How Trump Title X changes and other changes will impact contraception access

Susan Dunlap, New Mexico Political Report

This article was originally published by New Mexico Political Report.

If President-elect Donald Trump chooses to place barriers to accessing contraception, one of the first areas he might try would be to target family planning clinics that receive Title X funding.

While it’s not entirely clear what Trump will do in his second term regarding abortion care or contraception access, there are worries that he could sign a bill banning abortion or restricting abortion with gestation limits. He could also impact access to contraception, particularly since ending access to contraception is a part of the far-right agenda. 

One way Trump could do that is to return to the hamstring he placed on Title X funding, a federal grant program available for family planning clinics, during his first term. During his first term, he implemented what was called the domestic gag rule, which ended Title X funding to family planning clinics that made referrals for abortion care.

Alina Salganicoff, senior vice president and director of Women’s Health Policy for the nonprofit health policy research, polling, and news organization KFF, called this a likely scenario during a conversation with journalists. 

“We anticipate Trump will go back to previous policies,” Salganicoff said.

This move could impact contraception because Title X family planning clinics offer reproductive healthcare services, such as contraception and some offer sexually transmitted disease prevention and treatment. 

Brittni Frederiksen, KFF associate director for women’s health policy, said a return to Trump’s 2019 Title X regulations would be easy and that it would most harm the most vulnerable. President Joe Biden reversed Trump’s Title X funding regulations in 2021.

“It has huge implications for people who are low income. It’s a safety network for people who don’t have insurance to get contraception and other reproductive health services as well as people with Medicaid,” Frederiksen said.

How Title X family planning clinics would respond is yet unknown but in New Mexico, some School-Based Health Clinics or their sponsor agencies receive Title X funding. In addition, there are 61 Title X service sites in New Mexico, David Barre, communications coordinator for New Mexico Department of Health, said through email. 

“A cut or elimination of Title X funds would affect a large number of New Mexicans. In 2023, Title X clinics provided services to almost 14,000 distinct clients,” Barre said.

Another way Trump’s policies could impact contraception is through cutting Medicaid, which health policy experts have said will likely be a target for significant slashing in order to pay for Trump’s planned tax cuts to the top 5 percent earners. If he should succeed at severely cutting Medicaid, that could impact teens and families who rely on Medicaid reimbursement to visit Title X clinics or School-Based Health Clinics, some of which provide contraception on site or write referrals or prescriptions for it.

“Any cuts to Title X funding will negatively affect New Mexicans who receive Title X services. Over 90 percent of New Mexico’s Title X clients are at or below the federal poverty level,” Barre said.

Affordable Care Act

Another way the future Trump administration could target emergency contraception is by carving it out of the Affordable Care Act, which is a proposal by Project 2025, the authoritarian playbook for conservative governing put together by the Heritage Foundation.

Gretchen Borchelt, vice president for reproductive rights and health for the National Women’s Law Center, said that if Republicans in Congress succeed at that, then individuals would still be able to access contraception but it would not be covered by the New Mexico Health Exchange. That could impact access for individuals who are not eligible for Medicaid but who live on a limited budget and lack private health insurance.

Borchelt said that putting any barrier in the way of reproductive healthcare can mean that more vulnerable communities are less likely to seek the care.

“We have seen in the data that when you have better access for people, especially Black and Indigenous people or people with disabilities or others who have historically faced oppression or coercion, the more access they have to contraception, it improves their ability to get out of harmful relationships. They can move forward in their career and move forward in health. Putting barriers harm those communities the most,” Borchelt said.

Borchelt said another thing Project 2025 calls for is to carve out of the ACA coverage male contraception methods, which is covered under the women’s benefit in the ACA. Borchelt said the reason for it is because Project 2025 is “really leaning into gender binaries.”

“This is furthering their view that women are separate from men and they want to keep a bright line between them,” Borchelt said.

She said that making the purchase of male condoms harder to obtain doesn’t just impact pregnancy rates but also the rate of sexually transmitted infections.

Misinformation campaign

Another aspect to a Republican effort to target contraception is the misinformation campaign. Conservatives often conflate emergency contraception with abortion medication, but they are not the same thing.

Borchelt said that misinformation campaigns confuse people. She said the National Women’s Law Center runs a hotline in California and that the hotline sees spikes in calls when there’s a major event or news story around reproductive healthcare.

Borchelt said more people are trying to stock up on emergency contraception now because they are worried they will lose access after Trump returns to the White House on Jan. 20.

Frederiksen said that if conservatives at the national level succeed at conflating emergency contraception with abortion medication, then that same conflation will likely occur at the state level and states “will make decisions around that.”

She said that if that conflation is successful, one thing it could mean is that Congress could say that Medicaid cannot pay for emergency contraception because of the Hyde Amendment, which prohibits federal dollars to be spent on abortion care. 

The chipping away affect

Whether Republicans might try to target additional forms of contraception, Borchelt said that, at this point, she doesn’t think “anything is safe in this world.” She said that, particularly in some state legislatures, NWLC has seen lawmakers who target intrauterine devices or who claim that hormonal birth control are bad for women’s health and make false claims about what they do to the body. But since contraception is hugely popular in the U.S. and about 99 percent of women report using it at one time or another, she isn’t sure if even with a Republican trifecta there will be the political will to try to limit access to contraception beyond emergency contraception.

But, Borchelt said that NWLC is watching a case in Texas that, if it succeeds, could mean that minors in Texas could not access contraception without parental consent. Borchelt called this a “chipping away” of rights and that it is following the playbook laid out by conservatives for how to ban abortion.

Borchelt added that Supreme Court Justice Clarence Thomas also specifically invited a case to provide an opportunity to the court to overturn Griswold v. Connecticut, which prohibited states from banning contraception between married couples in 1965. Thomas wrote in his concurring opinion to the Dobbs decision, which overturned Roe v. Wade, that Griswold v. Connecticut relies on the same legal reasoning as Roe, and should also be overturned.

Legal personhood

Another worry for contraception is the notion of legal personhood, a claim that conservatives, including some who sit on the Supreme Court, sometimes rely on as an argument against abortion care. Legal personhood is a notion that the cells that begin to form in a uterus as soon as conception have the same rights under the law as any individual. If that notion is furthered into policy at the federal level, then all forms of contraception would likely be restricted as would access to fertility care. Borchelt said there are some Republicans who “really want to push this,” but she said it is so extreme and unpopular it seems politically very dangerous to do so.

But she said that the court’s Dobbs decision has emboldened lawmakers and now the idea of Trump and a Republican trifecta in power in Washington D.C. will as well. 

Borchelt said one check on Republicans in power could be the business community. Restricting access to contraception would impact women’s ability to participate in the workforce.

Borchelt said that given the fact that Republicans, which tends to promote itself as the party that keeps the interest of business central to its policy making goals, would choose to restrict access to contraception when access is popular amongst business leaders is connected to Project 2025’s stated goal about gender binaries.

“Their goal, laid out clearly in Project 2025, is to enshrine traditional gender roles in policy. Contraception does not fit in the picture of what women should be doing,” Borchelt said.