Title X Family Planning Rule

August 29, 2022

What is Title X?

Congress established the Title X program in 1970 to focus on “population research and voluntary family planning programs.”

The statute authorizes the Secretary of the U.S. Dept. of Health and Human Services (HHS) to “to make grants to and enter into contracts with public or nonprofit private entities to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents).”

The law also specifies that “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.”


How HHS implements Title X depends on the administration

Pro-abortion administrations have used Title X rules to shovel Title X funds to the abortion industry.

A U.S. Dept. Health and Human Services (HHS) 2019 “Protect Life” rule, however, reformed the Title X program and opened the door to a more life-affirming approach. The rule corrected measures that kept pro-life clinics from receiving grants and implemented measures to prevent the comingling of Title X and the abortion industry.

But on April 15, 2021, HHS under the Biden Administration published a proposed rule (see below) designed to eliminate the Trump Administration’s 2019 Title X Rule. The proposed rule public comment period ended May 17, 2021. Read Freedom2Care’s comment.

The 2019 rule remains in effect until replaced.


Biden 2021 Proposed Rule

The Biden Administration’s proposed rule would:

  1. Reopen the trough of tax dollars to abortion clinics;
  2. Eliminate conscience protections regarding abortion referrals, effectively barring pro-life clinics; and
  3. No longer require encouraging parents to be involved in their children’s decisions.

The Biden Title X Proposed Rule permits the “co-location” of abortion clinics and Title X clinics in the same facility.

Note that the underlying Title X statute (42 U.S.C. 300a-6) prohibits Title X dollars from funding abortion as a method of family planning.

  • Trump Administration’s Protect Life Rule: Required Title X grantees to maintain financial and physical separation from abortion providers, drawing a bright line between abortion and family planning (See section 59.15).
  • Biden Administration’s Proposed Rule: Removes this protection, allowing Title X grantees to be “co-located” with abortion providers. Allowing co-location creates an accounting gimmick that enables Title X funds to support abortion. Since money is fungible, providing Title X dollars to abortion clinics frees up other money to be used for abortion.
  • Implications: Prior to the Trump Administration’s Protect Life Rule, Title X was a prime funding source for Planned Parenthood, the largest abortion chain in America. Planned Parenthood gave up Title X funds rather than comply with the requirements of the Protect Life Rule. According to a 2018 GAO report, Title X funds accounted for nearly 60 percent of Planned Parenthood expenditures from all agencies reported between 2013 and 2015. This was $170 million from 2013 to 2015 (or an average of $56 million annually).

The Title X Proposed Rule requires grantees to make abortion referrals.

  • Trump Administration’s Protect Life Rule: Prohibited abortion referrals. It did allow a healthcare provider, if asked by a pregnant woman seeking an abortion, to provide a list of comprehensive health service providers (some, but not all of which also provided abortion). (See Section 59.14).
  • Biden Administration’s Proposed Rule: Requires grantees to offer abortion counseling and referrals to pregnant clients. (See Section 59.5). While the rule’s preamble notes that grantees with conscience objections will not be required to counsel and refer for abortion, this exception is not present in the rule itself. The rule requires all grantees to provide abortion referral and counseling.
  • Implications: It is a violation of federal law (the Weldon Amendment) for the federal government to discriminate against healthcare entities that do not refer for abortions.

The Title X Proposed Rule removes requirements that encouraged parental involvement for minors seeking Title X services.

The Trump Administration’s Protect Life Rule required Title X providers to encourage a minor to involve his/her parents or guardian in decisions to seek family planning services. The Biden Administration’s proposed rule removes that requirement. (See Section 59.2).

Trump 2019 Rule

 The 2019 rule benefits:

  • Patients seeking family planning services from health professionals and organizations with life-affirming values.
  • Taxpayers who do not want their tax dollars to fund the abortion industry.
  • Health professionals and organizations who could use federal funding to help provide services for family planning.


  • Conscience protections enforced
  • No required abortion referral or counseling*
  • New funding partners sought
  • Parents involved in decisions about children
  • “Family planning” more broadly defined

The rule can stop abuses by the abortion industry and others who under the old rule may have:

  • Used fungible federal funds to expand their abortion operations and did not physically separate abortion facilities and operations from Title X funds.
  • Used federal funds to lobby for, advocate for or routinely refer patients for abortion.
  • Declined to ask patients about or report suspected cases of abuse such as human trafficking, child abuse, child molestation, sexual abuse, rape, incest or intimate partner violence.
  • Not effectively involved parents and families in the healthcare of minor children.

*To apply for any exemption related to an abortion-related concern in prior Title X policies in effect until the new rule takes effect, contact the HHS Office for Civil Rights (Toll Free Call Center: 1-800-368-1019).


Review Title X grants from your home

…while gaining experience in federal grants. Consider applying to be a grant reviewer for federal Title X family planning grant applications. Peer reviewers are vital to this process because they assist the federal government in awarding funds to only the most qualified applicants.

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Additional Resources

House Hearing
June 2019
On June 19, the Democrat-led House Subcommittee on Oversight and Investigations, Committee on Energy and Commerce held a hearing to oppose the new Title X reform and regulation.

Americans United for Life Testimony

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