A federal poverty-fighting program focused on reducing unintended pregnancies is about to undergo a major overhaul.

Reproductive health clinics use Title X federal grant money to provide birth control, cancer screenings and testing, and treatment for sexually transmitted infections to people with little or no health insurance. Title X money cannot be used for abortions.

The Guttmacher Institute estimates that Title X, which was signed into law by Republican President Richard Nixon in 1970, has prevented almost 20 million unintended pregnancies and 9 million abortions. It has also helped reduce child poverty, according to the group, which supports abortion rights.

But President Donald Trump has taken aim at the program, which has long been a target for abortion opponents. Since regaining the White House, Trump has temporarily blocked and then restored grants to certain reproductive health clinics and proposed a U.S. Department of Health and Human Services budget with no funding for the program. The department’s recently issued funding guidelines for Title X grants represent a significant mission shift.

Instead of expanding access to contraception, the focus of Title X will be “to strengthen family formation and assist clients in achieving healthy pregnancies,” according to the new guidance. That will align the program with the administration’s efforts to increase the U.S. birth rate.

The new rules say Title X will prioritize educating Americans about natural methods to avoid pregnancy and overcome infertility, and will promote “body literacy education” and “informed, preventive, and restorative approaches to reproductive health.” Some conservative groups tout an obscure alternative treatment for infertility called “restorative reproductive medicine,” which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.

The guidance directs Title X clinics to promote “fertility-awareness-based methods,” such as period-tracking apps, which the American College of Obstetricians and Gynecologists says can be helpful for getting pregnant but less effective at preventing pregnancy. It also calls on clinics to offer counseling on male fertility issues and to address environmental causes of infertility, including pornography use. And it includes a prohibition on DEI efforts and warns grantees that federal money cannot be used to “facilitate or incentivize illegal immigration.”

Anti-abortion groups support the changes, but many health policy researchers say they will disproportionately harm low-income and minority women, who are more reliant on Title X services and are more likely to have unintended pregnancies.

Corinne Rocca, an epidemiology professor at the University of California, San Francisco, said the way to do that would be to spend more on childcare subsidies and other social programs to help new parents. “Policies that help people and families feel supported to meet their childbearing preferences … would actually help people who are open to the prospect of childbearing to do so,” Rocca said.

In line with Project 2025’s recommendations, HHS says Title X grantees will no longer be required to counsel or refer for abortions, and tells applicants that relationship counseling should encourage marriage as a precursor to having children.

As a Black woman and researcher focused on Black maternal health at Ibis Reproductive Health, Terri-Ann Thompson is better informed than most on the ways having children can be disproportionately more dangerous and less affordable for women who look like her.

But she says what she wasn’t expecting to uncover — during research for a study she co-authored in the journal Frontiers in Public Health this spring — is how much the fear of negative medical and criminal justice outcomes makes many Black women in Georgia and North Carolina scared of pregnancy.

“I was very surprised to see that folks were actually thinking about the context within which a Black child is born and raised well before they even contemplated starting a family,” Thompson said. “We had a lot of, just, stories of folks saying, ‘Why would I want to bring a child into this context; how does one prepare Black women to bring a child into this context?’”

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