The pro-life medical group Obria recently received a $5.1-million grant from the U.S. Department of Health and Human Services (HHS) to be used over three years — but that award has led to questions about how the group is meeting Title X requirements regarding the provision of hormonal contraception and whether a Catholic women’s health center can accept Title X funding under the grant requirements.

The purpose of the Title X program, enacted in 1970, is to provide low-income or uninsured individuals with “comprehensive family planning and related preventive health services.” Planned Parenthood, the nation’s largest abortion provider, had previously served 41% of Title X grant recipients. That’s about to change, pending the Trump administration’s new rules, which will forbid grant recipients from providing abortion referrals and which also require “clear financial and physical separation between Title X-funded projects and programs or facilities where abortion is a method of family planning.”

Last March, the Trump administration also signaled that the program could be even more inclusive of pro-life organizations by adding language that prioritized comprehensive health services, natural family planning (NFP), fertility awareness and abstinence education in Title X grants.

However, an HHS spokesperson told the Register that the Title X program regulations, in the case of both the previous ones and the Trump administration’s recent changes, require that each project that receives grant funding provides hormonal contraceptives.

“A broad range of family-planning methods must be provided, which would include hormonal contraception,” the spokesperson explained. “If an organization offers only a single method of family planning, it may participate as part of a project as long as the entire project offers a broad range of family planning services.” 

The Obria Group said that in order to receive Title X funding without providing contraceptives themselves or funding its provision through subgrantees, they joined with other groups. The organization earlier told the Register that it strategically partnered with local evangelical and Catholic federally qualified health centers that have their own pharmacies and provide contraceptives independently of any Title X funds.

According to Mauricio Leone, executive director of the Obria Group, their own Title X funding is dedicated to natural family planning, sexual risk-avoidance education, pregnancy tests, STD testing and treatment, and cancer screenings. And he told the Register there is “no allocation in our Title X family-planning budget for contraceptive distribution” and that none of Obria’s subgrantees are required to dispense contraception under the terms of the Obria grant.

But Obria has not responded to subsequent requests for comment on how that could be the case, given what HHS said about the hormonal-contraception requirement in any project receiving grant funding.

 

Pro-Life Women’s Health Care Providers

Other pro-life, Catholic women’s health centers weighed in, telling the Register about their experiences in attempting to apply for Title X funding and their perspective on the situation with Obria.

Teresa Kenney, a women’s health nurse practitioner with Sancta Familia in Omaha, Nebraska, told the Register that their pro-life health center was rejected for a Title X grant due to its refusal to refer for contraception or participate in a formal agreement with providers that did.

She provided the Register with a December 2018 letter that Sancta Familia received in which an HHS official concluded, “If you have determined that Sancta Familia Medical Apostolate will not be in a formal agreement with providers that provide these (contraceptive) services, then your application will be withdrawn from consideration to receive Title X funds due to the inability to comply with Title X program requirements.”

“Our experience at Sancta Familia with the Title X program in Nebraska would lead me to believe it would be difficult to get around this referral language,” Kenney commented.

Christine Accurso is the executive director of Pro Women’s Healthcare Centers, a consortium of pro-life health care providers that includes Sancta Familia. She told the Register that the centers have faced difficulties in the Title X application process and voiced skepticism over the conditions of Obria’s grant.

“Several certified Pro Women’s Healthcare Centers individually wrote letters of intent to apply for Title X funds, but many chose not to apply because the contraceptive requirement remains,” she explained. 

“We have no way of knowing what the Obria Group knew or didn’t know about the funding requirements of Title X, but if they did find a way to avoid providing or referring for contraception, it would be impressive, and we would applaud them,” Accurso acknowledged. “However, we have confirmed multiple times from HHS leadership that a sub-grantee is required to refer for contraceptives if they do not provide them.” 

She explained that involvement with artificial contraception is antithetical to the consortium’s “holistic and comprehensive” health care standards, as they do not believe artificial contraception is in the best interest of a woman’s health. She concluded that they are “hopeful that one day grants can be given to groups that would not provide or refer for contraception.”

 

Abby Johnson’s Perspective

Abby Johnson, a pro-life advocate whose conversion from working in the abortion industry was recounted in the film Unplanned, told the Register that she left Obria last year after advising them not to apply for Title X funding. Johnson’s “And Then There Were None” ministry, which helps abortion workers leaving the industry, is also an official partner of the Pro Women’s Healthcare Centers.

She said that when Obria CEO Kathleen Eaton Bravo discussed getting Title X money as Obria was facing financial difficulties, Johnson tried to tell her that “it’s not a program for a pro-life pregnancy center,” and “you will be required to either provide or refer for contraception.”

“They have two ‘Federally Qualified Health Centers’ that are subrecipients of the Obria funds; those two FQHCs do provide a full range of hormonal contraceptive services,” Johnson pointed out with respect to the Title X grant in California. Obria recently confirmed to Politico that two of subrecipients — Hurtt Family Health Clinic and Share Our Selves — are federally qualified health centers that both offer contraception.

In March, the Obria Group’s application for $23 million in additional Title X funding in Texas was made public by the Houston Chronicle. The application, made in conjunction with three local organizations but managed by Obria, clearly outlines that the project would provide “condoms, diaphragm-fit provision; combined oral contraception pills; three-month hormonal injection; vaginal ring; and long-acting methods which include intrauterine and implantable devices.” That portion of the application is on Obria letterhead.

Johnson, who used to administer Title X funds when she worked for Planned Parenthood, expressed skepticism that pro-life health centers with conscientious objections to contraception would ever be eligible for Title X funding, calling Title X “a contraceptive-management program — period.”

 

Abortion-Referral Pressures

The Obria group is facing other troubles as federal judges in Washington state and Oregon issued nationwide injunctions halting the Trump administration’s changes to Title X rules. The changes would have removed the current requirement to refer for abortion. Now, abortion groups are demanding that the Obria clinics be forced to make abortion referrals under current Title X requirements.

However, a HHS spokesperson told Politico that they have no intention of forcing groups like Obria to refer for abortion.

“The department has acknowledged that it cannot enforce the current requirement for nondirective abortion counseling and abortion referral with respect to Title X grantees, clinics, or providers that object to providing such services, as a result of certain federal conscience-protection statutes,” the spokesperson commented.

Melanie Israel, a researcher at the Heritage Foundation, told the Register that the lawsuits over the Trump administration’s Title X rule changes represent another obstacle for pro-life groups that have difficulty accessing Title X funding because of the contraception requirements. These complications make “it hard for some of these newer groups to simply get used to the process, whereas groups like Planned Parenthood — they’ve been doing this process and applying for these grants for decades and decades; and so there’s just this lack of familiarity with the more life-affirming groups.”

But Israel argued that since abortion referral is no longer an HHS requirement, a window has now opened to expand family-planning funds to include organizations exclusively offering the option of new fertility-awareness-based methods, rather than hormonal contraceptives.

“The organizations that would be more inclined to offer that to people haven’t wanted to participate because they would be required to refer for abortion, so we really are in this new, uncharted territory in a lot of ways,” she said, adding that research indicates that the number of women using these methods is growing.

In fact, Chelsea Polis, a senior research scientist at the pro-abortion Guttmacher Institute, told NPR recently about co-authoring an analysis of studies of fertility-awareness-based contraceptive methods.

She said that “newer methods that track body temperature, cervical mucous or urinary hormones” are more effective than the outdated calendar-based approach and that “about 3% of women who use contraception practice fertility-awareness-based methods, either alone or with other types of birth control, and their numbers are growing.

 

‘More Life-Affirming Opportunities’

Israel said such findings demonstrate that since the Title X program’s inception in the 1970s, “science has obviously advanced so this is a program that has to be able to evolve, obviously, as science and technology advances.”

Consequently, in terms of providing funds to applicants who won’t provide abortion or contraceptives, “I think it’s only natural that we see these changes to the program over the years in the types of methods and services that are emphasized.”

And while it appears that for the time being hormonal contraception remains a mandatory element of Title X, Israel hopes the Trump administration’s changes to the program ultimately will mean that “Americans have more choices and more life-affirming opportunities when taking advantage of this federal program.”

Lauretta Brown is the Register’s Washington-based staff writer.