Federal Register. However, the mandatory financial and physical separation of facilities’ activities will take effect later, at 120 days and one year after it is published in the register, respectively.

Stewart added, “The rule itself seeks to dismantle the nation’s birth control program in two ways — No. 1 is to gag health providers, which makes it illegal for people participating in the program to refer patients for abortion. This is completely unethical and that is why it has been opposed by every major medical association including the American Medical Association. Everyone regardless of income deserves access to the best medical care.”

This practice would go against informed consent and shared decision-making in medical ethics as defined by the American Medical Association. The AMA says physicians should tell patients about “the burdens, risks, and expected benefits of all options, including forgoing treatment.”

The American Nurses Association (ANA) released a statement condemning the proposal in May. Their statement read:

As the most “honest and ethical” profession, nurses must guard against any erosive policy that hinders patients from making meaningful, informed decisions about their own health, or that blocks access to care. The Code of Ethics for Nurses outlines that the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. This proposed rule interferes with that relationship and violates basic ethics of the profession.

In a statement to ThinkProgress, Guttmacher Institute Senior Policy Manager Kinsey Hasstedt said about the rule, “Since day one, the Trump administration, along with its anti-abortion and anti-contraception allies, has made it clear that they want to undermine and restrict people’s access to family planning care. The Title X program, which provides confidential, high-quality, medically accurate family planning services to four million people every year, has been one of their main targets.”

HHS has already taken a number of steps to restrict reproductive health services.

Last year, HHS created a new division within the Office for Civil Rights, called the Division of Conscience and Religious Freedom. This division is supposed to ensure that health care providers don’t have to provide services, such as abortion, that they object to morally or religiously. The department also released guidelines for Title X grant applications that concerned physicians and reproductive health groups. The document mentioned “natural family planning” such as the rhythm method and other tactics for preventing pregnancy that do not involve contraceptives.

Stewart said that all of the policies that HHS has pursued are part of the same attack.

“The intent here that the administration is pursuing is to completely dismantle the birth control program that has been operating for decades and to replace it with a health care system designed to deny access to full information and care,” Stewart said. “It’s part of a much larger agenda designed to undercut people’s access to health care … They are trying to deny people access to information about their bodies and they are using every single tool in their toolbox to do it.”

“Title X is our nation’s gold-standard family planning program that serves low-income patients for free,” Ruth Harlow, ACLU Reproductive Freedom Project Senior Staff Attorney, said in a statement to ThinkProgress on Friday. “Now the Trump administration wants to prevent Title X patients from receiving full information about their care options and drive many of the most experienced health care providers from the program. Nobody should be denied access to reproductive health care or receive inadequate care because of their lack of income. We won’t sit back while Trump upends the family planning safety net as part of his anti-woman, anti-poor, and anti-health care agenda.”

The International Women’s Health Coalition released a statement to ThinkProgress explaining that it believes the funding restrictions will lead to increases in unwanted pregnancies and delay diagnosis and treatment of sexually transmitted infections and reproductive cancers.

Numerous studies have found that other health care providers would be unable to fill the gap left by Planned Parenthood. One study from the National Campaign to Prevent Teen and Unplanned Pregnancy found that in 105 counties across the country, Planned Parenthood is the only clinic offering comprehensive contraceptive services.

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