The couple sits with their newborn in their home in Bentonville, Arkansas. The Trump administration is shifting the federal Title X program, which has traditionally provided access to contraception, toward an emphasis on childbearing. (Photo: Antoinette Grajeda/Arkansas Advocate)
The federal anti-poverty program, focused on reducing unintended pregnancies, will soon undergo a major overhaul.
Reproductive health clinics operate federal Title X grant money to provide birth control, cancer screening, and testing and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.
Guttmacher Institute estimates that Title X, signed by Republican President Richard Nixon in 1970, prevented nearly 20 million unintended pregnancies and 9 million abortions. It also helped reduce child poverty, according to the abortion rights group.
But President Donald Trump took aim at a program that has long been a target of abortion opponents. Since taking back the White House, Trump has been on a transient lockdown, and then restored provides grants to some reproductive health clinics and has proposed the creation of the U.S. Department of Health and Human Services budget without financial resources for the program.
Recently released section financing guidelines in the case of a Title X grant, it represents a significant change in mission.
Under the fresh guidelines, instead of increasing access to contraception, Title X will focus on “enhancing family formation and helping clients achieve healthy pregnancies.” This will align the program with the administration’s efforts to raise the U.S. birth rate.
The fresh rules say Title Some conservative groups tout a little-known alternative infertility treatment called “reproductive regenerative medicine,” which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.
The guidelines direct Title X clinics to promote “fertility awareness-based methods” such as period tracking apps that American College of Obstetricians and Gynecologists claims it may be helpful in getting pregnant, but less effective in preventing pregnancy. It also calls on clinics to offer advice on male fertility issues and to address environmental causes of infertility, including pornography operate. It also includes a ban on DEI efforts and warns recipients that federal money cannot be used to “facilitate or encourage illegal immigration.”
Anti-abortion groups support these changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who are more dependent on Title X services and more likely to have unintended pregnancies. Scientists also say the fresh guidelines are unlikely to achieve the administration’s “pro-natalist” goal of reversing falling birth rates.
Corinne Rocca, a professor of epidemiology at the University of California, San Francisco, said a way to do this would be to raise spending on child care subsidies and other social programs that facilitate juvenile parents.
“Policies that help people and families feel supported in meeting their childbearing preferences… would actually help people who are open to the prospect of having children to do so,” Rocca said.
Rocca is co-author of a study published in JAMA network open last fall, suggesting that Black and Latina women are less likely than other racial groups to be able to choose whether, when and how to start a family.
Clinics must reapply for funding under the fresh guidelines by January 9, 2027. HHS did not respond to a request for comment.
During his first term, Trump banned Title X clinics from referring patients to other providers for abortions or even mentioning it as an option. It also banned grantees from offering family planning and abortion services in the same building. As a result, many grantees, including more than a dozen state health departments and all participating Planned Parenthood affiliates, left the program.
In 2019, the program served approximately 844,000 more people. fewer patients than in 2018, when 3.9 million patients were covered, according to HHS. About 225,000 fewer patients received oral contraceptives; about 50,000 fewer received hormonal implants; and about 86,000 fewer people received IUDs.
The Title X reformulation reflected in the fresh guidelines was a recommendation included in a controversial plan known as Project 2025, created by the conservative think tank the Heritage Foundation as a guide for the second Trump administration.
According to Project 2025 RecommendationsHHS says Title X grantees will no longer be required to provide abortion counseling or referrals, and informs applicants that relationship counseling should encourage marriage as a precursor to having children.
“At a time when we face a rapidly declining birth rate that is well below the replacement fertility rate, we should do everything we can to encourage and support family formation and fertility,” Dr. Christina Francis, CEO of Pro-Life American College of Obstetricians and Gynecologists, he told MedPage Today in April.
“Women deserve accurate information about their fertility and health, and that includes highlighting the many benefits of pregnancy and motherhood.”
Some abortion opponents have criticized Title X for promoting certain forms of contraception, such as IUDs, which they consider abortifacients. A spokesman for the National Right to Life Committee said the organization does not take a position on contraception that prevents fertilization, “however, the National Right to Life Committee opposes any device or drug that could destroy life created at the moment of fertilization.”
“If there is any concern, we recommend that a woman talk to her doctor to determine whether a particular medication will cause an abortion,” a spokeswoman said in an email.
But Leonard Lopoo, a professor at Syracuse University’s Maxwell School of Citizenship and Public Affairs who has studied fertility and family policy for the past three decades, said the federal government can facilitate families achieve their family planning goals by expanding pregnancy prevention and infertility treatment at all income levels.
“When you try to take away funds from someone who doesn’t want to have a child, that’s not the same as providing funds to support someone who does want to have a child,” Lopoo said.
As a Black woman and Black maternal health researcher at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most that having children can be disproportionately more perilous and less accessible for women who look like her.
However, she says what she did not expect to discover – while collecting materials for a study she co-authored in a journal Borders in public health this spring – so fear of the negative effects of medicine and the criminal justice system has many black women in Georgia and North Carolina fearing pregnancy.
“I was very surprised to see that people were actually thinking about the context in which a black child is born and raised long before they even considered starting a family,” Thompson said. “We’ve had a lot of just stories of people saying, ‘Why would I want to bring a baby into this context; how do I prepare black women to bring a baby into this context?'”
Thompson said her team’s findings show how much Black women depend on inexpensive access to long-acting, reversible contraceptives like IUDs.
“We have people who have gone very, very far to get a sliding scale to get an IUD inserted, an IUD removed, or even take birth control pills,” Thompson said.
“If the administration continues to implement these restrictions, we will be taking away contraceptive access from at-risk populations.”
Stateline reporter Sofia Resnick can be reached at: sresnick@stateline.org.
This story was originally produced by state linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
