U.S. Births Fall to New Low as Trump Pushes Title X Changes

The Trump administration said it wanted more babies even as federal family-planning policy began shifting away from the contraception that helps many Americans avoid unintended pregnancies. New Centers for Disease Control and Prevention data showed about 3,606,400 U.S. births in 2025, a 1% decline from 2024 and a 23% drop from 2007. The general fertility rate also slipped to 53.1 births per 1,000 women ages 15 to 44.

That demographic decline has put Title X back at the center of a political fight over whether Washington should be trying to boost births by reordering the nation’s only dedicated federal family-planning program. The U.S. Department of Health and Human Services says Title X, run through its Office of Population Affairs, has served as a safety-net entry point into care for nearly 195 million people over more than 50 years. The program currently supports hundreds of subrecipients and thousands of service sites and serves more than 2.8 million low-income and uninsured patients.

In March, the administration gave clinics only one week to apply for Title X funding after opening the application window on March 13, a deadline that came as the program normally renews on April 1. Many clinics did not learn their funding status until after that renewal date passed. HHS later restored 2026 Title X funds, but the episode signaled how quickly the administration could reshape a program that many clinics use to provide contraception, cancer screenings, STI testing and other preventive care.

The new guidance is aimed at 2027 grant applications and steers the program toward fertility awareness and natural family planning rather than hormonal birth control. HHS’s fiscal 2026 budget request had proposed eliminating the $286 million Title X appropriation altogether, although Congress kept the money in the enacted spending law. Official notices later opened fiscal 2027 grants on April 3 with an estimated total program funding level of $257 million.

The administration’s approach has drawn criticism from public-health and family-planning groups, which say restricting contraception access is unlikely to reverse the birth slump and could reduce access to basic care. Marcella Nunez-Smith called family planning a “Trojan horse” for another agenda, a warning that captures the core dispute now surrounding Title X: whether it should remain a public-health program built around patient access, or become a pronatal tool built around fertility promotion. Planned Parenthood also faces a potential funding hit under the new guidance and a promised rule that could take effect in 2027.