The Fight to Keep Title X Strong

By Lauren Weiss, Director, Advocacy & Communications, National Family Planning and Reproductive Health Association and Zara Day, Pharmacy Analyst, Planned Parenthood Federation of America

 On March 4, 2019, the Trump-Pence administration finalized a regulation, sometimes referred to as the domestic gag rule, which would dramatically alter the Title X (ten) family planning program. For nearly 50 years, Title X has served as the nation’s only federal program dedicated to ensuring high-quality, affordable family planning and sexual health care for poor, low-income, and otherwise underserved people.

 For the last six years, the Department of Health and Human Services has been appropriated $286.5 million to administer the competitive grant program in communities across the country. Unfortunately, this funding level for Title X is wholly insufficient to meet the demand for the program. In fact, current funding levels are less than 40 percent of what is needed to meet the need for publicly funded family planning in this country, according to analyses published in the American Journal of Public Health. Despite reflecting a small portion of federal dollars spent on health care and the program’s statutory prohibition on using funds for abortion services, Title X has been on the receiving end of criticism and pushback in recent years from conservative lawmakers who seek to undermine the program as part of an anti-choice policy agenda.

 Title X funding goes to nonprofits and state and local public health agencies to subsidize family planning and related preventive health services, including contraceptive counseling, services, and supplies; Pap smears; cancer screenings; sexually-transmitted infection (STI) testing and treatment, HIV testing and education, and community outreach and sexual and reproductive health education. All services are provided at no cost to people who have incomes below the federal poverty line (FPL) – who make up more than two-thirds of patients served - and on a schedule of discounts to people with incomes between 101 and 250 percent FPL.

 All of these critical services are at risk under the new rule. The Trump-Pence administration’s final rule gags providers from offering patients a full range of medical options, prohibiting them from referring for abortions even if a patient requests a referral, and coercively requiring that all patients with a positive pregnancy test be referred for prenatal care regardless of the patient’s wishes. The rule also removes the term “medically approved” from a requirement that Title X projects offer a broad range of contraceptive methods, potentially opening the door for crisis pregnancy centers to receive federal funds to provide confusing, medically unsound and unethical care to patients. The rule imposes unnecessary physical and financial separation requirements between a Title X program and the provision of abortion services or any other activity the administration deems to support, promote or advocate for abortion. Additionally, the rule creates onerous reporting requirements for program participants. In the aggregate, all of these changes are targeted at penalizing the current network of highly qualified health centers, some of whom separately offer abortion care, an ethical and legal service. If the courts do not block this unlawful rule, the nation should expect decreased access to high-quality, compassionate care for low-income patients and for patients of color, who are disproportionately represented in the Title X patient population.

 So, some CHF members are fighting back. NFPRHA, jointly with one of its Washington state-based members, Cedar River Clinics, as well as PPFA, jointly with the American Medical Association, have filed lawsuits, including motions for preliminary injunctions, seeking to block the rule from taking effect. This is in addition to separate litigation filed by the Title X grantees in California and Maine and the attorneys general representing Washington, California, the city of Baltimore, and Oregon, the last of which is joined by 19 states and the District of Columbia.

 Both public health experts and the medical community are on the side of barring the Trump-Pence administration from moving forward with these egregious policies. Moreover, an array of stakeholders are working together to raise awareness about the dangers posed by this rule and to mobilize our champions in Congress to speak out against this attack and support bold policies that strengthen the network, including increased funding to meet the needs of people across the country. The response has been tremendous - in the last month, 197 members of the House of Representatives and 42 members of the Senate have signed Dear Colleague letters in support of increased funding for Title X in the FY 2020 appropriations process. Clare Coleman, NFPRHA’s President & CEO, also testified about the need to support the current network of providers in front of the Labor, Health and Human Services, and Education Subcommittee of the House Appropriations Committee. Blocking the rule and strengthening investments in Title X annually will help the program deliver on the nation’s imperative to ensure that the people are able to access affordable birth control and preventive to care, which in turn supports their ability to fulfill their goals.

 NFPRHA and PPFA urge you to join us in support of Title X and the millions of patients who rely on it. For more information about fighting the Title X rule, please contact Lauren Weiss at and Jack Rayburn at  

 The National Family Planning & Reproductive Health Association (NFPRHA) is a non-partisan 501(c)3 membership association that advances and elevates the importance of family planning in the nation’s health care system and promotes and supports the work of family planning providers and administrators, especially in the safety net.

 Planned Parenthood (PPFA) is the nation’s leading women’s health care provider and advocate and a trusted, nonprofit source of primary and preventive care for women, men, and young people in communities across the United States. Each year, Planned Parenthood’s more than 600 health centers provide affordable birth control, lifesaving cancer screenings, testing and treatment for sexually transmitted diseases (STDs), and other essential care to 2.4 million patients. We also provide abortion services and ensure that women have accurate information about all of their reproductive health care options.