As the Donald Trump administration mulls changes to funding for family planning and preventative health services, cities across the country decry the possible outcome.

More than 75 mayors nationwide signed a joint letter to Trump’s health czar, Alex Azar, head of the Department of Health and Human Services, opposing the pending alterations to the country’s Title X program. Austin Mayor Steve Adler, Dallas Mayor Mike Rawlings, and Houston Mayor Sylvester Turner were the Texans that added their names to the letter.

The dozens of city representatives oppose a proposed rule that controls the manner in which doctors and health providers refer patients to abortions.

Title X does not fund abortion services, but the changes would strip funding for doctors and health providers who refer women to abortion services without the patients specifically asking first. Those doctors are allowed to deliver a list of options, which may include abortion providers, but the list must not exclusively have abortion providers on it.

These adjustments impact Texans who already face barriers to abortion services since the state legislature abandoned funding in 2013. Reproductive rights advocates call the proposal a “gag rule.”

“This is an incredibly dangerous step for America to take where we are gagging or blocking what our medical professionals can talk to a patient about,” Planned Parenthood of Greater Texas spokesperson Sarah Wheat said.

“Especially in a state like Texas where there are so many uninsured residents, and Texas leads the country in some of the highest rates of uninsured women, this is what allows them to get an annual healthcare visit, an annual cancer screening, access to an IUD (intrauterine device) or implant to plan or space their pregnancy, clinical breast exam, this program is critical, it’s a lifeline, it’s basic healthcare,” Wheat stated.

Pro-life group Texas Right to Life supports the proposal, the organization’s legislative director John Seago said, because it would stop doctors from promoting abortion practices.

“We’re talking about federal funding, we’re talking about taxpayer dollars and for Texans, Texans are deciding that we don’t want to use taxpayer dollars to promote an abortion business,” Seago said.

Supporters of the rule change said it works to prevent clinics from going out of their way to advocate for abortions.

“The Texas Legislature has determined that it is against our state interests to support and to benefit an industry like Planned Parenthood that sells abortions to Texas women,” Seago asserted.

The Texas Policy Evaluation Project (TxPEP) evaluates the effects of legislation in the state that relate to women’s reproductive health. Investigator Joe Potter, Ph.D., a sociology professor and faculty research associate at UT Austin, said much of his group’s research focuses on barriers.

“I think what people find problematic… is that it’s essentially telling doctors or nurse practitioners what they have to say, or limiting their ability to communicate and provide what they consider to be full information to patients,” Potter explained of those who oppose the rule.

“But on the other side, there’s kind of this promotion, implicit promotion of parental [involvement]. All Title X would like to have teens in communication and talking with their parents, but many teens don’t want to do that and they don’t want their parents to know they’re having sex,” Potter added, balancing the scale.

Potter said Title X started, “to provide family planning to low income people and highly effective as the contraception that people want.”

“It’s a miniscule proportion of the low income population of Texas women who want to use natural family planning,” Potter mentioned. “Natural family planning withdrawal and those things are not what women want to be doing in the state.”

The public comment period on the  guidelines ends in July, and those who have applied for the federal Title X funding expect to hear from the feds in the fall.

Nexstar File Photo