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Introduction

Since taking office, the Trump administration has unleashed a blitz of regressive and discriminatory laws and policies. Of the many issues under attack, few have seen similar ire and attention as sexual and reproductive health and rights (SRHR). Both internationally and domestically, the Trump administration has engaged in a broad, systematic effort to undermine reproductive choice and bodily autonomy.

Internationally, the Trump administration has attempted to undermine international law and institutions that protect SRHR and has cut funding for organizations that promote reproductive rights and services. Within days of taking office, President Trump reinstated and expanded the Global Gag Rule, an onerous policy that limits funding for foreign non-governmental organizations that provide abortion services as a method of family planning and restricts a wide variety of speech about abortion services, research, and advocacy, with well-documented detrimental impacts on sexual and reproductive health, HIV and AIDS services, and maternal mortality. The Trump administration has attempted to erase language on SRHR from governmental and inter-governmental documents, such as in the State Department’s annual human rights report, United Nations (UN) negotiated documents, and UN resolutions.  In 2019, the United States (US) cut funding to the Organization of American States (OAS), a quasi-governmental regional body, for allegedly violating restrictions on lobbying for abortion rights by commenting on state practice on reproductive choice. Most recently, the unlawfully formed and operated State Department’s Commission on Unalienable Rights, created to advise the Secretary of State on human rights and intended to inform US foreign policy, issued a draft report which misrepresents the nature of the international human rights framework and inaccurately frames access to abortion as a “divisive social and political controvers[y]” rather than an established right under international law.

The Trump administration’s attacks on reproductive rights are not limited to international and foreign-policy related targets. Domestically, the Trump administration has also taken steps to erode protections for SRHR, including by targeting the Title X Family Planning program with new regulations, Compliance with Statutory Program Integrity Requirements (the Final Rule), published on March 4, 2019. The Final Rule imposes a number of new physical, financial, and administrative burdens on clinics receiving Title X funding in an effort to restrict women’s access to particular reproductive health information and services. As this report documents, the Final Rule violates fundamental human rights and the US’ obligations under international human rights law. Although the US has attempted to minimize or ignore its international human rights obligations, as shown in the recent Commission on Unalienable Rights draft document, this report reviews the substantive obligations of the US and the binding nature of these legal obligations.

The Trump administration’s attacks on reproductive rights are not limited to international and foreign-policy related targets. Domestically, the Trump administration has also taken steps to erode protections for SRHR, including by targeting the Title X Family Planning program with new regulations, “Compliance with Statutory Program Integrity Requirements (the Final Rule),” published on March 4, 2019. The Final Rule imposes a number of new physical, financial, and administrative burdens on clinics receiving Title X funding in an effort to restrict women’s access to particular reproductive health information and services. As this report documents, the Final Rule violates fundamental human rights and the US’ obligations under international human rights law. Although the US has attempted to minimize or ignore its international human rights obligations, as shown in the recent Commission on Unalienable Rights draft document, this report reviews the substantive obligations of the US and the binding nature of these legal obligations.

Part II of this report provides background information on the establishment and administration of the Title X program and specifics of the Final Rule amending how Title X funding should be directed. Part III addresses the impact of the Final Rule restrictions on clinics’ participation in the Title X program and on access and quality of medical care for patients. It also considers specific populations likely to be disproportionally impacted by the Final Rule changes, including women, low-income families, people of color, non-English speakers, people living in rural areas, people with disabilities and LGBTQ communities.

Part IV examines whether the new Title X regulations are consistent with the US’ international legal obligations. It first considers whether the Final Rule violates treaties the US has signed and ratified, including the International Covenant on Civil and Political Rights (ICCPR), the Convention on the Elimination of All Forms of Racial Discrimination (CERD), and the Convention Against Torture (CAT). It then examines whether the Final Rule would defeat the object and the purpose of the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the Convention on the Rights of the Child (CRC), three treaties the US has signed but not yet ratified. For the reasons discussed below, the Final Rule violates a number of the rights guaranteed by treaty obligations binding on the US, including the rights to life, equality, privacy, freedom from gender, racial and ethnic discrimination, freedom from cruel, inhuman and degrading treatment and freedom of speech and association, and must therefore be revoked.