BOSTON — State leaders and reproductive health care providers are blasting new rules that withhold federal money from health centers providing or referring patients to abortion services, arguing that the changes will hurt low-income women.

Under the rules, which go into effect in May, the U.S. Department of Health and Human Services' $260 million Title X grant program will stop funding providers such as Planned Parenthood that perform or promote abortion as a method of family planning.

An organization that performs abortions would have to do so in a facility that is physically and financially separate from those offering other Title X services, such as gynecological care, cancer screening and testing for sexually transmitted diseases.

Title X providers give priority to low-income families, who receive care for free or on a sliding scale. Federal funds are already prohibited by law from being used for abortion.

Attorney General Maura Healey has joined 21 other state attorneys general and several medical advocacy groups in a federal lawsuit challenging the rule.

Gov. Charlie Baker, a moderate Republican who supports abortion access, also opposes the plan to cut Title X funding.

Women's health advocates say the new rules will impact any clinic that supports or even refers patients for abortion services.

"This is an attempt to take away basic health care from low-income women across the country," said Rebecca Hart-Holder, executive director for NARAL Pro-Choice Massachusetts. "It's a rule that is going to prevent people from getting birth control, cancer screenings, treatment for STDs and even basic wellnesses care."

About 100 health care providers in Massachusetts — including five run by the Planned Parenthood League of Massachusetts — received more than $6.1 million through the Title X program in 2017, according to federal data. That money helped provide services to an estimated 75,000 people.

Alain A. Chaoui, a physician and president of the Massachusetts Medical Society, said a "gag order" attached to the rule restricting medical advice on abortion services will force providers to choose between receiving vital federal money and giving trustworthy advice to patients.

"Any situation in which a physician is prohibited from delivering all critical health-related information to a patient is unfair and dangerous for all involved," Chaoui said in a statement. "This rule and the pathway it intends to build toward further restricting access to health care services are unconscionable."

Planned Parenthood loses

Opponents of the proposal held a press briefing earlier this week with U.S. Sen. Ed Markey, a Malden Democrat, who said the move will "roll back the clock" on women's health.

Health and Human Services Secretary Alex Azar has said the Trump administration's goal is protecting "the dignity of human life from conception to natural death."

"This means not just protecting human life in the administration of our programs but also respecting the conscience rights of those who participate in HHS-funded programs," he said in a statement.

The department is creating a new Conscience and Religious Freedom Division to ensure "compliance with and enforcement of laws that protect conscience and free exercise of religion in health care and human services," the agency said.

While none of the money provided for Title X services may be used for abortion, religious conservatives and other opponents for decades have complained that many Planned Parenthood affiliates receive grant money while also providing abortions, which means the funding could be improperly mixed.

"The Trump administration is merely tightening a loose interpretation of the law that has allowed federal money to go to abortions," said C.J. Doyle, spokesman for the Catholic Action League of Massachusetts, which opposes abortion. "They want to ensure the disbursement of Title X funds more faithfully complies with the law."

Defunding Planned Parenthood has been a goal of the anti-abortion movement for decades. President Donald Trump pledged to do so during his 2016 campaign.

Nationally, Planned Parenthood — which operates about 40 percent of the 4,000 Title X clinics in the country, serving more than 4 million people — stands to lose an estimated $60 million year in funding.

Abortion falling in Bay State

Massachusetts is one of 17 states where public money is used to fund abortions and other reproductive services for low-income women.

A 1981 Supreme Judicial Court ruling holds that because the state provides medical coverage through its Medicaid programs to eligible women for births and other reproductive services, it must also provide coverage for abortions.

Abortion providers are reimbursed through Medicaid payments, but it's not clear how much the state spends on them.

Those opposed to the recent changes in the federal grant say they hope state lawmakers will fill gaps in funding if the lawsuit to block the proposed rule fails.

In 2017, when Trump issued an executive order allowing employers to opt out of providing birth control coverage by claiming religious or moral objections, lawmakers and Baker rushed to approve legislation that guarantees insurance coverage for women's birth control regardless of changes in federal policy.

Overall, the number of women seeking abortions in Massachusetts appears to be falling.

There were 18,285 abortions performed in the state in 2017, according to the most recent data from the state Department of Public Health.

That's down more than 12 percent from 2010 when hospitals, clinics and physicians reported 20,802 abortions to health officials.

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhi.com

###