In early April, the Centers for Disease Control and Prevention released data indicating fertility rates in the U.S. had hit an all-time low, part of a broader downward trend over the last two decades. Around the same time the report was released, the Trump administration moved closer to a complete overhaul of the Title X family planning program, which provides birth control and other sexual health services to millions of low-income people in the U.S.
The Department of Health and Human Services posted new guidance for clinics that are dependent on Title X family planning services grants, which could affect clinics when they reapply for funding in January 2027. In the 70-page document, there is no mention of contraception except once, where it’s mentioned within the context of “reducing overmedicalization in health care.”
Notably, a major role of Title X funding is providing family planning services, including contraception. Established in 1970 under the Public Health Service Act, the Title X program has traditionally aimed to provide access to affordable services, including contraceptive methods, pregnancy testing, options counseling, and sexually transmitted infection testing. According to recent government data on Title X, an estimated 9 of every 10 clients at Title X-funded clinics are female. A majority of them are under the age of 30 and have an income below the poverty level.
The new proposed guidance changes its focus from preventing pregnancies to promoting “natural family planning methods” and suggests that its main goal is to “strengthen family formation and assist clients in achieving healthy pregnancies.” In 2027, the guidance explains, Title X will fund “voluntary family planning projects” that offer a broad range of “acceptable and effective family planning method” and services for adolescents and infertility. It emphasizes that clinics funded through these grants could promote “body literacy,” as in education on menstrual cycles, hormonal health, male and female fertility, which could help address the “nation’s growing infertility crisis.”
If Title X clinics encourage restorative reproductive medicine, it will only “reinforce the idea that infertility is a personal failure, primarily a women’s issue, or can be solved through lifestyle changes alone.”
“By supporting body literacy education alongside evidence-based evaluation and treatment of chronic disease, Title X services can help patients move beyond symptom-focused care toward informed, preventive and restorative approaches to reproductive health,” the new guidance says. “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 word restorative in the guidance is notable, as there has been a rise in discussions of a non-medical approach to infertility called “restorative reproductive medicine” — which many doctors and public health experts warn is motivated by ideology rather than based in science.
According to the American College of Obstetricians and Gynecologists, restorative reproductive medicine is built on two ideas. One that endometriosis is the dominant cause of infertility, which ACOG says is untrue, and that infertility can be addressed by “fertility awareness and lifestyle changes” — exactly what the new HHS Title X guidelines are encouraging. ACOG also states that restorative reproductive medicine has ties to the fetal personhood movement, which, in the world of infertility, is against in vitro fertilization, because it views the legal status of fertilized eggs as people with human rights.
“The concern with RRM isn’t the idea of treating root causes, because that is already part of the standard of care — it’s what RRM leaves out,” Danielle Melfi, CEO of RESOLVE: The National Infertility Association, told Salon via email. “If RRM becomes the standard in Title X programs, it risks steering people away from evidence-based treatments they may need to build their families, like IVF and IUI [intrauterine insemination], while excluding many patients altogether, including LGBTQ+ families and those facing male-factory infertility.”
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In America, infertility is already difficult to treat thanks to an overall dysfunctional healthcare system. As Melfi recently wrote in Cosmopolitan magazine, the condition is shaped by “biology, timing and access to care.” Title X is the only federal program to reliably offer basic infertility care to women and men. Melfi said if Title X clinics encourage RRM, it will only “reinforce the idea that infertility is a personal failure, primarily a women’s issue, or can be solved through lifestyle changes alone.”
Infertility is caused by a multitude of different factors, Dr. Rachel Jensen, ACOG’s Darney-Landy fellow, told Salon. Some of the approaches used in RRM — such as fertility awareness, endometriosis
“Management of these conditions, which are not the only causes of infertility, are also already part of the evidence-based care provided by gynecologists and reproductive
President Donald Trump has touted his record on women’s health, including support for in vitro fertilization, saying he’ll one day be known as the “fertilization president.” This comes as some in Trump’s orbit bemoan the decline in teen pregnancies, yet experts say Trump is ignoring one of the main things that could help boost fertility rates: making childcare affordable.
In a statement to NBC News earlier this month, Emily Hilliard, a spokesperson for HHS, said that the “HHS is aligning the program with President Trump’s pro-life and pro-family agenda.” Notably, as reported by NBC News, Hilliard did not answer a question about whether the government would allow the use of Title X funds for hormonal birth control in 2027.
HHS did not respond to Salon’s request for comment.
“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,” Jensen told Salon. “Clinicians and clinics receiving Title X funds should provide scientifically accurate, evidence-based, comprehensive care.”
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