What is Title X? An Explainer

Know Your Facts

What is Title X?

The Title X Family Planning Program is a federal grant program created to provide comprehensive and confidential family planning services and preventive health services. Title X was first enacted in 1970 as a bipartisan bill designed to address worsening maternal and child health outcomes and related significant public health and economic implications, including lack of access to care for people with low incomes. Since its creation, the Title X program has helped build and support a network of family planning clinics that deliver evidence-based reproductive and sexual health care services to millions of individuals every year.

Title X services include contraceptive counseling and provision, breast and cervical cancer screenings, testing and treatment for sexually transmitted infections (STIs), and pregnancy diagnosis and counseling, among other services.

The Title X program prioritizes serving people and families with low incomes and is implemented through federal grants from the Department of Health and Human Services (HHS) to over four thousand clinical sites, including public health departments and non-profit health centers. The Title X program ensures that people have access to key preventive reproductive and sexual health care services without cost barriers.

Why is Title X important?

Title X clinics provide a broad range of family planning services and preventive health care to millions of people throughout the United States. Title X funds support the largest network of reproductive and sexual health care providers in the country and ensure that people no matter their socioeconomic status can access care. Title X clinics provide care to individuals who may otherwise not be able to access health care. Title X clinics are a main source of health care for people of color, LGBTQ+ individuals, and people living in rural or geographically isolated areas.

Who benefits from Title X funding?

Everyone benefits when patients and families are supported in determining their ideal family size and timing of that family. Title X facilities also offer important preventive care that can identify serious health conditions. Title X ensures that people can access a spectrum of sexual and reproductive health care services without cost. In 2022, Title X funding supported 4,126 clinics and funded almost 4.1 million visits. With Title X funding, providers were able to serve 2.6 million family planning patients in 2022.

Title X clinics, services, and clinicians provide a wide array of crucial reproductive and sexual health care services to millions of people. Further, the Title X program ensures that people who often face barriers to care due to structural and systemic discrimination and oppression are able to access key reproductive and sexual health care without cost barriers.

What would happen to patients if they didn’t have access to Title X funded care?

Without Title X services, millions of individuals would lose access to crucial sexual and reproductive health care services and providers would no longer be able to meet the reproductive and sexual health care needs of their community members. This will inevitably worsen existing sexual and reproductive health inequities.

Without Title X, maternal health outcomes will worsen, rates of sexually transmitted infections (STIs) will increase, people’s ability to access pregnancy planning support and resources will decrease, and cancer screenings and other preventive care services will no longer be accessible to millions.

Every person should be able to determine if, when, and how to start a family, and all individuals deserve access to comprehensive sexual and reproductive health care. Without the Title X network, millions of individuals will no longer be able to access care.

What is the Domestic Gag Rule?

On March 4, 2019, the Trump Administration published harmful regulations governing the implementation of Title X and distribution of funds, titled “Compliance with Statutory Program Integrity Requirements” (hereafter referred to as the 2019 Rule).

The 2019 Rule drastically changed the requirements providers must adhere to in order to receive Title X funding, making it nearly impossible for the Title X network to still provide care. Specifically, clinics that also provided abortion care and providers who provide referrals for that care were targeted and pushed out of the Title X network.

The Domestic Gag Rule was one of the biggest threats to care within the 2019 Rule.  The “Domestic Gag Rule” refers to the interpretation of Section 1008 of Title X to mean that Title X recipients were barred from using federal funds to “promote, counsel, or refer clients for abortion care” and prohibited recipients from providing abortion care at the same clinics, even if federal dollars were in no way used in the provision of abortion services.

The Domestic Gag Rule prohibited providers from referring patients for abortion care or having co-located family planning and abortion services. It pushed out crucial care providers from the Title X network and severely limited individuals’ ability to access care.

Although the Reagan Administration first established the Domestic Gag Rule, it was never fully in effect and was rescinded by the Clinton Administration. President Trump re-established the Domestic Gag Rule in 2019. More recently, the Biden Administration revoked the Domestic Gag Rule, once again allowing Title X clinics to provide referrals for the full spectrum of reproductive health care options, including abortion care.

What would happen if providers were “gagged” from giving patients abortion referrals?

It is critically important that patients receive information about all their health care options, so they can make the best decision for themselves and their families. A rule prohibiting providers from counseling a pregnant patient about all of their options and providing appropriate referrals would unquestionably be a gross interference into the practice of medicine and a violation of Title X’s requirements. This is not good medicine, and this care would be outside of professional standards.

Gag rules shame people seeking abortion care, worsen abortion stigma, prevent individuals from accessing desired and necessary care referrals, and discourage patients from continuing to see providers for other health care needs.

What are the obligations of providers under Title X?

Title X requires providers to provide nondirective, comprehensive pregnancy counseling and referrals upon a pregnant patient’s request. Current Title X regulations require providers to have information available about a wide spectrum of pregnancy and childbirth related services, including prenatal care and delivery, infant care, foster care, adoption, and abortion care.

Title X recipients must provide a broad range of medically approved family planning methods and services, including pregnancy testing and counseling, contraceptive care, assistance to achieve pregnancy, basic fertility services, STI services, preconception health services, adolescent-friendly services, and referrals for family planning services not provided on-site.

Title X clinics must provide services in a manner that is client-centered, culturally and linguistically appropriate, inclusive, and trauma-informed.

What can folks do to protect Title X?

Speak up, speak out. Advocate for yourself, for your friends and family, for your patients. Write a letter to the editor of your paper. Call, email, or tweet your senators and representatives.

Demand more funding for Title X and protections to ensure that Title X clinics can continue to provide evidence-based preventive sexual and reproductive health care services and referrals.

Want to learn more about Title X?

• Title X 101: A comprehensive introduction to the Title X program that details the program’s history, services provided, legislative framework and the impacts of recent modifications.
• The Current State of Title X: Provides an overview of the recent changes and current challenges facing the Title X program.

Last updated: June 2024