The number of babies born in the United States declined by 1% in 2025 compared to the previous year, according to data from the Centers for Disease Control and Prevention. The federal government is responding with proposed changes to Title X, its only dedicated family planning program, sparking debate over access to contraception and reproductive health services.
This development matters because Title X has long provided low-income women with access to contraception and reproductive health care regardless of their ability to pay. The recent Notice of Funding Opportunity from the Department of Health and Human Services includes minimal mention of contraception and emphasizes fertility, family formation, and treatment for reproductive health conditions such as endometriosis and low testosterone.
Jessica Marcella, a former senior official overseeing Title X during the Biden administration, said: "What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda," noting that President Donald Trump has proposed eliminating Title X altogether. The funding notice signals a shift away from preventing unintended pregnancies—a core goal since the program's inception in 1970—toward supporting healthy pregnancies.
Demographer Alison Gemmill from UCLA said timing factors are most important in explaining declining birth rates: "Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage." Philip Cohen at the University of Maryland added that women continue to have more than two children on average by age 45. Economist Phillip Levine noted: "Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy."
Some conservative advocates welcome these changes. Emma Waters at the Heritage Foundation described them as overdue attention on neglected aspects of women's health: “I was particularly encouraged to see language that spoke to delays in diagnosis for conditions like endometriosis...and ensure that real root-cause was promoted through Title X.” However, medical experts point out contradictions; while prioritizing diagnosis for conditions like endometriosis, first-line treatments recommended by professional groups are being deemphasized under new guidelines.
Critics argue that shifting focus away from contraceptive services could increase barriers for patients seeking comprehensive care. Laura Lindberg at Rutgers School of Public Health warned that sidelining contraception could result in fewer options for patients and move funding toward organizations opposed to contraceptive care. Dr. Christine Dehlendorf at University of California-San Francisco stated there is no evidence restricting access leads to positive outcomes: "Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies."
As changes take effect—including frozen grants leading some clinics to reduce or halt services—Marcella concluded: "[The overhaul] directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions...from getting the care they have relied on for decades. It’s bad policy."
