Trump Administration Reorients Title X Grants Toward Pronatalism

The Department of Health and Human Services’ Office of Population Affairs issued an updated notice of funding opportunity for Title X, the federal program that supplies low- or no-cost birth-control and reproductive health services to roughly 2.8 million people annually. The revised notice emphasizes “building body literacy, addressing infertility, planning and spacing pregnancies, and navigating reproductive-health conditions such as endometriosis,” while contraceptives receive only a brief mention in a section on “overmedicalization.” The language signals a shift from the program’s historic focus on contraception toward encouraging pregnancy and fertility.

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The change aligns with a broader pronatalist movement that links higher birth rates to political goals. The administration’s “Trump Accounts” program, effective this month, will provide $1,000 to children born between January 2025 and December 2028. Officials cited include Assistant Secretary for Health Brian Christine, a former anti-abortion advocate, and Secretary of Health Robert F. Kennedy Jr., who have been described as advancing a “Project 2025 MAHA” vision that prioritizes births over reproductive autonomy. The notice originally required an ideological “alignment review” by political appointees, which was later removed after criticism.

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In June, the National Family Planning and Reproductive Health Association (NFPRHA) and other Title X providers sued, alleging that the administration is “willfully violating the statute” and attempting to rewrite the law through the grant notice. Plaintiffs argue that the shift threatens access to contraception and could allow crisis-pregnancy centers—clinics opposed to hormonal birth control—to receive federal funds.

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The Department of Health and Human Services declined to comment on the notice. The administration, however, promoted the “Trump Accounts” incentive and has framed the pronatalist agenda as a response to perceived “declining genetic quality” and population decline, citing concerns voiced by figures such as Vice President J.D. Vance.

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• “I would characterize it as really a shift toward this Project 2025 MAHA vision of prioritizing having babies over reproductive autonomy,” — Amy Friedrich-Karnik, director of federal policy, Guttmacher Institute

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• “We believe that this is truly an attempt by the administration to hijack the program,” — Clare Coleman, president, NFPRHA

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• “They do not have the expertise to provide reproductive health care. They often oppose hormonal birth control methods, which is directly contrary to making sure that folks in Title X have access to the full range of contraceptive methods,” — Amy Friedrich-Karnik

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• “RFK Jr. is really using this to push an extremist agenda that prioritizes increasing births over ensuring people have the information and health care they need to make their own reproductive care decisions,” — Taylor St. Germain, interim co-executive director, Reproductive Equity Now

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