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Abortion protesters attempt to hand out literature as they stand in the driveway of a Planned Parenthood clinic in Indianapolis on Aug. 16.

Michael Conroy/AP

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Michael Conroy/AP

Planned Parenthood is leaving the federal Title X family planning program rather than comply with new Trump administration rules regarding abortion counseling.

The new rules issued by the U.S. Department of Health and Human Services earlier this year prohibit Title X grantees from providing or referring patients for abortion, except in cases of rape, incest or medical emergency.

“The Trump administration has forced Planned Parenthood grantees out of Title X,” said Alexis McGill Johnson, Planned Parenthood’s acting president, in a conference call Monday. “The impact of the Trump administration’s gag rule will reverberate across the country.”

Officials say that means patients are likely to see longer wait times or increased costs for reproductive health services.

Planned Parenthood and other medical groups say the rule is unethical and interferes with the doctor-patient relationship; abortion-rights opponents, meanwhile, have long argued for a complete separation between federal dollars and any organization involved in providing or facilitating abortions.

The announcement follows a letter submitted by Planned Parenthood last week to the U.S. Court of Appeals for the 9th Circuit. An attorney for Planned Parenthood said the organization had hoped to remain in the program but stop using Title X funds while the matter is being litigated. But, the letter says, recent guidance from HHS informed grantees that they would have to leave the program if they could not show “good-faith efforts” to comply. The letter expresses “deep regret” but says Planned Parenthood clinics “now have no option but to withdraw from the Title X program.”

HHS officials said in a statement last week that by not complying, Planned Parenthood “is actually choosing to place a higher priority on the ability to refer for abortion instead of continuing to receive federal funds to provide a broad range of acceptable and effective family planning methods and services to clients in need of these services.”

Planned Parenthood’s withdrawal from the $286 million federal program represents a significant shift in the way the family planning program operates. Planned Parenthood has been involved in the program since its inception, and officials say they serve about 40% of the nation’s 4 million Title X recipients, who receive services such as contraception and STD screenings.

Doreen Denny, senior director of government relations for Concerned Women for America, which opposes abortion rights, called the news “a day of reckoning and decision” for Planned Parenthood.

“I think that Planned Parenthood certainly knew that they had a choice to make when they first applied for grants this round. They knew that these rules could take effect,” Denny said. “So this isn’t a surprise to them.”

Abortion-rights opponents have called on political leaders to defund Planned Parenthood and have praised President Trump for his administration’s efforts to deliver on his campaign promise to do just that.

The impact of the rule change is not limited to Planned Parenthood. Maine’s sole Title X grantee, Maine Family Planning, is also withdrawing. In a letter to HHS, CEO George Hill said his group is leaving the program “more in sorrow than in anger.”

Emily Nestler is an attorney with the Center for Reproductive Rights, which is representing Maine Family Planning in its own legal challenge to the Trump administration rules. She said the move could force as many as 15 clinics to close in the largely rural state.

“Today is the tipping point, I think, and you’re going to really see the unwinding of a program that has provided extraordinary care and been a huge success for decades,” Nestler said in an interview with NPR.

Anti-abortion advocates say they hope the changes to the Title X program will open up funding for other groups, including religiously based organizations and crisis pregnancy centers that counsel women against abortions. Some of those groups do not provide a full range of contraceptive services.