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Title X: Federal contraception program gets new attention after Dobbs

Birth control pills in packaging
Title X, a more than 50-year-old federal program, offers birth control, screenings for sexually transmitted infections and other reproductive health care to low-income patients. Funding for the program hasn't increased for the past 8 years. (Photo: Crixell Matthews/VPM News)

In June's Dobbs v. Jackson decision by the Supreme Court, Justice Clarence Thomas argued in his concurrent opinion that the court “should reconsider” its past rulings related to contraception.

Advocacy groups have said Thomas’ words set the stage for a new battleground over reproductive rights. Republican lawmakers in some states have pushed for new restrictions on contraceptive access, and the Democratic-controlled House of Representatives passed legislation last month designed to protect the right to birth control.

One prong of the fight involves Title X, a more than 50-year-old federal program offering birth control, screenings for sexually transmitted infections and other reproductive health care to low-income patients.

Title X providers expected funding to increase after President Joe Biden took office in 2021 and Democrats won narrow control of Congress, according to Clare Colemen, CEO of National Family Planning & Reproductive Health Association in Washington.

Instead, it remained at the same level it has for the past eight years, even as more providers applied. Coleman and other advocates are now calling for Democrats to use every tool at their disposal to increase financial support for the program.

“I think the Supreme Court has sent a signal to those who oppose both abortion and contraception to have at it, to come and attack these programs,” Coleman said. “We're hopeful … Democrats will fight to the wall.”

Coleman argues there’s never been enough money to meet the need since former President Richard Nixon created the program in 1970. But this year, some longtime providers faced surprise funding cuts as their grants weren’t renewed or were scaled back.

California’s Title X funding dipped by about $8 million in the latest round of funding. A local Nevada health department is shelving plans to hire new staff after budget cuts there. And in Virginia, a health department serving parts of the Shenandoah Valley announced last month it would no longer offer family planning services.

The scramble for funding is connected to changes former President Donald Trump made to the program in 2019. The rule banned Title X participants from providing or referring patients for abortion services except in the case of incest, rape or medical emergency.

The regulation was popular with Trump’s base but sparked a backlash: Critics called it the domestic gag rule. An estimated one-quarter of Title X service sites withdrew or stopped receiving funding. After the Biden administration reversed those rules in October 2021, the federal government saw a flood of new applications from healthcare providers, but Congress didn’t approve new funding.

Referrals and Title X

For many patients, like New York resident Rhea Beddoe, Title X is a lifeline that stretches beyond birth control — even if they don’t always know the program exists.

Beddoe had a procedure to remove precancerous cells while working at a law firm, only to get laid off and lose her benefits. The follow-up appointment six months after the procedure would have cost $300 without insurance, she said.

So, Beddoe called a local Planned Parenthood in New York, filled out paperwork on her income and scheduled an appointment. She had no signs of cancer.

“It was such a relief that I was able to get the care that I needed when I was uninsured and unemployed,” Beddoe said.

Adela Griswold, a nurse-midwife at a Title X-funded health clinic at the Alexandria Health Department, said a patient might come in looking for birth control and leave having had their first pap smear, gotten a COVID-19 booster and been tested for STIs.

Griswold also provides referrals for other services, including mental health care.

“We are often the sole entry point to care for folks,” she said. “They wouldn't be getting care elsewhere otherwise.”

The program — which once had bipartisan support — has become a lightning rod, entwined in debates over abortion.

Olivia Gans Turner is director of the Virginia Society for Human Life, as well as American Victims of Abortion. Both are part of the National Right to Life, which takes no position on Title X funding, but supported the Trump administration’s rules — including a ban on Title X providers making abortion referrals.

“We had no problems with funding going to legitimate contraceptive programs because we don't take a position on contraception,” Turner said. “What we wanted to prevent was the funding of organizations or programs that were also promoting or practicing abortion.”

Title X doesn’t actually fund abortions. But Turner said abortion providers shouldn’t be eligible for any federal funds — even if it’s earmarked for other services, like birth control.

“You could say, ‘Well, the one doesn’t go to the other,’” Turner said. “Except, if I give you the money to pay the rent, you've got a lot more money to go to the movies this week, don't you?”

It’s not an argument likely to sway Democrats, who still control Congress. But as with many issues, they face an obstacle in the U.S. Senate’s filibuster rules. Sen. Tim Kaine (D-Virginia), who is among the Democrats pushing to increase Title X funding, said “finding Republican support for Title X has not been easy.”

Still, Kaine said June’s Supreme Court decision overturning a Constitutional right to abortion might move the needle on contraception.

“I think people are realizing, 'Well, we can't take this for granted.' That may open up an opportunity for us to be successful,” Kaine said.

The battle is also playing out in statehouses across the country. Earlier this year, some Republican lawmakers in Missouri unsuccessfully tried to ban taxpayer funding for emergency contraception, which some lawmakers consider a form of abortion. Republican legislators in several states, including Missouri and Texas, have passed laws barring Planned Parenthood from seeing Medicaid patients for family planning services.

Coleman said she expects more legislation in the upcoming statehouse sessions this winter. She argued the Supreme Court decision should drive home that contraceptive access should not be taken for granted.

“We need to stop questioning whether or not this is possible,” Coleman said. “This is clearly possible. The legitimacy and legality of contraception is threatened.”