Planned Parenthood said today that it would withdraw from the federal family planning program that provides birth control and other health services to poor women rather than comply with a new Trump administration rule that forbids referrals to doctors who can perform abortions.

Planned Parenthood receives about $60 million given annually through the federal program known as Title X. The funds have enabled the group to provide more than 1.5 million low-income women each year with services like birth control and pregnancy tests, as well as screenings for sexually transmitted diseases and breast and cervical cancer. In some rural communities, Planned Parenthood is the only provider of such services.

In states like Utah, where Planned Parenthood is the only organization receiving Title X funds, and Minnesota, where Planned Parenthood serves 90% of the Title X patients, those seeking care may face long waits for appointments, the group said, while other patients may delay care or go without. Overall, Planned Parenthood gets more Title X money than any single group, and it serves 40% of all Title X patients.

The group’s decision to stop accepting the money was cheered by anti-abortion groups that have long sought to deprive Planned Parenthood of federal support. “It is a long-awaited victory that will energize the pro-life grassroots,” said Jeanne Mancini, president of the March for Life.

Planned Parenthood has continually received Title X money since the program was enacted in 1970 during the Nixon administration.

Alexis McGill Johnson, acting president of Planned Parenthood, today accused the administration of forcing Planned Parenthood out of the Title X program. “When you have an unethical rule that will limit what providers can tell our patients, it becomes really important that we not agree to be in the program,” she said.

The Department of Health and Human Services said in a statement today that groups that refused to comply with the rule “are now blaming the government for their own actions.” The agency added: “They are abandoning their obligations to serve their patients under the program.”

The rule says that while clinics accepting Title X funds may continue to talk to patients about abortion, they may not refer women to an abortion provider or suggest where to obtain an abortion.

Planned Parenthood and many other organizations, including the American Medical Association, say the restriction would force physicians and clinics to withhold medical information from patients, would interfere with the doctor-patient relationship and could deny pregnant women the range of options available to them.

“We will continue to defend the right for patients to talk freely with their physicians about all their health care options,” Dr. Patrice A. Harris, president of the American Medical Association, said in an email.

The Trump administration has steadily shifted federal health programs toward conservative preferences like promoting abstinence in teen pregnancy prevention programs and allowing exemptions to insurance coverage of birth control for employers with religious objections.

Withdrawing from Title X will not deprive Planned Parenthood of all government funding, a longtime goal of many conservatives. Figures from Planned Parenthood’s 2017-18 annual report showed that the organization received about $500 million from Medicaid, the joint federal and state health care program for low income people. Federal funds cover most of that spending.

The immediate effect of a Planned Parenthood withdrawal is unclear and likely to vary by state. Hawaii, Illinois, New York, Oregon and Washington have said their states would not participate in Title X under the new rule. Legislatures in Massachusetts and Maryland have passed laws that essentially have the same effect. Planned Parenthood expects some of the states to make up some of the money.

The rule, announced in February, is being challenged in court by Planned Parenthood, other organizations and more than 20 states, but a federal appeals court in July said the policy change could take effect while the legal cases were pending.

Planned Parenthood and some other organizations that receive Title X funds had decided to stop using the money until the legal challenges were resolved, although they had not officially withdrawn from the program.

The Department of Health and Human Services said that such an intermediate status would not be acceptable. It said that organizations had until Aug. 19 to submit an “assurance and action plan” showing they intend to make “good faith efforts” to comply with the new rule.

Last week, Planned Parenthood sent a letter to the 9th U.S. Circuit Court of Appeals, asking a panel of judges to stay the deadline until the legal cases could be decided. On Friday, the court declined to do so.

Earlier this month, the Department of Health and Human Services posted an explanation of the timeline and details of the new policy, saying that it is “not a gag rule.”

“Health professionals are free to provide nondirective pregnancy counseling, including counseling on abortion, and are not prohibited in any way from providing medically necessary information to clients,” the department said. “The Final Rule does NOT include the 1988 Regulation’s prohibition on counseling on abortion — characterized by some as a ‘gag rule’ — but neither does it retain the mandate that all grantees MUST counsel on, and refer for, abortion.”

The department said that “while Title X providers are prohibited from referring for abortion as a method of family planning, referral for abortion because of an emergency medical situation is not prohibited.”

It said providers may give pregnant women “a list of comprehensive health care providers (including prenatal care providers), including some (but not the majority) who perform abortion as part of a comprehensive health care practice. However, this list cannot serve as a referral for, nor identify those who provide abortion — and Title X providers cannot indicate those on the list who provide abortion.”

Because clinics receiving Title X money will no longer have to counsel women on all reproductive options, including abortion, the new rule may make faith-based providers and others that oppose abortion eligible for funding — a change that could significantly alter the guidance patients receive.

Organizations receiving Title X funds will still be able to perform abortions, but will have to do so in a separate facility from their other operations and adhere to the new requirement that they not refer patients to it. Clinics have been prohibited for years from using federal money to finance abortion services. The new rule goes a step further by ordering them to keep separate books for their abortion operations. Those changes are expected to take effect in 2020.

Planned Parenthood is not the only provider that has bridled at the new rule. In Maine, the only Title X recipient, Maine Family Planning, has decided to withdraw from the program, but has said that, for now, it will not close any of its 18 clinics.

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