U.S. Modifies Abortion-Advice Rules for Clinics

The Bush Administration said Friday that it was modifying its controversial rules governing family planning clinics so doctors may give pregnant patients “complete medical information,” including advice about abortion.

However, clinic doctors may not refer a pregnant woman to a facility that primarily performs abortions. In addition, nurses and clinic counselors are still forbidden to advise patients about abortion.

The provisions were the highlights of new guidelines issued late Friday by the Department of Health and Human Services. Ten months ago, the Supreme Court gave the Administration the go-ahead to begin enforcing strict rules against abortion referrals in federally subsidized clinics.

The regulations--dubbed “gag rules” by critics--as first proposed in 1988 would have prohibited doctors, nurses and counselors from advising patients about abortion. In some early versions, clinic operators were told that they could not even mention the word “abortion.”

The clinics challenged those guidelines on First Amendment grounds until the case reached the Supreme Court.

But the court’s ruling last May, rather than settling the issue, set off a wave of criticism among physicians and moderate Republicans on Capitol Hill. In response, the Administration delayed enforcing the rules.

Despite Friday’s modifications in the rules, however, the Planned Parenthood Federation denounced President Bush for “caving in to pressure from the far right.” David John Andrews, a vice president of the abortion-rights group, said Bush “has shown that he is willing to jeopardize women’s health to prove his allegiance to right-wing extremism.”

Meanwhile, the National Right to Life Committee expressed “strong approval” of the guidelines and said they will “prohibit the promotion of abortion as a birth-control method at federally funded clinics.”

The change announced Friday was not a true surprise. In November, Bush declared that his Administration did not intend to “gag” doctors. He also directed HHS officials to implement the rules in a way that allowed doctors to fully discuss a pregnant woman’s medical options, including abortion.

An HHS official, who asked not to be identified, indicated that the government would not try to limit in any way a doctor’s freedom to discuss abortion with patients.

But an official of the national organization that represents 90% of the clinics called Friday’s action “a cynical attempt by the Administration to have it both ways.”

“They know very well it is not doctors who run these programs. Physicians don’t spend their time doing this kind of counseling,” said Judith DeSarno, executive director of National Family Planning and Reproductive Health Assn. “They haven’t lifted the ‘gag rule’ for everyone else.”

The guidelines, which take effect in three months, will be sent to about 4,000 family planning clinics that receive federal funding under Title X of the Public Health Services Act. An estimated 5 million poor women and teen-agers visit these clinics annually to get medical tests and advice on matters such as contraception, venereal diseases or pregnancy.

“Nothing in these regulations is to prevent a woman from receiving complete medical information about her condition from a physician,” the guidelines say, quoting Bush’s November directive.

“This statement is intended to apply to medical information provided only by a physician directly to his or her patient, in a clinic visit or a subsequent conversation directly with the physician,” the guidelines add.

“Title X projects may not counsel, refer or steer clients to abortion,” the guidelines state. “Referrals may be made by Title X projects to full-service health providers that perform abortions but not to providers whose principal activity is providing abortion services.”

Gary Bauer, a social policy adviser to President Ronald Reagan, who in 1988 pushed HHS to tighten its rules on family planning clinics, said Friday that he was pleased by the outcome.

“The main purpose was to keep these federally funded clinics from promoting abortion. That’s what this was all about,” he said in telephone interview.

HHS officials released the guidelines at the close of business Friday and did not make themselves available to discuss the rules in detail. A House health subcommittee chaired by Rep. Henry A. Waxman (D-Los Angeles) scheduled a hearing for March 30 to question HHS officials on how the guidelines are to be applied.