Facts
- Title X authorizes federal grants for family-planning services and provides that none of its funds may be used “in programs where abortion is a method of family planning.”
- For many years, Title X projects commonly provided nondirective pregnancy counseling and abortion referrals while maintaining that Title X funds were not used to perform abortions.
- In 1988, HHS issued regulations barring Title X projects from counseling, referring for, or advocating abortion as a method of family planning.
- The regulations also required “program integrity,” including separation of facilities, personnel, and accounting records between Title X projects and any abortion-related activities of the same grantee.
- Title X grantees, physicians, and a state challenged the regulations as contrary to Title X and unconstitutional under the First and Fifth Amendments.
- The district court granted summary judgment to HHS, and the court of appeals affirmed; the Supreme Court granted review to resolve a circuit split.
Issues
- Whether the 1988 HHS regulations are a permissible interpretation of Title X, including the statutory limitation that Title X funds not be used in “programs where abortion is a method of family planning.”
- Whether prohibiting abortion counseling, referrals, and advocacy within Title X projects violates the First Amendment.
- Whether the regulations violate the Fifth Amendment by burdening the right to choose abortion, interfering with the physician-patient relationship, or denying equal protection.
Decision
- The Supreme Court affirmed and upheld the regulations.
- The Court held the statute was ambiguous on abortion counseling/referral and program-separation requirements, and HHS’s interpretation was reasonable and therefore entitled to deference.
- The Court held the First Amendment was not violated because the government may define the scope of a federally funded program and may fund childbirth-oriented family planning without funding abortion-related counseling or referrals within that program.
- The Court held the Fifth Amendment was not violated because the regulations did not prohibit abortion or place a governmental obstacle in a woman’s path; they reflected a funding choice, leaving women and providers free to seek and provide abortion information and services outside the Title X project.
Legal Principles
- When a statute administered by an agency is ambiguous on a point, a reasonable agency interpretation may be upheld under judicial deference principles.
- The government may allocate public funds to favor certain activities or messages and may define the limits of a federally funded program without thereby violating the First Amendment, so long as the restriction operates within the funded program.
- The Constitution protects the right to choose abortion, but it does not require the government to subsidize abortion or abortion-related counseling and referrals.
- A funding restriction that declines to support abortion-related activity within a public program, without barring access to abortion or penalizing private speech outside the program, generally does not violate substantive due process or equal protection.
Conclusion
The Court upheld HHS’s Title X regulations as a reasonable construction of Title X and as consistent with the First and Fifth Amendments, concluding that the government may structure a federally funded family-planning program to exclude abortion counseling, referrals, and advocacy within the program while leaving private speech and abortion access outside the program intact.