For a responsible reproductive health care provider, it’s an unthinkable choice: provide patients with the highest standard of medical care and risk losing federal funding, or accept the funding and limit the care. It’s a dilemma a provider should not have to consider, but that was the decision Title X family planning clinics faced this month.

Last week, Planned Parenthood announced it will refuse federal funds rather than accept the prohibitive conditions imposed by the Trump administration. And it’s not just Planned Parenthood, other Title X providers may do the same. As a consequence, hundreds of thousands—and perhaps millions—of low-income individuals will lose access to government-subsidized reproductive health care services.

The Title X program, enacted in 1970, is a federal family planning program that provides more than $280 million annually to bring contraception, disease and cancer screenings, and other reproductive health services to people who otherwise couldn’t afford it. The program annually supports services for over 4 million patients, many of whom have nowhere else to go to receive health care.

The Trump/Pence administration has implemented what some call the “domestic gag rule,” but the new rule is far more expansive than that. It is a coercive measure that prohibits health care providers from discussing abortion options with their patients and requires the clinic to refer a patient to prenatal care services, even if the patient wants to terminate the pregnancy. It also requires that Title X clinics be financially and physically removed from the provision of any abortion services. Furthermore, it no longer requires nondirective counseling, which means providers can now instruct their patients as to what option they prefer for their clients.

Several states and reproductive health organizations sued the Trump/Pence administration over the harmful new rule. The 9th Circuit Court of Appeals said it will hear oral arguments in late September to determine the legality of the rule, but denied a stay requested by the plaintiffs. This allowed the Trump administration to require Title X recipients to submit an “assurance and action” plan by August 19 to demonstrate how they will comply with the new rule, making reproductive health organizations decide what unbearable choice to make by the deadline.

Up until now, Planned Parenthood was the recipient of slightly over 20 percent of Title X funding per year and served 40 percent of Title X patients. In some states like Utah, Planned Parenthood was the only Title X grantee. For these individuals, finding an alternative Title X clinic to obtain family planning care isn’t even an option. It’s not known yet how many other health care providers will reject Title X funding, but Planned Parenthood is not the only one. Maine Family Planning, the only Title X provider in the state, and Washington State’s Department of Health both withdrew from the program and withdrawals in other states can be expected.

The great bulk of existing Title X clinics electing to comply with the new Trump-era regulations are not doing so because they embrace the new rules; they simply must in order to not to close their doors and continue providing care.

Trump administration supporters have downplayed the dangerous effects of forcing Planned Parenthood clinics and others out of the Title X program by saying “pro-life” clinics will take their place. These clinics, like Obria, focus on abstinence and natural family planning as methods of birth control. In some cases, these clinics don’t even provide several contraceptive methods outside of “natural family planning” for their patients seeking services. The efficacy of these methods of family planning are not supported by scientific research, and therefore, have no right being funded through federal dollars.

Administration officials may be targeting Planned Parenthood, and that attack may please Trump’s political base, but it’s the 4 million people served by the Title X program who will be the ultimate victims. Shame on the Trump administration.

This op-ed by Population Institute Director of Research Bridget Kelly originally ran on August 28, 2019 in Newsweek