---
title: "Rust v. Sullivan"
description: "The regulations are a permissible construction of the Public Health Service Act and do not violate the First or Fifth Amendments. The government may selectively fund some activities and not others without violating the Constitution."
type: "case"
court: "U.S. Supreme Court"
decided: "1991-05-23"
citation: "500 U.S. 173 (1991)"
docket: "89-1391, 89-1392"
status: "Good law on spending/speech doctrine"
source_url: "https://www.abhortion.org/cases/rust-v-sullivan-1991.html"
---

# Rust v. Sullivan

_Full caption: Rust et al. v. Sullivan, Secretary of Health and Human Services_

**Citation:** 500 U.S. 173 (1991) · **Docket No.** 89-1391, 89-1392

**Status:** Good law on spending/speech doctrine

| Field | Value |
| --- | --- |
| Court | U.S. Supreme Court |
| Argued | October 30, 1990 |
| Decided | May 23, 1991 |
| Vote | 5-4 |
| Majority author | Rehnquist, C.J. |
| Joined by | White, Kennedy, Scalia, Souter, JJ. |

## Question presented

Whether HHS regulations prohibiting Title X federal family-planning grantees from counseling patients about abortion, referring for abortion, or advocating abortion violate the First and Fifth Amendments.

## Holding

The regulations are a permissible construction of the Public Health Service Act and do not violate the First or Fifth Amendments. The government may selectively fund some activities and not others without violating the Constitution.

## Reasoning

Chief Justice Rehnquist held that Congress's decision to fund only some activities (family planning excluding abortion) does not violate the First Amendment. Grantees retained the ability to speak about abortion outside the Title X program.

## Opinions

### Majority — Rehnquist, C.J.

_Joined by White, Kennedy, Scalia, Souter, JJ._

The regulations are a permissible construction of the Public Health Service Act and do not violate the First or Fifth Amendments. The government may selectively fund some activities and not others without violating the Constitution.

### Dissent — Blackmun, J.

_Joined by Marshall, J.; O'Connor, J. (Part I); Stevens, J. (Parts II and III)_

Argued the regulations violated the First Amendment and the Fifth Amendment.

### Dissent — Stevens, J.

_Not joined by any other justice_

Argued the regulations exceeded statutory authority.

### Dissent — O'Connor, J.

_Not joined by any other justice_

Argued on statutory grounds.

## Key quotes

> "The Government has no constitutional duty to subsidize an activity merely because the activity is constitutionally protected and may validly choose to fund one activity to the exclusion of another."
> — Rehnquist, C.J. (majority) · 500 U.S. at 193

> "This case involves definition of the boundaries of the First Amendment right of every American to speak, and, more importantly, of the corresponding right of every American to hear what the speakers have to say... Until today, the Court has never upheld a viewpoint-based suppression of speech."
> — Blackmun, J. (dissenting) · 500 U.S. at 207

## Practical effect

Title X regulations restricting abortion counseling remained in effect. President Bush declined to veto Congressional counter-legislation, then modified the regulations. President Clinton reversed them in 1993, President Trump reinstated similar rules in 2019, President Biden reversed in 2021, President Trump reinstated on returning to office in 2025.

## Perspectives

The summaries below are descriptive, not evaluative — an attempt to represent fairly how each camp typically frames this case.

### Abolitionist framing

Abolitionists support Rust as ensuring federal money cannot be used to promote abortion.

### Mainstream pro-life framing

Widely supported. Basis for Hyde Amendment expansions and 'Mexico City policy' framework.

### Pro-choice framing

Criticized as chilling essential reproductive health counseling for low-income women.

## Significance

Foundational funding-conditions precedent; regulations continue to swing with administrations.

| Measure | Score |
| --- | --- |
| Overall significance | 5 / 10 |
| Legal precedential weight | 6 |
| Practical impact on access | 4 |
| Movement relevance (abolitionist) | 4 |
| Enduring relevance, 2026 | 5 |

## Sources

### Primary sources

- [supreme.justia.com/cases/federal/us/500/173](https://supreme.justia.com/cases/federal/us/500/173/)

### Secondary sources

- [en.wikipedia.org/wiki/Rust_v._Sullivan](https://en.wikipedia.org/wiki/Rust_v._Sullivan)

## Related cases

**Cites earlier cases:**

- [Harris v. McRae (1980)](harris-v-mcrae-1980.md)

**Cited by later cases:**

- [NIFLA v. Becerra (2018)](nifla-v-becerra-2018.md)

## Notes

The 'gag rule' has been rescinded and reinstated multiple times by successive administrations.