A Trump administration rule change in Title X is creating a family planning crisis

Oct 11, 2019 | Health

By Clare Coleman and Julie Rabinovitz | Special to CalMatters

The gold standard. A public health success story. A community cornerstone. These are some of the ways Title X, the nation’s only program dedicated to family planning and sexual health care, is characterized.

But now, new regulations forced onto the program by the Trump administration are having a devastating and widespread impact on providers and patients in diverse health settings and communities across the country.

The Title X program was created in 1970 by Congress with bipartisan support to equalize access to modern methods of birth control for uninsured and low-income individuals, who might otherwise lack a pathway to accessing essential health services like contraception, cancer screenings, and STD testing and treatment, HIV services, and counseling.

Title X has played a significant role in reducing unintended pregnancy rates to historic lows, and last year the program served nearly 4 million patients.

Unfortunately, today the future of our federal family planning program is in question. Earlier this year, the Trump administration imposed the most sweeping and extreme changes introduced in the history of the program.

These harmful and unlawful changes put political ideology over public health by enacting regulations that go against clinical standards and best practices. The regulations deny patients comprehensive information about their pregnancy options, and if allowed to stand, will establish a two-tiered health system with a lower standard of care for low-income patients.

The regulations, which took effect on July 15, are having a ripple effect across the nation.

At least 18 Title X grantees nationwide, nearly 20%, have left the program to date, including six state governments. The states of Washington, Utah, and Maine do not have any Title X provider whatsoever.

Although the administration and those who advocated for the regulations to be released have made no secret that new program policies were a targeted attack on health care providers that directly offer abortion care, the reality on the ground shows the reach is much greater.

In California, home to the largest, most comprehensive Title X provider network in the nation, a broad range of agencies have withdrawn from program participation. These include federally qualified health centers, city and county health departments, Planned Parenthood affiliates, and women’s health clinics.

This has created a seismic shift, resulting in a nearly 40% reduction in patients served by the program across the state. In addition, the number of California counties with a Title X provider has been almost cut in half, dropping from 38 to 19, since the regulations were implemented.

While the effects will be felt differently by region, we know that the loss of Title X funding will be a long-term hit to patient access – disproportionately impacting underserved and rural areas, and communities of color.

Across the country, health centers have already started to close and low-income patients are paying more out of pocket for birth control.

We are deeply concerned that the longer these regulations remain in place, patients in California could start facing some real barriers to access, including longer wait times, and cutbacks in outreach programs and health center hours.

That is why we are continuing to seek judicial relief to halt implementation of the regulations. The National Family Planning & Reproductive Health AssociationEssential Access Health, and our other litigation partners presented a strong case before a panel of 11 judges on the U.S. 9th Circuit Court of Appeals. These regulations are unlawful, and threaten to dramatically, and potentially permanently, unravel the family planning safety net.

We must maintain the robust Title X infrastructure built over the past 50 years, and protect the program’s mandate to provide comprehensive family planning services for all. We are committed to fighting at every turn to keep Title X strong for another half century to come. Because this is the fight of our generation.


Clare Coleman is president and chief executive officer of the National Family Planning & Reproductive Health AssociationCColeman@nfprha.org. Julie Rabinovitz is president and chief executive officer of Essential Access HealthJRabinovitz@essentialaccess.org. They wrote this commentary for CalMatters, a public interest journalism venture committed to explaining how California’s Capitol works and why it matters.



Share This