Title X Under Attack—Our Comprehensive Guide

Kinsey Hasstedt and Ruth Dawson, Guttmacher Institute

Updated on April 15, 2021: 

On April 14, 2021, the Biden-Harris administration released a notice of proposed rulemaking to overhaul restrictive Trump-era regulations, collectively known as the "domestic gag rule," that have had a devastating impact on the Title X national family planning program. Asserting that the Trump-era regulations "have undermined the public health of the population the program is meant to serve," the U.S. Department of Health and Human Services intends to restore Title X back to its pre-Trump regulatory framework, with "several modifications needed to strengthen the program and ensure access to equitable, affordable, client-centered, quality family planning services for all clients, especially for low-income clients." The rule is open to comments through May 17, and the Trump-era regulations remain in effect for now. 

Updated on January 28, 2021: 

On January 28, 2021, the Biden-Harris administration took its first step toward rescinding the "domestic gag rule"—the destructive Trump-Pence administration overhaul of regulations governing the Title X national family planning program. President Biden signed a presidential memorandum directing the U.S. Department of Health and Human Services to review those regulations and consider whether to suspend, revise or rescind them; it may take several months to complete this action and restore funding to family planning clinics that were forced out of the Title X program. 

First published on March 22, 2019: 

In the wake of the 2016 elections, the Trump administration and social conservatives in Congress ramped up attempts to undermine the Title X national family planning program as part of their larger ideological agenda attacking sexual and reproductive health and rights. Title X is a cornerstone of the publicly funded family planning network and these attacks threaten safety-net providers’ ability to deliver high-quality services to millions of patients who need and want them.


Title X is the only federal program dedicated to providing family planning services for low-income patients. It supports nearly 4,000 service sites nationwide, serving approximately four million people per year.

Shoring Up Reproductive Autonomy: Title X's Foundational Role (July 17, 2019)

Why We Cannot Afford to Undercut the Title X National Family Planning Program (January 30, 2017)

Domestic Gag Rule

In March 2019, the Trump administration finalized an overhaul of the federal regulations that govern the Title X program. If implemented, the rule would impose sweeping and destructive changes to Title X. The rule would prohibit abortion referrals, impose coercive counseling standards for pregnant patients, and impose unnecessary and stringent requirements for the physical and financial separation of Title X–funded activities from a range of abortion-related activities—a set of provisions commonly referred to as the domestic gag rule. The rule would also enable the administration to undermine the existing provider network and threaten Title X’s standards on quality of care and confidentiality, among other changes. We analyzed proposed and final versions of the rule, and synthesized extensive evidence in support of legal action to stop the rule from going into effect.

Trump Administration’s Domestic Gag Rule Has Slashed the Title X Network’s Capacity by Half (February 5, 2019)

The Title X Gag Rule Is Wreaking Havoc—Just as Trump Intended (August 29, 2019)

Guttmacher Institute Declaration Filed in the U.S. District Court for the Eastern District of Washington: National Family Planning & Reproductive Health Association, et al. v. Alex M. Azar II, et. al (March 22, 2019)

What the Trump Administration’s Final Regulatory Changes Mean for Title X (March 4, 2019)

Dangerous and Coercive Title X Gag Rule Released (February 27, 2019)

Proposed Changes to the Title X National Family Planning Program: Guttmacher Institute Comments to the U.S. Department of Health and Human Services (July 31, 2018)

Trump Administration Looks to Impose "Domestic Gag Rule," Continuing Its Assault on Reproductive Health and Rights (June 20, 2018)

A Domestic Gag Rule and More: The Administration’s Proposed Changes to Title X (June 18, 2018)

Compromising Care for Pregnant People and Adolescents

Among other negative impacts, the new rule and other attacks on Title X compromise the rights and health of people who rely on the program, including by restricting abortion counseling and referral for pregnant people and by rolling back adolescents’ ability to obtain confidential care.

Unbiased Information on and Referral for All Pregnancy Options Are Essential to Informed Consent in Reproductive Health Care (January 10, 2018)

Ensuring Adolescents’ Ability to Obtain Confidential Family Planning Services in Title X (November 15, 2018)

Subverting the Network of Providers

Antiabortion policymakers have attempted to narrow the network of Title X providers by excluding those that offer abortion using non–Title X funds (such as many health centers affiliated with Planned Parenthood). The purpose of these restrictions is to force providers to cease offering abortion care or else exit the Title X network. If the gag rule forces some providers to leave the Title X network, other safety-net clinics (such as federally qualified health centers, or FQHCs) could not be realistically expected to accommodate expanded caseloads.

Beyond the Rhetoric: The Real-World Impact of Attacks on Planned Parenthood and Title X (August 3, 2017)

Federally Qualified Health Centers: Vital Sources of Care, No Substitute for the Family Planning Safety Net (May 17, 2017)

Response to Inquiry Concerning the Impact on Other Safety-Net Family Planning Providers of "Defunding" Planned Parenthood (June 15, 2017)

Response to Inquiry Concerning the Availability of Publicly Funded Contraceptive Care to U.S. Women (May 17, 2017)

Recent Funding Restrictions on the U.S. Family Planning Safety Net May Foreshadow What Is to Come (December 19, 2016)

Funding Announcements

In February 2018, the Trump administration released its first funding opportunity announcement for Title X service providers, signaling how this administration would seek to fundamentally undercut the reach of the program and the quality of the care it supports. Specifically, the funding announcement indicated the administration’s intent to reshape the provider network, promote natural family planning over other contraceptive methods, and emphasize discredited abstinence-only messages among adolescents.

The Trump Administration’s Irresponsible Use of Research in Pushing Its Abstinence-Only Agenda into Title X (May 16, 2018)

Four Big Threats to the Title X Family Planning Program: Examining the Administration’s New Funding Opportunity Announcement (March 5, 2018)

Source URL: https://www.guttmacher.org/article/2019/03/title-x-under-attack-our-comprehensive-guide