In Memphis, TN, Title X family planning funds have been awarded to Christ Community Health Services, a religious health provider that has indicated that it may refuse to provide information, referrals, and some kinds of health care to Shelby County’s women.
Title X funds have historically gone to Planned Parenthood in Memphis; the move to give the funds to an anti-choice organization is part of nationwide efforts to defund Planned Parenthood because PP provides abortions. Existing laws already clearly prohibit Title X or other federal funds from being used for abortion services – the money goes to provide necessary services like contraception and cancer screenings.
Reports indicate that Christ Community has no intention of providing referrals to women who choose to have abortions, whether that is for personal or medical reasons. From a report by a Memphis newspaper (emphasis added):
[Christ Community CEO] Waller initially said the clinic refers patients to abortion providers if they request it, but he and Dr. Rick Donlon, a founding physician at the clinic, later called the newspaper to change that statement.
“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Donlon said.
“They know where to go.” That doesn’t exactly sound like a professional provider of medical services to me. The clinic leaders obviously made a point of contacting the newspaper to make sure it was clear that they would *not* provide referrals, demonstrating a clear intent to put religious belief ahead of the medical care of women who may consider or require abortions.
Christ Community has also said it will not provide emergency contraception, only doing so through a third party. No details are available about how this will happen in practice, and how much additional time, travel and cost women may be subjected to in order to access this legal, previously available, and non-abortifacent medical care. This change clearly creates an additional burden for women seeking emergency contraception, and the women of Memphis currently have no guarantees that the third party provision will happen in a timely way, while timely administration of emergency contraception drugs is absolutely crucial for them to work.
I have not seen this discussed elsewhere, but it is also not readily apparent to me whether Christ Community would or could ever decide that any other forms of birth control are off-limits because of purely theoretical possibilities of preventing fertilized egg implantation. If we’re already providing the Title X money to a provider who can pick and choose services because of religious beliefs, I don’t see that refusing other forms of contraception is completely out of the question.
The organization also is reportedly working to install “crisis pregnancy centers” at its locations; these centers are well known for providing false and misleading information about abortion and exist to convince women not to choose abortion. Title X rules require “nondirective” counseling about abortion, and Planned Parenthood and other reputable providers who do provide abortions (using other, non-federal money) have processes and counselors in place to check whether women are certain of their decisions without pushing them in either direction.
Given the interest in installing deliberately biased in-house counseling and the stated intention to refuse to refer women out to other providers for abortion, it seems unlikely that Christ Community will be able to or has any intention of meeting the rules requiring factual, nondirective counseling. Women who cannot afford to access family planning care elsewhere will be subjected to a provider who clearly wishes to influence women’s choices, rather than providers who are committed to medical accuracy and offer women a full range of choices, supporting their right to individual decision-making about their bodies.
One woman reports that “Christ Community provides high-quality medical services, but that they sometimes come with a ‘sermon.'” She says she was told by a Christ Community provider, “If only my relationships with people and God were right, I would have fewer health problems.”
In addition to these concerns, there may be other issues with Christ Community’s administration of the Title X funds. I’m not personally familiar with CCHS’s existing health clinics and services on the ground. A Memphis local informed me Christ Community does not take appointments – patients must show up first thing in the morning and wait to be seen, and may even have to come back the next day if too many people show up. This is obviously not a good model for providing family planning services, especially when emergency contraception or other urgent services are needed or when women must take time off from jobs, school, or childcare in order to wait around for care. Although the organization’s website does have an “appointment line,” it indicates that this is to find out which clinics provide which services; I’d like to hear from others about whether this matches their experience at Christ Community clinics.
Another serious concern is that Christ Community’s proposal to provide these services clearly indicated that they would provide less care to fewer women than would Planned Parenthood. Steve Ross, of Memphis and blogging at Vibinc, has an excellent series chronicling the whole debacle, from the Tennessee state government pressuring the Memphis health department to take the funds despite their lack of capacity for family planning through to the current funding of Christ Community (parts 1, 2, 3, and 4). In part 2, he lays out the numbers and apparent relative deficiencies of the Christ Community proposal, including their lower numbers for proposed services and inconsistencies in how the proposals from Christ Community and Planned Parenthood were scored by local officials.
In Part 3, Steve points to the questions asked by the potential providers – Christ Community, Planned Parenthood, and a third non-religious applicant. Although they are unattributed, we can only assume that the following questions were asked by Christ Community, the only applicant with an explicit religious mission and on the record about refusing services because of beliefs. I think these are very telling about the intentions of the leadership of the organization that asked these questions, and how they plan to approach women’s health:
In providing information about pregnancy termination, is it sufficient to have the referral information in writing? [My interpretation: In other words, do we even have to bother to actually have a conversation with women about this?]
If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office that it does not provide that service because of its beliefs.
If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?
The answers to these questions explicitly state that emergency contraception must be provided, the organization cannot choose not to provide forms of contraception because of its beliefs, and they are not allowed to talk about refusing abortion and referrals because of beliefs. Yet everything we’ve heard – as mentioned above – indicates that Christ Community plans to do exactly that.
As Steve writes:
To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.
Honestly, I’m sure this whole thing will end in lawsuits, and I wouldn’t be unhappy if HHS would intervene. In the meantime, poor women suffer.
I will leave you with this excellent rant from Sig at DowntownMemphisBlog:
Public policy needs to be based on reason and fact, not feelings and faith. Abortion is a legal medical procedure. Any organization that aspires to hold a government contract in the area of family planning needs to present all options and perform all medical procedures, not just the ones it agrees with or likes. Not just the ones that make them feel warm and fuzzy inside. Not just the ones that fit into the narrow world view defined by their archaic religious beliefs.
See also: Aunt B
[cross-posted from Women's Health News]