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The number of babies born in the United States fell again last year.<\/p>\n
According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a 1% decline<\/a> from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.<\/p>\n The Trump administration has said it wants to reverse this trend. President Donald Trump has called for \u201ca new baby boom,\u201d and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also proposing to reshape<\/a> the federal government\u2019s only dedicated family planning program: Title X.<\/p>\n For more than five decades, Title X has been geared \u2014 with bipartisan support \u2014 toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the safety net program<\/a> served more than 5 million patients a year. Six in 10<\/a> Title X clients have reported the program as their sole source of health care in a given year.<\/p>\n In early April, the Department of Health and Human Services invited nonprofit organizations to apply<\/a> for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception \u2014 describing it as overprescribed, associated with negative side effects, and part of a broader \u201coverreliance on pharmaceutical and surgical treatments.\u201d<\/p>\n The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.<\/p>\n While Title X will continue to help women \u201cachieve healthy pregnancies,\u201d the grant document does not explicitly reference preventing unintended pregnancies \u2014 a long-standing goal of the program.<\/p>\n Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.<\/p>\n \u201cWhat we\u2019re seeing is trying to use our nation\u2019s family planning as a Trojan horse for an entirely different agenda,\u201d Marcella said, noting that Trump has proposed<\/a> eliminating Title X altogether.<\/p>\n Birth Rates and Fertility Trends<\/strong><\/p>\n The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.<\/p>\n The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. \u201cChildbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,\u201d she said.<\/p>\n Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.<\/p>\n \u201cHaving children has become more contingent and more planned,\u201d she said.<\/p>\n Much of the decline since 2007 reflects women postponing births rather than forgoing them.<\/p>\n \u201cThe average number of babies women are having in their whole lives has not fallen. It\u2019s still more than 2.0 for women aged 45,\u201d said Philip Cohen, a professor of sociology at the University of Maryland.<\/p>\n Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. \u201cEfforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,\u201d he said.<\/p>\n Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: \u201cApplicants for the 2027 Title X funding cycle will be expected to align with the administration\u2019s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.\u201d<\/p>\n Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda<\/a> that seeks to boost birth rates by steering policy toward family formation.<\/p>\n The document\u2019s language reflects both: It repeatedly invokes \u201coptimal health\u201d and \u201cchronic disease\u201d while sidelining the contraceptive services that have defined Title X for half a century<\/a>.<\/p>\n Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program \u201cis designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,\u201d she said.<\/p>\n Title X\u2019s New Focus<\/strong><\/p>\n The administration\u2019s changes have been welcomed on the right.<\/p>\n Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls \u201crestorative reproductive medicine,\u201d said the new funding notice reflects overdue attention to neglected aspects of women\u2019s health.<\/p>\n \u201cI was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,\u201d Waters said.<\/p>\n She described the notice as an expansion, not a narrowing, of the program\u2019s mission: \u201cI see this iteration of Title X as the fulfillment of its purpose. The goal was never just \u2018more contraception\u2019 but a wholesale empowerment of women to govern their own fertility.\u201d<\/p>\n Waters also argued that untreated reproductive health problems may contribute to lower birth rates.<\/p>\n \u201cOne of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman\u2019s desire to have kids,\u201d she said, pointing to endometriosis.<\/p>\n An estimated 5% to 10% of women<\/a> of reproductive age have endometriosis, and of those, 30%-50% experience infertility<\/a>. Scientifically speaking, the relationship is an association, not a proven cause. Women aren\u2019t screened for endometriosis if they don\u2019t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.<\/p>\n Infertility rates in the U.S., meanwhile, have not risen. An analysis of federal survey data<\/a> found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply \u2014 a divergence that points away from untreated reproductive disease as an explanation.<\/p>\n Meanwhile, in February, the American College of Obstetricians and Gynecologists issued new clinical guidelines<\/a> enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an \u201coverreliance on pharmaceutical and surgical treatments.\u201d The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.<\/p>\n Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are not covered by Title X<\/a>. When President Richard Nixon signed Title X into law in 1970, he described it<\/a> as a way to expand access to family planning services \u2014 helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. Medicaid<\/a>, not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it does not cover IVF<\/a>.<\/p>\n Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.<\/p>\n \u201cThere\u2019s not even enough funding to support the core premise of contraception,\u201d Romer said. \u201cAnd so, if you want to expand Title X funding, you can expand the scope, but you can\u2019t move away from the foundation.\u201d<\/p>\n The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by KFF in 2024 reported having used some form of contraception<\/a> in the previous 12 months.<\/p>\n Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, \u201cIf contraception is sidelined in Title X, it won\u2019t just change language on paper but will show up as fewer options and more barriers for patients.\u201d Funding could move away from providers who offer a full range of contraceptive care, she added, \u201ctoward organizations that are ideologically opposed to contraception and don\u2019t deliver the same standard of health care services.\u201d<\/p>\n The Stakes Are High<\/strong><\/p>\n The United States already has one of the highest maternal mortality rates among wealthy nations \u2014 17.9 deaths per 100,000 live births<\/a> as of 2024. According to the CDC, 4 in 5 pregnancy-related deaths<\/a> in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.<\/p>\n And since the Supreme Court\u2019s Dobbs<\/em> decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade<\/em>, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated 32,000 additional births annually<\/a>, disproportionately among young women and women of color.<\/p>\n Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said \u201cthere is absolutely no evidence for any positive outcome of restricting access to contraception.\u201d Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.<\/p>\n Since Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than 4 million patients to <\/a>1.5 million<\/a>. The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.<\/p>\n The second Trump administration\u2019s overhaul of the program, Marcella said, \u201cdirectly undermines the public health intent of our nation\u2019s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It\u2019s bad policy.\u201d<\/p>\n\n\t\t
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