WASHINGTON — The Trump administration’s Department of Health and Human Services (HHS) has changed the rules on Title X family planning in a bid to bring on board more providers of natural family planning and abstinence education.

But pro-life health and women’s care clinics, welcoming the gesture, expressed concern they would not be able to participate without a waiver from the broad contraception requirements for Title X grants.

HHS opened the annual competition for $260 million in Title X grants for 2018 with an announcement that listed comprehensive health services, natural family planning (NFP), fertility awareness and abstinence education as new priorities for Title X grants.

It also encouraged prospective organizations submitting grant proposals to partner with community-based and faith-based organizations and required training in reporting signs of human trafficking, domestic violence and sexual abuse.

But HHS guidelines that followed the announcement of Title X changes have a number of pro-life health centers questioning how they would be able to submit NFP and abstinence-education proposals for Title X, if they are expected to provide or refer for a broad range of contraception and sterilization services as part of the grant conditions.

Ana Hidalgo Stooks, the executive director of Guiding Star Tampa, which is a holistic women’s care center in the Guiding Star network, said her organization is just in the research phase. Guiding Star Tampa has pursued state funding, but obtaining a federal grant would be a first.

If there are no real roadblocks — such as the requirement to provide a broad range of contraception — she envisioned they would submit a Title X proposal.

“We’re looking at it making sure it’s something that is in line with our center’s vision and mission and the values we hold,” she said.

Stooks said having a mode of reimbursement for fertility awareness and natural family planning would help the staff expand their services, which are supported by donors. Many of the low-income women they serve pay what they can, when they can.

She added that education is the heart of holistic fertility care. The contraceptive model, she said, assumes women’s bodies are “broken” and need to be fixed with a device or hormones. However, she said this leaves women ignorant of a key part of their bodies’ health and well-being.

Holistic fertility education, by contrast, empowers women with knowledge, but Stooks added it takes time for them to learn their cycles and fertility factors, so they can decide when to conceive or not conceive a baby.

Mauricio Leone, the director of operations and grants for the Obria Foundation, which supports the pro-life Obria Medical Clinics, told the Register that their organization is awaiting a technical webinar and further documentation. The foundation’s members hope the Trump administration “will focus on organizations that have been historically underrepresented (natural family planning, abstinence education and infertility treatment) and will waive the contraceptives requirement.”

“If we find out that the contraceptives requirement will be enforced, then we will not be able to apply for the grant,” he said.

Andrew Lichtenwalner, the executive director of the Secretariat of Laity, Marriage, Family Life and Youth for the U.S. Conference of Catholic Bishops, expressed similarly qualified optimism. He told the Register that the decision by itself to open Title X funding to clinics “promoting sexual risk avoidance and natural methods of family planning” was “very promising.”

“We hope that it will encourage a greater diversity of options for those seeking services in accord with their conscience and that respect the dignity of the human person,” he said.

But if the Trump administration’s HHS does not waive the contraception requirement, then pro-life organizations face a limited pathway for their participation in Title X.

Jozef Zalot, staff ethicist at the National Catholic Bioethics Center in Philadelphia, told the Register he did not believe a Catholic nonprofit could seek a Title X grant to provide NFP and abstinence education, with the aim of subcontracting out the “broad range of family-planning methods and services” required for the proposal. It would raise both the issue of “implicit formal cooperation” with evil and the specter of scandal.

“Stated differently, it would be kind of hard for a pro-life clinic to justify ‘partnering’ with an organization that dispenses RU-486 and ‘Ella,’ or that refers for (or even performs) tubal ligations and/or vasectomies solely for the purpose of gaining Title X funding,” he said.

On the other hand, Zalot said it could be morally permissible if the primary Title X grant recipient were, for example, a hospital seeking out a pro-life clinic as a subcontractor that would receive patients referred for NFP and abstinence education.

Planned Parenthood in a statement complained that the new Title X priorities would lead women to go to providers that emphasize abstinence, do not provide the whole range of contraception, and counsel against abortion.

It noted the Title X announcement dropped all references to the Obama-era emphasis on contraception as the heart of family planning, including the requirement that grant recipients provide access to 18 FDA-approved methods of contraception, and mentioned natural family planning several times without noting popular “Long-Acting Reversible Contraception” (LARCs), such as the “birth-control shot.”

“The Trump-Pence administration is quietly taking aim at access to birth control under the nation’s program for affordable reproductive health care, which more than 4 million people rely on each year,” Dawn Laguens, the executive vice president of Planned Parenthood Federation of America, said in the statement. She added, “This is a clear attempt to roll back access to the type of birth control that most women want to use.”

Leone, of Obria, said it was clear HHS was looking for Title X grantees that have a “holistic vision of health,” with an emphasis on natural family planning, fertility awareness and abstinence education, which have been historically underrepresented in Title X grants.

If pro-life organizations can get waivers to compete for Title X grants in line with their values, Leone said it would benefit pro-life organizations in states with liberal abortion laws, such as California, where federal Title X money has typically been tied to demands that it follow state-mandated family-planning rules that require recipients provide or refer for abortion.

The new Title X changes, he pointed out, allow nonprofits to directly compete for Title X family-planning grants, instead of having to go through states.

“They are trying to bypass the state government,” he said. For Obria Medical Clinics in California, a direct Title X grant would circumvent the state’s abortion mandates typically attached to public health funding.

Chuck Donovan, president of the Charlotte Lozier Institute, the pro-life research arm of the Susan B. Anthony List, told the Register that the HHS seems to be making room for neglected elements of the original statutory vision of Title X.

Donovan explained the Title X program originated out of the 1970s rush to implement family planning based largely on the new artificial methods that had recently been developed, such as the contraceptive pill, for population-control purposes. However, Donovan said, even then, some of its sponsors did not wish the program to be simply “anti-child,” but had a broader purpose of promoting personal and family health and well-being that subsequently fell by the wayside. “It was meant to be a broader program than it turned out to be, rather than a Planned Parenthood funnel,” Donovan said.

Donovan added that the Trump administration move appears aimed at making sure women have more options by opening the door for pro-life health clinics with more comprehensive services and stable funding to have access to Title X grants. He said the request seems to “invite creativity” in helping women and men work with their natural fertility, such as by postponing pregnancy or treating conditions such as endometriosis.

Carol Tobias, president of the National Right to Life Committee, told the Register that the new change with Title X “sounds very positive.” She welcomed the possibility that pro-life health and women’s care clinics would finally be able to get access to federal money that previously has flowed largely to Planned Parenthood and other abortion providers.

Peter Jesserer Smith is a Register staff reporter.