We Must Fix Title X and Make It Right for Millions

We are coming to the end of the most disruptive and profound change in the federal family planning program since its creation. After an unyielding assault that arguably began Jan. 20, 2017, the damage to Title X, the nation’s family planning program, is in the numbers: six states without a single Title X provider; 40 grantees across 34 states that lost providers; nearly 1,000 health centers that have been forced to survive without critical funding; and 1.5 million people who have lost access to care by their trusted Title X providers. And that’s just how the devastation can be quantified. It does not speak to the countless stories of the people in our communities, many of whom are already struggling, that have borne the brunt of the Trump administration’s ideologically driven Title X rule.

Without a reinstatement of Title X funds, Maine Family Planning, a longtime program grantee forced to withdraw because of the rule, is at risk of needing to shutter 13 of its 18 clinics within the next two years, which would reduce providers’ capacity to serve patients fiftyfold. 

In Washington state, where the health department also left Title X, the legislature may have to reduce the state health department’s funding by 15 percent because of the deficit created by the COVID-19 pandemic, which could seriously affect access to sexual and reproductive health services — especially in rural areas where agencies could drop out of the program.

The publicly funded family planning network has been pushed to its limit, providers are exhausted and health centers continue to be tested by the overwhelming threat of COVID-19. The Trump emergency has taken our minds off all the ways we can improve access to care, the experience of care, the ease of care, the responsiveness of care – and concentrated our minds on one thought: “Please, just let this be over.”

Now it is over, and Title X has survived. There is a resounding sentiment across the Title X network of administrators and providers: we stood with our patients, we endured the challenge of the Trump rule and we are still here. Now, we are ready for the opportunity to make it right for Title X.

It is incumbent upon the Biden-Harris administration to respond with the same clear-eyed tenacity. Undoing the Trump rule cannot happen overnight, but the Biden-Harris administration can and should act on Day 1 to begin the process that will restore the quality family planning standards that have reinforced Title X as the gold standard of family planning care and allow highly qualified providers to re-enter Title X.

These critical first steps will send a strong and immediate signal that the Biden-Harris administration is prioritizing the health of at-risk communities. As the administration seeks to bring the COVID-19 pandemic under control, restoring the Title X network offers a clear opportunity to advance health equity and support our nation’s underfunded and overutilized public health infrastructure. Acting to make it right for Title X also demonstrates the president-elect’s commitment to the importance of science.

The provider network delivers vital family planning care — such as STD screening and treatment, cancer screening, and contraceptive care and counseling — to communities that need it the most. Family planning providers, supported by Title X, are considered places of trust and safety for millions of people – many of whom rely on their provider are their sole source of health care. Recognizing that Title X providers have long been a point of entry into care for many individuals in medically underserved areas, this network is an essential partner when responding to public health crises: During the H1N1 outbreak, vaccination at Title X sites became a permissible activity within the program, and we hope that Title X sites can once again be an access point for vaccines.

Communities across the country have endured too many dark days, wrought with so much fear and uncertainty. They are disproportionately shouldering the burdens of the pandemic — medically, as well as financially — while simultaneously suffering harm brought on by the Trump rule.

Finally, it is time to look ahead. With a determined and focused effort, we can rebuild an innovative and collaborative Title X family planning provider network that is worthy of community trust and delivers extraordinary levels of service to the most vulnerable in our society.


Clare Coleman is the president and CEO of the National Family Planning & Reproductive Health Association, representing publicly funded family planning providers and administrators nationwide, and she has served in that role since 2009.

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Correction: A previous version of this op-ed misstated the number of health centers that have been forced to survive without critical funding due to inaccurate information provided by the contributor.

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