The United States witnessed another dip in the number of babies born last year, a trend that is prompting federal policy reevaluation and sparking debate over the future of reproductive healthcare access. New data released by the Centers for Disease Control and Prevention (CDC) reveals that in 2025, the nation recorded approximately 3.6 million births, marking a 1% decrease from the previous year. This continues a long-standing pattern, with the overall fertility rate falling to 53.1 births per 1,000 women aged 15 to 44, a significant 23% decline since 2007.
This demographic shift has captured the attention of the Trump administration, which has publicly expressed a desire to reverse this trend. President Donald Trump has articulated a vision for "a new baby boom," and his administration has actively solicited ideas from various advocacy and policy groups. These proposals have ranged from direct financial incentives, such as "baby bonuses," to a broader examination of fertility planning services. A key area of focus for the administration is the proposed reshaping of Title X, the federal government’s sole program dedicated to family planning services.
For over half a century, Title X has operated as a critical public health safety net, enjoying bipartisan support. Its core mission has been to provide essential reproductive healthcare services, including contraception, screenings for sexually transmitted infections, and general reproductive health consultations, to low-income women and individuals, irrespective of their ability to pay. At its operational zenith, this program served upwards of 5 million patients annually. The program’s profound impact is underscored by data indicating that six in ten Title X clients rely on it as their primary source of healthcare in any given year.
The current reorientation of Title X began to take shape in early April when the Department of Health and Human Services (HHS) issued a Notice of Funding Opportunity (NOFO) for fiscal year 2027 grants, which commence in October. This extensive 67-page document outlined new grant parameters for nonprofit organizations seeking to provide Title X services. Notably, the NOFO contained only a single mention of contraception, framing it as potentially overprescribed and associated with adverse side effects, part of what it characterized as an "overreliance on pharmaceutical and surgical treatments."
This language signals a departure from the program’s historical emphasis. Instead of focusing on broad public health interventions and preventive care, the grant notification directs a shift towards an agenda centered on fertility, family formation, and the management of specific reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, low testosterone, and erectile dysfunction. While the program will still aim to assist women in "achieving healthy pregnancies," the explicit goal of preventing unintended pregnancies, a cornerstone of Title X’s longstanding mission, is conspicuously absent from the document.
This redefinition of family planning has drawn sharp criticism. Jessica Marcella, who previously managed the Title X program as a senior official in the Biden administration, described the new funding notice as a fundamental alteration of the program’s purpose. "What we’re seeing is an attempt to use our nation’s family planning as a Trojan horse for an entirely different agenda," Marcella stated, referencing President Trump’s prior proposals to eliminate Title X entirely.
The Demographic Context: Declining Birth Rates and Fertility Trends
The administration’s overhaul of Title X is occurring against the backdrop of persistent declines in birth rates. However, researchers specializing in fertility trends argue that these declines are driven by complex socioeconomic factors largely independent of contraception access. They contend that restricting access to contraception is unlikely to yield the desired increase in birth rates.
Demographer Alison Gemmill of UCLA points to the increasing tendency for childbearing to be delayed. "Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage," she explained. Gemmill further notes that most American women still complete their childbearing years with an average of two children, suggesting a societal shift towards smaller families rather than a rise in childlessness. "Having children has become more contingent and more planned," she added.
The observed decline in birth rates since 2007, according to experts, largely reflects women postponing childbirth rather than abandoning it altogether. Philip Cohen, a sociology professor at the University of Maryland, stated, "The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45."
Economist Phillip Levine of Wellesley College attributes the declining birth rate to evolving societal perspectives on work, leisure, and parenting. "Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy," Levine commented.
In response to inquiries about the role of contraception in reducing maternal mortality and how the new funding notice addresses this, HHS press secretary Emily Hilliard issued a statement: "Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law."
Marcella posits that the current changes to Title X are the result of two converging influences: the "Make America Healthy Again" movement, characterized by a skepticism of conventional medicine and an emphasis on lifestyle interventions, and a "pronatalist agenda" aimed at increasing birth rates through policies focused on family formation. The language within the funding document, she observes, reflects both these influences, with repeated references to "optimal health" and "chronic disease," while diminishing the role of contraceptive services that have been central to Title X for decades.
Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, expressed concern that linking Title X to birth rate objectives supplants individual decision-making with governmental directives. "The program is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy," Coleman stated.
Title X’s New Direction: A Shift in Focus
The administration’s proposed changes to Title X have garnered support from conservative organizations. Emma Waters, a senior policy analyst at the Heritage Foundation, who advocates for what she terms "restorative reproductive medicine," views the new funding notice as a long-overdue acknowledgment of neglected aspects of women’s health. "I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X," Waters commented. She interprets the notice as an expansion, rather than a contraction, of the program’s mission, asserting, "I see this iteration of Title X as the fulfillment of its purpose. The goal was never just ‘more contraception’ but a wholesale empowerment of women to govern their own fertility."
Waters further argues that untreated reproductive health issues may contribute to lower birth rates. "One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids," she said, citing endometriosis as an example.
Endometriosis affects an estimated 5% to 10% of women of reproductive age, and between 30% and 50% of these women experience infertility. While there is an association, scientific consensus does not establish untreated endometriosis as a direct cause of infertility. Screening for endometriosis typically occurs when symptoms are present, and the condition’s prevalence and the precise mechanisms by which it affects fertility remain areas of ongoing research. Importantly, treating the disease does not guarantee the restoration of fertility.
Furthermore, national infertility rates have not shown a significant increase in recent decades. An analysis of federal survey data indicated that infertility rates remained largely stable between 1995 and 2019, even as the national birth rate experienced a sharp decline. This divergence suggests that untreated reproductive diseases are unlikely to be the primary driver of the falling birth rate.
In February, the American College of Obstetricians and Gynecologists (ACOG) released new clinical guidelines aimed at facilitating earlier diagnosis of endometriosis without requiring surgery. This initiative aligns with efforts to address diagnostic delays. However, the primary treatment recommended by ACOG is hormonal therapy, a category of care that the Title X funding notice critiques as part of an "overreliance on pharmaceutical and surgical treatments." This creates a perceived contradiction: Title X is now emphasizing the diagnosis of endometriosis while seemingly de-emphasizing the pharmaceutical interventions commonly used to manage it.
Crucially, advanced treatments that have demonstrated efficacy in improving fertility for women with endometriosis, such as laparoscopic surgery and in vitro fertilization (IVF), are not covered by Title X. When President Richard Nixon signed Title X into law in 1970, it was intended to broaden access to family planning services, enabling individuals to control the timing and number of their children through accessible contraception and related preventive care, particularly for those with financial constraints. While Medicaid serves as the primary government health insurance program for low-income women, like many commercial insurance plans, it does not typically cover IVF.
Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who was involved in updating program guidelines, acknowledges that many of the conditions now prioritized in the funding notice warrant attention. However, she argues that these fall outside the practical scope of what Title X can realistically address. "There’s not even enough funding to support the core premise of contraception," Romer stated. "And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation."
The emergence of an ideology within federal health policy that appears to question or downplay the importance of contraception is striking, especially given the broad public support for birth control access. A 2024 survey by KFF found that eight in ten women of childbearing age had used some form of contraception in the preceding 12 months.
Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, warned of tangible consequences: "If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients." She added that funding could be diverted from providers offering comprehensive contraceptive care "toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services."
High Stakes: Maternal Health and Reproductive Rights
The United States faces a significant public health challenge with one of the highest maternal mortality rates among wealthy nations, reporting 17.9 deaths per 100,000 live births as of 2024, according to the CDC. Data from the CDC further indicates that four in five pregnancy-related deaths in the U.S. are potentially preventable. Medical research consistently demonstrates that pregnancy carries substantially higher risks of serious complications, including blood clots, stroke, and cardiovascular issues, compared to hormonal contraception.
The landscape of reproductive healthcare has been further reshaped since the Supreme Court’s 2022 Dobbs decision, which overturned the constitutional right to abortion established by Roe v. Wade. This ruling has led to significant restrictions on abortion access in numerous states. While national abortion numbers have seen an increase, largely attributed to telehealth and interstate access, studies indicate a rise in births in states with abortion bans, resulting in an estimated 32,000 additional births annually, with a disproportionate impact on young women and women of color.
Dr. Christine Dehlendorf, director of the Person-Centered Reproductive Health Program at the University of California-San Francisco, asserted, "There is absolutely no evidence for any positive outcome of restricting access to contraception." She warned that such restrictions would likely increase demand for abortion care and complicate efforts by women to prevent high-risk pregnancies.
Since President Trump’s return to office, a dozen Title X grantees have experienced grant freezes, forcing some health centers to suspend services, lay off staff, or close their doors. During his first administration, regulatory changes led to a dramatic decrease in Title X participation, from over 4 million patients to approximately 1.5 million. The program saw a gradual recovery under the Biden administration, reaching about 3 million clients before the current round of funding disruptions.
The second Trump administration’s overhaul of Title X, as articulated by Marcella, "directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy." The implications of these policy shifts extend beyond individual access to care, potentially impacting broader public health outcomes and the reproductive autonomy of millions of Americans.
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