In late October, Maine Family Planning announced three rural clinics in northern Maine would close by month\u2019s end. These primary care and reproductive health clinics served about 800 patients, many uninsured or on Medicaid.<\/p>\n
\u201cPeople don\u2019t realize how much these clinics hold together the local health system until they\u2019re gone,\u201d said George Hill, the group\u2019s president and CEO. \u201cFor thousands of patients, that was their doctor, their lab, and their lifeline.\u201d<\/p>\n
Maine Family Planning\u2019s closures are among the first visible signs of what health leaders call the biggest setback to reproductive care in half a century. The U.S. Department of Health and Human Services\u2019 Office of Population Affairs, which administers the Title X family planning program<\/a>, has been effectively shut down. At the same time, Medicaid cuts, the potential lapse of Affordable Care Act subsidies, as well as cuts across programs in the Health Resources and Services Administration and Centers for Disease Control and Prevention are eroding the broader safety net.<\/p>\n \u201cWhen you cut OPA, HRSA, and Medicaid together, you\u2019re removing every backup we have,\u201d said Clare Coleman, president of the National Family Planning and Reproductive Health Association. \u201cIt\u2019s like taking EMTs off the road while closing the emergency rooms.\u201d<\/p>\n Asked about the cutbacks, HHS press secretary Emily G. Hilliard said, \u201cHHS will continue to carry out all of OPA\u2019s statutory functions.\u201d<\/p>\n How the Safety Net Frays<\/strong><\/p>\n For more than 50 years, Title X has underwritten a national network of clinics, now numbering over 4,000<\/a>, that provide contraception, pregnancy testing, testing and treatment for sexually transmitted infections, cancer screening, and other primary and preventive care to nearly 3 million low-income or uninsured patients annually. OPA managed nearly $400 million in grants, issued clinical guidance, and ensured compliance.<\/p>\n In mid-October, OPA\u2019s operations went dark amid federal layoffs<\/a> that also affected hundreds of CDC staffers<\/a>. \u201cUnder the Biden administration, HHS became a bloated bureaucracy \u2014 expanding its budget by 38% and its workforce by 17%,\u201d a spokesperson for the department said at the time, adding, \u201cHHS continues to eliminate wasteful and duplicative entities, including those inconsistent with the Trump administration\u2019s Make America Healthy Again agenda.\u201d<\/p>\n According to Jessica Marcella, who led OPA under the Biden administration, the office was previously staffed by 40 to 50 people. Now, she says, only one U.S. Public Health Service Commissioned Corps officer remains.<\/p>\n \u201cThe structure to run the nation\u2019s family planning program disappeared overnight,\u201d said Liz Romer, OPA\u2019s former chief clinical adviser.<\/p>\n \u201cThis isn\u2019t just about government jobs,\u201d Coleman said. \u201cIt\u2019s a patient care crisis. Every safety net program that touches reproductive health is being weakened.\u201d<\/p>\n A Policy Linking Health, Autonomy, and Opportunity<\/strong><\/p>\n Created in 1970 under President Richard Nixon and rooted in President Lyndon Johnson\u2019s War on Poverty, Title X was designed as a cornerstone of preventive public health, not a partisan cause. Nixon called family planning assistance key to a \u201cnational commitment to provide a healthful and stimulating environment for all children,\u201d and Congress agreed overwhelmingly across party lines.<\/p>\n Sara Rosenbaum, a professor of health law at George Washington University, said the program reflected a pivotal shift in how policymakers understood health itself.<\/p>\n \u201cBy the late 1960s, there was a deep appreciation that the ability to time and space pregnancies was absolutely essential to women\u2019s and children\u2019s health,\u201d she said. \u201cTitle X represented the idea that reproductive care wasn\u2019t a privilege or a moral issue. It was basic health care.\u201d<\/p>\n UCLA economist Martha Bailey later found that children born after the first federally funded family planning programs were 7% less likely to live in poverty<\/a>, and had household incomes 3% higher, than those born before. Research by Bailey just published by the National Bureau of Economic Research<\/a> showed that when low-income women can access free birth control, unintended pregnancies drop by 16% and abortions drop by 12% within two years.<\/p>\n Those findings underscore what Rosenbaum calls \u201cone of the great public health achievements of the 20th century \u2014 a program that linked economic opportunity to health and autonomy.\u201d<\/p>\n That bipartisan foundation and evidence-based mission, Rosenbaum said, make today\u2019s unraveling especially striking.<\/p>\n \u201cWhat was once common sense, that access to family planning is essential to a functioning health system, has become politically fragile,\u201d she noted. \u201cTitle X was built for continuity, but it\u2019s being undone by neglect.\u201d<\/p>\n The Hidden Health Risks Behind Unplanned Pregnancies<\/strong><\/p>\n Family planning is central to maternal and infant health because it gives women the time to optimize medical conditions like high blood pressure, diabetes, and heart disease before pregnancy, and allows them to safely space out their births.<\/p>\n \u201cPregnancy is the ultimate stress test,\u201d said Andra James, a maternal-fetal medicine specialist who advised the CDC on its contraceptive guidelines. \u201cIt increases the heart\u2019s workload by up to 50%. For people with heart disease, diabetes, or hypertension, that stress can be dangerous.\u201d<\/p>\n Brianna Henderson, a Texas mother, learned this firsthand. Weeks after delivery, she developed peripartum cardiomyopathy, a form of heart failure that can occur during or after pregnancy. She survived. Her sister, who had the same undiagnosed condition, died three months after giving birth to her second child. Those kids are now 12 and 16, and they\u2019re growing up without a mom. Their dad and his mother look after the kids now.<\/p>\n \u201cContraception has been a lifesaving option for me,\u201d Henderson said.<\/p>\n James and other specialists warn that without CDC-informed guidance on contraceptive safety for complex conditions, clinicians and patients are left without clear, current standards.<\/p>\n What History and the Data Predict Happens Next<\/strong><\/p>\n Title X clinics provide millions of STI tests each year and are often the only cancer screening sites for uninsured women. Cuts to Medicaid and ACA subsidies will make it even harder for people to afford preventive visits.<\/p>\n \u201cIf these clinics close, we\u2019ll see more infections, more unplanned pregnancies, and more maternal deaths, especially among Black, Indigenous, and rural communities,\u201d said Whitney Rice, an expert on reproductive health at Emory University.<\/p>\n And the geographic gaps are large already. Power to Decide, a nonprofit reproductive rights group, counts more than 19 million women<\/a> living in \u201ccontraceptive deserts<\/a>,\u201d where there\u2019s no reasonable access to publicly supported birth control.\u00a0<\/p>\n \u201cThese are places where the nearest clinic might be 60 or 100 miles away,\u201d said Power to Decide interim co-CEO Rachel Fey. \u201cFor many families, that distance might as well be impossible.\u201d<\/p>\n The High Price of Short-Term Savings<\/strong><\/p>\n Each pregnancy averted through Title X saves about $15,000<\/a> in public spending on medical and social services, according to an analysis by Power to Decide. And an analysis by the Guttmacher Institute<\/a> shows that every $1 invested in publicly funded family planning programs saves roughly $7 in Medicaid costs.<\/p>\n Cutting federal funding for reproductive health services \u201cisn\u2019t saving money. It\u2019s wasting it,\u201d said Brittni Frederiksen, an associate director with KFF\u2019s Women\u2019s Health Policy program and a former OPA health scientist. \u201cWe\u2019ll spend far more fixing the problems these cuts create.\u201d KFF is a health information nonprofit that includes KFF Health News.<\/p>\n Supporters of cuts argue federal spending must be reduced and states should set their own priorities.<\/p>\n Strain on the Ground<\/strong><\/p>\n Affirm, Arizona\u2019s Title X grantee<\/a>, oversees a statewide network of clinics that provide family planning services to more than 33,000 patients each year.<\/p>\n Affirm CEO Br\u00e9 Thomas said the state could lose $6.1 million in Title X funding if federal appropriations expire after March 31. It\u2019s a cut that would reduce access to care across the network. \u201cThat\u2019s $6.1 million for Arizona,\u201d she said. \u201cThat means over 33,000 patients in our state could lose access to services.\u201d<\/p>\n Thomas noted that two consecutive funding reductions, combined with 11 years of flat federal support and rising health care costs, have already strained operations. Without new funding, she warned, clinics may be forced to limit contraceptive options to cheaper methods, reduce preventive care, and lay off staff, especially in rural communities. \u201cWe\u2019re talking about impacts to people\u2019s jobs and their ability to access the care they need,\u201d she said.<\/p>\n Megan Kavanaugh, a scientist at the Guttmacher Institute, underscored those limits.<\/p>\n \u201cFederally Qualified Health Centers<\/a> do not have the capacity to absorb the number of patients who will lose care,\u201d she said, referring to federally funded community-based clinics for underserved populations. \u201cSome people may find another clinic, but a large share simply won\u2019t, and we\u2019ll see that reflected in higher rates of unintended pregnancy, untreated infections, and later-stage disease.\u201d<\/p>\n Hospitals are beginning to absorb the spillover.<\/p>\n \u201cThe safety net is shrinking, and hospitals can\u2019t absorb everyone,\u201d said Sonya Borrero, a reproductive health expert at the University of Pittsburgh School of Medicine and a former chief medical and scientific adviser at OPA. \u201cWait times will get longer, and preventable problems will rise.\u201d<\/p>\n Funding Frozen, Oversight Halted<\/strong><\/p>\n With OPA offline, Title X dollars already awarded can be spent, but no new funds are moving.<\/p>\n \u201cMost programs can hang on for a few months,\u201d Romer said. \u201cBy spring, many won\u2019t have enough money to stay open.\u201d<\/p>\n The halt also suspends compliance reviews and technical assistance tied to CDC-aligned guidelines.<\/p>\n Marcella, the former OPA leader, warned of a \u201cbackdoor dismantling.\u201d<\/p>\n \u201cIf there aren\u2019t people to administer the grants, then the administration can later argue the program isn\u2019t working and redirect the funds elsewhere,\u201d she said. \u201cThis is a functional elimination, done quietly.\u201d<\/p>\n Kavanaugh called the moment \u201cone more step toward dismantling the public health infrastructure that has supported people\u2019s reproductive health for decades.\u201d<\/p>\n Without staff to move money and guidance, she said, \u201cthat\u2019s how a system collapses.\u201d<\/p>\n What Can Still Be Done<\/strong><\/p>\n According to the National Association of Community Health Centers<\/a>, Federally Qualified Health Centers can still use HRSA money that was already approved, even during the government shutdown<\/a>. But no new funding is being released, similar to the freeze on Title X funds. At the same time, HRSA has stopped first-quarter payments<\/a> for its Title V Maternal and Child Health program, which limits how states can provide preventive care and services for children and young people with special health needs.<\/p>\n Some states \u2014 California, New Mexico, Washington \u2014 are plugging holes with state dollars, and health systems are expanding telehealth, but most jurisdictions cannot replace federal support at scale.<\/p>\n \u201cPrivate donors can\u2019t replace the federal government,\u201d said Hill, of Maine Family Planning. \u201cYou can\u2019t crowdfund your way to a working health system.\u201d<\/p>\n Congress could restore Title X and rebuild OPA\u2019s staffing, but without administrators in place, money can\u2019t reach clinics quickly. States have a short window to bridge care by stabilizing Medicaid coverage, shoring up community health centers, and protecting contraceptive access.<\/p>\n \u201cThis isn\u2019t a political debate,\u201d Romer said. \u201cIt\u2019s women showing up for care and finding the doors locked.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n