Reducing or Eliminating the Title X Family Planning Program Would Restrict Contraceptive Access Nationwide

The Title X Family Planning Program provides equitable and reliable access to contraception nationwide and is a critical funding stream for building and maintaining the overall health of people in the United States. Title X is the government’s only program solely dedicated to funding family planning services, which include contraceptive counseling and care, pregnancy testing, basic infertility services, and sexually transmitted infection/HIV testing and treatment. The program also supports other critical primary care services like health screenings and vaccines. In 2023, Title X served 2.8 million people, of which 72 percent reported using a form of contraception for family planning. By law, people who visit a Title X health center and have incomes at or below the federal poverty level do not pay for their care as part of a mandatory sliding-fee scale.

Access to contraceptives through Title X is crucial for preventing unwanted pregnancy; the program ensures reliable access that improves maternal health, infant health outcomes, and individuals’ lifelong sexual and reproductive health. Public investment in contraceptive access is cost-effective for American taxpayers. The Guttmacher Institute estimates that every public dollar invested in contraceptives saves taxpayers more than 7 dollars by avoiding unintended pregnancies, births, and associated care. In 2014, this amounted to more than $13 billion across federal spending programs. Despite the program’s critical role in driving contraceptive access, improving overall health, and reducing federal spending, President Trump’s 2026 budget request proposes eliminating the program completely. History tells us that eliminating or cutting Title X would have a devastating and long-lasting impact on access to family planning services and contraceptive care. These effects will be compounded by new policies impacting other safety-net health programs like Medicaid.

To understand the likely impact that Title X cuts or elimination would have on access to family planning services and contraceptive care, we can analyze the ongoing ramifications of the first Trump administration’s restrictions on Title X providers. The 2019 domestic gag rule restricted Title X health centers from providing comprehensive family planning services by prohibiting abortion counseling and referrals for abortion care, despite federal law already restricting the use of Title X funds for abortion services. As a result, by 2020, the number of Title X providers decreased by 23 percent and the program served 50 percent fewer patients (3.1 million in 2018 vs 1.5 million in 2020). After the rule was implemented, Title X providers were less likely to offer comprehensive contraceptive services than non-Title X providers and Title X patients were less likely to use the method of their choice, such as the pill instead of an IUD.

Although President Biden reversed the rule in 2021, Title X has not recovered, with fewer providers and fewer services available to patients nationwide compared to 2019. The 2019 rule permanently altered the landscape for patients who rely on safety-net providers for family planning services and contraceptive care. Newly proposed cuts to or elimination of Title X would create another major shift in access. Already, the second Trump administration has frozen funding to 16 Title X grantees. If made permanent, the Guttmacher Institute estimates that 834,000 people (or nearly 30% of Title X patients) would lose access to services, including contraceptive counseling and care. Many of the people affected already face systemic barriers to quality health care in the U.S.

The lack of access to family planning services would compound inequities due to new and proposed federal policies that decrease federal spending on safety-net services, like Medicaid and the Teen Pregnancy Prevention Program. Following the passage of H.R. 1, an estimated 15.9 million people, including 5.7 million women of reproductive age, will lose Medicaid coverage. A decline in coverage also means fewer reimbursable services under Medicaid, which will create financial instability for many safety-net providers and “defund” Planned Parenthood and other core reproductive health providers from Medicaid. Paired with the elimination or reduction of Title X funding, these changes could leave many safety-net providers struggling to keep their doors open. For Title X health centers, these policies would threaten up to 55 percent of their revenue (17% Title X funding and 38% Medicaid reimbursements, per 2023 federal data), and significantly challenge their ability to provide care nationwide. The funding cuts or programmatic changes to Title X will be even more acute for the communities most impacted by recent Medicaid changes.

Access to family planning is a critical part of health equity. Contraceptive access is vital to individual and national health, education, and workforce goals. Without the support of Title X and other sources of public funding, access to family planning care and comprehensive contraceptive services will be at risk for the patients and communities who need it most.