By Céline Gounder, KFF Health News
In late October, Maine Family Planning announced three rural clinics in northern Maine would close by month’s end. These primary care and reproductive health clinics served about 800 patients, many uninsured or on Medicaid.
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“People don’t realize how much these clinics hold together the local health system until they’re gone,” said George Hill, the group’s president and CEO. “For thousands of patients, that was their doctor, their lab, and their lifeline.”
Maine Family Planning’s 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’ Office of Population Affairs, which administers the Title X family planning program, 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.
“When you cut OPA, HRSA, and Medicaid together, you’re removing every backup we have,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association. “It’s like taking EMTs off the road while closing the emergency rooms.”
Asked about the cutbacks, HHS press secretary Emily G. Hilliard said, “HHS will continue to carry out all of OPA’s statutory functions.”
How the safety net frays
For more than 50 years, Title X has underwritten a national network of clinics, now numbering over 4,000, 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.
In mid-October, OPA’s operations went dark amid federal layoffs that also affected hundreds of CDC staffers. “Under the Biden administration, HHS became a bloated bureaucracy — expanding its budget by 38% and its workforce by 17%,” a spokesperson for the department said at the time, adding, “HHS continues to eliminate wasteful and duplicative entities, including those inconsistent with the Trump administration’s Make America Healthy Again agenda.”
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.
“The structure to run the nation’s family planning program disappeared overnight,” said Liz Romer, OPA’s former chief clinical adviser.
“This isn’t just about government jobs,” Coleman said. “It’s a patient care crisis. Every safety net program that touches reproductive health is being weakened.”
A policy linking health, autonomy, and opportunity
Created in 1970 under President Richard Nixon and rooted in President Lyndon Johnson’s 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 “national commitment to provide a healthful and stimulating environment for all children,” and Congress agreed overwhelmingly across party lines.
Sara Rosenbaum, a professor of health law at George Washington University, said the program reflected a pivotal shift in how policymakers understood health itself.
“By the late 1960s, there was a deep appreciation that the ability to time and space pregnancies was absolutely essential to women’s and children’s health,” she said. “Title X represented the idea that reproductive care wasn’t a privilege or a moral issue. It was basic health care.”
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, and had household incomes 3% higher, than those born before. Research by Bailey just published by the National Bureau of Economic Research showed that when low-income women can access free birth control, unintended pregnancies drop by 16% and abortions drop by 12% within two years.
Those findings underscore what Rosenbaum calls “one of the great public health achievements of the 20th century — a program that linked economic opportunity to health and autonomy.”
That bipartisan foundation and evidence-based mission, Rosenbaum said, make today’s unraveling especially striking.
“What was once common sense, that access to family planning is essential to a functioning health system, has become politically fragile,” she noted. “Title X was built for continuity, but it’s being undone by neglect.”
The hidden health risks behind unplanned pregnancies
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.
“Pregnancy is the ultimate stress test,” said Andra James, a maternal-fetal medicine specialist who advised the CDC on its contraceptive guidelines. “It increases the heart’s workload by up to 50%. For people with heart disease, diabetes, or hypertension, that stress can be dangerous.”
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’re growing up without a mom. Their dad and his mother look after the kids now.
“Contraception has been a lifesaving option for me,” Henderson said.
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.
What history and the data predict happens next
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.
“If these clinics close, we’ll see more infections, more unplanned pregnancies, and more maternal deaths, especially among Black, Indigenous, and rural communities,” said Whitney Rice, an expert on reproductive health at Emory University.
And the geographic gaps are large already. Power to Decide, a nonprofit reproductive rights group, counts more than 19 million women living in “ contraceptive deserts,” where there’s no reasonable access to publicly supported birth control.
“These are places where the nearest clinic might be 60 or 100 miles away,” said Power to Decide interim co-CEO Rachel Fey. “For many families, that distance might as well be impossible.”
The high price of short-term savings
Each pregnancy averted through Title X saves about $15,000 in public spending on medical and social services, according to an analysis by Power to Decide. And an analysis by the Guttmacher Institute shows that every $1 invested in publicly funded family planning programs saves roughly $7 in Medicaid costs.
Cutting federal funding for reproductive health services “isn’t saving money. It’s wasting it,” said Brittni Frederiksen, a KFF health economist and former OPA scientist. “We’ll spend far more fixing the problems these cuts create.” KFF is a health information nonprofit that includes KFF Health News.
Supporters of cuts argue federal spending must be reduced and states should set their own priorities.
Strain on the ground
Affirm, Arizona’s Title X grantee, oversees a statewide network of clinics that provide family planning services to more than 33,000 patients each year.
Affirm CEO Bré Thomas said the state could lose $6.1 million in Title X funding if federal appropriations expire after March 31. It’s a cut that would reduce access to care across the network. “That’s $6.1 million for Arizona,” she said. “That means over 33,000 patients in our state could lose access to services.”
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. “We’re talking about impacts to people’s jobs and their ability to access the care they need,” she said.
Megan Kavanaugh, a scientist at the Guttmacher Institute, underscored those limits.
“Federally Qualified Health Centers do not have the capacity to absorb the number of patients who will lose care,” she said, referring to federally funded community-based clinics for underserved populations. “Some people may find another clinic, but a large share simply won’t, and we’ll see that reflected in higher rates of unintended pregnancy, untreated infections, and later-stage disease.”
Hospitals are beginning to absorb the spillover.
“The safety net is shrinking, and hospitals can’t absorb everyone,” 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. “Wait times will get longer, and preventable problems will rise.”
Funding frozen, oversight halted
With OPA offline, Title X dollars already awarded can be spent, but no new funds are moving.
“Most programs can hang on for a few months,” Romer said. “By spring, many won’t have enough money to stay open.”
The halt also suspends compliance reviews and technical assistance tied to CDC-aligned guidelines.
Marcella, the former OPA leader, warned of a “backdoor dismantling.”
“If there aren’t people to administer the grants, then the administration can later argue the program isn’t working and redirect the funds elsewhere,” she said. “This is a functional elimination, done quietly.”
Kavanaugh called the moment “one more step toward dismantling the public health infrastructure that has supported people’s reproductive health for decades.”
Without staff to move money and guidance, she said, “that’s how a system collapses.”
What can still be done
According to the National Association of Community Health Centers, Federally Qualified Health Centers can still use HRSA money that was already approved, even during the government shutdown. 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 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.
Some states — California, New Mexico, Washington — are plugging holes with state dollars, and health systems are expanding telehealth, but most jurisdictions cannot replace federal support at scale.
“Private donors can’t replace the federal government,” said Hill, of Maine Family Planning. “You can’t crowdfund your way to a working health system.”
Congress could restore Title X and rebuild OPA’s staffing, but without administrators in place, money can’t reach clinics quickly. States have a short window to bridge care by stabilizing Medicaid coverage, shoring up community health centers, and protecting contraceptive access.
“This isn’t a political debate,” Romer said. “It’s women showing up for care and finding the doors locked.”
©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.
