Ashley Brink, the abortion team lead at Boulder Valley Women's Health Center in Boulder, Colorado, tells Bustle the facility is the only clinic in the state that receives Title X funds and provides abortions, so it's in a uniquely tough position.

Established in 1973 as the first abortion clinic in the state, Boulder Valley Women's Health Center receives $500,000 annually from the Title X program, which makes up 20% of its total budget. Many of the clinic's patients who qualify for Title X support receive STD testing, STI screening, and cancer screenings, according to Brink. Title X funding, along with the clinic's sliding scale payment option, lets "some people leave with not having paid anything because they qualify," they say.

"We're not going to stop providing sliding scale family planning and reproductive services, because we know that it's a need in our community," Brink tells Bustle. "But it is going to make it harder for us as a whole to continue doing that without having those federal dollars."

Brink says the center will try to ensure patients are impacted by the rule as little as possible. However, she says the lack of federal funds will affect how many low-cost services the clinic can afford to provide, unless it's able to make up the difference with a combination of state funds and private donations.

The Trump administration's rule is "pushing health care out of reach for the people who are in most need of it," Brink says. "We want to stand here with our patients and ensure that we can continue to provide full spectrum access to all services, and that includes abortion."

Nicky Mathieu is the manager of the Center for Reproductive Health under Maine Family Planning (MFP), which has 18 clinics across that state and will reject Title X funding in order to continue providing abortions. "The people hit hardest by the loss of Title X funds ... would be the low-income and rural folks, who do represent the bulk of our patients," she says. "We're working with folks at their most vulnerable time."

The Center for Reproductive Rights is currently leading a lawsuit against the gag rule on behalf of MFP, which is just one of many health organizations that have mounted legal challenges. Deirdre Fulton-McDonough, MFP's communications director, says MFP believes the gag rule is unconstitutional because it "erects barriers to essential care."

MFP has withdrawn from receiving about $800,000 in Title X funding for the remainder of the year and $1.8 million for 2020, according to Fulton-McDonough. For now, she says the organization is looking to private donations from supporters and some public funding options to make up the difference left by the lack of Title X funds.

"Until that happens, or for the immediate future, we are funding Maine’s entire family planning system through our own reserves, which are very limited, and this is only a short-term solution," she says.

Planned Parenthood announced it will reject Title X funds in light of the rule, so physicians at its facilities won't be "gagged." But the rule's effects on other facilities could still affect Planned Parenthood patients, according to Dr. Jamila Perritt, who works at Planned Parenthood facilities in Washington D.C. and Maryland.

Perritt, who is also a fellow of Physicians for Reproductive Health, says the portion of the rule that cuts off funding to clinics and providers that provide information about or referrals for abortions will also steer money "towards clinics, providers, health systems, that don’t provide even a broad range of contraceptive options for their patients," which "really impacts my patients’ ability to be able to make informed health care decisions about planning pregnancies in the future.”

Roughly 4 million women depend on the Title X program for access to birth control, health screenings, and other services. Perritt says that number doesn't actually allow people to "see" the patients that she's treating every day who rely on Title X funds, though, citing the example of a woman she took care of during her training who died from cervical cancer.

"No one should die from cervical cancer in this country because we know that with routine pap tests we can screen and treat abnormal cells on the cervix that would eventually lead to cervical cancer," Perritt tells Bustle. "But this is a person who was ineligible for funding services because of her age, because of her income, and subsequently died, prematurely, in my opinion, from a disease that could be prevented."

When talking about the 4 million people that will be affected, Peritt says that patient is "the first person that comes to mind, because she’s a person I took care of that would’ve benefited from being able to get these services on a sliding scale, and that’s what Title X does.”

Health care in the United States has become "two-tiered" in Perritt's view, where people with means can access high-quality care, but the kind of care that people with lower incomes can access is determined by politicians rather than medical professionals.

"As a physician who trained for many years to take care of people in my community — a community that I grew up in — I find it absolutely unacceptable that now the care that I provide in my community is going to be determined by people who have no medical education, no medical training, who really couldn't care less about what’s happening to the individual," she says.

Sharon Lewis, executive director of Women's Health Center of West Virginia, tells Bustle it would be "ludicrous" for the center — the only abortion provider in the state — to continue taking Title X funds but abandon a core part of its services. The center typically serves about 2,000 patients under the Title X grant program, and she says they're working on strategies to make up the funds they will lose by refusing to comply.

"I think that Title X is a critical program for access to reproductive health services for low-income women and men," she tells Bustle. "Taking the access to care, and primarily the access to information, away from patients is unconscionable, in my opinion."

Terry Sallas Merritt, an executive team member at A Woman's Choice (AWC), which has three abortion-providing health care clinics in North Carolina and one in Jacksonville, Florida, says that while AWC does not receive Title X funding, its clinics will feel the ripple effects of the rule.

Restricting access to Title X funding could force people to choose between getting contraception and supporting their families, as 59% of women who get abortions already have children.

"If I'm going to pay for $45 a month for a birth control prescription, what does that do about my childcare money, my bus transportation money, my dinner money for the kids? It affects every single aspect of their lives," Sallas Merritt tells Bustle. "When a Title X funder does not exist anymore, that affects all of us who serve women, because all of us end up trying to help women in whatever ways we can — to help them be able to still take responsibility for their own bodies and their own lives."

A Woman's Choice clinics offer significant discounts on many of their services and will often work with national health and abortion funds to get procedures covered for its patients. Sometimes funding doesn't come through in full, in which case Sallas Merritt says the provider will often go forward with the procedure anyway. It will be even more difficult for A Woman's Choice to provide an abortion under those circumstances if the gag rule ends up restricting some people's access to contraception and causing an increase in unexpected pregnancies, Sallas Merritt says.

"It means that we're working harder to find more funding for organizations that have lost their funding for their ability to help women prevent unplanned pregnancies," she tells Bustle.

Sallas Merritt says all reproductive health care providers will have to work harder for funding, because now more of them will be turning to private donors and nonprofits — which will overlap — to help people access the health care they need.

"We have an organization right now we usually go to for help, but they're already out of money," she says. "So that's one of the other impacts: the more people who look for funding, the more funding is needed."

Amy Hagstrom Miller, founder and CEO of Whole Woman's Health, which has clinics in Texas, Indiana, Virginia, Maryland, and Minnesota, similarly tells Bustle that while the clinics don't receive Title X funds, the care they provide will be affected by the gag rule.

First, Hagstrom Miller says the rule will normalize restrictions on reproductive health care and limit what kind of care low-income people can access and where they can access it. Title X is a program that's been proven to work, Hagstrom Miller notes, and no prior administration — Democrat or Republican — has instituted a similar rule. Though the impetus behind the gag rule is to limit access to abortion, Hagstrom Miller says it will make it harder for people to access affordable contraception, which will actually increase unintended pregnancies. As a result, abortion rates will go up as well.

Many of the patients Whole Woman's Health sees come to the center "because they weren't able to access the care that they needed" elsewhere, Hagstrom Miller says. "So 40% of the people we see in Texas weren't able to get the contraceptives that they needed to prevent the pregnancy they came to us to help them take care of."

Like A Woman's Choice Inc., Whole Woman's Health anticipates the Title X funding restrictions will result in the center having to spend more time finding funds to support people who have unintended pregnancies.

"We're going to spend a lot of time trying to help people who don't have insurance and who don't have Medicaid coverage," Hagstrom Miller says. "It'll put a strain on our fundraising team because there will be more low-income people who need high quality care who aren't able to access it."