Trump ‘gag rule’ on abortion referral can be enforced, U.S. appeals court rules

By Jonathan Stempel

(Reuters) – A sharply divided federal appeals court on Monday said the Trump administration may enforce a rule labeled by critics as a “gag rule” that could deprive abortion providers of federal funding for family planning.

In a 7-4 decision, the 9th U.S. Circuit Court of Appeals upheld a ruling last June by a unanimous three-judge panel to lift injunctions won by California, Oregon and Washington against the rule, which deprives clinics that provide abortion referrals of Title X family planning funds.

The rule was meant to help President Donald Trump fulfill a 2016 campaign pledge to end federal support for Planned Parenthood, which received about $60 million annually, or one-fifth, of Title X funds.

Planned Parenthood left the program last August rather than comply with the rule, which is enforced by the U.S. Department of Health and Human Services.

In a statement, California Attorney General Xavier Becerra said the “troubling” decision helps Trump “roll back women’s access to reproductive healthcare.”

Planned Parenthood’s acting president Alexis McGill Johnson called on Congress to overturn the rule, which she said created “egregious barriers” to healthcare for low-income people.

A U.S. Department of Justice spokeswoman said the decision properly upholds HHS’ prohibition on using taxpayer money to “subsidize abortion” through Title X.

Writing for Monday’s majority, Circuit Judge Sandra Ikuta said HHS was owed “broad deference” and acted reasonably, not arbitrarily or capriciously, in adopting a “less restrictive” rule than the one blessed by the Supreme Court in 1988.

“There is no ‘gag’ on abortion counseling,” Ikuta wrote, saying the rule allows healthcare providers to discuss, though not to encourage, abortion.

The appeals court returned the cases to federal district courts for further proceedings. A federal judge in Baltimore on Feb. 14 blocked the rule’s enforcement in Maryland.

Circuit Judge Richard Paez dissented, saying the rule would deprive people of cancer screening, HIV testing and other needed healthcare, and undermine Congress’ intent that patients be able to communicate openly with healthcare providers.

“The consequences will be borne by the millions of women who turn to Title X-funded clinics for lifesaving care and the very contraceptive services that have caused rates of unintended pregnancy – and abortion – to plummet,” he wrote. “I strongly dissent.”

All seven judges in the majority were appointed by Republican presidents, including two by Trump. The dissenters were appointed by Democratic presidents.

The cases in the 9th U.S. Circuit Court of Appeals include California v Azar et al, No. 19-15974; Oregon et al v Azar et al, No. 19-35386; and Washington et al v Azar et al, No. 19-35394.

(Reporting by Jonathan Stempel in New York and Nate Raymond in Boston; Editing by Steve Orlofsky and Sonya Hepinstall)

U.S. raps global health summit over abortion, sex education

By Nita Bhalla

NAIROBI (Thomson Reuters Foundation) – Ten countries – including the United States, Brazil and Egypt – criticised a global conference on sexual and reproductive health on Thursday, saying it promoted abortion and sex education.

Heads of state, financial institutions and donors were among the 9,500 delegates in Nairobi this week to address maternal mortality, violence against women and voluntary family planning.

But 10 of the United Nation’s 192 member states said they did not support the International Conference on Population and Development’s (ICPD) use of the term “sexual and reproductive health and rights” as it could be used to promote abortion.

Valerie Huber, senior policy advisor with the U.S. Department of Health and Human Services, said not all countries had been fully consulted ahead of the event, organised by the United Nations, Denmark and Kenya.

“There is no international right to abortion. In fact, international law clearly states that everyone has the right to life,” said Huber.

“We cannot support sex education that fails to adequately engage parents and which promotes abortion as a method of family planning,” she said in a joint statement on behalf of the group.

In 2017, President Donald Trump reinstated a decades-old, U.S. government policy that restricts international aid to charities that support abortion.

The so-called global gag rule has forced the closure of health clinics, outreach programs and refugee services by charities, risking the health of millions of women, reproductive rights experts said.

UNDER ATTACK

Sexual and reproductive rights campaigners said the U.S.-led statement was discouraging with women’s rights already threatened by far-right, populist rhetoric across the world, including moves to restrict abortion in the United States.

The ICPD conference marks 25 years since a landmark summit in Cairo when nations agreed to address issues such as maternal health, violence against women and equal opportunities.

Every day, more than 800 women die from preventable causes during pregnancy and childbirth, according to the U.N. Population Fund (UNFPA). More than 230 million women want to prevent pregnancy but are not using modern contraception.

One in three women globally have faced some form of physical or sexual violence in their lifetime, according to the UNFPA.

Organisers of the Nairobi summit denied any suggestion the event was exclusively focused on abortion or sex education.

“I believe their statement is based on some misunderstandings of what this is about,” IB Petersen, Denmark’s special envoy for the ICPD, told a news conference.

“This is not a pro-abortion summit – it is about the ICPD program of action – abortion is part of that.”

Petersen said the summit had already yielded results, citing a pledge by Kenya to end female genital mutilation by 2022.

Almost $10 billion in investments has also been pledged by countries – including Britain, Norway, Germany and Denmark – and a host of private organisations.

The UNFPA estimates countries need about $264 billion to end maternal deaths, gender-based violence, child marriage, and provide family planning to all women by 2030.

(Reporting by Nita Bhalla @nitabhalla, Editing by Claire Cozens and Lyndsay Griffiths. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s and LGBT+ rights, human trafficking, property rights and climate change. Visit http://news.trust.org)

‘Two is enough,’ Egypt tells poor families as population booms

An Egyptian family prepares a cabbage meal for lunch in the province of Fayoum, southwest of Cairo, Egypt February 19, 2019. Picture taken February 19, 2019. REUTERS/Hayam Adel

By Lena Masri

SOHAG, Egypt (Reuters) – Nesma Ghanem is hoping for a fourth child even though her doctor says her body can’t handle a pregnancy at the moment. She has three daughters and would like them to have a brother.

“In the future he could support his father and the girls,” said Ghanem, 27, who lives in a village in Sohag, Eygypt, an area with one of the country’s highest fertility rates.

The family depends on her husband’s income from a local cafe. “If I have a son people, here in the village can say that he will carry on his father’s name,” she said.

As Egypt’s population heads towards 100 million, the government is trying to change the minds of people like Ghanem. “Two Is Enough” is the government’s first family-planning campaign aiming to challenge traditions of large families in rural Egypt. But Ghanem’s wish to have a son shows how hard that could be.

“The main challenge is that we’re trying to change a way of thinking,” said Randa Fares, coordinator of the campaign at the Social Solidarity Ministry. “To change a way of thinking is difficult.”

Egypt’s population is growing by 2.6 million a year, a high rate for a country where water and jobs are scarce and schools and hospitals overcrowded. President Abdel Fattah al-Sisi says the two biggest threats to Egypt are terrorism and population growth.

An Egyptian family prepare traditional sweets at their house in the province of Fayoum, southwest of Cairo, Egypt February 19, 2019. Picture taken February 19, 2019. REUTERS/Hayam Adel

An Egyptian family prepare traditional sweets at their house in the province of Fayoum, southwest of Cairo, Egypt February 19, 2019. Picture taken February 19, 2019. REUTERS/Hayam Adel

“We are faced with scarcity in water resources … scarcity in jobs, job creation, and we need to really control this population growth so that people can feel the benefits of development,” Minister of Social Solidarity Ghada Wali told Reuters.

Decades ago, Egypt had a family-planning program, supported by the United States. The fertility rate fell from 5.6 children per woman in 1976 to 3.0 in 2008 while the use of contraceptives went up from 18.8 percent to 60.3 percent. Large amounts of contraceptives were made available and advertisements increased demand for birth control.

Support for family planning from the Egyptian government and large sums from donors helped make the program successful, said Duff Gillespie, who directed USAID’s population office from 1986 to 1993.

But Egypt was relying on donor support and when that assistance went away, family planning was neglected. By 2014 the fertility rate had gone up to 3.5. The United States is supporting family planning in Egypt again, providing more than $19 million for a five-year project ending in 2022 and $4 million for a smaller private sector project ending in 2020.

Those amounts are significantly lower than the $371 million the United States spent on family planning in Egypt between 1976 and 2008.

“Two Is Enough” is mainly financed by Egyptian money, with the Social Solidarity Ministry spending 75 million Egyptian pounds ($4.27 million) and the U.N. providing 10 million pounds, according to the ministry.

The two-year campaign targets more than 1.1 million poor families with up to three children. The Social Solidarity Ministry, with local NGOs, has trained volunteers to make home visits and encourage people to have fewer children.

Mothers are invited to seminars with preachers who say that Islam allows family planning, and doctors who answer questions. Billboards and TV ads promote smaller families. The government aims to reduce the current fertility rate of 3.5 to 2.4 by 2030.

At a session teaching volunteers how to speak to mothers and fathers about family planning in a village in Giza, Asmaa Mohammad, a 25-year-old volunteer, told Reuters she would rather have three children than two.

“Since I was a child I knew I wanted three children,” said Mohammad who is unmarried and doesn’t have children yet.

Deeply rooted traditions and lack of education explain why many Egyptians have big families. Al-Azhar, Egypt’s top Sunni Muslim authority, endorses family planning, but not all Egyptians agree.

Some view children as a future source of support. Others who only have girls keep having more until they get a boy who can carry on the family name.

During a visit from a campaign volunteer, Ghanem said her wish to have a boy was not the main reason she wasn’t using contraceptives. She stopped using an IUD after suffering from bleeding.

About one in three Egyptian women stop using contraceptives within a year, often due to misinformation about the side effects or lack of information about alternatives, according to the United Nations Population Fund.

Nearly 13 percent of married women of reproductive age in Egypt want to use contraceptives but are unable to, according to official data from 2014.

Now the government has renovated clinics, added staff and provided more free contraceptives. Under “Two is Enough” the goal is to have 70 new clinics up and running in March.

But when Reuters visited a clinic in Sohag last month, there were no contraceptives left. Nema Mahmoud, who had traveled from her village, was told to come back the next day.

Sohag, one of Egypt’s poorest governorates, also has one of the highest fertility rates at 4.3. The National Population Council said contraceptive use in Sohag is the lowest among six governorates surveyed.

For years Mahmoud, 33, didn’t use contraceptives consistently even though she wanted a small family. Her mother-in-law kept her from traveling to the city to get contraceptives when the local clinic was out, she said.

It was only after her mother-in-law died that she started using contraceptives properly. By then Mahmoud had three children and three miscarriages.

Since January, the government has limited cash assistance to poor families to two children instead of three in an attempt to push them to have fewer kids. Mahmoud will receive less cash every month. Her husband works only a few days a month, making 45 Egyptian pounds ($2.60) a day, she said.

Mahmoud and her neighbor Sanaa Mohammad, a 38-year-old mother of three, said the change should apply to new families, not women like them who already benefit from the program and have more than two children.

“It’s not fair to give someone something and then take it away,” said Mohammad.

The government sees the population boom as a threat to its economic reform plans. Every year, 800,000 young Egyptians enter the labor market, where unemployment is officially 10 percent.

In Egypt, population growth is around half the economic growth rate, but it should be no more than a third – otherwise it will be difficult to invest in social programs and improve living standards, said Magued Osman, chief executive of Baseera, the Egyptian Center for Public Opinion Research.

Analysts say Egypt should target people before they have children and sex education should be available in schools.

“Two Is Enough is good, but by itself it will not do the job,” said Abla Abdel Latif, executive director of the Egyptian Center for Economic Studies.

Wafaa Mohammad Amin, 36, a mother of four who works on “Two Is Enough”, got married at 17 and had her first child a year later. Two of her children were malnourished because she didn’t know how to breastfeed properly. She had to postpone her education and couldn’t work for years.

“There are many things I know now that I wish I had known back then,” she said. “I don’t want others to go through what I went through.”

(Reporting and writing by Lena Masri; Editing by Giles Elgood)

Judge rules for Trump administration in suit over family-planning program shift

FILE PHOTO: Healthcare activists with Planned Parenthood and the Center for American Progress protest in opposition to the Senate Republican healthcare bill on Capitol Hill in Washington, U.S., June 28, 2017. REUTERS/Joshua Roberts/File Photo

By Brendan O’Brien

(Reuters) – A federal judge ruled on Monday against birth control organizations that sought to block the Trump administration from shifting a federal family-planning grant program toward prioritizing groups that are faith-based and counsel abstinence.

Three planned Parenthood organizations along with the National Family Planning Reproductive Health Association filed lawsuits, which were later combined, in May challenging guidelines the Department of Health and Human Services (HHS) issued in February.

Those guidelines set forth new criteria for how the department under Republican President Donald Trump would assess applications for grants under the Title X family planning program. The grants are expected to total $260 million.

The organizations objected to the criteria’s focus on abstinence, easier access to primary health care, increasing family participation and cooperation with faith-based organizations, according to the ruling.

The organizations argued that the changes require a notice and comment rule-making process, violate the Title X law and were “arbitrary and capricious.”

United States District Court Judge Trevor McFadden, who was appointed by Trump in 2017, said in his ruling that “courts cannot review substantive objections to a non-final agency action, nor can they require formal rulemaking for a change in agency procedure.”

McFadden also said that if he could rule on the merits of the case, the government’s changes align with program’s commitment to support “voluntary family projects … offering a broad range of acceptable and effective family planning methods and services.”

Vice President Mike Pence, a former Indiana governor and strident opponent of abortion, has pushed Congress to defund Planned Parenthood. The non-profit’s clinics provide contraception, health screenings and abortions.

“The Trump-Pence administration is trying to impose its ideology on people – no matter how many it hurts,” Dawn Laguens, Executive Vice President of Planned Parenthood Federation of America, said in a statement on Monday, adding that the ruling could effect the health care of four million people.

Planned Parenthood health centers serve more than 40 percent of patients receiving care subsidized by Title X.

HHS could not be reached for comment.

(Reporting by Brendan O’Brien in Milwaukee; Editing by Darren Schuettler)

Supreme court strikes down California law on anti-abortion centers

Anti-abortion activists (L-R) Terrisa Bukovinac, Megan Lott and Peter Hinman stand outside of the U.S. Supreme Court in Washington, U.S., June 26, 2018. REUTERS/Leah Millis

By Andrew Chung

WASHINGTON (Reuters) – The U.S. Supreme Court on Tuesday struck down a California law requiring clinics that counsel women against abortion to notify clients of the availability of abortions paid for by the state, ruling it violated the free speech rights of these Christian-based facilities.

The Supreme Court legalized abortion in 1973, and while the broader issue of abortion rights was not at issue in the case, the 5-4 ruling represented a significant victory for abortion opponents who operate these kinds of clinics – called crisis pregnancy centers – around the country.

The court’s five conservative justices were in the majority in the ruling authored by Justice Clarence Thomas, with the four liberals dissenting.

Crisis pregnancy centers have said they offer legitimate health services but that it is their mission to steer women with unplanned pregnancies away from abortion.

There are roughly 2,700 crisis pregnancy centers in the United States, including around 200 in California, according to abortion rights advocates, vastly outnumbering abortion clinics. California officials said some of the centers mislead women by presenting themselves as full-service reproductive healthcare facilities, going so far as to resemble medical clinics, down to lab coats worn by staff.

California’s Reproductive FACT Act, passed by a Democratic-led legislature and signed by Democratic Governor Jerry Brown in 2015, required centers licensed by the state as family planning facilities to post or distribute notices that the state has programs offering free or low-cost birth control, prenatal care and abortion services. The law also mandated unlicensed centers that may have no medical provider on staff to disclose that fact.

(Reporting by Andrew Chung; Editing by Will Dunham)