The Trump administration has banned family planning clinics that receive taxpayer funding from referring women for abortions.
The policy also requires clinics to separate their finances from abortion providers. Existing US laws bar the use of tax money for elective abortions.
Medical and women’s rights groups have decried the rule, which is seen as a win for anti-abortion groups.
The health department is to speak with the affected clinics again on Tuesday.
The Department of Health and Human Services (HHS) confirmed to the BBC that clinics using this federal grant money had been notified on Monday that compliance with the new policy would be enforced immediately.
What is the policy?
Abortions are still legal in the US under federal law, and under the new rule, providers at clinics receiving federal funding will still be able to discuss with patients about abortions, but cannot promote it and will not be mandated to counsel patients about abortion.
The compliance rule states that funding regulations for the family planning programme known as Title X have been amended “to remove the requirement for nondirective abortion counselling and referral, to prohibit referral for abortion, and to clarify compliance obligations with state and local laws”.
And HHS plans on requiring providers to keep abortion facilities in separate buildings from clinics receiving funding by March 2020.
Should that policy go into effect, it could see many clinics shutter over the additional costs or be forced to withdraw from Title X funding.
The American Medical Association (AMA), along with advocacy groups and over a dozen states, had sued the administration over the rule in March.
But in June, a three-judge panel in the 9th Circuit Court of Appeals allowed the rule to stand, saying the funding programme was meant to provide “pre-pregnancy family planning services – it does not fund medical care for pregnant women”. Federal courts in July also denied another motion for an injunction.
As a result, HHS said that the courts “made clear that HHS may begin enforcing” the rule.
The administration is also fighting legal battles to allow employers to deny women free birth control by citing religious or moral objections and giving health care providers the ability to deny procedures for similar grounds.
What is Title X?
The Title X federal fund was established in 1970 as a means of ensuring lower-income families had access to reproductive healthcare. This includes birth control, cancer screenings, and HIV and sexually transmitted disease testing.
According to the AMA without Title X, the rates of unintended pregnancy and abortion would be an estimated 31% higher.
According to a Congressional Research Service report, some four million Americans used Title X-funded clinics in 2017. The vast majority of patients using these services have incomes below 150% of the poverty level, HHS reports.
Federal law already prohibits the use of Title X funds for elective – or family planning – abortion, and clinics are monitored by HHS to ensure no misappropriation of funds. Though some anti-abortion groups argue that funding providers that also have abortion services is indirectly funding abortion.
According to the Kaiser Family Foundation, several states would see more than 50% of their Title X clinics lose funding under the new rules.
What’s the reaction?
Religious conservatives and anti-abortion groups have praised the measure. Marjorie Dannenfelser, president of the Susan B Anthony List. an anti-abortion advocacy network, said the policy “simply draws a bright line between abortion and family planning”.
The AMA and reproductive healthcare provider Planned Parenthood have spoken out against the rule, saying it allows the government to interfere in a patient’s care and would negatively affect primarily low-income women.
The Planned Parenthood Action Fund tweeted on Tuesday: “The Trump admin’s devastating, illegal, & unethical Title X gag rule puts birth control and other essential care at risk for millions.”