The Trump administration, dominated by religious anti-abortion conservatives and reeling in money from a new wave of pronatalist tech reactionaries, has long been considering ways to persuade, pressure and cajole women into having more babies. The Dobbs decision overturning Roe v Wade in 2022, in which Donald Trump’s three first-term supreme court appointees cast decisive votes, was a first step; later, after he returned to office, Trump reportedly fielded proposals for $5,000 “baby bonuses” – not quite enough to raise a child, one notices – and “motherhood medals” for fertile women that are similar to awards dispensed by the Nazi regime.
Now, it’s seeking out a new tactic: removing birth control access. This month, the Trump administration renewed its attacks on Title X, the federal reproductive health program that provides birth control to an estimated 2 million low-income Americans. In the White House’s proposed budget, funding for the program was eliminated altogether. Then, the Title X administrators at the Department of Health and Human Services announced new guidance to the program’s partner providers, the clinics and medical practices that actually dispense the medication and care. The program was changing, the providers were told. For decades, Title X had been a contraception program. Now, it was going to be reimagined as a pro-conception one.
The document also instructs clinics and providers to end DEI programs; to make sure that federal money is not used to “facilitate or incentivize illegal immigration”; and to support parental rights to “direct the religious upbringing of their children,” likely a coded instruction not to provide minors with reproductive healthcare in instances where their parents might object on religious grounds. That last instruction would seem to exceed the boundaries of state law: minors are entitled to access birth control without parental consent in 24 states and Washington DC, and they are allowed to get STD screenings without parental knowledge nationwide.
The guidance instead encourages clinics to use the funds for fertility education and “restorative” reproductive medicine, likely a reference to a scientifically dubious set of fertility improvement practices embraced by anti-abortion Christians. The document does not mention hormonal contraception – the medicines that women rely on to secure their educations, careers, ambitions, health, self-determination, and dignity, and which millions access through Title X – except to say that the drugs have side effects and are overprescribed. The new guidance reverses the identity and purpose of the 50-year-old Title X, transforming the program meant to boost public health and bolster women’s equality into a tool to trap women into motherhood and dependence in the service of a misogynist culture-war agenda.
It was also several months late. The new vision for Title X as outlined in the guidance issued by Health and Human Services closely follows the vision for the program outlined in the Heritage Foundation’s Project 2025 document; the department usually releases such guidance documents, which explain how clinics should use their Title X funds, several months before the deadline for clinics to reapply for funding. The Trump HHS had promised the guidance by the end of 2025, several months ahead of the funding application deadline in March. But the document wasn’t released; neither was a funding application. In the end, clinics and providers had just one week to scramble to apply for their 2026 Title X grants before funding ran out at the end of last month. One wonders: if the new vision for Title X has already been handed to the Trump administration’s HHS bureaucrats by the conservative political movement, why have they been so incompetent in administering it?
One reason might be because the office within HHS that oversees Title X has already been decimated by the Trump administration’s sweeping cuts to federal programs. In October, during the government shutdown, employees at HHS’s Office of Population Affairs were abruptly locked out of their government emails and computers, and were later told that they had been laid off – part of a broad effort by Trump during the shutdown to eliminate what he called “Democrat programs”.
By March, when clinics were rushing to reapply for this year’s funding, there were just 10 staffers assigned to review dozens upon dozens of applications for participation in the nearly $300m program. Now, many of those health clinics will be declared ineligible to participate in Title X – precisely because they are committed to providing healthcare, not ideological misogynist indoctrination or pronatalist, pseudo-scientific quackery. Instead, it seems that when the new guidelines go into effect next year, the providers who are eligible to receive Title X money under the Trump administration’s new vision of the program will be mostly from crisis pregnancy centers – anti-abortion clinics that pose as providing real gynecological and obstetric care but in fact serve to entrap women who are seeking abortions. Those outfits already receive millions in federal funds.
The Trump administration can’t seem to decide what, exactly, it wants to do with Title X. Does it want to eliminate the program altogether, or keep it so that it can be used as a tool to coerce women into living the way that Republicans want them to? This conflict – between a vision of small government and a low tax burden on the wealthy, and a vision of a big government that has the administrative capacity to force ordinary people to comply with the right’s cultural agenda – has long been a conflict within Maga.
It could be that the new guidelines will never be enforced because the Trump administration will find a way, in spite of the congressionally appropriated funds for the Title X program, to eliminate it altogether; it might be that the guidelines go into effect, but that the program has so few and such incompetent staffers administering it, that it fails in its mission of compelling more women to have more babies. Either way, what has happened to the Title X program represents a version of what has happened to the United States in miniature: an institutions that was once born out of aspiration to a healthier, more prosperous, more dignified, and more equal country has been transformed into a theater of bigotry and incompetence. No matter what happens, it’s the women who will lose.
