With abortion access limited, protecting Title X is critical
As laws limiting abortion access become reality across the U.S, it is critical we give teens the tools to prevent unintended pregnancies. An essential step is expanding and augmenting funding for Title X, the federal family planning program that provides adolescents and young adults with sexually transmitted infection (STI) treatment and contraception, even in states that have or will largely curb abortion services.
Established in 1970, the Title X program is mandated to fund confidential, comprehensive, free or low-cost family planning care for everyone, regardless of age, nationality or the ability to pay. This mandate allows Title X-funded clinics unique legal protection: They can provide confidential services for minors, even in the 30 states that do not have these legal protections in place. That is why anyone can walk into one of the more than 3,000 Title X-funded clinics and get services including STI testing, treatment and birth control — no questions asked.
As pediatricians, we are aware of the importance of these privacy protections. We care for young people who are sexually active and seeking sexual and reproductive health care. Some are fortunate to have parents who help them access these services. However, nearly 1 in 5 teenagers report they would not seek reproductive health services if their parents might find out. For these youth, clinics funded by the Title X program provide a critical lifeline.
Unfortunately, state and federal policymakers have been chipping away at the Title X program in tandem with restrictions to access to abortion. In 2011, Texas lawmakers cut the budget for sexual and reproductive health services by two-thirds and redirected the remaining funds away from dedicated family planning clinics. This resulted in fewer individuals consistently using long-acting reversible contraception and increased rates of childbirth. Then, in 2019, the Trump administration enacted a rule change that required any clinic accepting Title X funds to be physically and financially separate from abortion services and prohibited Title X-funded clinics from discussing or referring patients for abortions. This is despite the fact that the Title X program has never, in its history, funded abortions.
In new research, we examined the impact of the 2019 Title X rule change. We found that it resulted in nearly 40 percent of Title X clinical sites leaving the program. As a result, adolescents living in 8.7 percent of census tracts completely lost access to confidential reproductive care — a total of 933,647 youth aged 15-17. Those living in the Midwest or in rural areas were disproportionately impacted. While the long-term impacts of these changes aren’t known yet, data from earlier restrictions to the Title X program in Texas suggest that fewer teens will be using the most effective forms of contraception and this could impact rates of unintended pregnancies.
The Title X rules were reversed in 2021, enabling previously funded clinics to reapply for the program. Our data suggest that this is not enough: Even if all clinics were reinstated, we estimate that nearly 880,000 youth aged 15-17 would still be without access to confidential reproductive care. These numbers will rise even further if Title X rules are again restricted.
Moving forward, it is critical that policymakers disentangle positions they have on abortion from the common goal of reducing sexually transmitted infections and unintended pregnancies. At the federal level, Congress must urgently expand Title X funding, as the services it provides are more important than ever for youth in need. At the state level, policymakers should enact legal protections allowing adolescents to consent to sexual and reproductive health care and that ensures this health information cannot be disclosed without their consent.
Geography, income or the political party in power should not determine whether an adolescent gets the health care they need. Expanding the Title X program is the first step toward giving all young people the opportunity to access evidence-based health care and allowing them to make sexual and reproductive health decisions for themselves.
Polina Krass is a pediatrician, researcher at PolicyLab at Children’s Hospital of Philadelphia and fellow at the Leonard Davis Institute at the University of Pennsylvania. Tracey A. Wilkinson, MD, MPH is a pediatrician and an assistant professor of pediatrics at Indiana University School of Medicine.
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