The Trump administration has announced a freeze of close to $35 million in federal funding set to be disbursed to Title X Family Planning Program grantees. Under this freeze, 16 Title X grantees, including 9 Planned Parenthood affiliates, did not receive scheduled payments. This action leaves seven states—California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah—without any Title X funding because these grantees were the only Title X providers in the state.

The US Department of Health and Human Services announced that the agency is investigating whether recipients of the suspended grants are in compliance with federal law and executive orders curtailing diversity efforts. Freezing this funding threatens access to affordable reproductive health care for millions of people who receive services through the Title X program.

During his first administration, President Trump also significantly changed the Title X program by instituting restrictions on funding, sometimes referred to as the domestic “gag rule.” These stipulations barred grantees from counseling patients on or referring patients to abortion services. These restrictions resulted in large declines (PDF) in participating sites and numbers of clients served by the program, and evidence suggests these changes limited access to affordable reproductive health care for patients. Though the current freeze does not impose these restrictions, they could be reinstated in the future.

Though the Biden administration reversed the gag rule restrictions in 2021, the new Trump administration’s funding freeze is once again disrupting the Title X program. Funding instability could cause serious negative effects on family planning and reproductive health care in the US, particularly for people with low incomes and people who are uninsured.

The Title X program makes family planning services accessible to people with low incomes and those without insurance

The Title X program is a critical component of this country’s health safety net, providing family planning services regardless of income or insurance status. The program awards grants to state, city, and county health departments, family planning clinics, and community-based organizations to offer birth control services; breast and cervical cancer screening; testing, referral, and prevention education for sexually transmitted infections and HIV; and pregnancy testing and counseling (PDF). The program received $286.5 million in federal funding in 2023.

The Urban Institute’s 2018 Survey of Family Planning and Women’s Lives showed that 31.6 percent of women of reproductive age had used a safety net family planning clinic, often to receive family planning services, but sometimes for general health care as well. Some survey respondents indicated these clinics were the only place they could get desired services. In 2023, 83 percent of Title X clients received care for free or on a sliding fee scale, and 27 percent did not have health insurance.

The first Trump administration’s restrictions disrupted the reproductive health care safety net

A provision of the Title X statute dictates that “none of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” In 2019, the Trump administration adopted a stricter interpretation of this provision, revising regulations to prohibit grantees from counseling patients on or referring patients to abortion services. Grantees were also unable to receive funds if they offered colocated family planning and abortion services, even if the abortion services were not funded by Title X.

While these restrictions were in effect, around one-third of Title X sites left the program. Planned Parenthood formally withdrew as an organization, resulting in 411 affiliated clinics leaving the program, in addition to 869 nonaffiliated clinics. Under the gag rule, six states did not have any Title X–funded clinics.

Clinics that left the Title X program were more likely to report changes to sliding fee structures or increased service fees because of budget constraints, compared with those that stayed in the program. These sites were also more likely to struggle with staff retention. Additionally, the first Trump administration specified that grantees were no longer required to provide a full range of contraceptive methods, stipulating that sites “may offer only a single method or a limited number of methods of family planning,” including “natural family planning methods.” As a result, crisis pregnancy centers that did not provide contraception were permitted to join the Title X program.

This reshaping of the safety net hindered patients’ access to affordable, comprehensive reproductive health care. The number of patients the Title X program served dropped from 3.1 million in 2019 to 1.5 million in 2020. Although 37 percent of that decrease is attributed to the COVID-19 pandemic, the remaining 63 percent is linked to the gag rule. Evidence suggests patients faced increased barriers to accessing quality care that met their needs and preferences in the wake of these changes.

At the time of this writing, the current Trump administration has not reimposed the gag rule. Though the current funding freeze is a separate policy action, it will likely interfere with Title X grantees’ ability to provide high-quality, affordable reproductive health care in similar ways.

Freezing Title X funding could further limit access to affordable family planning and preventive health care

The number of Title X sites rebounded under the Biden administration and all six states that left the program have rejoined, but the effects of the Trump-era restrictions still linger. Of the sites that left the program during the first Trump administration, 817 rejoined, including 70 percent of the Planned Parenthood clinics. Sites that did not offer comprehensive counseling and contraceptive services were once again disqualified from the program. Despite these reversals, Title X served just 2.8 million clients in 2023, a marked increase from the gag rule years but still 1 million fewer than in 2018.

The 2022 Dobbs v. Jackson Women’s Health Organization ruling also shaped the rebuilding of the Title X program. In states where abortion is banned, state laws or policies were in direct conflict with Title X requirements under the Biden administration. For instance, the Tennessee and Oklahoma state health departments were disqualified from receiving Title X funding because of their refusal to provide comprehensive pregnancy-options counseling, which includes providing referral to abortion care if requested. The Trump administration restored some of these funds to both states.

As the second Trump administration moves to withhold Title X funding, access to family planning and preventive health care could be in peril. Evidence indicates that disruptions to Title X funding weaken the reproductive health care safety net and create barriers to affordable care for millions of people, particularly people with low incomes and people who are uninsured.