Title X Under Siege: Nation’s Family Planning Program Politicized and Sabotaged By Trump Administration

The Trump Administration Has Attacked The Intent, Purpose Of The Nation’s Family Planning Program — Beginning With Its Politicization Of The Title X Grant Process

Since Trump took office, Title X — the nation’s family planning program for low-income individuals — has been in constant peril. In 2018, the Department of Health and Human Services (HHS) delayed the release of the program’s grant guidelines for months — and when they were finally released, the Trump administration undercut the mission of Title X by promoting less effective and so-called “natural” family planning methods and failing to even mention the words “birth control” or “contraception,” which Title X grant recipients had always been mandated to provide their patients. After both outcry and a realization that birth control could not be eliminated, the 2019 Title X guidelines were altered to reintroduce contraception but also doubled down on the importance of abstinence, “sexual risk avoidance,” “fertility awareness-based methods of family planning,” and “fostering interaction with community and faith-based organizations.” The administration also took a major step in politicizing the program, when it took final approval of the grant awards away from non-political regional health administrators, and gave anti-birth control political appointees the final say on which entities would receive funding (SEE APPENDIX).

Most recently, Trump’s HHS made it easier for anti-abortion organizations to apply for Title X family planning grants — awarding one extremist organization over $5 million in their 2019 family planning grants while simultaneously cutting funding for five Planned Parenthoods. Through attempts at a domestic gag rule, undermining providers, and personally reaching out to prospective grantees, Trump’s health department has turned a historically bi-partisan, non-political program intended to ensure low-income people get the care they need into a political football.

The Trump Administration Diverted Limited Title X Funds From Legitimate Health Care Providers To Anti-Abortion, Anti-Birth Control Extremists In 2019

In March 2019, Trump’s HHS announced its Title X family planning grantees. Obria — an anti-abortion organization that does not provide any forms of birth control and advertises medically unproven “abortion reversals” — will gain a total of $5.1 million in Title X grants from HHS from 2019 to 2022 for their California clinics. Emboldened by their navigation of HHS, Obria is now pushing their affiliate expansion plan nationwide. In May 2019, Obria made its intentions even clearer by filing a lawsuit against HHS in order to retain its Title X funding without having to comply with the program’s requirements that grant recipients distribute birth control and provide referrals to abortion providers. Obria claimed the regulations — which it said it would comply with in its 2019 grant application — are an infringement on its first amendment rights.

The same year that Obria received the large grant from the nation’s only family planning program — diverting funds from already under resourced legitimate health care providers — the health department cut funding from five Planned Parenthoods across the country. In four of these states (Virginia, North Carolina, Wisconsin, and Hawaii) state health departments are now the sole Title X providers — a move that is alarming due not just to the loss of Planned Parenthood’s health services, but also due to the Trump administration’s efforts to influence the family planning program through state health departments.

The Trump Administration Has Meddled With States’ Title X Grants And Program Implementation In Efforts To Sabotage The Program

In addition to its attempts to change the very nature of the program, Trump’s HHS has been meddling in the grant application process. The health department is trying to divert funds from traditional providers to both faith-based clinics that offer a very limited amount of services, and — as Equity Forward has learned through public records requests — to state health departments, where HHS political appointees can coordinate with state health departments to control program implementation or prevent program implementation from occurring whatsoever. Missouri, Utah and Arizona provide a window into this state-level sabotage.

Equity Forward obtained internal documents from the Missouri Department of Health and Senior Services (MDHSS) and the Utah Department of Health (UDH) that show that high-level HHS appointees engaged in political sabotage to re-direct Title X funds away from proven providers to medically inadequate health departments and anti-abortion centers. HHS has been actively working with MDHSS and UDH to divert funds away from qualified clinics by coaching the departments on their applications and encouraging them to submit records requests for proprietary information regarding current, successful grantees.

HHS has also attempted to coordinate with Arizona Department of Health Services (AZDHS) on Title X. Public records obtained from Equity Forward in March 2019 show that the AZDHS never got up to speed administering its nearly $1 million of 2018 Title X funds. 2018 was the first year AZDHS got Title X funds after its state legislature forced it to apply for Title X funds, so it was a steep learning curve for program implementation; in fact, the records Equity Forward obtained suggest that Arizona never provided Title X family planning services, in spite of receiving funding for the program. AZDHS didn't even hire a Title X coordinator until January 2019, and there are no subgrantees listed for AZDHS as of Nov. 2018.

For side by side chart comparisons of the Title X grant process changes from 2016, 2017, 2018 and 2019, please download the PDF below.

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