Every person, regardless of income or insurance status, deserves the chance to create the family they want on their own timeline. For more than 50 years, the Title X program—the only federal program that supports the provision of comprehensive reproductive health care to low-income people—has been dedicated to serving that mission. Title X was signed into law by a Republican president and has long received bipartisan support. However, today, the goal of ensuring that everyone has access to high-quality reproductive health care faces an unprecedented attack from the Trump administration.
While Title X has been underfunded in recent years—and took a massive hit under the first Trump presidency—it has shown resilience and continues to provide high-quality reproductive health care. In 2023 alone, Title X served 2.8 million people.
For decades, the Guttmacher Institute has tracked the Title X system, collecting data on patients, providers, and clinics as well as analyzing related policy changes. The current Trump administration—working hand in hand with leaders of the anti‑abortion movement, who want not only to ban abortion but also to limit access to all manner of contraception and reproductive health care—poses a unique and existential threat to Title X, on which millions of people rely for their care.
While the Trump administration has inflicted chaos on Title X funding since taking office, including freezing funds for several months in 2025 and proposing a fiscal year 2027 budget that eliminates all Title X funding, it has also been actively previewing their vision for fundamentally altering Title X and all other federally funded programs.
Three pressing concerns related to Title X include the administration’s intentions to push people toward contraceptive methods that may not be their preferred option; to erode long-lasting, high-quality, evidence-based standards of care and accountability; and to completely undermine health equity.
Threatening Access To Contraceptive Care
In early April, the Department of Health and Human Services (HHS) released program guidance that, if implemented, would fundamentally shift Title X from its mission of increasing access to affordable family planning care to focus on “fertility,” “family formation” and “reproductive health conditions.”
These concepts may appear supportive of reproductive health, but the language masks a shift toward Project 2025’s “Make America Healthy Again” vision of prioritizing having babies over reproductive autonomy—not a genuine commitment to providing the full range of contraceptive methods, sexually transmitted infection testing, cancer screening, and more reproductive services historically supported by Title X.
Layered onto this reframing is a distinctive shift: The guidance elevates fertility awareness-based methods (FABMs) above—and in place of—other types of contraception. While FABMs are increasingly popular and patients should have evidence-based, reliable information about this option, it is equally important that they receive information about the efficacy of all other methods and have full access to the method of their choice.
The administration is putting a heavy hand on the scale by reshaping Title X around a pronatalist, patriarchal vision of family, rather than one that is dedicated to providing the full scope of evidence-based services that patients need to feel fulfilled in their reproductive lives. Title X cannot function if it restricts the choices and access to care it was intended to protect.
Eroding Standards Of Care And Accountability
Since its inception more than five decades ago, Title X has set the bar for high-quality family planning care—services that are comprehensive, affordable, evidence-based, and person-centered. It has also maintained clear guardrails to ensure that patients receive care aligned with their needs and not politicians’ agendas.
Title X recipients must adhere to the Centers for Disease Control and Prevention’s Quality Family Planning recommendations, which were updated and released by HHS in 2024 with input from experts across the field and are largely aligned with patient preferences. The new guidance would sidestep those recommendations, clearing the way for Title X recipients to operate without standards that reflect evidence-based, person-centered care.
Removing these guardrails would allow ideologically driven organizations, such as crisis pregnancy centers, to participate in the program. The Trump administration unabashedly promotes these centers, which already receive millions of dollars in public funding. Allowing even a small share of Title X funding to these disingenuous “providers”—which often don’t have the expertise to provide reproductive health care and openly oppose hormonal methods of birth control such as the pill or patch—is a direct disservice to the patients who rely on and trust Title X care.
The Trump Administration Is Undermining Health Equity
Notably, the Title X program was specifically designed to address income-based disparities in access to sexual and reproductive health care. But as one of their first moves against Title X in this second term, the Trump administration froze funding for several months, accusing clinics of promoting “diversity, equity, and inclusion” initiatives. Then, just recently, the administration proposed new regulations governing all federal grants that, among many harmful provisions, would prohibit funding for programs that promote diversity, equity, and inclusion and replace unbiased grantmaking decisions with ideology and politics. This would impact Title X and much more, threatening to have a detrimental impact on people’s access to sexual and reproductive health care.
The consequences of reducing or restricting Title X funding are not hypothetical. After the first Trump administration implemented the 2019 “domestic gag rule”—which, among other restrictions, required providers receiving Title X funding to separate any abortion-related services from Title X services and prohibited abortion referrals—the overall number of patients served by Title X plummeted, and many states were left with few or no Title X clinics remaining. (The domestic gag rule was rescinded in 2021.) Many Planned Parenthood clinics left the Title X program, and while conservative policy makers claimed that other clinics would step in to cover their caseload, that turned out not to be the case. Guttmacher research showed that non-Planned Parenthood Title X–supported sites would have had to increase their contraceptive client caseloads by an average of 70 percent to fill the gap.
The fallout of restrictions will disproportionately impact people with low incomes, people of color, young people, those who are uninsured or underinsured, and those in medically underserved areas—the very communities served by the program. Decades of research show that when a policy change restricts care, it is those who already face inequitable barriers to health care who take the brunt. One study post-Dobbs v. Jackson Women's Health Organization showed that young people, those born outside the United States, and those living at less than 200 percent of the poverty level had poorer contraceptive outcomes compared to others. Furthermore, as a result of efforts to defund Planned Parenthood—including a provision passed in the 2025 budget reconciliation law—51 Planned Parenthood health center closed in 2025, and 75 percent of those had been in rural or medically underserved areas.
A renewed push to reinstate the domestic gag rule, as described in Project 2025, along with the new proposed federal funding regulations, would layer even more restrictions onto an already strained family planning system.
Patients Will Pay The Price
Decades of Guttmacher research show that Title X has been essential to helping millions of people afford birth control and other critical care—allowing them to make informed decisions about their lives, families, and futures. And yet, this administration seems intent on further restricting patients’ access to care and information. When asked by anti-abortion members of Congress during congressional hearings in April 2026 about when HHS plans to restrict Title X even further, Secretary Robert F. Kennedy Jr. noted that the new guidance was “very aligned with [their] thinking” and assured those members they would be “very happy” with it.
Viewed on their own, the Trump administration's plans for Title X are deeply troubling. Viewed in the larger context of rising pronatalism, looming cuts to Medicaid and other public programs, and the undercutting of unbiased, evidence-based science and medical research, these changes are nothing short of alarming. Title X was built as an evidence-based program aimed at providing high-quality sexual and reproductive health care to everyone; leading with ideology, weakening the program’s standards, and loosening oversight will do the opposite.
Authors’ Note
Kavanaugh reports funding from co-principal investigator role on Office of Population Affairs grant Generating Actionable Data to Ensure High-Quality, Equitable Sexual and Reproductive Health Care from 2022 to 2025.