HHS Changing Its Tune on Contraceptive Access

HHS is changing its orientation when it comes to contraceptive access, shifting to a bigger focus on conception, “natural family planning,” and pregnancy.

HHS’s Office of Population Affairs (OPA) issued guidance earlier this month to future applicants for its Title X grant program, which awards funding for reproductive health services. OPA said it plans to distribute about $257 million for as many as 90 grant awards for a period of up to 5 years, although “the actual amount available will not be determined until enactment of the fiscal year 2027 federal budget.” The $257 million figure represents a drop from previous years; funding stood at $286 million for nearly a decade, according to a 2023 KFF report. Grant applications are due next January.

At the same time, in its proposed fiscal year 2027 budget submitted to Congress, the Trump administration proposed zeroing out the Title X program (listed as “Family Planning”) entirely. Title X family planning would be one of several programs eliminated “to align with the administration’s priorities, streamline the bureaucracy, restore a clearer division of responsibilities between federal and state government, and save taxpayer funds,” according to the administration’s Budget in Brief document.

The new OPA guidance, whose existence was first reported in Politico, states that “We expect applicants to demonstrate how their Title X projects will integrate noninvasive, evidence-based practices that promote health literacy, fertility awareness, and reproductive health without unnecessary medicalization or symptom suppression.” The guidance suggests several “key strategies” for advancing health; those include “fertility-awareness–based” methods — which the authors note are “often referred to as ‘natural family planning'” — along with education and counseling to encourage healthy pregnancies.

The word “contraception” is mentioned only once in the 70-page document, during a discussion of “overreliance on pharmaceutical and surgical treatments” when it comes to family planning. “Over the years, the CDC’s National Survey of Family Growth reports have shown a decrease in females’ current use of any contraception … The most common reason women reported discontinuing use related to dissatisfaction was side effects,” the authors wrote.

The emphasis on pharmaceutical and surgical contraception methods “has failed to adequately address the root causes of the nation’s chronic disease burden, resulting in ongoing health challenges that affect fertility, pregnancy outcomes, and long-term health outcomes,” the guidance said. The authors stress approaches that “focus on the underlying behavioral and lifestyle factors of health — such as nutrition, sleep, physical activity, stress management, and environmental factors — that impact overall health.”

The Trump administration’s approach represents a turnaround from prior administrations. Under President Biden, for example, Title X programs provided comprehensive family planning services, including access to a wide range of contraceptives as well as referrals for abortions.

Several reproductive health groups panned the change in approach. “Patients deserve access to and information for all evidence-based options when considering contraception,” Jamila Perritt, MD, MPH, president and CEO of Physicians for Reproductive Health, told MedPage Today in an email. “No one should be coerced into any method of family planning, nor should they be restricted from the contraceptive method of their choice due to the government’s ideological and religiously-driven agenda. It should be up to each individual person to decide if and when they start a family.”

The American College of Obstetricians & Gynecologists (ACOG) agreed. “As the only federal program dedicated to providing family planning services for people with low incomes, Title X is essential to their ability to affordably and confidentially obtain birth control, cancer screenings, STI [sexually transmitted infection] tests, and other basic care,” ACOG said in an email. “ACOG strongly opposes reduction, restriction, or elimination of Title X funding, as that would cut off access to critical family planning and preventive care for millions of people, particularly those who are low-income, uninsured, or adolescents.”

“Healthcare providers receiving Title X funds should provide scientifically accurate, evidence-based, comprehensive contraceptive care that includes a breadth of contraceptive methods,” the organization said. “It is inappropriate for the Title X program to place emphasis on any singular method or approach to family planning. Contraceptive counseling should be patient-centered, ensuring that patients’ priorities and needs are paramount when choosing a method.”

But other groups praised the change. “Families flourish when women are supported before, during, and after pregnancy,” Christina Francis, MD, CEO of the American Association of Pro-Life Obstetricians and Gynecologists, said in an email. “Societies flourish when families are supported and encouraged. In a time when we are facing a rapidly declining birth rate that falls far short of the replacement fertility rate, we should be doing all we can to encourage and support family formation and fertility.”

“We are encouraged to hear that life-affirming options for family planning are being prioritized by the administration,” she added. “Women deserve accurate information about their fertility and their health — and this includes highlighting the many benefits of pregnancy and motherhood.”

The National Right to Life Committee also was pleased. “National Right to Life commends the administration for its continued commitment to advancing pro-life policies and restoring integrity to the Title X program,” Madison LaClare, the organization’s director of federal government affairs, said in an email. “These recent actions by HHS, along with an increased emphasis on policies supporting families, are significant steps towards creating a culture of life. These changes, particularly when paired with broader policy efforts, will reduce the number of abortions by ensuring that federal programs prioritize life-affirming care and do not subsidize the abortion industry.”

The American Academy of Family Physicians took a more cautious approach, saying in a statement that it “supports women’s right to access the full scope of high-quality healthcare, including comprehensive family planning services. We believe decisions about reproductive and family planning care are best made between patients and their trusted family physician. There is no one-size-fits-all approach, and women deserve access to the full range of evidence-based options so they can choose what is right for their health, their families, and their lives.”