The Trump administration has issued its final draft of a rule that makes sweeping changes to Title X, the federal program that provides birth control and other reproductive health services to millions of low-income Americans.

Under the new rule, posted Friday by the federal Department of Health and Human Services Office of Population Affairs, any organization that provides or refers patients for abortions is ineligible for Title X funding to cover STD prevention, cancer screenings and contraception. Federal funding for abortion already is illegal in most cases.

The rule, first proposed last year, has been popular with President Trump's socially conservative base. It's expected to be formally published to the Federal Register soon, and would go into effect 60 days later.

Anti-abortion-rights activists have long called on lawmakers to "defund Planned Parenthood." They argue that no organization with any ties to abortion should receive the federal funds.

"Abortion is not part of family planning," Tom McClusky, vice president of government affairs at the anti-abortion March for Life, said in a recent interview with NPR. "Those services should be separate and even have separate facilities."

Doreen Denny, senior director of government relations at Concerned Women for America, said her group supports a "bright line of separation between any kind of provider that would have any kind of engagement in abortion services" and federal Title X funding.

Abortion-rights supporters have criticized the regulation as a "gag rule" that will prevent doctors from speaking openly with pregnant women about options including abortion.

Dr. Leana Wen, president of Planned Parenthood, recently told NPR that withholding information about abortion from Title X patients would violate medical ethics. "As a doctor, this compromises the oath that I took to serve my patients and help them with making the best decision for their own health," Wen said. "My patients expect me to speak honestly with them, to answer their questions, to help them in their time of need. It's unconscionable and unethical for politicians to restrict doctors like me from speaking honestly to our patients."

Wen and other reproductive rights advocates say the new regulations would force groups like Planned Parenthood to refuse Title X funds, which could reduce the number of locations where low-income women and other recipients can receive reproductive health care. Wen said Planned Parenthood clinics serve 41 percent of Title X recipients nationwide and warned that dramatic changes to the program could jeopardize access to care for the 4 million low-income people served by the program.

In addition to blocking grants to organizations that provide abortions or referrals, some religiously affiliated groups are hoping the new regulations will enable organizations like crisis pregnancy centers, which counsel women against abortions, to receive the funds.

"There are a number of options out there that can take up the banner," said McClusky, with the March for Life. "And Planned Parenthood's not the only game in town."

Some of those organizations emphasize abstinence outside of marriage or promote fertility awareness methods, which depend on understanding a woman's cycle and restricting sexual activity at times she is fertile.

Mario Dickerson, executive director of the Catholic Medical Association, said he would like to see the program move in that direction.

"We could provide abstinence programs; we could provide natural family planning ... but not have to provide these other services," Dickerson said.

That idea worries Julie Rabinovitz, president of Essential Access Health, which administers Title X grants in California. She said the Trump administration is making "some of the most extreme policy shifts" in the history of the Title X program. She said diverting federal funds to groups that do not provide a full scope of contraceptive options could reduce the number of facilities where low-income women can be prescribed birth control pills or IUDs.

"Birth control is a time-sensitive service, and it's an essential health care service," Rabinovitz said. "And we want to make sure that women are able to get the kind of birth control that they need and want in a very timely manner."

Reproductive rights groups are expected to fight the regulations in court.

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