For over 50 years, the federal Title X program has been crucial in delivering sexual and reproductive health services across the US, particularly aiding low-income populations in accessing family planning care. Numerous studies have highlighted the program’s effectiveness in improving healthcare access and outcomes. However, as political divisions have intensified, Title X has been embroiled in partisan conflicts, leading to decreased funding, frequent programmatic changes with each new administration, and a series of legal challenges that have hindered its operations.
Our current proposal aims to extend a research project, previously funded by the Office of Population Affairs, which examines the impact of these changes on sexual and reproductive health outcomes. Our earlier research analyzed the effects of the 2019 and 2021 rule changes using a mixed methods approach. The findings revealed the extensive impact of policy shifts on grantees and the clients they serve, as well as the innovative strategies grantees employed to maintain high-quality care despite funding cuts, legal disputes, and restrictive policies.
Today, further challenges loom with the termination of some Title X grantees, decreased funding, and proposed budget cuts in the 2026 presidential plan, posing unprecedented risks to the program and its national network. This research leverages existing data sharing agreements and qualitative research partnerships to examine how current threats differ and to document evolving resilience strategies. Ultimately, the research aims to capture the impact of a decade’s worth of policy changes on Title X and to advocate for sustaining its crucial role in public health.