Faith-based health clinics spurn contraceptives under Trump rule

The Trump administration’s effort to reshape a decades-old, federally funded family planning program has its roots in Southern California, where one faith-based group wants to be the “pro-life” Planned Parenthood.

Obria Medical Clinics, which opposes contraception and teaches abstinence, recently became the first group of its kind to receive federal funding through a family planning program established by Congress in 1970 to support clinics and organizations providing low-income women with birth control and other reproductive health care services.

{mosads}The controversial move by the administration was praised by anti-abortion groups that see Obria’s inclusion as one of the first steps to reforming Title X, the federal program that has long been a key source of Planned Parenthood’s government funding.

The shift also indicates where the administration is headed as it prepares to implement changes to Title X that bar Planned Parenthood from the program while placing an emphasis on faith-based family planning clinics that don’t provide abortions.

“Many women also want the opportunity to visit a professional, comprehensive health care facility — not an abortion clinic — for their health care needs,” Obria CEO and founder Kathleen Eaton Bravo said in a statement to The Hill. “Obria gives women that choice.”

Title X grantees have always been prohibited from using federal funds to provide abortions, but abortion providers have been allowed to access the funds to pay for other health services.

The Department of Health and Human Services (HHS) announced in March that Obria would receive $1.7 million for this year’s grant cycle, with the potential to receive an additional $3.4 million over the next two years.

Documents obtained by The Hill through a Freedom of Information Act request reveal how Obria plans to run its Title X project, which will serve an estimated 12,000 patients at 21 service sites in four California counties.

The most controversial aspect of the project, which is blasted by reproductive rights organizations, is the fact that 13 of those sites don’t offer contraceptives like birth control pills, condoms and IUDs.

Instead, they teach abstinence and offer a natural family planning program that helps women track their fertility so they can avoid or achieve pregnancy.

The clinics that don’t offer contraceptives won’t refer patients to clinics that provide that service, a departure from standard medical practice but a reflection of Eaton Bravo’s personal opposition to contraceptives.

“We are a faith-based, pro-life organization, and I am one of those hardcore believers,” Eaton Bravo said in March during an interview with EWTN Pro-Life Weekly. “If you really study contraception, it is the floodgates to abortion.”

Reproductive rights activists say Obria is antithetical to the goals of Title X: providing contraception to low-income women.

“The goal of the program was always to get birth control to low-income people in America,” said Mary Alice Carter, a senior adviser to Equity Forward, a reproductive health care advocacy group that launched after President Trump was elected.

“The idea that now nearly 50 years into the program we’re going to start funding an organization that doesn’t provide birth control is the antithesis to the program,” said Carter, who has worked at Planned Parenthood and NARAL Pro-Choice America New York. 

Eight of the clinics Obria will partner with provide a “broad range of contraceptive methods,” according to the documents obtained by The Hill.

That ensures Obria complies with Title X’s requirements that say part of a project must provide the full range of contraceptives.

But none of the Title X funds Obria receives will go toward contraceptives, avoiding a conflict with their faith-based mission. The funds will instead go toward abstinence education and a natural family planning program called Fertility Education and Medical Management (FEMM).

Advocates worry about the women who want contraception but might end up at one of the 13 clinics that don’t provide it.

“It could be a huge burden on women if they go to Obria first and are not able to get the care that they want,” said Julie Rabinovitz, president and CEO of Essential Access Health, California’s main Title X grantee and the largest grantee in the U.S.

After learning that Obria was funded in Orange County, Essential Access Health partnered with three more health centers there to offer comprehensive family planning.

“So that we can make sure that women do have options and do have a place to go to get their comprehensive family planning services,” Rabinovitz said.

While some women choose natural family planning or hormonal birth control, experts say it’s important they are presented with the full range of options.

Only 2 percent of Title X patients choose fertility awareness–based methods when offered the full range of birth control methods, says Robin Watkins, director of health care at Power to Decide.

“Offering only fertility awareness–based methods limits access to the methods patients are requesting 98 percent of the time and simply does not meet the needs of our patients,” Watkins said. “While not every Title X site can offer every FDA-approved method on site, intentionally limiting access to the full range of FDA methods is contrary to patients’ needs and not appropriate in a family planning setting.”

FEMM, the natural family planning program Obria uses, has faced criticism recently for not disclosing that it is funded by anti-abortion advocates and that its medical advisers are reportedly not licensed to practice in the U.S.

It’s not clear how effective FEMM is at preventing pregnancy. HHS says that 25 percent of couples who use natural family planning methods, including fertility awareness, may become pregnant.

Opponents of Obria worry about the information being presented to patients, from overemphasizing the side effects of hormonal birth control to promoting “abortion pill reversal.”

Several of the clinics in Obria’s Title X project list “abortion pill reversals” as a service on their websites.

An Obria spokesperson said Title X funds are not used for these services.

Obria would not have been eligible for Title X funds under the Obama administration, but they are following recent changes at HHS.

The changes, which take effect in September, remove requirements that providers refer women for abortions and encourages the participation of faith-based providers like Obria that offer only one form of birth control. 

Anti-abortion advocates cheered the rules as a way to defund Planned Parenthood, which serves 40 percent of Title X patients, to make room for other providers, like Obria.

“Obria is benefiting from making the family planning program authentic again,” said Marjorie Dannenfelser, president of the Susan B. Anthony List. “It is actually part of a movement we’re trying to encourage: allowing pregnancy care centers that don’t do abortions, providing funding for them.”

{mossecondads}Obria underwent a rebranding in 2015, adding more medical services so it could better attract millennials and qualify for state and federal grants. Like many nonprofits, Obria has struggled to raise money in recent years, but has primarily been funded by organizations associated with the Catholic church.

Part of its long-term growth goal involves billing insurers and qualifying for government funds, including Medicaid, Title X and other programs, to expand its presence in other states.

Like other Title X projects, Obria plans to offer a range of health services, including pregnancy tests, “limited ultrasounds,” prenatal care, parenting education, STD and HIV testing and treatment, pap smears, breast and cervical cancer screenings, basic infertility services and abstinence education.

Andrea Swartzendruber, an assistant professor and an expert in reproductive health at the University of Georgia’s College of Public Health, raised concerns about groups like Obria receiving Title X funding. 

“I think it’s entirely and very concerning that any type of crisis pregnancy centers, including Obria, would be funded through the Title X program,” she said. 

“Offering medical services is not their primary goal, and the health of their clients is not their primary goal. The primary goal is an anti-abortion mission.” 

But anti-abortion groups and social conservatives say the changes are beneficial to women and will provide them with more options.

“It’s a good thing that women are going to have more choices, that they’re going to have access to multiple options, so that they’ll be able to choose where to go to find care that meets their needs, reflects their values,” said Melanie Israel, a research associate for the DeVos Center for Religion and Civil Society at The Heritage Foundation.