Trump changes pregnancy-prevention program to promote childbearing

Title X, a Nixon-era poverty-fighting program, will shift away from reducing unintended pregnancies

A couple sits with their newborn inside their Bentonville, Arkansas, home. The Trump administration is shifting the federal Title X program, which has traditionally provided access to contraception, toward an emphasis on childbearing. (Antoinette Grajeda/Arkansas Advocate)

By Sofia Resnick

Stateline

A federal poverty-fighting program focused on reducing unintended pregnancies is about to undergo a major overhaul.

Reproductive health clinics use Title X federal grant money to provide birth control, cancer screenings and testing and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.

The Guttmacher Institute estimates that Title X, which was signed into law by Republican President Richard Nixon in 1970, has prevented almost 20 million unintended pregnancies and 9 million abortions. It has also helped reduce child poverty, according to the group, which supports abortion rights.

But President Donald Trump has taken aim at the program, which has long been a target for abortion opponents. Since regaining the White House, Trump has temporarily blocked and then restored grants to certain reproductive health clinics, and proposed a U.S. Department of Health and Human Services budget with no funding for the program.

The department’s recently issued funding guidelines for Title X grants represent a significant mission shift.

Instead of expanding access to contraception, the focus of Title X will be “to strengthen family formation and assist clients in achieving healthy pregnancies,” according to the new guidance. That will align the program with the administration’s efforts to increase the U.S. birth rate.

The new rules say Title X will prioritize educating Americans about natural methods to avoid pregnancy and overcome infertility, and will promote “body literacy education” and “informed, preventive, and restorative approaches to reproductive health.” Some conservative groups tout an obscure 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 methods,” such as period-tracking apps, which the American College of Obstetricians and Gynecologists says can be helpful for getting pregnant but less effective at preventing pregnancy. It also calls on clinics to offer counseling on male fertility issues and to address environmental causes of infertility, including pornography use. And it includes a prohibition on DEI efforts and warns grantees that federal money cannot 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 are more reliant on Title X services and are more likely to have unintended pregnancies. Researchers also say the new guidelines are unlikely to achieve the administration’s “pronatalist” goal of reversing declining birth rates.

Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that would be to spend more on childcare subsidies and other social programs to help new parents.

“Policies that help people and families feel supported to meet their childbearing preferences … would actually help people who are open to the prospect of childbearing to do so,” Rocca said.

Rocca co-authored a study published in JAMA Network Open last fall suggesting Black and Hispanic women are less likely than other racial groups to be able to choose if, when and how to start a family.

Clinics must reapply for funding under these new guidelines by Jan. 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 an abortion or even mentioning it as an option. He also prohibited grantees from offering family planning services and abortions in the same building. As a result, many grantees quit the program, including about a dozen state health departments and all participating Planned Parenthood chapters.

The program served about 844,000 fewer patients in 2019 than it did 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 received IUDs.

The reframing of Title X that is reflected in the new guidelines was a recommendation laid out in the controversial blueprint known as Project 2025, created by the conservative think tank Heritage Foundation as a guide for the second Trump administration.

In line with Project 2025’s recommendations, HHS says Title X grantees will no longer be required to counsel or refer for abortions, and tells applicants that relationship counseling should encourage marriage as a precursor to having children.

“In a time when we are facing a rapidly declining birth rate that falls far short of the replacement fertility rate, we should be doing all we can to encourage and support family formation and fertility,” Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, told MedPage Today in April.

“Women deserve accurate information about their fertility and their health — and this 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, that they view as abortifacients. A spokesperson for the National Right to Life Committee said the organization does not take a stance on contraception that prevents fertilization, “however, National Right to Life does oppose any device or drug that would destroy a life already created at fertilization.”

“If there is any doubt, we recommend that a woman speak with her doctor to determine if an agent would cause an abortion,” the spokesperson said in an email.

But Leonard Lopoo, a professor at the Maxwell School of Citizenship and Public Affairs at Syracuse University who has studied fertility and family policies for the past three decades, said the federal government could help families achieve their family planning goals by expanding pregnancy prevention and infertility treatments at all income levels.

“When you’re trying to take away the funding for someone who doesn’t want to have a child, that’s not the same as providing funding to support someone who does,” Lopoo said.

As a Black woman and researcher focused on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most on the ways having children can be disproportionately more dangerous and less affordable for women who look like her.

But she says what she wasn’t expecting to uncover — during research for a study she co-authored in the journal Frontiers in Public Health this spring — is how much the fear of negative medical and criminal justice outcomes makes many Black women in Georgia and North Carolina scared of pregnancy.

“I was very surprised to see that folks were actually thinking about the context within which a Black child is born and raised well before they even contemplated starting a family,” Thompson said. “We had a lot of, just, stories of folks saying, ‘Why would I want to bring a child into this context; how does one prepare Black women to bring a child into this context?’”

Thompson said her team’s findings show how much Black women depend on low-cost access to long-acting reversible contraceptives such as IUDs.

“We have people who drove very, very far just to get a sliding scale to either get an IUD placed, an IUD removed, or to even get on birth control pills,” Thompson said.

“If the administration moves forward with these restrictions, what we are doing is we are removing access to contraceptives for a population that is at higher risk.”

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