In late October 2025, a quiet but seismic shift rattled the foundation of reproductive health care in the United States. Maine Family Planning, a stalwart provider in the state’s rural north, announced the closure of three clinics by month’s end—clinics that delivered primary care and reproductive health services to about 800 patients, many of whom were uninsured or relied on Medicaid. For these Mainers, the loss was more than just a change in routine; it was the abrupt disappearance of their doctor, their laboratory, and, as George Hill, president and CEO of Maine Family Planning, put it, “their lifeline.”
According to KFF Health News and CBS News, the closures in Maine are only the first visible cracks in what health leaders warn is the most significant setback to reproductive care in half a century. The U.S. Department of Health and Human Services’ Office of Population Affairs (OPA)—the federal agency responsible for administering the Title X family planning program—was effectively shut down in mid-October 2025 amid sweeping federal layoffs. The ripple effects of this closure are compounded by deep cuts to Medicaid, looming threats to Affordable Care Act subsidies, and reductions across the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC).
“When you cut OPA, HRSA, and Medicaid together, you’re removing every backup we have,” Clare Coleman, president of the National Family Planning and Reproductive Health Association, told CBS News. “It’s like taking EMTs off the road while closing the emergency rooms.”
For more than fifty years, Title X has been the backbone of a national network of over 4,000 clinics, serving nearly 3 million low-income or uninsured patients annually with contraception, pregnancy testing, STI testing and treatment, cancer screening, and other essential preventive care. OPA, which managed nearly $400 million in grants and issued clinical guidance to these clinics, has been reduced from a staff of 40 to 50 people during the Biden administration to just one U.S. Public Health Service Commissioned Corps officer, according to its former leaders.
“The structure to run the nation’s family planning program disappeared overnight,” said Liz Romer, former chief clinical adviser at OPA. Jessica Marcella, who led OPA under the Biden administration, described the shutdown as a “backdoor dismantling.” Without staff to administer grants and provide oversight, she warned, “the administration can later argue the program isn’t working and redirect the funds elsewhere. This is a functional elimination, done quietly.”
Asked about the cutbacks, HHS press secretary Emily G. Hilliard told CBS News, “HHS will continue to carry out all of OPA’s statutory functions.” A department spokesperson also stated that under the Biden administration, HHS “became a bloated bureaucracy—expanding its budget by 38 percent and its workforce by 17 percent,” and that it is “eliminating wasteful and duplicative entities, including those inconsistent with the Trump administration’s Make America Healthy Again agenda.”
But for patients and providers, the impact is immediate and deeply personal. “This isn’t just about government jobs,” Coleman emphasized. “It’s a patient care crisis. Every safety net program that touches reproductive health is being weakened.”
Title X’s bipartisan origins stretch back to 1970, when it was established under President Richard Nixon and rooted in Lyndon Johnson’s War on Poverty. Nixon called family planning a “national commitment to give every American the means to plan their families,” and Congress agreed overwhelmingly across party lines. Sara Rosenbaum, a professor of health law at George Washington University, said the program marked a pivotal shift in how policymakers understood health. “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 explained. “Title X represented the idea that reproductive care wasn’t a privilege or a moral issue. It was basic health care.”
Research supports the profound public health and economic effects of Title X. UCLA economist Martha Bailey 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. Her latest research, published by the National Bureau of Economic Research, shows that when low-income women have access to free birth control, unintended pregnancies drop by 16% and abortions by 12% within two years. Rosenbaum calls Title X “one of the great public health achievements of the 20th century—a program that linked economic opportunity to health and autonomy.”
Yet, as Rosenbaum notes, “What was once common sense, that access to family planning is essential to a functioning health system, has become politically fragile. Title X was built for continuity, but it’s being undone by neglect.”
The consequences of this unraveling are not abstract. Family planning is central to maternal and infant health, giving women time to optimize medical conditions like high blood pressure, diabetes, and heart disease before pregnancy and to safely space out their births. “Pregnancy is the ultimate stress test,” said Dr. Andra James, a maternal-fetal medicine specialist who advised the CDC on 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.”
For Brianna Henderson, a Texas mother, contraception was literally lifesaving. After delivering her child, she developed peripartum cardiomyopathy, a form of heart failure. She survived, but her sister, who had the same undiagnosed condition, died three months after giving birth to her second child. “Contraception has been a lifesaving option for me,” Henderson shared.
Experts warn that without CDC-informed guidance on contraceptive safety for complex conditions, clinicians and patients are left without clear, current standards. Title X clinics also provide millions of STI tests each year and are often the only cancer screening sites for uninsured women. With cuts to Medicaid and ACA subsidies, preventive visits will become even harder to afford. “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, a reproductive health expert at Emory University.
The geographic gaps are already staggering. Power to Decide, a nonprofit reproductive rights group, counts over 19 million women living in “contraceptive deserts,” where the nearest clinic might be 60 or even 100 miles away. “For many families, that distance might as well be impossible,” said Rachel Fey, interim co-CEO of Power to Decide.
Economically, the case for Title X is compelling. Each pregnancy averted through the program saves about $15,000 in public spending, and every $1 invested in publicly funded family planning saves roughly $7 in Medicaid costs, according to analyses by Power to Decide and the Guttmacher Institute. “Cutting federal funding for reproductive health services isn’t saving money. It’s wasting it,” said Brittni Frederiksen, associate director at KFF’s Women’s Health Policy program and a former OPA health scientist.
The strain is acute in states like Arizona, where Affirm, the state’s Title X grantee, could lose $6.1 million in funding after March 31, 2026, potentially affecting over 33,000 patients. “That means over 33,000 patients in our state could lose access to services,” said Affirm CEO Bré Thomas, who noted that years of flat federal support and rising health care costs have already left clinics on the brink. “We’re talking about impacts to people’s jobs and their ability to access the care they need.”
With OPA offline, existing Title X dollars 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 freeze also suspends compliance reviews and technical assistance. Megan Kavanaugh of the Guttmacher Institute warned, “Federally Qualified Health Centers do not have the capacity to absorb the number of patients who will lose care. 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.”
Some states—California, New Mexico, Washington—are using state funds to fill the gaps, and health systems are expanding telehealth. But as Hill of Maine Family Planning put it, “Private donors can’t replace the federal government. You can’t crowdfund your way to a working health system.” The window for Congress and states to act is closing fast. As Romer concluded, “This isn’t a political debate. It’s women showing up for care and finding the doors locked.”
The United States now faces a crossroads: restore the reproductive health safety net, or watch the consequences unfold for millions of women and families who can least afford the loss.
