As the U.S. birth rate continues to decline, federal policy changes are raising concerns among reproductive health experts. According to the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a 1% decline from 2024, with the fertility rate dropping to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.
Title X Program Reshape
The Trump administration is proposing to reshape Title X, the federal government’s only dedicated family planning program. In early April, the Department of Health and Human Services invited nonprofit organizations to apply for Title X grants for fiscal year 2027. The 67-page Notice of Funding Opportunity included only one mention of contraception, describing it as overprescribed and associated with negative side effects.
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. While Title X will continue to help women achieve healthy pregnancies, the document does not explicitly reference preventing unintended pregnancies, a long-standing goal of the program.
For more than five decades, Title X has been geared with bipartisan support toward giving low-income women access to contraception, STI screening, and reproductive health care regardless of ability to pay. At its peak, the program served more than 5 million patients annually, with six in 10 clients reporting it as their sole source of health care in a given year.
Fertility Trends and Public Health
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. According to demographer Alison Gemmill of UCLA, childbearing is increasingly delayed as part of a broader shift toward later adult milestones including stable employment, leaving home, and marriage. The United States already has one of the highest maternal mortality rates among wealthy nations, with 17.9 deaths per 100,000 live births as of 2024, and according to the CDC, 4 in 5 pregnancy-related deaths may be preventable.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://kffhealthnews.org/news/article/us-birth-rate-decline-title-x-family-planning-grants-contraception-pronatalist/