The number of babies born in the United States fell again last year.
There will be 3.6 million births in 2025, a 1% decrease from 2024, according to new data from the Centers for Disease Control and Prevention. The birth rate has fallen to 53.1 births per 1,000 women aged 15 to 44, a 23% decrease since 2007.
The Trump administration has said it wants to reverse this trend. President Donald Trump has called for a “new baby boom,” and aides are seeking proposals from outside advocates and policy groups on everything from maternity benefits to expanded birth planning. The administration also proposes restructuring Title X, the federal government’s only dedicated family planning program.
For more than 50 years, Title At its peak, the safety net program served more than 5 million patients annually. Six out of 10 Title X customers report the program as their only source of medical care for the year.
In early April, the Department of Health and Human Services invited nonprofit organizations to apply for Title X grants for fiscal year 2027, which begins in October. The 67-page funding opportunity notice included just one mention of contraceptives, which it described as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”
This grant notice restructures the program from traditional public health intervention efforts focused on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.
Although Title
Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding letter represents a complete redefinition of family planning.
“What we’re seeing is an attempt to use our nation’s family planning system as a Trojan horse for an entirely different purpose,” Marcella said, noting that President Trump has proposed repealing Title X entirely.
Fertility rates and fertility trends
The administration is overhauling Title X against the backdrop of declining birthrates. But researchers studying fertility trends say this decline is driven by factors that have little to do with access to contraception, and that restricting contraception is unlikely to increase births.
The most important factor has to do with timing, said UCLA demographer Alison Gemmill. “Having children is increasingly being delayed as part of a broader transition towards later adulthood milestones such as stable employment, leaving the parental home and marriage,” she says.
Most American women still reach childbearing age with an average of two children, he said, suggesting a shift to smaller families rather than an increase in childlessness.
“Having children has become more accidental and more planned,” she said.
Much of the decline since 2007 reflects women postponing childbearing rather than abandoning it.
“The average number of babies a woman has over her lifetime is not going down. It’s still over 2.0 babies for a 45-year-old woman,” said Philip Cohen, a sociology professor at the University of Maryland.
Philip Levin, an economist at Wellesley College, said birth rates are declining because of changes in how women approach work, leisure and child-rearing. “Efforts to reverse these patterns will be more successful if they can make childbirth more desirable, rather than making pregnancy more difficult to prevent,” he said.
Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS spokeswoman Emily Hilliard said in a statement: “Applicants for the 2027 Title We look forward to following the priorities stated by the Administration in the Funding Opportunity Notice. Under the leadership of Secretary Kennedy and President Trump, HHS will continue to support policies that support lives, family well-being, maternal health, and societal challenges to the chronic disease epidemic. remains focused on improving maternal outcomes and ensuring programs are implemented in accordance with applicable law. ”
Marcela said the new funding announcement is the result of a confluence of two forces: the Make America Healthy Again movement, which is skeptical of conventional medicine and emphasizes lifestyle and behavioral interventions, and the pronatalist agenda, which seeks to increase birth rates by steering policies toward family formation.
The text of this document reflects both. While repeatedly invoking “optimal health” and “chronic disease,” it sidelines the contraceptive services that have defined Title X for half a century.
Claire Coleman, president and CEO of the National Family Planning and Reproductive Health Association, which represents medical professionals focused on family planning, said tying Title X to fertility goals replaces individual decision-making with government goals. The program is “designed to facilitate access to family planning services, including services for pregnancy achievement and prevention,” she said.
Title X’s new focus
The right wing welcomes the change in government.
Emma Waters, a senior policy analyst at the conservative Heritage Foundation who has advocated for what she calls “restorative reproductive medicine,” said the funding letter reflects overdue attention to a neglected aspect of women’s health.
“I was especially encouraged by the language that talked about the delays in diagnosing diseases like endometriosis, the need for women to actually understand how their menstrual cycles and fertility work, and the need to make sure we are promoting real root causes through Title X,” Waters said.
She explained that this notice expands, not narrows, the program’s mission. “I believe this iteration of Title
Waters also argued that untreated reproductive health issues can lead to lower birth rates.
“One of the interesting aspects of this debate, and one that is often overlooked, is the extent to which painful, unaddressed reproductive health issues can inhibit a woman’s desire to have children or create ambivalence,” she said, pointing to endometriosis.
An estimated 5% to 10% of women of reproductive age have endometriosis, and 30% to 50% of these experience infertility. Scientifically speaking, this relationship is an association, not a proven cause. Women who do not have symptoms may not be tested for endometriosis, and endometriosis may be more prevalent than realized. Researchers still don’t fully understand why some women with endometriosis have difficulty conceiving while others have difficulty conceiving, and treating endometriosis does not guarantee a return to fertility.
Meanwhile, infertility rates in the United States are not increasing. An analysis of federal government survey data found that the birth rate remained roughly flat from 1995 to 2019, even as the national birth rate declined sharply. This discrepancy cannot be explained by untreated reproductive disease.
Meanwhile, the American College of Obstetricians and Gynecologists issued new clinical guidelines in February that allow for early diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. However, the first-line treatment recommended by ACOG is hormone therapy, part of the same category of treatments that the funding letter dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” Reproductive health experts say the effects are contradictory. Title X currently prioritizes the diagnosis of endometriosis and de-emphasizes the drugs clinicians use to treat endometriosis.
Title X does not cover treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization. When President Richard Nixon signed Title X in 1970, he described it as a way to expand access to family planning services. It said it would help women decide on the number and spacing of their children by making contraception and related preventive care more widely available, especially for those who cannot afford it. Medicaid, not Title X, is the main government health insurance program that covers medical care for low-income women, but like many commercial insurance plans, it does not cover in vitro fertilization.
Many of the conditions prioritized in the funding letter are noteworthy, said Liz Romer, a former chief clinical advisor in the HHS Office of Population Affairs who helped write the updated guidelines for family planning programs. But they are outside of what Title X can realistically provide.
“We don’t even have enough funding to support the core premise of contraception,” Romer said. “So if you want to expand your Title X funding, you can expand your scope, but you can’t move away from the foundation.”
She said the rise of anti-contraceptive ideology in federal health policy is surprising, given the public’s widespread support for access to contraception. Eight in 10 women of childbearing age surveyed by KFF in 2024 reported using some form of contraception in the past 12 months.
“If contraception were sidelined in Title She added that funding could be directed away from health care providers who provide all types of contraceptive care and toward groups that are “ideologically opposed to contraception and do not provide the same level of health care services.”
the stakes are high
The United States already has one of the highest maternal mortality rates among wealthy countries, with 17.9 deaths per 100,000 live births in 2024. According to the CDC, four out of five pregnancy-related deaths in the United States are potentially preventable. Medical research shows that pregnancy carries a significantly higher risk of blood clots, stroke, and cardiovascular complications than hormonal contraception.
Since the Supreme Court’s decision, dobbs The 2022 decision overturned the constitutional right to abortion. Roe vs. WadeAccess to abortion has been drastically reduced in large parts of the country. While the number of abortions nationwide is increasing, driven largely by telemedicine and interstate access, research shows that states with bans are seeing an increase in births, with an estimated 32,000 additional births per year, disproportionately among young women and women of color.
“There’s no evidence that restricting access to contraception has any positive outcomes,” said Dr. Christine Dehrendorff, director of the Person-Centered Reproductive Health Program at the University of California, San Francisco. Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.
Since President Trump returned to office, more than a dozen Title During the first Trump administration, regulatory changes reduced the number of Title X participants from more than 4 million to 1.5 million. The program grew slowly under the Biden administration, reaching about 3 million customers before the current round of disruptions began.
Marcella said the second Trump administration’s overhaul of the program “directly undermines the public health intent of our nation’s family planning programs and could leave millions of people without the care they have relied on for decades. This is bad policy.”
