Birth rates in the United States declined again in 2025, with the Centers for Disease Control and Prevention reporting 3.6 million births, a one percent drop from the previous year. The fertility rate now stands at 53.1 births per 1,000 women between the ages of 15 and 44, down 23 percent since 2007. The Trump administration has made reversing that trend a stated priority. But the policy tools it is reaching for are drawing fierce opposition from reproductive health experts who say the approach is not only unlikely to work but could make pregnancy significantly more dangerous for vulnerable women.
What Title X is and what it does
For more than five decades, Title X has served as the federal government’s only dedicated family planning program, providing low-income women with access to contraception, sexually transmitted infection screening and reproductive health care regardless of their ability to pay. At its peak the program served more than five million patients annually. Six in ten clients have historically reported Title X as their only source of health care in a given year.
In early April, the Department of Health and Human Services issued a 67-page funding opportunity notice for fiscal year 2027 grants. The document contained only a single mention of contraception, characterizing it as overprescribed and part of a broader overreliance on pharmaceutical and surgical treatments. The new direction reorients the program toward fertility, family formation and conditions such as endometriosis, polycystic ovary syndrome, low testosterone and erectile dysfunction. Preventing unintended pregnancies, a foundational goal of the program since its creation under President Richard Nixon in 1970, is no longer explicitly referenced.
Why researchers say this approach will not raise birth rates
Demographers and sociologists who study fertility trends are skeptical that restricting contraception access will produce more births. The decline in birth rates since 2007 reflects a broad social shift toward delayed childbearing rather than an increase in childlessness. Women are waiting longer to have children as they pursue education, stable employment and financial security. Studies show the average number of children women have over their lifetimes has remained above two for women over 45, suggesting the issue is timing rather than a permanent decision to forgo parenthood.
Researchers argue that making pregnancy harder to prevent is far less effective at boosting birth rates than making parenthood more financially and socially desirable. The conditions most likely to encourage more births, they say, include affordable childcare, paid family leave and economic stability, none of which are addressed by changes to Title X.
The contradiction at the heart of the new policy
The funding notice’s emphasis on endometriosis diagnosis has drawn particular scrutiny. While the administration is encouraging earlier identification of the condition, which affects an estimated five to ten percent of women of reproductive age, the standard first-line treatment is hormonal therapy, the same category of care the document dismisses as over-reliance on pharmaceutical treatment. Treatments proven to improve fertility in women with endometriosis, including laparoscopic surgery and in vitro fertilisation, are not covered by Title X at all. The result is a policy that prioritises diagnosing a condition while sidelining the tools clinicians use to treat it.
The stakes for maternal health
The United States already carries one of the highest maternal mortality rates among wealthy nations, at 17.9 deaths per 100,000 live births as of 2024. The CDC estimates that four in five pregnancy-related deaths may be preventable. Medical research consistently shows that the health risks associated with pregnancy, including blood clots, stroke and cardiovascular complications, are substantially higher than those associated with hormonal contraception.
Since the Supreme Court’s Dobbs decision in 2022 curtailed abortion access across much of the country, an estimated 32,000 additional births per year have occurred in states with bans, disproportionately affecting young women and women of color. Reducing contraception access further, reproductive health experts warn, would increase that number and place more women in high-risk pregnancies without the safety net they have historically relied upon.
More than a dozen Title X grantees have already had their grants frozen since the current administration took office, forcing some health centers to reduce services, lay off staff or close entirely.
