The Title X program, which has provided family planning services to low-income Americans since 1970, is under threat from the Trump administration. This anti-science, anti-woman administration has already distinguished itself in other areas of public health that negatively affect the welfare of pregnant people and children -- and this effort is no exception.
Under guidance released on Friday, March 2, the Department of Health and Human Services will preferentially fund programs that focus on abstinence and "natural family planning" -- also known as the rhythm method -- instead of birth control. And that's bad news for millions of low-income people who count on Title X to help them determine the timing and spacing of their children.
While this shift in funding priorities doesn't outright exclude Planned Parenthood, a frequent target for defunding campaigns, it's clear that the preferences expressed in the funding document are designed to funnel money to unscientific and ineffective family planning programs.
"Natural family planning" has a failure rate of up to 25 percent, even when practiced under ideal conditions -- a far cry from from hormonal birth control, barrier contraceptives and other options, which can be 98 percent effective or higher, depending on the methods used.
One thing organizations never provided with Title X funds? Abortion care, because it's forbidden by law.
Until recently, health care providers that offered abortion care could use Title X money for other services, as long as they were clearly separated, but the Department of Health and Human Services reversed this policy shortly after Trump took office. The budget proposal also targets abortion providers with further constraints on funding. In essence, the federal government is pushing reproductive health providers to drop abortion from their services or forfeit their federal funding.
It's notable that Valerie Huber, the woman tasked with overseeing the Title X office, came from a private sector career with Ascend, which heavily promotes abstinence education. Some of the language in the call for grant proposals mimics that used by Ascend in its own literature, with a significant implication that programs promoting abstinence may get a leg up in the funding competition. Huber's tenure at HHS, incidentally, has been especially bad for teens.
People who count on Title X funding to access evidence-based medicine could also be in trouble. If funding is allocated in the direction of entities that focus on promoting abstinence and ineffective birth control methods, this may force low-income people who can't afford care elsewhere to seek inadequate family planning services with these entities, including crisis pregnancy clinics. And that could reverse the promising trend of fewer teen pregnancies in the US, as well as pose a greater risk of contracting STIs. People receiving health care interventions weighted towards abstinence are less likely to get comprehensive sexual education that helps them learn how to reduce their risks.
The American College of Obstetricians and Gynecologists has expressed grave concerns about these policy changes, saying they "reduce individuals' options for care." Numerous other organizations that advocate for public health and access to reproductive care have echoed these comments, explaining that the change could be dangerous for vulnerable low-income people. These adjustments to Title X funding priorities also take place within a larger landscape of policy changes designed to limit options for patients who rely on federally-funded programs -- and that seems to be no accident.