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Reproductive health advocates hope President-elect Trump will restore a rule that weakened the nation’s only family planning program funded during his first term once he returns to office next year.
The Title X Family Planning Program, which makes it easier for millions of low-income Americans to access reproductive services like birth control, emergency contraception and abortion referrals, is still struggling with the ‘impact of the restrictions imposed by the first Trump administration five years ago.
In 2019, the administration issued a rule that prohibited providers receiving Title X funds from mentioning abortion or performing abortions and stipulated that recipients of the program must be physically separated from any abortion activity.
Before the rule, Title X funds helped support roughly 4,000 clinics nationwide that provided family planning services to 3.9 million low-income or uninsured Americans, according to the policy research non-profit healthcare KFF.
The rule forced 1,000 clinics to withdraw from the program, leaving six states (Hawaii, Maine, Oregon, Utah, Vermont, and Washington) without any Title X-funded services in 2020. according to a report of the Population Affairs Office of the Department of Health and Human Services.
These closures, along with the movement restriction that occurred during the COVID-19 pandemic, reduced the number of people served by the program to 1.5 million in 2020.
According to Power to Decide, a nonprofit working to end unplanned pregnancy, most of the people who went without care as a result likely didn’t have insurance.
President Biden’s administration quickly reversed those regulations after he was elected in 2020, but the program and the number of people it serves have yet to recover.
Reproductive health advocates told The Hill they expect Trump to try to reinstate the rule earlier in his second term than when he first issued it in his first term, likely within 12 weeks of taking office on inauguration day
Uninsured Americans would be particularly affected by the rule’s potential rollback, advocates stress, noting that services provided through Title X-funded clinics are especially essential for these patients, who could receive their only medical care throughout the year during these visits.
“Take away these family planning services and critical public health services from people who can’t afford them otherwise means they’re going to miss out and that’s unconscionable,” said Brigitte Amiri, deputy director of the Project of Reproductive Freedom of the American Civil Liberties Union. .
Maine Family Planning, a nonprofit that provides reproductive health care, was one of the clinic networks forced to drop out of the Title X program in 2019. George Hill, the organization’s president and CEO, said on The Hill that there was no need to close the clinics, but leadership had to scramble to find new sources of funding to replace the 25% of revenue it lost by leaving the program.
Hill worries that reinstating the rule — and the cost of the legal battle that would entail — could put the network’s rural clinics in a vulnerable position or make it harder to bring new mobile medical services to Mainers at home.
Advocates point to Project 2025, a conservative policy project spearheaded by the Heritage Foundation, as evidence that the future of Title X is in jeopardy.
The bill calls for the reinstatement of the 2019 rule in addition to asking Congress to supplement it by passing legislation that would prohibit family planning grants from going to entities that perform abortions or provide funding to other abortion providers.
One of these bills is the Title X Abortion Providers Prohibition Actwhich was introduced in 2021 by Sen. Marsha Blackburn (R-Tenn.), but has since sat on a Senate committee.
Project 2025 also calls on the federal government to eliminate “religious discrimination” in the Title X program’s grant selection process and to guarantee the program’s “right of conscience and religious freedom of health care workers and participants.”
Trump tried to distance himself from Project 2025 during the campaign, saying yes “nothing to do” with the proposal. However, some of its authors served in his first administration, and since his re-election, he has used several people connected to it to shape his next one.
Clare Coleman, president and CEO of the National Association for Family Planning and Reproductive Health, believes that any new rules issued by the Trump administration to restore the 2019 regulations will seek to further restrict access to health care sexual and reproductive.
He told The Hill, for example, that he is concerned that a new rule would also require Title X program recipients to receive notice or consent from parents before providing services to minors.
That’s it the case of Texaswhere the state’s 156 Title X recipients were required to obtain parental consent before serving teenagers in a March ruling. Texas is one of the few states that requires parental consent before a teenager can receive birth control, but the Title X program provided an exception to that rule.
Before the March ruling, Title X clinics in Texas could provide birth control to minors without their parents’ knowledge and regardless of income or immigration status.
The decision came after a years-long legal battle that involved a federal lawsuit by the Biden administration arguing that Title X regulations overruled the Texas law. Earlier this year, Texas Attorney General Ken Paxton (R) the Biden administration sued arguing that Title X could not preempt state parental consent laws.
Coleman also worries that a new rule could ban abortion counseling, impose even stricter physical separation requirements on facilities that provide abortion care with non-Title X funds, or prohibit any entity that funds an abortion provider is part of the program.
“Many state governments fund abortion providers in their Title X programs,” he said. “So this would affect nonprofits and state agencies.”
Another possibility, he fears, is that a new rule would designate some emergency contraceptives like IUDs as capable of causing an abortion and try to disqualify them from the program’s coverage.
There is also concern that a new rule will work to further stigmatize transgender or gender non-binary people, for example by requiring Title X program recipients to treat people only according to their biological sex, Coleman added .
Some clinics that use Title X funds, such as Maine Family Planning, offer LGBTQ patients gender-affirming care.
Ultimately, however, reinstating a version of the 2019 rule is a means to make it harder for “disadvantaged providers” like Planned Parenthood to drop out of the program and make it easier for favored providers to join, advocates say.
Some of these favored providers are religiously affiliated health systems, such as Catholic-run hospitals and health systems, or other health systems that are ideologically opposed to abortion. as Obria and crisis pregnancy centers.
Updated at 10:37am EST
