Addressing increased funding and expansion of programs for Sexual Reproductive Health

By Deborah Denis

Executive Summary

Title X Family Planning Program is the only federal program dedicated to providing affordable birth control and other reproductive health care to people with low incomes through providing funding to health care organizations.[I]  It is critical that the current administration increase funding for the program to ensure people of low socioeconomic income levels continue to have access to adequate healthcare. Title X can achieve its goals through three alternatives; however, I recommend an increase in funding towards training and conferences on reproductive health to equip healthcare providers with the resources to provide adequate services to those who need it. This recommendation is more efficient and socially acceptable. It also ensures equity and meets the liberty/freedom criteria. The pandemic has made women’s choices and right to sexual health care challenging and has exacerbated disparities [ii]. The best solution for the Title X program will be the third alternative to achieve its policy objective amidst these challenges.

Background & Problem Statement

The Trump administration ruled the ‘Title X Gag Rule’ into effect on July 11, 2019, which blocked the nation’s funding for organizations that support abortion services.  The gag rule reduced the ‘Title X’ network capacity by 46% nationwide, affecting potentially 1.6 million female family planning patients.[iii]  This statistic is not inclusive of other damages incurred by this rule on reproductive health services.   On January 28, 2021, President Biden issued a ‘Memorandum on Protecting Women’s Health at Home and Abroad[iv] to rescind Trump’s Title X rule’ and support women’s health. The pandemic exposes new and unique challenges for women of reproductive age. On March 11, 2021, President Biden signed the American Rescue Plan Act, which has restored critical funding for the Title X program [v]. However, new approaches to meet current reproductive health care needs are crucial. The current administration will have to provide more funding and permanent government structures to support this policy and solve complex problems as they arise.


This memo assesses alternatives that address the issues of the Title X program through the following criteria:

  • Equity How likely is this alternative to prefer fairness or justice in distributing policy costs, benefits, and risks across population subgroups such as women of color or marginalized women?
  • Liberty/freedom How likely is this alternative to extend or restrict privacy and individual rights and choices such as the reproductive right to choice and access to information and care? 
  • Social acceptability: How likely is this alternative supported by the public’s polarized ideologies about specific reproductive issues such as abortion?
  • Efficiency: How likely to meet the program’s goals and the largest benefit in relation to cost?


The Title X program’s objective is to prioritize the needs of low-middle income families or uninsured people to access health care services. Its overall purpose is to promote positive birth outcomes and healthy families by allowing families to decide their children’s number and spacing. [vi] It can achieve this policy goal through the three policy alternatives outlined below.

Alternative 1:  Support mainly family planning with limited support for other reproductive health services (Status Quo)

The Title X program has provided support for family planning services since it was enacted in 1970v. In 2018, the program served 3.9 million people, 87% of them women[vii]. It has supported low-income families and prevented unwanted pregnancy. Still, the funds were not used to support abortion services, and from 2019 the regulations were revised by the Trump administration, making it harder for clinics that refer women to an abortion provider to receive funds, limiting its efficiency. Even though those restriction rules were rescinded, abortion remains a considerable concern in this program[viii] , limiting liberty and freedom of choice for women. However effective for decades, this alternative does not meet the equity criteria because there are still discrepancies between groups regarding reproductive health care services[ix].

Alternative 2: Integrated approach to reproductive health services, including safe abortion care.

A second alternative for the Title X program is to expand its programs to focus on all aspects of reproductive health care, including safe abortion care. This is because reproductive issues are interrelated[x], and for the achievement of its policy goals, they should all be supported by the program. An integrated approach to delivering sexual and reproductive health services serves clients better with the cross-utilization of services and continuity of care [xi]. This alternative foster equity and freedom/liberty because it ensures that budgets cover all required services and permits women’s freedom of choice to have access to abortion services and information/counseling. However, it may not be socially acceptable due to polarized ideologies around abortion in the country[xii] , and it will be capital intensive, thereby limited in efficiency to cost.

Alternative 3: Provide funding for equipping providers through training that support holistic reproductive health care services

The third alternative is for the Title X program to fund healthcare providers’ training to equip them to provide services, information, and counseling on all reproductive health care needs. However, they may not offer direct abortion services but can provide education and counseling on safe abortion care and referral for those who will choose to access safe abortion care. This alternative meets the criteria of efficiency as it maximizes cost by providing comprehensive quality care to women.[xiii] It is equitable because providers are well trained to meet all categories of people with various needs and ensure liberty/freedom of choice. It will be easier to persuade the conservative right towards providing information and counseling on abortion rather than the services directly, thereby making this alternative more socially acceptable by the public. This alternative will also be supported by states that have favorable abortion laws. 

Policy Recommendation

I recommend that the Title X program choose alternative three and increase funding towards training and conferences on reproductive health to equip healthcare providers with the resources to provide adequate reproductive health care services. This will help in achieving its policy goal of having healthy families across the country. All alternatives effectively accomplish this goal. However, the third alternative will meet all four criteria and allow for quality reproductive services available and accessible for a more significant number of people. I recommend that the Title X program choose Alternative 3. 


Deborah Denis is a first-year MPA PNP student at NYU Wagner specializing in Advocacy and Political Action. She has been a humanitarian aid worker for over four years with the International Rescue Committee, supporting women and girls in displaced communities in Northeast Nigeria. She is passionate about women’s empowerment, gender equity, and reproductive rights. She has a bachelor’s in Health Education and a background in Health Planning and Management.


[i] Planned Parenthood The American Rescue Plan Act Includes Important Strides For Health Equity, Access & Sexual and Reproductive Health The American Rescue Plan Act Includes Important Strides for Health Equity, Access & Sexual and Reproductive Health ( Accessed March 5, 2021

[ii] World Economic Forum COVID-19 could have effects on women’s health, says the UN | World Economic Forum ( March 30 2021

[iii] Guttmacher Institute, February 2020 Policy Analysis Trump Administration’s Domestic Gag Rule Has Slashed the Title X Network’s Capacity by Half | Guttmacher Institute

[iv] The White House, January 28, 2021. Presidential Actions.  Memorandum on Protecting Women’s Health at Home and AbroadMemorandum on Protecting Women’s Health at Home and Abroad | The White House. Accessed March 5, 2021

[v] American Rescue Plan Act of 2021 American Rescue Plan Act of 2021 – Wikipedia Accessed March 27, 2021

[vi] Title X Title X – Wikipedia Accessed March 27, 2021

[vii] Fowler, C. I., Gable, J.,Wang, J.,Lasater, B., &Wilson, E. (August 2019). Family Planning Annual Report:2018 National Summary1) Maintain the status quo and support mainly family planning with sketchy support for other reproductive health services Retrieved May 4, 2020.

[viii] Rewire News Group The New Health Reform Law: Pros and Cons For Reproductive Health The New Health Reform Law: Pros and Cons for Reproductive Health – Rewire News Group Accessed April 2, 2021

[ix] Center For Disease Control Reproductive Health Data Statictics Data & Statistics – Reproductive Health | CDC Accessed April 2, 2021

[x] Fathalalla Mahmoud Issues In Reproductive Health paper3 ( Accessed April 2, 2021

[xi] International Women Health Coalition Pathway to Integration of Sexual Reproductive Heath Services Microsoft Word – SRHR Policy Brief 2_ FINAL.docx ( Accessed April 2, 2021

[xii] The Week Why America is becoming more polarized on Abortion Why America is becoming more polarized on abortion ( Accessed April 2, 2021

[xiii] World Health Organization Training health care providers to health women survivors of violence WHO | Training healthcare providers to help women survivors of violence Accessed April 2, 2021

Photo Credit: Planned Parenthood Rally, NYC 2011. Credit: Charlotte Cooper