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Three reproductive rights groups are suing the Trump administration over changes to the federal Title X program—changes that restrict comprehensive health services for women. Two separate lawsuits were filed against the Department of Health and Human Services: one by the American Civil Liberties Union and the National Family Planning & Reproductive Health Association, and another from Planned Parenthood affiliate groups in Wisconsin, Ohio and Utah.

The suits take aim at a Funding Opportunity Announcement (FOA)—a document containing all the official information about a federal grant— for Title X, which did not cite contraception use as a legitimate means of family planning. The groups hope to force the administration to refocus the family planning program on contraception, and Planned Parenthood’s lawsuit asks the court to block the FOA.

By focusing on fertility awareness (family planning) and abstinence, the funding guidance could pave the way for the administration to favor organizations that prioritize those methods over contraception to receive funding. Providers like Planned Parenthood could lose their Title X funds and would potentially be unable to serve patients who rely on Title X coverage. Title X coverage affects more than birth control: it also includes STI and STD testing, annual health exams, and screenings for cervical and breast cancer.

“This is a radical shift, and the way the FOA is written, it just flies in the face of the best medical practice,” said Tanya Atkinson, president and CEO of Planned Parenthood of Wisconsin, one of the plaintiffs. “It … could have a big impact on people’s health.”

“These changes would mean using government funds to promote no-sex-outside-of-marriage ideology,” Ruth Harlow, senior staff attorney for the ACLU Reproductive Freedom Project, said Wednesday. “Trading in FDA-approved contraceptive methods for shame- and abstinence-based programs that we know don’t work is wrong, it’s bad for public health, and it’s outside the law.”

Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, said in a statement to NPR that the Trump administration’s approach to family planning is “disrespectful” to low-income patients and undermines Title X “by shifting to a narrow, ideological vision of how people should live their lives: no sex until marriage; family participation at all ages; and natural family planning methods first and foremost.”

NPR provides additional political context for the lawsuits:

The lawsuit comes amid continued efforts on multiple fronts by abortion-rights opponents and other social conservatives to make progress on a longtime goal of cutting federal funds to groups like Planned Parenthood that provide a range of reproductive health services, including abortion. So far, despite controlling both Congress and the White House, Republicans have been unable to do so. …

Under Trump, many anti-abortion rights activists see a renewed opportunity for states to make such moves. Guidance issued early this year rolled back an Obama-era rule that had forbidden states to exclude Planned Parenthood and other abortion providers from the Medicaid program.

In an interview with NPR, Steve Aden, general counsel to Americans United for Life, called that change a “big deal” for states wishing to prevent public funds from going to organizations that provide abortions.

“We think that’s laudable. We think that’s appropriate. And we hope that the process will continue,” Aden added.

The lawsuits were announced the same day that Republican legislators sent Gov. Kim Reynolds of Iowa a bill that would ban most abortions once a fetal heartbeat is detected, which often occurs before a woman knows she is pregnant.

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