FEDERALLY funded family planning clinics around the country are hoping that Congress will save them from an agonizing choice. The clinics could be faced with the prospect of refraining from discussing abortion with patients in order to keep their federal subsidies or forgoing the money - and almost certainly cutting back on services - so that clients may hear all their options.
Officials at the Planned Parenthood Federation of America (PPFA), the nation's single largest provider of family-planning services, don't like to speak publicly about what the future will look like if Congress fails.
Instead, they say, they are focusing on getting legislation passed in both chambers of Congress that would override the United States Supreme Court's May 23 Rust v. Sullivan decision, which upheld federal rules forbidding discussion of abortion in clinics that receive money from the federal government's family planning program, Title X of the Public Health Service Act.
PPFA has launched what it calls its largest media campaign ever, which it expects will cost between $3 million and $5 million.
Initially, says Planned Parenthood president Faye Wattleton, the campaign will target congressional leadership to get them to push the legislation through as quickly as possible. Time is of the essence. Clinics have roughly between 60 and 90 days from the date of the Supreme Court ruling to come into compliance.
Until now, court injunctions have prevented implementation of the regulations in most parts of the country. But PPFA and other family-planning officials concede that the legislation faces an uphill battle, especially since it needs a two-thirds majority to make it impervious to a promised veto by President Bush.
A random sampling of congressional offices showed that members have so far not received much mail on the issue. The office of House Speaker Thomas Foley (D) of Washington reported some 250 pieces of mail as of last week not much," says a spokeswoman, "but it's still early." Most of the mail favors overturning the regulations.
Proponents of the legislation hope to pick up votes by stressing the freedom-of-speech and medical ethics aspects, not abortion rights. In fact, some of the bill's sponsors, such as Sen. Mark Hatfield (R) of Oregon, are anti-abortion. But getting to two-thirds will be tough, and the talk among family-planning administrators across the country centers on what to do "if." For the most part, clinics have not announced what they will do if Congress fails.
"We've told them to do nothing so far," says Joan Henneberry, director of family planning for the Colorado Department of Health. "There are still a lot of unknowns in the Supreme Court decision." One unknown involves the word "separation." According to the regulations, Title X funding is limited to programs that "maintain physical and financial separation from prohibited abortion activities," which includes abortion counseling.
Clinics already functioning under the Title X rules have managed so far to keep their subsidies and inform pregnant women of all their options, either by having counselors whose salaries are not covered by Title X do the counseling or by referring patients to non-Title X clinics for counseling.
Until now, the Department of Health and Human Services has not issued precise guidelines as to how the rules will be enforced. Some abortion-rights advocates say HHS is lying low deliberately. "They're being very, very low key, for good reason," says a lawyer who advises a family-planning organization. "What if HHS came out today and said, 'You'll need separate buildings, separate staffs, separate everything'? It might have an impact on Congress."
Alexander Sanger, president and CEO of Planned Parenthood of New York City, says HHS is "playing a game. [It's] trying to suck as many clinics as possible into submitting proposals for compliance so that Congress will think it doesn't need to overturn the regulations."
Mr. Sanger's affiliate, which represents many clinics, has already announced that it will forgo Title X funds if the regulations hold.
There is no way, he says, a Planned Parenthood clinic can accept the limitations on speech and fulfill the Planned Parenthood standard that a pregnant woman be advised of all her options - having the baby, putting it up for adoption, or having an abortion.
At least two other PPFA affiliates, Wisconsin and Northern New England, have also announced they won't take Title X money. By taking an early stand and assuming the strictest interpretation of the ruling - ahead of HHS itself - the three have called attention to what the future may hold for the 4 million largely low-income women who rely on federally funded health facilities.
"We will have clinic closings, I'm sure," says David Hass, president of the board of directors of Planned Parenthood of Wisconsin. His affiliate stands to lose $225,000 of its $11 million budget.
The New York affiliate will lose $430,000, or 3 percent of its budget. By late last week, it had received $85,000 in private donations. Sanger, the PPNYC president, says the affiliate may be able to make up its lost funds this year because of publicity over Title X.
But, he adds, in future years it won't be possible.