Iowa clinics warn of potential loss of birth control access under Trump funding freeze

Access to free or low-cost birth control for thousands of Iowans may be in jeopardy due to federal funding of Title X family services being withheld by President Donald Trump’s administration, Iowa clinics warn.

The U.S. Department of Health and Human Services announced at the end of March that it was withholding 16 family planning grants across 23 states, affecting 870 health facilities serving more than 840,000 patients across the country. It includes funding to networks of clinics that include health departments, federally qualified health centers, school-based providers and Planned Parenthood clinics.

Enacted in 1970, the Title X Family Planning Program is the only federally funded program dedicated solely to providing comprehensive family planning and related preventive health services, including cancer screenings and testing for sexually transmitted infections, in addition to education, counseling and access to a wide variety of contraception methods.

Federal officials said the funds were being withheld “pending an evaluation of possible violations” of federal civil rights laws — language the administration has used to target programs promoting racial and gender-based equality. Additionally, undocumented immigrants were barred “from obtaining taxpayer-funded benefits” under a Trump executive order.

Politico reported grantees were given 10 days to submit detailed records showing they don’t discriminate in hiring or in patient care, but those who did so by the deadline said they still have not received a response.

The National Family Planning and Reproductive Health Association and the American Civil Liberties Union filed a lawsuit Thursday in the U.S. District Court for the District of Columbia. The 35-page filing alleges the Department of Health and Human Services “unlawfully withheld” the tens of millions in Title X funds approved by Congress over disagreements about organizations’ “opposition to racism” and “providing care to undocumented immigrants.”

The Family Planning Council of Iowa is one of two organizations in the state that receive funding through Title X. The other is the Iowa Department of Health and Human Services. Both organizations have received only partial funding to provide contraception and other reproductive health services to low-income patients.

Allison Smith, executive director of the Family Planning Council of Iowa, said it has received about $1 million, less than half its expected funding for this grant year. Smith said the council typically receives $2.2 million annually.

“And there's been no explanation as to why that is, and we don't know if there's going to be any additional funding or when that might be available,” Smith said.

A spokesperson for Iowa Health and Human Services said the department applied for more than $1.5 million in Title X grant funds and received a partial award of about $1.2 million for the April 1 project period via a continuing resolution, with the remainder being approved upon passage of a budget reconciliation bill by Congress.

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The state’s Title X program supports 15 clinic sites across Iowa, providing more than 11,100 services in calendar year 2024.

While partial awards are not common, they have occurred in the past due to federal budget disputes. Congress in March approved a temporary measure to fund the government through the rest of the federal fiscal year that ends Sept. 30, successfully averting a government shutdown.

Smith said a similar issue occurred last year, under former President Joe Biden’s administration, where the council was awarded 40 percent of its grant funds in March 2024.

“However, it was made clear to us that the remaining grant funding would be available later that year,” once Congress approved a budget deal, she said. “That communication has not occurred currently. And so that's, I think, the most concerning part for us.”

The Family Planning Council of Iowa supports 15 clinics that provided health care services to more than 21,500 unique clients during the 2024 budget year. They include those run by county public health departments, hospital-based clinics, federally qualified health centers, independent clinics, Planned Parenthood and community action organizations.

Smith said she’s unsure how they’ll be able to keep clinics afloat without full funding, and worries it may lead to Iowans not having places to go to get care. She said the council is trying to operate as usual as best it cab, but has had to offer six-month contracts instead of 12-month contracts due to the uncertainty.

She said the funding pause “further limits access to care” at time when Title X already has been underfunded for years. Congress has appropriated $286 million for Title X, a level of funding that has not increased for the past 10 years.

“I think the bottom line is this is an attack on access to birth control,” Smith said. “The Title X program has been crucial for more than 50 years. … I think it's important that we reach out to our federal Congress members to let them know how important protecting Title X is to Iowans.”

Because many Title X-backed health centers are operated by Planned Parenthood, the program has become a target for abortion rights opponents, even though the program itself does not provide funding to support abortion care or services. While Title X clinics are not allowed to use their funds for abortion services, they can provide non-directive pregnancy counseling, including information about abortion, and referrals for abortion services.

Heather Montgomery is executive director of Women’s Health & Family Services in Clinton, which has been a Title X family planning clinic for nearly all of its 50 years of operation. The clinic sees over 1,400 unique patients every year.

Montgomery, like Smith, worries Iowa clinics like hers will no longer be able to provide free and discounted services, including contraception, to woman to help them plan for the family size that they want and can afford. She noted Title X funds help cover care for people who don’t qualify for Medicaid or state programs, as well as low-income people.

“There’s a lot of insurance companies that have extremely high deductibles or co-pays, which can affect their birth control option and how much that’s going to cost them,” Montgomery said.

She said a long-acting reversible contraceptive implant inserted under the skin of the upper arm can cost $550. And other long-acting reversible contraceptives, like an intrauterine device, can cost $100 up to $400. Additionally, some employers do not cover birth control in their health plans.

If the federal dollars don’t come through, she said it’s unlikely clinics will be able to replace them, and clinics could close.

“We run with pretty much a skeleton crew, because we’re a not-for-profit clinic,” Montgomery said. “Losing that funding affects us greatly. It’s half what it was last year, and last year wasn’t even enough. It gets to be more and more difficulty to keep our doors open.”

She said she recently eliminated a nurse practitioner due to reduced funding, dropping from 2.5 to 1.5 providers.

“Which is a huge cost savings to us, but that’s less patients that we can see,” Montgomery said.

“It’s a beneficial program that keeps a lot of women off state aid when you can have the number of kids that you can afford,” she said. “It would be, I think, a loss to our community. … There’s a lot of clinics that won’t be able to sustain without that family planning funding. That’s going to make it a lot harder for women to access that family planning care. … I unfortunately think you’re going to have a lot of not wonderful repercussions coming back from that.”

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