Tennessee’s Title X family planning funding could change under a second Trump term

Tennessee’s rigid anti-abortion policies lost the state millions of dollars in family planning funding under the Biden Administration. Experts say it’s not easy to predict what the Trump Administration will do about it.

The current situation

Title X funds clinics across the country to help them provide reproductive health services — traditionally with a focus on contraception. The national grant program allows health centers to offer low- or no-cost services to uninsured patients who are trying to prevent pregnancy, trying to decide what to do about a pregnancy that has already started, or who need more general health services like screenings for STI’s (sexually transmitted infection) and cancer.

The program enjoyed mostly bipartisan support from its creation in 1970 until a little over a decade ago. As the national abortion debate heated, presidents started using Title X funding as a tool.

Under President Biden, Title X clinics were required to mention abortion when counseling pregnant patients on their options. When Tennessee state officials refused, the state lost about $7 million in federal funding.

During his first term, President Donald Trump took the opposite approach. He banned discussion of abortion in Title X clinics — a policy that became known as the domestic gag rule. His administration also created new requirements for clinics, saying they had to be physically and financially separate from providers that performed abortions.

About a third of the country’s clinics lost funding, according to the Kaiser Family Foundation. The Title Xprogram served nearly 4 million patients in 2018. In 2021, it served 1.5 million — a 60% drop.

What’s next nationally?

It’s hard to predict what Trump will do with Title X in a second term, said Dr. Cynthia Harper. She’s a doctor and professor who researches reproductive health access at University of California San Francisco.

“Now, we’re post Dobbs and we have a really different landscape,” she said.

After the U.S. Supreme Court issued the Dobbs v. Jackson opinion in 2022, states like Tennessee had the authority to pass abortion bans. That raised the stakes for access to contraceptives in those states. It also means opponents of abortion rights have won that particular battle, and they are moving on to new ones — such as allowing more companies to deny health insurance coverage for their employees’ contraception.

She also notes that there is broad support among Republicans to cut spending on health programs such as Medicaid. Health policy analysts predict the administration will pursue conservative policies such as work requirements or caps on federal spending.

“So I just think in general, we’ll see fewer dollars going to health care and going to reproductive health care,” Harper said.

She also says it’s hard to foresee how a second Trump administration will handle Title X because he threw some unprecedented curveballs during his first term.

“In the last Trump administration, they actually started giving Title X dollars to clinics that didn’t even have contraception,” she said. “So they weren’t family planning clinics.”

One example: a chain of Catholic clinics in California called Obria secured millions of dollars in Title X funds. It offered no contraceptives like condoms or birth control. It counseled patients to either abstain from sex totally or use the rhythm method. That means refraining from intercourse during peak fertility days in the menstrual cycle. The Mayo Clinic calls it the least effective form of prevention, and states that as many as one in four couples using the method report a pregnancy within the first year of using it.

What’s next locally?

After the Biden Administration dropped Tennessee’s Title X funding, the state legislature began backfilling it.

Lawmakers pass a budget annually, which means they decide whether to fund programs like this during every legislative session. The next one begins in January.

In September of last year, Planned Parenthood of Tennessee and North Mississippi announced it secured a $7 million Title X grant by partnering with another chapter that was already getting the funding.

The future of that funding is unclear. In Tennessee and nationwide, Republican officials have pledged to block public funds from the organization. In Tennessee, that has included rejecting HIV prevention funding as a means of reducing the amount of money going to Planned Parenthood.