The federal government's only family planning program is being turned into a baby factory, and the people who run it believe embryos are already children.

"Congress intended this program to help equalize access to contraception. The only mention of contraception is that mention in the pejorative, and talking about overmedicalization and side effects."

— Clare Coleman, president of the National Family Planning and Reproductive Health Association

Title X has existed for 55 years. It is the only federal program in the United States dedicated to family planning services, providing low and no cost contraception, cancer screenings, and STI testing to roughly 2.8 million people annually, mostly low income. In April of this year, the Department of Health and Human Services published its funding guidelines for the program's next fiscal year. Contraception was barely mentioned. Instead, the document was filled with language about "body literacy," infertility services, pregnancy spacing, and endometriosis. The government's birth control program had quietly become a baby making program.

The shift was not an accident. It was the work of Brian Christine, the assistant secretary for health who oversees the Office of Population Affairs and administers Title X. Christine is a former penile implant surgeon with a long history of anti abortion advocacy. He has publicly championed crisis pregnancy centers, deceptively advertised clinics that aim to talk people out of getting abortions. Christine has called these centers "a model for a post-Roe world." Under his leadership, the funding notice for Title X was rewritten to prioritize pregnancy and parenthood over the contraceptive access Congress authorized.

Translation: the person in charge of the nation's birth control program would rather you were pregnant.

The funding notice went even further than reorienting the program's mission. It originally included a "pre-merits alignment review" that would have required all grant applicants to undergo an ideological audit by political appointees. Providers would need to demonstrate their commitment to the administration's priorities, including ending diversity, equity, and inclusion efforts and opposing gender affirming care. The statute that created Title X explicitly requires grantees to promote health equity and provide care to transgender recipients. The alignment review was eventually removed after legal pressure, but only after providers had already seen what was coming.

Amy Friedrich Karnik, director of federal policy at the Guttmacher Institute, called the shift "a really clear pivot toward this Project 2025 MAHA vision of prioritizing having babies over reproductive autonomy, and really undermining the program from top to bottom."

The pronatalist movement behind this effort splits into two camps. The traditional conservatives, best represented by Vice President JD Vance, who declared in his first address as vice president that he "want[s] more babies in the United States of America." And the tech pronatalists, exemplified by Elon Musk, a former administration official who advocates for having as many children as possible to create an "elite" human race with more "high-IQ" people. Both camps talk about "declining genetic quality" in "the West" and generally oppose immigration, even as they decry falling birth rates. In some cases, the movement overlaps with white Christian nationalism that wants not just more babies, but more white babies.

The Trump administration has embraced both wings. Trump calls himself the "fertilization president" even though his administration gutted the CDC's IVF research team. His "Trump Accounts" program, which launched this July, gives $1,000 to families for children born between January 2025 and December 2028. The president also floated giving mothers who have six or more children medals. When people pointed out that the Nazis did something similar, the idea went quiet.

The Title X funding notice is part of a broader pattern at HHS. In June, the administration issued a notice for the Embryo Adoption Awareness and Services program that defined an embryo as "a child already in existence." The National Family Planning and Reproductive Health Association described this as an attempt to advance fetal personhood arguments, "using a certain religious belief that sperm meets egg equals life."

Providers are fighting back. In June, the NFPRHA, the Family Health Council of Central Pennsylvania, and the ACLU filed a lawsuit, NFPRHA v. Kennedy, in the Middle District of Pennsylvania. The complaint argues that the administration is willfully violating the Title X statute and attempting to rewrite the law through a grant notice. The lawsuit also challenges the federal government's withholding of $65.8 million in Title X family planning grants.

"NFPRHA is suing the federal government to stop its latest hostile action to destabilize Title X, the nation's family planning program," Coleman said. "We are asking the federal government to explain the conflict between the law and its application guidance in court."

The Family Health Council of Central Pennsylvania, a Title X provider for more than 50 years, serves 31,000 people annually across 24 counties. Patricia Fonzi, its president and CEO, said the council "welcome[s] a competitive grant process" but believes applicants should be evaluated on their ability to serve communities, not their political alignment.

The danger is not just ideological. Crisis pregnancy centers, the type of organizations Christine wants to bring into the Title X program, are not real medical clinics. They lack the expertise to provide reproductive health care and often oppose hormonal birth control. Friedrich Karnik noted that this is "directly contrary to making sure that folks in Title X have access to the full range of contraceptive methods."

Taylor St. Germain, interim co-executive director of Reproductive Equity Now, called the entire effort "a part of the MAHA movement that is really a veneer for an anti-abortion agenda and an anti-bodily-autonomy agenda."

Coleman said what is happening is deeply unusual for a funding announcement. "It's sneaky," she said. "It's quite unusual in my 17 years in this job to do a lot of calls with reporters about funding announcements." The administration is using grant notices precisely because they attract little public attention. While headlines chase tariff announcements and press gaggles, the program that provides contraception to nearly three million Americans is being dismantled through bureaucratic paperwork.

The Department of Health and Human Services did not respond to requests for comment.

The program Congress created to help people control whether and when they have children is being converted into a program that assumes they should. The question is not whether the administration can do this. The question is how many more people will lose access to contraception before anyone notices.