Trump Administration Redirects Birth Control Funding to Promote Pronatalism

The Trump administration is making significant changes to a federal program aimed at providing affordable birth control and reproductive health services to low-income individuals. The Department of Health and Human Services (HHS) recently updated its "notice of funding opportunity" for Title X, a program that serves approximately 2.8 million people annually by offering contraceptive options and other reproductive health care.

Title X has faced considerable uncertainty under the Trump administration, with President Donald Trump attempting to eliminate it from his proposed budget in 2027 and previously freezing substantial portions of its funding before reversing course. However, this latest update to the program's guidelines marks a stark shift in its mission. Instead of focusing on birth control access, which has long been Title X’s primary objective, the new notice emphasizes initiatives that promote higher fertility rates.

The revised funding criteria prioritize services such as "body literacy," addressing infertility issues, and assisting individuals with planning pregnancies and managing reproductive health conditions like endometriosis. Notably, mentions of contraceptives are sparse, except in a section discussing what it terms as “overmedicalization,” which appears to praise the reduction in female contraceptive use.

Critics argue that these changes reflect a broader ideological shift within HHS towards pronatalism—a movement with roots in eugenics and a history of promoting biological superiority among white, straight, able-bodied individuals. This perspective often disregards women's autonomy and their right to choose whether or not they want to become mothers.

Providers who are contesting these changes in court highlight the potential for far-right actors within the administration to exert greater control over vulnerable communities' health care decisions. Assistant Secretary for Health Brian Christine, a vocal opponent of abortion rights and former penile implant surgeon, is overseeing the implementation of these new guidelines.

Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a leading research organization focused on sexual and reproductive health, describes this shift as aligning with Project 2025 MAHA's vision. This initiative prioritizes increasing birth rates over protecting individuals' reproductive rights and autonomy.

The initial version of the funding notice included provisions for an ideological alignment review, requiring all grantees to undergo assessments by political appointees based on their adherence to administration priorities such as ending diversity efforts and gender-affirming care. However, these controversial requirements were later removed from the document.

Health experts contend that under Secretary Robert F. Kennedy Jr., HHS is attempting to reshape a public health program intended for broad access to reproductive services into an instrument supporting pronatalist goals, potentially undermining the very communities Title X was designed to assist.