Pam Belluck

The vaccines — against flu and whooping cough — are strongly recommended during every pregnancy. But only about 35% of pregnant women in the country are receiving both vaccines, according to a new CDC report, and just over half receive one.

The consequences of missing vaccines for flu and whooping cough, also called pertussis, can be dire.

“Influenza and pertussis, or whooping cough, are serious infections that can be deadly for babies, especially for those who are too young to be vaccinated directly,” said Dr. Anne Schuchat, principal deputy director of the CDC in a briefing. “We are stressing the importance of two safe and effective vaccines for pregnant women and the risks to both women and their babies when these vaccines are not given during pregnancy.”

Whooping cough can be fatal, especially for babies, who cannot get their first vaccine against it until they are 2 months old. The CDC report said that about 70% of people who died from whooping cough in recent years were infants younger than 2 months.

“When infants get whooping cough they are usually very sick and have difficulty breathing, eating, drinking or sleeping,” Schuchat said. “Parents may see their baby gasping for air and even turning blue from lack of oxygen.”

When a woman receives the whooping cough vaccine during pregnancy, antibodies are transmitted to the fetus. Those antibodies protect babies when they are born until they can build up their own immunity from a series of five immunizations against the disease. The report said that if women receive the vaccination early in the third trimester of pregnancy, it gives their newborns optimal protection and will prevent nearly 80% of whooping cough cases in babies under two months old.

Flu can be particularly risky for pregnant women and can cause complications like premature birth. The report found that pregnant women account for about a quarter to a third of women of reproductive age who are hospitalized for influenza — even though only about 9% of women in that age group are pregnant in any given year.

Babies younger than 6 months — the age at which they can receive their first flu vaccine — are hospitalized from flu much more often than older children and are at greater risk of dying from it. Schuchat said infants with flu can develop problems like pneumonia, dehydration and swelling of the brain.

“Maternal immunization rates have been steadfastly stuck at about 50%,” said Dr. Denise Jamieson, chairwoman of the department of gynecology and obstetrics at Emory University School of Medicine, who was not involved in the new report. “We really haven’t moved the needle at all.”

The new report analyzed data on hospitalization and death from flu and whooping cough between 2010 and 2018. The researchers also conducted an online survey this past spring of about 2,600 women who reported being pregnant any time since August 2018. It included questions about whether the women’s health care providers recommended the vaccines and whether the women agreed to get vaccinated.

About three-quarters of the women surveyed said that during pregnancy their providers recommended the flu vaccine and the Tdap vaccine, which protects against whooping cough, tetanus and diphtheria. But even among those women, about a third did not get vaccinated, the report said.

The most common reason the women gave for not getting the flu vaccine was a belief it was not effective. The reason they gave most often for not getting the Tdap vaccine was not knowing it is necessary during each pregnancy. For both vaccines, the second most common reason women refused it was concern about whether it was safe for their babies, the report said.

Jamieson, a former CDC official who now practices obstetrics and gynecology at Grady Memorial Hospital, said that pregnant patients in her practice who declined to be vaccinated often said, “they heard bad things about the vaccine, misconceptions that it makes you sick or wasn’t safe,” she said. Some didn’t think they were at risk for flu she said.

Jamieson said women were generally more likely to accept the Tdap vaccine, possibly because it is newer so there are fewer misconceptions about it. The flu vaccine has been recommended in pregnancy since 1960, Jamieson said, but the Tdap has only been recommended for pregnant women since 2012.

The report found that African-American women were less likely than women of other races to be vaccinated and were less likely to report that their providers offered them or referred them for vaccination. Women who were uninsured, poor or living in the South were also less likely to be advised they should get the flu vaccine. Women age 35 or older and working women were less likely to have had received a recommendation for a whooping cough vaccine, although the report did not explain why.

Vaccines for flu and whooping cough are the only two immunizations recommended for all pregnant women, according to the American College of Obstetricians and Gynecologists, which posts a list of vaccines that are considered unsafe in pregnancy and others that can be given under certain circumstances.

This article originally appeared in

Pregnant Women Should Get Flu and Whooping Cough Shots, CDC Says

Millions of pregnant women in the United States are not getting two vital vaccines that protect not only their health, but their babies, the Centers for Disease Control and Prevention said Tuesday.

The bill, which would use money raised from private donors to equip and train campus health centers, grew out of a student-led movement at the University of California, Berkeley, and it has sparked the introduction of a similar bill in Massachusetts.

Anti-abortion groups say they are likely to challenge the legislation if Gov. Gavin Newsom signs it into law. He has a month to decide. A spokesman declined to say what he will do, but last year during his campaign for governor, Newsom said he supported a similar effort.

The bill would apply to 34 campuses throughout the state, with nearly 750,000 enrolled students — 11 under the umbrella of the University of California and 23 under the California State University System. A 2018 study estimated that hundreds of students at these schools seek medication abortion each month.

“We can show the rest of the country, especially while there’s these crazy abortion bans sweeping the country,” said Zoe Murray, 23, a recent graduate of the University of California, Santa Barbara, who sought a medication abortion from the student health center there when she was a sophomore, but had to go off campus. “Going to university is really stressful as is, and a lot of students are struggling financially, or like me, I was struggling with my mental health at the time.”

Under the bill, as of 2023, campus health centers would be required to offer medication abortion — a process that involves taking two types of pills, legally approved to terminate pregnancies that are within 10 weeks of gestation.

Private donations of about $10.3 million, which organizers say has already been raised, would be used to train staff at university health centers and to buy ultrasound machines. State law already requires that insurers cover the cost of abortion.

The two California higher education systems did not take a position on the bill. They raised concerns about whether they would have to bear costs for logistics, liability or security, which they might then pass on to students, and said they were working with legislators to address those.

The abortion pill method, approved by the Food and Drug Administration in 2000, now accounts for about a third of U.S. abortions, and studies have shown it to be safe and effective in most cases. The FDA requires that the first of the two drugs, mifepristone, be dispensed by a certified medical provider after a consultation, but women can then take one or both of the drugs at home.

Most campus health centers now provide gynecological exams and contraception, but refer students seeking abortions to outside clinics. Advocates for the bill argued that sending students off-campus for a process that typically involves medical visits before and after the medication was taken posed hurdles.

“The barriers are about economics and schedules and frankly also about stigma,” said Marj Plumb, campaign director of JustCARE. “It’s the idea that this procedure, which really is simple and really is safe, that there is something wrong that they had to go somewhere else to get this medicine.”

Opponents of the bill include the California Catholic Conference, whose president, Bishop Jaime Soto, last month urged Christians to “pray with me a novena to Our Lady of Guadalupe, patroness of unborn children, asking her powerful intercession to defeat this bill.”

Kristi Hamrick, a spokeswoman for Students for Life of America, said her organization called medication abortions “toilet bowl abortions,” adding that “at the rallies, we often bring toilet seats as a visual.” Her group contends that medication abortions are damaging to women’s health.

“We also are very concerned about the conscience rights of people — students whose fees will be used to underwrite these health centers,” she said.

A similar bill has been introduced in Massachusetts by state Rep. Lindsay Sabadosa, a Democrat. “It feels like a very winnable fight,” she said.

The student health program at the University of Illinois Chicago, which has about 33,300 students, currently provides medication abortion.

“We’re their regular doctor, they don’t have to walk through protesters, there’s no stigma,” said Dr. Ariel Leifer, medical director of the university’s Family Medicine Center at University Village. “It works very well, they like doing it in the comfort of their own home, the pain is manageable, it’s private.”

Berkeley students, including Adiba Khan, organized Students United for Reproductive Justice in 2015 and began trying to get the university’s health services to provide medication abortions.

They were unsuccessful, but members of the Women’s Policy Institute, an activist-training program run by the Women’s Foundation of California, contacted the students about working on legislation.

A spokeswoman for Berkeley, Tami Cate, said, “The university did discuss the issue of medication abortion services with students and others, but it had not taken a position on the matter.”

A bill introduced in 2017 passed both chambers in 2018, but was vetoed by Gov. Jerry Brown, a Democrat, who said that because California has abortion clinics located, on average, 5-7 miles from campuses, the bill was unnecessary. Newsom, then the lieutenant governor, said he would have signed the bill.

Activists on both sides of the abortion debate see California’s vote as a new step in national abortion-rights strategy.

Nick Reynosa, the Northern California coordinator of the anti-abortion Students for Life of America, described the bill as “a symbolic gesture to push back against the success of the pro-life movement.”

Murray said she believes the bill “is going to really change and begin to destigmatize abortion, so we can start to talk about our experiences openly with abortion and with pregnancy on campus.”

California Puts Abortion Pills in Public Universities

At a time when conservative states are sharply limiting abortion access, California signaled a new frontier in abortion-rights on Friday with the passage of legislation that would require all public universities in the state to provide medication abortion on campus.

An ambitious new study — the largest ever to analyze the genetics of same-sex sexual behavior — found that genetics does play a role, responsible for perhaps a third of the influence on whether someone has same-sex sex. The influence comes not from one gene but many, each with a tiny effect — and the rest of the explanation includes social or environmental factors — making it impossible to use genes to predict someone’s sexualuality preference.

“I hope that the science can be used to educate people a little bit more about how natural and normal same-sex behavior is,” said Benjamin Neale, a geneticist at the Broad Institute of MIT and Harvard and one of the lead researchers on the international team. “It’s written into our genes and it’s part of our environment. This is part of our species and it’s part of who we are.”

The study of nearly half a million people, funded by the National Institutes of Health and other agencies, found differences in the genetic details of same-sex behavior in males and females. The research also suggests the genetics of same-sex sexual behavior shares some correlation with genes involved in some mental health issues and personality traits — although the authors said that overlap could simply reflect the stress of enduring societal prejudice.

Even before its publication Thursday in the journal Science, the study has generated debate and concern, including within the renowned Broad Institute itself. Several scientists who are part of the LGBTQ community there said they were worried the findings could give ammunition to people who seek to use science to bolster biases and discrimination against gay people.

One concern is that evidence that genes influence same-sex behavior could cause anti-gay activists to call for gene editing or embryo selection, even if that would be technically impossible. Another fear is that evidence that genes play only a partial role could embolden people who insist being gay is a choice and who advocate tactics like conversion therapy.

“I deeply disagree about publishing this,” said Steven Reilly, a geneticist and postdoctoral researcher who is on the steering committee of the institute’s LGBTQ affinity group, Out@Broad. “It seems like something that could easily be misconstrued,” he said, adding, “In a world without any discrimination, understanding human behavior is a noble goal, but we don’t live in that world.”

Discussions between Neale’s team and colleagues who questioned the research continued for months. Neale said the team, which included psychologists and sociologists, used suggestions from those colleagues and outside LGBTQ groups to clarify wording and highlight caveats.

“I definitely heard from people who were kind of ‘why do this at all,’ and so there was some resistance there,” said Neale, who is gay. “Personally, I’m still concerned that it’s going to be deliberately misused to advance agendas of hate, but I do believe that the sort of proactive way we’ve approached this and a lot of the community engagement aspects that we’ve tried were important.”

The moment the study was published online Thursday afternoon, the Broad Institute took the unusual step of posting essays by Reilly and others who raised questions about the ethics, science and social implications of the project.

“As a queer person and a geneticist, I struggle to understand the motivations behind a genome-wide association study for non-heterosexual behavior,” wrote Joe Vitti, a postdoctoral researcher at the Broad Institute, in one essay. “I have yet to see a compelling argument that the potential benefits of this study outweigh its potential harms.”

In a way, the range of opinions by scientists who also identify as LGBTQ underscores a central finding of the study: Same-sex sexuality is complicated.

The study analyzed the genetic data of 408,000 men and women from a large British database, the U.K. Biobank, who answered extensive health and behavior questions between 2006 and 2010, when they were between the ages of 40 and 69. The researchers also used data from nearly 70,000 customers of the genetic testing service 23andMe, who were 51 years old on average, mostly American, and had answered survey questions about sexual orientation. All were of white European descent, one of several factors that the authors note limit their study’s generalizability. Trans people were not included.

The researchers mainly focused on answers to one question: whether someone ever had sex with a same-sex partner, even once.

A much higher proportion of the 23andMe sample — about 19% compared to about 3% of the Biobank sample — reported a same-sex sexual experience, a difference possibly related to cultural factors or because the specific 23andMe sexual orientation survey might attract more LGBTQ participants.

Despite its limitations, the research was much larger and more varied than previous studies, which generally focused on gay men, often those who were twins or were otherwise related.

“Just the fact that they look at women is hooray,” said Melinda Mills, a professor of sociology at the University of Oxford, who wrote a commentary that Science published alongside the study.

There might be thousands of genes influencing same-sex sexual behavior, each playing a small role, scientists believe. The new study found that all genetic effects likely account for about 32% of whether someone will have same-sex sex.

Using a big-data technique called genomewide association, the researchers estimated that common genetic variants — single-letter differences in DNA sequences — account for between 8% and 25% of same-sex sexual behavior. The rest of the 32% might involve genetic effects they could not measure, they said.

Researchers specifically identified five genetic variants present in people’s full genomes that appear to be involved. Those five comprise less than 1% of the genetic influences, they said.

And when the scientists tried to use genetic markers to predict how people in unrelated data sets reported their sexual behavior, it turned out to be too little genetic information to allow such prediction.

“Because we expect the sum of the effects that we observe will vary as a function of society and over time, it will be basically impossible to predict one’s sexual activity or orientation just from genetics,” said Andrea Ganna, the study’s first author, whose affiliations include the Institute of Molecular Medicine in Finland.

While many genetic variants tend to have the same effect in both men and women, Mills said, two of the five variants the team found were discovered only in males and one was discovered only in females. One of the male variants might be related to sense of smell, which is involved in sexual attraction, the researchers report. The other male variant is associated with male pattern balding and sits near genes involved in male sex determination.

In a finding that could be especially sensitive, the researchers found that whether someone ever engaged in same-sex sexual behavior showed genetic correlations with mental health issues, like major depressive disorder or schizophrenia, and with traits like risk-taking, cannabis use, openness to experience and loneliness.

They emphasized that the study does not suggest that same-sex sexual behavior causes or is caused by these conditions or characteristics, and that depression or bipolar disorder could be fueled by prejudicial social experiences.

“We are particularly worried that people will misrepresent our findings about mental health,” Neale said.

“That right there is the big issue with looking for the genetics of sexual orientation — social context could be a big part of the expression of the trait,” said Jeremy Yoder, an assistant professor of biology at California State University, Northridge, who is gay and follows genetic research in the field.

Neale said increasing social acceptance might be reflected in the fact that younger study participants were much more likely than older ones to report same-sex sexual experiences. He and others noted that older participants came of age when homosexual behavior was criminalized in Britain and that for much of their life homosexuality was classified as a psychiatric disorder.

Reilly and others said such stark differences between older and younger participants show the trickiness of trying to draw representative biological information from a study population so strongly influenced by society’s changing attitudes. People steeped in a culture that demonized same-sex encounters might only have the gumption to admit it in a study if they were risk-takers to begin with.

Later, the researchers compared the genetic underpinnings of whether people ever had same-sex sex with their answers to what proportion of same-sex partners they had. They found there was little genetic correlation between answers to the “ever-never” question and whether someone ended up having a bisexual mix of partners, said Neale, who sees those results as a genetic reflection of the variety of sexual orientations within the expanding alphabet of the LGBTQ community.

The researchers also looked at answers to other questions in the 23andMe survey, including people’s sexual identity and what gender they fantasized about. There, they found considerable genetic overlap between those results and whether people ever engaged in same-sex sex, suggesting that these aspects of sexual orientation share common genetics, they said.

Dean Hamer, a former National Institutes of Health scientist who led the first high-profile study identifying a genetic link to being gay in 1993, said he was happy to see such a large research effort.

“Having said that, I’d like to emphasize that it’s not a gay gene study — it’s a study of what makes people have a single same-sex experience or more,” said Hamer, now an author and filmmaker. The gene he identified was on the X chromosome, one of the sex chromosomes, a location the new study did not flag as being significant for same-sex sexual behavior.

“Of course they didn’t find a gay gene — they weren’t looking for one,” Hamer said.

Experts widely agree that the research, was conducted by first-rate scientists.

“I kind of held my breath when I first saw the study — I thought, oh no,” said Mills of Oxford. “But it’s the top geneticists and some of the top social scientists in the field working on this, so if somebody was going to do it, I’m glad they did it.”

Indeed, Neale, who also consults for several pharmaceutical companies, said one reason his team did the study was to ensure less careful researchers would not tackle it first, “given how sensitive and hot-button this topic really is and how personal it is.”

Robbee Wedow, a member of the research team who also belongs to Out@Broad, served as a kind of bridge, organizing meetings between the researchers and their Broad Institute critics.

“I grew up in a highly religious evangelical family,” said Wedow, a research fellow with the Broad Institute and Harvard’s sociology department. “Being confused about not being attracted to women and being attracted to men, being convinced it was a sin and that I would go to hell.”

For a long time, “I definitely tried to pray it away, tried to like girls, tried to have girlfriends,” he said. “This wasn’t something I, of all people, would have chosen. There must be some sort of biological background.”

He concluded: “Saying ‘sorry, you can’t study this’ reinforces it as something that should be stigmatized.”

Outside LGBTQ groups who were consulted did not seem as strongly concerned as some of the Out@Broad members, he said. Zeke Stokes, chief programs officer at GLAAD, who was shown the findings several months ago, said, “Anyone who’s LGBTQ knows that their identity is complicated and to have science sort of bear that out is a positive thing.”

Overall, Neale said he believes the study shows that “diversity is a natural part of our experience and it’s a natural part of what we see in the genetics. I find that to actually just be beautiful.”

Many Genes Influence Same-Sex Sexuality, Not a Single 'Gay Gene'

How do genes influence our sexuality preferences? The question has long been fraught with controversy.

Planned Parenthood receives about $60 million given annually through the federal program known as Title X. The funds have enabled the group to provide more than 1.5 million low-income women each year with services like birth control and pregnancy tests, as well as screenings for sexually transmitted diseases and breast and cervical cancer. In some rural communities, Planned Parenthood is the only provider of such services.

In states like Utah, where Planned Parenthood is the only organization receiving Title X funds, and Minnesota, where Planned Parenthood serves 90% of the Title X patients, those seeking care may face long waits for appointments, the group said, while other patients may delay care or go without. Overall, Planned Parenthood gets more Title X money than any single group, and it serves 40% of all Title X patients.

The group’s decision to stop accepting the money was cheered by anti-abortion groups that have long sought to deprive Planned Parenthood of federal support. “It is a long-awaited victory that will energize the pro-life grassroots,” said Jeanne Mancini, president of the March for Life.

Planned Parenthood has continually received Title X money since the program was enacted in 1970 during the Nixon administration.

Alexis McGill Johnson, acting president of Planned Parenthood, on Monday accused the administration of forcing Planned Parenthood out of the Title X program. “When you have an unethical rule that will limit what providers can tell our patients, it becomes really important that we not agree to be in the program,” she said.

The Department of Health and Human Services said in a statement Monday that groups that refused to comply with the rule “are now blaming the government for their own actions.” The agency added: “They are abandoning their obligations to serve their patients under the program.”

The rule says that while clinics accepting Title X funds may continue to talk to patients about abortion, they may not refer women to an abortion provider or suggest where to obtain an abortion.

Planned Parenthood and many other organizations, including the American Medical Association, say the restriction would force physicians and clinics to withhold medical information from patients, would interfere with the doctor-patient relationship and could deny pregnant women the range of options available to them.

The Trump administration has steadily shifted federal health programs toward conservative preferences like promoting abstinence in teen pregnancy prevention programs and allowing exemptions to insurance coverage of birth control for employers with religious objections.

Withdrawing from Title X will not deprive Planned Parenthood of all government funding, a longtime goal of many conservatives. Figures from Planned Parenthood’s 2017-18 annual report showed that the organization received about $500 million from Medicaid, the joint federal and state health care program for low income people. Federal funds cover most of that spending.

The immediate effect of a Planned Parenthood withdrawal is unclear and likely to vary by state. Hawaii, Illinois, New York, Oregon and Washington have said their states would not participate in Title X under the new rule. Legislatures in Massachusetts and Maryland have passed laws that essentially have the same effect. Planned Parenthood expects some of the states to make up some of the money.

The rule, announced in February, is being challenged in court by Planned Parenthood, other organizations and more than 20 states, but a federal appeals court in July said the policy change could take effect while the legal cases were pending.

Planned Parenthood and some other organizations that receive Title X funds had decided to stop using the money until the legal challenges were resolved, although they had not officially withdrawn from the program.

The Department of Health and Human Services said that such an intermediate status would not be acceptable. It said that organizations had until Aug. 19 to submit an “assurance and action plan” showing they intend to make “good faith efforts” to comply with the new rule.

Last week, Planned Parenthood sent a letter to the 9th U.S. Circuit Court of Appeals, asking a panel of judges to stay the deadline until the legal cases could be decided. On Friday, the court declined to do so.

Earlier this month, the Department of Health and Human Services posted an explanation of the timeline and details of the new policy, saying that it is “not a gag rule.”

“Health professionals are free to provide nondirective pregnancy counseling, including counseling on abortion, and are not prohibited in any way from providing medically necessary information to clients,” the department said. “The Final Rule does NOT include the 1988 Regulation’s prohibition on counseling on abortion — characterized by some as a ‘gag rule’ — but neither does it retain the mandate that all grantees MUST counsel on, and refer for, abortion.”

The department said that “while Title X providers are prohibited from referring for abortion as a method of family planning, referral for abortion because of an emergency medical situation is not prohibited.”

It said providers may give pregnant women “a list of comprehensive health care providers (including prenatal care providers), including some (but not the majority) who perform abortion as part of a comprehensive health care practice. However, this list cannot serve as a referral for, nor identify those who provide abortion — and Title X providers cannot indicate those on the list who provide abortion.”

Because clinics receiving Title X money will no longer have to counsel women on all reproductive options, including abortion, the new rule may make faith-based providers and others that oppose abortion eligible for funding — a change that could significantly alter the guidance patients receive.

Organizations receiving Title X funds will still be able to perform abortions, but will have to do so in a separate facility from their other operations and adhere to the new requirement that they not refer patients to it. Clinics have been prohibited for years from using federal money to finance abortion services. The new rule goes a step further by ordering them to keep separate books for their abortion operations. Those changes are expected to take effect in 2020.

Planned Parenthood is not the only provider that has bridled at the new rule. In Maine, the only Title X recipient, Maine Family Planning, has decided to withdraw from the program, but has said that, for now, it will not close any of its 18 clinics.

This article originally appeared in <a href="https://www.nytimes.com/2019/08/19/health/planned-parenthood-title-x.html" id="7d8a5c0f-92cc-3743-aa7b-3abe0b7b534b">The New York Times</a>.

Planned Parenthood Refuses Federal Funds Over Abortion Restriction

Planned Parenthood said Monday that it would withdraw from the federal family planning program that provides birth control and other health services to poor women rather than comply with a new Trump administration rule that forbids referrals to doctors who can perform abortions.

Such a move could affect more than 1.5 million low-income women who rely on Planned Parenthood for services like birth control, pregnancy tests and screening for sexually transmitted diseases. Planned Parenthood operates about 40% of the more than 4,000 clinics that receive money under Title X. In some rural communities, Planned Parenthood is the only provider of such services.

The Trump administration said that while clinics accepting Title X funds could continue to talk to patients about abortion, they could not refer women to an abortion provider or suggest where to obtain an abortion.

That distinction may seem like a subtle one, but Planned Parenthood and many other organizations, including the American Medical Association, say the restriction would force them to withhold medical information from patients, interferes with the doctor-patient relationship, and could deny pregnant women the range of options available to them.

“Trump’s administration is trying to force us to keep information from our patients,” Alexis McGill Johnson, acting president of Planned Parenthood, said in a statement Friday. “The gag rule is unethical, dangerous, and we will not subject our patients to it.”

The decision by Planned Parenthood is the latest step in the faceoff between those who oppose restricting women’s reproductive health choices and the Trump administration, which has been steadily shifting federal health programs in the direction of conservative preferences like promoting abstinence and allowing exemptions to insurance coverage of birth control.

Planned Parenthood receives about $60 million of the $286 million given annually by Title X to health centers providing reproductive health care, as well as screenings for breast cancer and cervical cancer, to about 4 million patients.

The Trump administration rule, announced in February, is being challenged in court by Planned Parenthood, several states and other organizations, but a federal court in July said the policy change could take effect while the legal cases were pending.

Planned Parenthood and some other organizations that receive Title X funds had decided to stop using the money until the legal challenges were resolved, although they have not officially withdrawn from the program.

The Department of Health and Human Services said that a type of intermediate status would not be acceptable. It said organizations had until Aug. 19 to submit an “assurance and action plan” showing they intend to make “good faith efforts” to comply with the new rule.

Last week, Planned Parenthood sent a letter to the U.S. Court of Appeals for the 9th Circuit, asking a panel of judges to stay the deadline until the legal cases could be decided. On Friday, the court declined to do so.

The immediate effect of a Planned Parenthood withdrawal is unclear and likely to vary by state. Planned Parenthood has said many clinics would feel pressure from the cuts.

The organization said that at least one program — a mobile health center in Cleveland that provides HIV testing, pregnancy tests and other services — would have to close. In states like Utah, where Planned Parenthood is the only Title X grantee, and Minnesota, where Planned Parenthood serves 90% of the Title X patients, those seeking care may face long waits for appointments. Some patients may delay care or go without.

Some state governments have promised to make up the lost federal funding. Governors in Hawaii, Illinois, New York, Oregon and Washington have said their states would not participate in Title X under the new rule. Legislatures in Massachusetts and Maryland have passed laws that essentially have the same effect.

Earlier this month, the Department of Health and Human Services posted an explanation of the timeline and details of the new policy, saying it is “not a gag rule.”

Planned Parenthood May Withdraw From Title X Funding

Planned Parenthood will announce Monday whether it will withdraw from Title X, the federal family planning program, rather than comply with a new Trump administration rule that restricts what health providers can say about abortion.

Judge Stanley Bastian of the U.S. District Court for the Eastern District of Washington state said in his order that the rule would cause family planning clinics “to face a Hobson’s choice that harms patients as well as the providers.”

Bastian wrote that the plaintiffs in the case had “submitted substantial evidence of harm” if the administration’s rule were to take effect. “Yet,” he wrote, “the government’s response in this case is dismissive, speculative and not based on any evidence presented in the record before this court.”

The judge’s ruling granted an immediate preliminary injunction, preventing the imposition of the Trump administration rule, which was scheduled to take effect May 3.

“He concurred with all of our legal arguments and he rejected all of the administration’s arguments,” said Bob Ferguson, Washington’s attorney general, who had filed the case along with the National Family Planning &amp; Reproductive Health Association, which represents publicly funded family planning providers. “The judge stated from the bench that we met our very high burden to have a national injunction granted.”

He said his office would return to court to ask the judge to make the injunction permanent.

A Justice Department spokeswoman said Thursday night that a response would be forthcoming. It is expected that the administration will appeal.

The rule, announced in February, would deny clinics across the country millions of dollars from the federal family planning program called Title X. Title X provides $286 million for programs that provide services like birth control, screening for breast cancer and cervical cancer, and screening and treatment for sexually transmitted diseases. These programs serve about 4 million patients each year, many of them poor, at more than 4,000 clinics.

The rule was partly seen as an attack on Planned Parenthood, which operates about 40 percent of those clinics, is the only provider in some communities, and receives nearly $60 million in Title X funding each year.

While the rule would not prevent clinics from talking to patients about abortion, it would prevent them from informing patients where they could obtain the procedure. And it would lift a requirement that clinics counsel women on all reproductive options, including abortion, a change that was expected to make anti-abortion and faith-based providers eligible for funding.

In addition, while organizations receiving Title X money could still perform abortions, they would have to do so in a separate facility from their other operations, which could raise their costs significantly, some providers said.

The case filed in Washington state was one of several legal challenges to the Trump administration rule, including cases in California and Maine.

This week, in a case filed by attorneys general from 20 states and the District of Columbia, along with Planned Parenthood and the American Medical Association, a federal judge in Oregon said that he would issue a preliminary injunction but that his order would not be national in scope.

In that case, Judge Michael McShane of U.S. District Court said he would detail the terms of his injunction soon. He called the Trump administration rule an “arrogant assumption” on the part of the federal government and a “ham-fisted approach to public health policy.”

In the Washington case, Ferguson said his office argued that the Trump administration rule violated four federal statutes, including the Affordable Care Act, the law establishing Title X, and the Administrative Procedure Act. He said among those violations was that the rule “limited access to care” and “what doctors can say to their patients, putting politicians in the room in place of the doctors.”

Bastian wrote that the “harmful consequences” would “uniquely impact rural and uninsured patients.”

Clare Coleman, president and chief executive of the National Family Planning &amp; Reproductive Health Association, called the ruling “a tremendous public health victory and a welcome reprieve for our members in all 50 states and territories that serve more than 93 percent of Title X patients.”

This article originally appeared in <a href="https://www.nytimes.com/2019/04/25/science/title-x-injunction-abortion-referrals.html" id="fe5fd327-eaad-3e74-a194-688da2597db4">The New York Times</a>.

A federal judge Thursday issued a nationwide injunction temporarily blocking a controversial Trump administration rule that would bar organizations that provide abortion referrals from receiving federal family planning money.

Judge Temporarily Blocks Trump Rule on Abortion Referrals

“In evaluating evidence and witness statements, we found that Quake observed proper scientific protocol,” said a letter from the university to Quake, obtained by The New York Times on Tuesday.

Referring to the Chinese scientist, He Jiankui, by his nickname, JK, the letter said that Stanford’s investigators concluded that Quake did not “directly participate in any way in JK’s research, including in the conception or performance of the work.”

In fact, the letter said, Quake discouraged He from pursuing the project and urged him to follow proper scientific practices after he insisted on going ahead.

Quake was one of three professors whose interactions with He were being reviewed by Stanford, and his association with He was the most extensive. The other two — Matthew Porteus, a genetics researcher, and William Hurlbut, an ethicist — had previously said they strongly discouraged He when he told them of his idea to create genetically engineered babies.

Since He announced the birth of the gene-edited twins in November, the research community has been debating what actions scientists should take if they know about ethically questionable experiments. Global institutions, including the World Health Organization, are working to establish an international reporting and monitoring system.

Quake’s interactions with He were detailed in a recent New York Times article, which included excerpts from emails that Quake showed to a Times reporter.

The emails show that He, 35, who had been a postdoctoral student in Quake’s lab in 2011, kept Quake apprised of major steps, including the implantation of the edited embryos in the woman’s womb and the birth of the twins months later. They show that Quake suggested He obtain ethical approval from Chinese institutions and submit the project’s data for vetting by peer-reviewed journals.

On Tuesday, Quake said: “I’m pleased this inquiry is over and its conclusion is consistent with what I knew to be true: that I had urged Dr. He not to pursue this path and when it became clear he wouldn’t listen to me, to adhere to high scientific and ethical standards in his research.”

This article originally appeared in <a href="https://www.nytimes.com/2019/04/16/health/stanford-gene-editing-babies.html" id="44df7dbb-9d39-358d-ac0c-2d9c5d4f4214">The New York Times</a>.

Stanford Clears Professor of Helping With Gene-Edited Babies Experiment

Stanford University has cleared Stephen Quake, a bioengineering professor, of any wrongdoing in his interactions with a Chinese researcher who roiled the scientific world by creating the first gene-edited babies.

The sender was He Jiankui, an ambitious, young Chinese scientist. The recipient was his former academic adviser, Stephen Quake, a star Stanford bioengineer and inventor.

“Wow, that’s quite an achievement!” Quake wrote back. “Hopefully she will carry to term …”

Months later, the world learned the outcome of that pregnancy: twins born from genetically engineered embryos, the first gene-altered babies. Reaction was fierce. Many scientists and ethicists condemned the experiment as unethical and unsafe, fearing that it could inspire rogue or frivolous attempts to create permanent genetic changes using unproved and unregulated methods.

A Chinese government investigation concluded in January that He had “seriously violated ethics, scientific research integrity and relevant state regulations.”

Questions about other American scientists’ knowledge of He’s plans and their failure to sound a loud alarm have been an issue since He revealed his work in November.

But now, Quake is facing a Stanford investigation into his interaction with He. That inquiry began after the president of He’s Chinese university wrote to Stanford’s president alleging that Quake had helped He.

“Prof. Stephen Quake provided instructions to the preparation and implementation of the experiment, the publication of papers, the promotion and news release, and the strategies to react after the news release,” he alleged in letters obtained by The New York Times. Quake’s actions, he asserted, “violated the internationally recognized academic ethics and codes of conduct, and must be condemned.”

Quake denied the allegations in a lengthy interview, saying his interaction with He, who was a postdoctoral student in his lab eight years ago, had been misinterpreted.

“I had nothing to do with this and I wasn’t involved,” Quake said. “I hold myself to high ethical standards.”

Quake showed The Times what he said were the last few years of his email communication with He. The correspondence provides a revealing window into the informal way researchers navigate a fast-moving, ethically controversial field.

The emails show that He, 35, informed Quake, 49, of milestones, including that the woman became pregnant and gave birth. They show that Quake advised He to obtain ethical approval from Chinese institutions and submit the results for vetting by peer-reviewed journals, and that he agreed to He’s requests to discuss issues like when to present his research publicly.

None of the notes suggest Quake was involved in the work himself. They do contain expressions of polite encouragement like “good luck!” Though Quake said he urged He not to pursue the project during an August 2016 meeting, the emails, mostly sent in 2017 and 2018, don’t tell him to stop.

As global institutions like the World Health Organization work to create a system to keep cowboy scientists from charging into the Wild West of embryo editing, Quake’s interactions with He reflect issues that leading scientific institutions are now grappling with.

When and where should scientists report controversial research ideas that colleagues share with them in confidence? Have scientists acted inappropriately if they provide conventional research advice to someone conducting an unorthodox experiment?

“A lot of people wish that those who knew or suspected would have made more noise,” said R. Alta Charo, a bioethicist at the University of Wisconsin-Madison who co-led a 2017 national committee on human embryo editing.

But she said scientists were not necessarily complicit if instead of trying to stop rogue experimenters, they advised them to follow ethical and research standards in hopes that institutions would intervene.

Rice University has been investigating Michael Deem, He’s Ph.D. adviser, because of allegations that he was actively involved in the project; he had said publicly that he had been present during parts of it. Deem’s lawyers issued a statement strongly denying the allegations.

The correspondence Quake shared provides new details about He’s project, also called germline editing, including indications that the twin girls were quite premature and remained hospitalized for several weeks. They were born in October, contrary to previous reports.

Quake is an entrepreneur whose inventions include blood tests to detect Down syndrome in pregnancy and to avoid organ transplant rejection. He is co-president of an institute funded by Facebook founder Mark Zuckerberg and his wife, Dr. Priscilla Chan. He does not do gene editing and said he was surprised when He told him during a 2016 visit to Stanford that he wanted to be the first to create gene-edited babies.

“I said, ‘That’s a terrible idea. Why would you want to do that?’” Quake recalled. “He kind of pushed back and it was clear that he wasn’t listening to me.”

Quake changed tack. “I said, ‘All right, if you’re not going to be convinced that I think this is a bad idea and you want to go down this path, then you need to do it properly and with proper respect for the people who are involved, and the field.’”

That meant obtaining ethical approval from the equivalent of U.S. institutional review boards (known as IRBs), Quake advised, as well as getting informed consent from the couples participating and only editing genes to address a serious medical need.

“I didn’t think it was something he would seriously do,” said Quake, adding that he assumed if He sought ethical approval and was rebuffed, “presumably he’d stop.”

Soon afterward, He emailed: “I will take your suggestion that we will get a local ethic approve before we move on to the first genetic edited human baby. Please keep it in confidential.”

In June 2017, He, nicknamed JK, emailed a document saying a hospital ethics committee had approved his proposal, in which he boasted that his plan could be compared to Nobel-winning research.

“It was good to see that he had engaged with his IRB-equivalent there and had approval to do his research, and I’m thinking it’s their responsibility to manage this,” Quake said in the interview. “If in my interactions with JK I had any hint of misconduct, I would have handled it completely differently. And I think I would have been very aggressive about telling people about that.”

As a postdoctoral adviser to He and other students, Quake considered his role to be mentorship. He’s work in his lab did not involve gene editing; it concerned immune responses to the flu vaccine.

He was “bright and ambitious,” Quake said, but “he was, I felt, always in too much of a hurry and I, you know, worried that he was a sort that would cut corners a little bit.”

After leaving for the university job in China in 2012, He sought Quake’s help with starting a company based on a genome-sequencing technique Quake had invented. Quake, whose American firm selling that technique had gone bankrupt, made introductions that helped He license patents for his company, Direct Genomics. Quake visited in 2015 but eventually declined an offer to serve on the company’s scientific advisory board.

In He’s 2017 correspondence, he said he would be editing a gene called CCR5, altering a mutation that allows people to become infected with HIV. Many scientists have since argued it was medically unnecessary because babies of HIV-positive parents can be protected other ways. Quake said he believed there was not scientific consensus about that.

In early April 2018, He’s “Success!” email said “the embryo with CCR5 gene edited was transplanted to the women 10 days ago, and today the pregnancy is confirmed!”

Quake did not reply immediately. Instead, he forwarded the email to someone he described as a senior gene-editing expert “who I felt could give me advice.” He redacted the name of the expert.

“FYI this is probably the first human germ line editing,” Quake wrote. “I strongly urged him to get IRB approval, and it is my understanding that he did. His goal is to help hiv positive parents conceive. It’s a bit early for him to celebrate but if she carries to term it’s going to be big news I suspect.”

The expert replied: “I was only telling someone last week that my assumption was that this had already happened. It will definitely be news ...”

Quake considered that response “very blasé,” he said. “He’s not surprised at all. And he’s not saying, ‘Oh my god, you got to notify the mythical science police.’”

Six months later, in mid-October, He emailed again: “Great news! the baby is born (please keep it in confidential).”

He asked to meet on a planned visit to San Francisco, saying, “I want get help from you on how to announce the result, PR and ethics.”

Quake replied, “Let’s definitely meet up.”

In that meeting, Quake recalled, He walked him through what he had done. “And I pressed him on the ethical approval, and I said this is going to get an enormous amount of attention, it’s going to be very closely scrutinized. Are you sure you’ve done everything correctly?”

He’s response unsettled him, he said. “The little corner-cutting thing came up again: ‘Well, there were actually two hospitals involved and you know, we had approval from one and we did work at both hospitals.’ And I said, ‘Well you better make sure you have that straightened out.’”

Back in China, He wrote: “Good news, the hospital which conducted the clinical trial approved the ethic letter,” adding, “They signed to acknowledge the ethic letters from another hospital.”

PALO ALTO, Calif. — “Success!” read the subject line of the email. The text, in imperfect English, began: “Good News! The women is pregnant, the genome editing success!”

Pam Belluck

Articles written by the author

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