Does the Trump Administration Really Want More Teen Pregnancies?

Ms. Filipovic is a journalist, a lawyer and an author.

Some 60 years ago, American legislators set out to tackle a problem that was driving employment and education rates down, driving health care and welfare costs up and making American family life significantly less stable: Many American women, and particularly poor women and teenagers, were having more children than they wanted or could afford. Close to half of births were to women who had not intended to get pregnant.

Decreasing the unintended pregnancy rate was a bipartisan wish. In 1969, President Richard Nixon recognized that “unwanted or untimely childbearing is one of several forces which are driving many families into poverty.” A year later, Congress passed Title X: the first federal program entirely dedicated to family planning and reproductive health care.

It would go on to become one of the most successful federal programs of the last century, with one study finding it prevented some 20 million unintended pregnancies in just 20 of its 50 years by providing women with free and low-cost birth control. It has significantly reduced child poverty. In 1957, nearly one in 10 teenage girls gave birth. Today, the rate is closer to one in 100. For every dollar spent on family planning funds, the government saves $7 in Medicaid costs.

But President Trump seems intent on killing Title X. This month, the Department of Health and Human Services quietly issued new funding guidelines that have effectively subverted the program’s entire purpose. Instead of getting highly effective contraception methods to the country’s poorest women so that they may decide if and when to have children, Title X under Mr. Trump seems aimed at getting more women pregnant, whether they want to be or not. And it appears to cater to three influential parts of the Trump coalition: The anti-abortion movement; the MAHA, or Make America Healthy Again, movement; and pronatalists who want to see birthrates rise at nearly any cost.

More than half of patients at Title X clinics use modern contraceptive methods to prevent pregnancy. But the word “contraception” comes up just once in the Title X funding document, and only in a section on “reducing overmedicalization in health care.” Instead, in a change pulled directly from Project 2025, H.H.S. tells Title X clinics to emphasize “fertility-awareness-based methods,” a broad category that includes things like tracking your periods or your body temperature to estimate which days you might be fertile. These methods can be helpful for getting pregnant, but are generally far less so for preventing pregnancy. Fertility awareness methods have typical-use failure rates between 12 and 24 percent in the first year, according to the American College of Obstetricians and Gynecologists. The intrauterine device, by contrast, has a failure rate of less than 1 percent.

The health department seems to want to shift taxpayer dollars away from reliable contraception and toward counseling men on erectile dysfunction, testosterone levels and sperm motility, each of which merits three mentions in the new guidance, while IUDs and birth control pills earn none. The document is a mishmash of Make America Healthy Again talking points on lifestyle changes, conservative bromides on marriage before babies and pronatalist nods to fertility.

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