A couple sits with their newborn baby in their home in Bentonville, Arkansas. The Trump administration is shifting the federal Title X program, which traditionally provided access to contraceptives, to a focus on childbirth. (Photo by Antoinette Grajeda/Arkansas Advocate)
A federal anti-poverty program focused on reducing unintended pregnancies is about to undergo a major overhaul.
Reproductive Health Clinics Use Federal Grants Title X funds cannot be used for abortions.
The Guttmacher Institute Estimates that Title It has also helped reduce child poverty, according to the group that advocates for abortion rights.
But President Donald Trump has targeted the program, which has long been a target of abortion opponents. Since Trump regained the White House, he has temporarily blocked it and then restored Grants for certain reproductive health clinics and proposed a U.S. Department of Health and Human Services budget without funding the program.
The department recently issued Funding guidelines because Title X grants represent a significant mission shift.
Rather than expanding access to contraceptives, Title’s focus is to align the program with the government’s efforts to augment the U.S. birth rate.
The fresh rules state that title Some conservative groups are promoting an hidden alternative treatment for infertility called “restorative reproductive 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 guidance directs Title X clinics to promote “fertility awareness-based practices,” such as period tracking apps that American College of Obstetricians and Gynecologists says it may be helpful in getting pregnant, but less effective in preventing pregnancy. Clinics are also encouraged to offer counseling on male fertility issues and address environmental causes of infertility, including pornography employ. And it includes a ban on DEI efforts and warns grant recipients that federal funds may not be used to “facilitate or incentivize illegal immigration.”
Anti-abortion groups support the changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who rely more heavily on Title X services and are more likely to have unintended pregnancies. Researchers also say the fresh guidelines are unlikely to achieve the government’s “pronatalist” goal of reversing falling birth rates.
Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that is to spend more on child care subsidies and other social programs to support fresh parents.
“Policies that help people and families feel supported in fulfilling their desires to have children … would actually help people who are open to the prospect of having children do so,” Rocca said.
Rocca co-authored a study published in JAMA network opened This suggests that black and Hispanic women are less likely than other racial groups to have the freedom to decide whether, when, and how to start a family.
Clinics must reapply for funding under these 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 abortion or even mentioning it as an option. He also banned grantees from providing family planning services and abortions in the same building. As a result, many grantees have left the program, including about a dozen state health departments and all participating Planned Parenthood departments.
The program served approximately 844,000 fewer patients in 2019 than in 2018, when it served 3.9 million patients. according to HHS. About 225,000 fewer patients received oral contraceptives; about 50,000 fewer received hormonal implants; and about 86,000 fewer IUDs.
The reformulation of title
In line with Project 2025 RecommendationsHHS says Title
“At a time when we are faced with 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,” says Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, said 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 titles A spokesman for the National Right to Life Committee said the organization does not take a stance on contraception that prevents fertilization, but “the National Right to Life opposes any device or drug that would destroy a life already created at fertilization.”
“If in doubt, we recommend that a woman speak with her doctor to determine whether an agent would cause an abortion,” the spokesperson 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 three decades, said the federal government can support families achieve their family planning goals by expanding pregnancy prevention and infertility treatments at all income levels.
“If you try to take away funding from someone who doesn’t want to have a child, that’s not the same as providing funding to someone who doesn’t want to have a child,” Lopoo said.
As a Black woman and researcher who focuses on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson knows better than most that having children can be disproportionately more hazardous and less affordable for women who look like her.
But she says what she didn’t expect – while researching a study she co-authored in the journal Limitations in public health This spring – fear of adverse medical and criminal consequences is so great among many Black women in Georgia and North Carolina that they are afraid to become pregnant.
“I was very surprised to see that people were actually thinking about the context in which a black child was born and raised long before they even thought about starting a family,” Thompson said. “We’ve had a lot of stories of people saying, ‘Why would I want to bring a child into this context? How do you prepare Black women to bring a child into this context?'”
Thompson said her team’s findings show how much Black women rely on affordable access to long-acting reversible contraceptives such as IUDs.
“We have people who have driven very, very far just to get a sliding scale that allows you to either insert an IUD, remove an IUD or even take birth control pills,” Thompson said.
“If the government continues with these restrictions, we will deprive a population that is at higher risk of access to contraceptives.”
Stateline reporter Sofia Resnick can be reached at sresnick@stateline.org.
This story was originally produced by State borderwhich is part of States Newsroom, a nonprofit news network that includes West Virginia Watch, and is a 501c(3) public charity supported by grants and a coalition of donors.
