VOLUME 16 | ISSUE 2| April 3, 2019
On March 4, the Trump Administration published a final rule, “Compliance with Statutory Program Integrity Requirements,” (the rule) amending Title X, the nation’s family planning program. The Family Planning Council of Iowa, as a Title X grantee, has grave concerns about the new rule as an unprecedented and unwarranted restructuring of a national health care program designed to ensure that all people in the United States have access to the sexual and reproductive health care they need.

The rule undermines evidence-based practice outlined in the recently-enacted national Quality Family Planning standards by diluting the requirement to make available a broad range of contraceptive services so that all patients can be assured of a method that is safe and effective for them regardless of their income; by eliminating the long-standing requirement for nondirective options counseling to ensure all patients receive nonjudgmental, nondirective information about all of their options; and by prohibiting abortion referrals while requiring all patients be referred for prenatal and/or social services, violating the basic tenets of patient-centered care. 

The rule creates a burden regarding abortion counseling and referrals. Should the new rule go into effect, it would greatly reduce the number of high quality providers willing and able to deliver preventive Title X services to patients in need throughout Iowa and the country, and would make it difficult if not impossible for all Title X providers – not just abortion providers - to counsel patients on all of their options – even when the patient asks for such counseling - thereby compromising care or requiring convoluted and ineffective care solutions for patients.

We are also concerned about the expansion of HHS discretion through vague standards that allow broad discretion in assessing compliance, changes to the criteria for evaluating applicants to the Title X program that give HHS seemingly unchecked power to prevent applications from even reaching the objective review process that governs the awarding of grants, and unprecedented access to information about and authority over care partners that may decrease participation in the program due to increased and unnecessary compliance and reporting-related requirements.

For nearly 40 years, the Family Planning Council of Iowa has joined other Title X providers across the country to worked tirelessly through administrations of every political and ideological stripe to stay true to the principles outlined in the landmark, bipartisan legislation that established our nation’s family planning program. The hallmark ideals of that program – that every person deserves to be treated with respect and to have access to full and accurate information and care in a confidential setting that meets their needs – ring as true today as at the inception of the program. 

Our decades of experience in this program cause us to conclude that the new rule is thoroughly hostile to the ideals and principles of the Title X program, threatening patient care, provider integrity, and the health and wellbeing of our nation. As a Title X grantee, we take our responsibility to effectively implement and diligently monitor this program very seriously, with a clear and steady focus on delivering the best care possible to meet the needs of millions of patients across the nation who might otherwise be forced to go without.

Executive Director

 There are many health awareness events and activities coming up. We encourage you to get connected with health promotion activities in your community!


  • Iowa School Nurse Organization: Building a Healthier Future April 11-12, 2019. This two-day conference offers participants an opportunity to learn current research-based practices for pediatric and school nursing through interactive teaching and learning strategies.

  • Iowa Department of Public Health: Governor's Conference on Public Health April 23-24, 2019. This two-day conference is a comprehensive continuing education opportunity those who work in public health, environmental health, primary care, health promotion, health education and laboratory sciences.

  • Prevent Child Abuse Iowa: Child Abuse Prevention & Family Support Conference May 6 - 7, 2019. This conference brings together more than 400 professionals with a focus on improving well-being in Iowa families. National and state experts share the latest research and strategies among service sectors, including family support, early childhood, education, health care and social work.

  • Family Planning Council of Iowa: Training Advisory Committee Webinar: Substance Use in Iowa May 9, 2019. This session will provide an overview of substance use in Iowa and the services made available through the Iowa Department of Public Health. Session will provide an introduction to Screening, Brief Intervention, Referral, and Treatment (SBIRT). Training Advisory Committee Training: Billing and Coding - May 22, 2019. For more information about this upcoming training, please contact Leila Schlenker at lschlenker@fpcouncil.com.
The Office of Population Affairs issued new rules on March 4, 2019 revising some Title X regulations. The changes specifically related to clinical services will be listed in this article.  

Title X requires clinics to provide a broad range of acceptable and effective medically approved family planning methods, as well as other family planning services, but now there is a push for fertility awareness-based methods and not necessarily “medically approved methods.” A single project now may offer only a single method or a limited number of methods as long as the entire project offers a broad range of family planning methods and services.

Title X requires adolescent counseling that encourages family participation in the decision to seek family planning services, but now adds that records must “document the specific actions taken to encourage such family participation (or the specific reason why such family participation was not encouraged).”

In the past, Title X has provided nondirective pregnancy options counseling, which consisted of providing information about prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination. Neutral, factual and nondirective information and counseling were provided if a woman requested information on any of these options. The new rule says, “Because Title X funds are intended only for family planning, once a client is medically verified as pregnant, she shall be referred to a health care provider for medically necessary prenatal health care.” If a client decides she wants an abortion, the client may be provided a list of “licensed, qualified, comprehensive primary health care providers (including providers of prenatal care), some, but not the majority, of which also provide abortion as part of their comprehensive health care services. Neither the list nor project staff may identify which providers on the list perform abortion.”

Many of the other changes relate to physical and financial separation relating to abortion; prohibition of activities that encourage, promote, or advocate for abortion; reporting requirements; and the appropriate use of funds.

The changes that relate to clinical services must be in place by May 3, 2019. Compliance with the financial separation must be accomplished by July 2, 2019, and the physical separation requirement by March 4, 2020. FPCI will be working to change policies and clinical protocols and provide training about these changes. More information will be coming in the near future.

The 2019 National Family Planning and Reproductive Health Association (NFPRHA) annual conference was held in Washington D. C. March 17-20. NFPRHA promotes and supports the work of Title X family planning and sexual health providers and administrators. The 10 Iowa members attending included FPCI staff, FPCI Board members as well as several staff from subrecipient agencies.
This year’s conference was attended by over 500 people from the Title X and family planning community throughout the United States. The conference had plenaries, concurrent workshops, and peer-to-peer sessions which provided informative, relevant and solution-oriented content. Many important topics were presented and discussed including the proposed new Title X Rules, STD/HIV Screening in Family Planning Settings, Reproductive Justice and Health Equity, New Perspectives in Fertility Awareness-Based Methods of Family Planning, Balancing Personal Preferences and Public Health Goals in Contraceptive Care, and more.
On the last day of the conference a group of Iowa family planners visited Congressional offices to provide a report on the Title X program in Iowa. 

At this year's National Family Planning and Reproductive Health Association Conference, our Executive Director, Jodi Tomlonovic was the honored as the recipient of the Dr. Allan Rosenfield Award. Jodi was unable to attend, however, Leila Schlenker, FPCI Training Coordinator, accepted the award on her behalf.

For nearly 35 years, Jodi has served as the Council's Executive Director. Every day we have the opportunity to see her dedication and commitment on full display.
That same dedication and commitment also extends to public officials who rely on factual, objective information about the benefits of family planning services for individuals, families, and communities; to people who rely on quality, affordable, confidential family planning services; to family planning providers who recognize the importance of providing these services to meet the public health need in their communities; and to her staff, colleagues and friends, for whom she always takes the time to listen, to care, to champion, and to stand in the gap for.

As many of you who work in family planning and reproductive health services can attest, the last few years have been extremely difficult. We are no exception. The Council has faced many critical challenges through the years. Yet, with Jodi's strong leadership and guidance, we have met every challenge and our resolve has been strengthened.

We are so pleased that she was honored among her peers at NFPRHA. On behalf of the Council Board and Staff we extend our heartfelt thanks to everyone at NFPRHA, and to Dorothy Mann, a longtime friend and family planning colleague for submitting our Director for this incredible honor.

As in the past, April is STD Awareness Month. This year CDC is bringing back four of their most successful STD Awareness campaigns. All four are now available on the STD Awareness Month website .
  • Get Yourself Tested (GYT) encourages young people to get tested and treated for STDs and HIV.
  • Syphilis Strikes Back highlights the resurgence of syphilis and the increased threat against gay and bisexual men, pregnant women, and newborn babies.
  • Talk. Test. Treat. focuses on three simple actions healthcare providers and patients can take to protect themselves/their patients.
  • Treat Me Right underscores the need for strong patient-provider relationships to overcome the rising STD burden.

The Iowa Department of Public health has decided to focus their efforts on the Talk. Test. Treat. campaign. According to CDC, Talk. Test. Treat. is a campaign that encourages individuals and healthcare providers to take three simple actions – Talk. Test. Treat. – to protect their health, the health of their partners, and that of their patients. The campaign reinforces that all STDs are preventable and treatable, and most are curable.
George Walton, STD Program Manager, reports that preliminary data indicate that 14,696 cases of chlamydia, 4,838 cases of gonorrhea, and 283 cases of syphilis were reported to IDPH in 2018. Compared to the preceding year, this represents a 5.8% increase in chlamydia, 28.3% increase in gonorrhea, and 1.7% decrease in syphilis. Trends observed with chlamydia and syphilis are similar to recent years. Congenital syphilis (in which a pregnant woman passes the infection on to her fetus) is an exception, though. Three cases were reported in 2018, continuing an upward trend. Reported cases of gonorrhea have increased substantially. There are likely multiple reasons for the increase in gonorrhea, including increased access to healthcare and testing and increased transmission among multiple populations.
All providers are encouraged to take advantage of the CDC website and materials to promote STD Awareness Month in your clinics. Materials are available for you to access and download. To help you get started , Download the STD Awareness Month toolkit to assist with planning.
For questions or more information, contact Colleen Bornmueller, CBSS Coordinator, cbornmueller@fpcouncil.com.
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This publication is funded in part by the U.S. Department of Health & Human Services - Office of Population Affairs/Family Planning: The information, comments, and views posted in this correspondence are the sole responsibility of the Family Planning Council of Iowa.
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