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THE TRUMP ADMINISTRATION IS COMING AFTER BIRTH CONTROL ACCESS IN A
TERRIFYING NEW WAY
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Jill Filipovic
April 20, 2026
The New York Times
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_ Not satisfied with the end of legal abortion in America, the
anti-abortion movement seems poised to end the era of affordable
contraception. The result isn’t just the end of Title X as we knew
it. It’s the demise of a long-held bipartisan consensus _
Marlen Mueller / Connected Archives // New York Times,
Some 60 years ago, American legislators set out to tackle a problem
that was driving employment and education rates down, driving health
care and welfare costs up and making American family life
significantly less stable: Many American women, and particularly poor
women and teenagers, were having more children than they wanted or
could afford. Close to half
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of births were to women who had not intended to get pregnant.
Decreasing the unintended pregnancy rate was a bipartisan wish. In
1969, President Richard Nixon recognized
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or untimely childbearing is one of several forces which are driving
many families into poverty.” A year later, Congress passed Title X:
the first federal program entirely dedicated to family planning and
reproductive health care.
It would go on to become one of the most successful federal programs
of the last century, with one study
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finding it prevented some 20 million unintended pregnancies in just 20
of its 50 years by providing women with free and low-cost birth
control. It has significantly reduced child poverty. In 1957, nearly
one in 10 teenage girls gave birth. Today, the rate is closer to one
in 100 [[link removed]]. For every
dollar spent on family planning funds, the government saves $7 in
Medicaid costs.
But President Trump seems intent on killing Title X. This month, the
Department of Health and Human Services quietly issued new funding
guidelines
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that have effectively subverted the program’s entire purpose.
Instead of getting highly effective contraception methods to the
country’s poorest women so that they may decide if and when to have
children, Title X under Mr. Trump seems aimed at getting more women
pregnant, whether they want to be or not. And it appears to cater to
three influential parts of the Trump coalition: The anti-abortion
movement; the MAHA, or Make America Healthy Again, movement; and
pronatalists who want to see birthrates rise at nearly any cost.
More than half of patients at Title X clinics use modern contraceptive
methods to prevent pregnancy. But the word “contraception” comes
up just once in the Title X funding document, and only in a section on
“reducing overmedicalization in health care.” Instead, in a change
pulled directly from Project 2025
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H.H.S. tells Title X clinics to emphasize “fertility-awareness-based
methods,” a broad category that includes things like tracking your
periods or your body temperature to estimate which days you might be
fertile. These methods can be helpful
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for getting pregnant, but are generally far less so
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for preventing pregnancy. Fertility awareness methods have typical-use
failure rates
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between 12 and 24 percent in the first year, according to the American
College of Obstetricians and Gynecologists. The intrauterine device,
by contrast, has a failure rate of less than 1 percent.
The health department seems to want to shift taxpayer dollars away
from reliable contraception and toward counseling men on erectile
dysfunction, testosterone levels and sperm motility, each of which
merits three mentions in the new guidance, while IUDs and birth
control pills earn none. The document is a mishmash of Make America
Healthy Again talking points on lifestyle changes, conservative
bromides on marriage before babies and pronatalist nods to fertility.
Some of the guidance sounds sensible on its face. H.H.S. cribs from
MAHA when it says it will focus on chronic disease in order to promote
“healthy pregnancies and family formation.” But contraception use
is a significant part of how women ensure they have healthy
pregnancies and form the families they desire, and it’s also a
common treatment for chronic diseases, including
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endometriosis and polycystic ovarian syndrome. Yet it doesn’t come
up in the section spelling out the department’s top Title X spending
priorities. What does? Addressing “exposure to harmful chemical and
environmental toxins,” low sperm count, and pornography use.
The new Title X guidance also includes many mentions of infertility.
It’s true that men and women desire more support in having wanted
pregnancies, but H.H.S.’s prescription, which includes “sleep”
and counseling on “marriage prior to childbearing,” is
unsatisfying. On the campaign trail, Mr. Trump declared
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himself the “father” of in vitro fertilization, yet I.V.F. is
absent from his administration’s family planning funding goals.
The good news is that, at least for now, Title X funds are still
required
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to go to clinics that provide or refer out for a range of modern
contraceptive options. The bad news is that this is only because of a
Biden-era rule that the administration
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has already signaled it might try to rescind. The threat to the
program is all the more concerning because, according to the most
recent data available, it still hasn’t fully recovered
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from draconian regulations put in place during Mr. Trump’s first
term, which led to an exodus of clinics and cut the number of patients
served by half.
An H.H.S. employee told Politico
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that the new guidance was catering to the anti-abortion wing of the
G.O.P. There’s a terrible irony here — by reducing unintended
pregnancy, Title X has prevented more than nine million abortions —
but it’s not surprising: Most of the major “pro-life” groups in
the United States either oppose contraception or stay mum on the
topic. The old anti-abortion movement strategy was to attack
contraception as immoral, though few Americans share that view. The
new tactic
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is more MAHA-coded, and with a pronatalist twist: Sow fear that modern
contraceptives are unnatural, push holistic alternatives instead,
generate alarm about declining birthrates and blame the dip on working
women. (In reality, it largely comes from fewer teen pregnancies.)
Women who are able to plan their pregnancies wind up in better
physical
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and psychological
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health, give birth to healthier
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infants [[link removed]], make more
money
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are less likely to get divorced
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are less likely to rely on public assistance and invest
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more in their children, who, in turn, do better educationally and
behaviorally. Modern contraception is nothing short of a medical
miracle — one that has saved the lives of millions of women
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worldwide.
Not satisfied with the end of legal abortion in America, the
anti-abortion movement seems poised to end the era of affordable
contraception. The result isn’t just the end of Title X as we knew
it. It’s the demise of a long-held bipartisan consensus that a
woman’s ability to shape her own future, even if she was poor, was
worth something — and certainly worth the government’s investment.
_[Jill Filipovic is a journalist, a lawyer and an author who writes at
__jill.substack.com_ [[link removed]]_.]_
* Birth Control
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* Women
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* Healthcare
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* war on women
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* Trump Administration
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* Donald Trump
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* pregnancy
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* Title X
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* contraception
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*
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*
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