The Biden administration announced another reversal of a Trump-era policy, this one related to Title X, the federal government’s family planning program.
President Joe Biden has welcomed abortion providers back into Title X — and requested $340 million for it this year, an increase of $53.5 million over current funding. Instead of devolving into the usual abortion debate, we should defund Title X purely in light of today’s demographic realities.
Women are squarely at the center of Title X issues not only in pregnancy and childbearing, but also as the first line of healthcare for their families and at work. America is chronically and acutely short of healthcare staff. U.S. population numbers are plummeting, yet Title X imposes a moral judgment against reproduction.
America’s low fertility rate, driven in part by Title X, is exacerbating the already critical healthcare labor shortage. The American Association of Colleges of Nursing relates the nursing shortage to our population cliff. As more nurses retire, nursing school enrollment is falling behind, leaving fewer active nurses. At the same time, more elderly require more care.
The shortage is across all health professions. To help, some states open their borders with license reciprocity laws. Immigration can help in a limited way. After closing 120 beds for short staffing, Michigan’s Henry Ford Health System recently announced hiring hundreds of nurses from the Philippines. However, they were short 5,000 job applicants this year.
Shuffling people around the globe cannot solve a worldwide healthcare labor shortage post-COVID-19.
Common sense says baseline local staffing is the path to long-term sustainability. An “all-of-the-above” strategy includes the obvious: Stop spending to reduce fertility. Certainly, stop casting moral judgment on low-income women for pregnancy.
Proposed in 1968, Title X reacted to fears of population explosion and global famine. In contrast, we now face population collapse following a long downward trend in fertility rates. It would be disingenuous to pass this off simply as pandemic pressures or Generation Z character traits.
U.S. birth rates had already peaked in the 1950s, dropping below replacement level shortly after Title X passed. We regained sustainable levels only briefly in the past 50 years as federal spending continued to focus on lower birth rates through contraception and abortion.
The federal family planning approach is also morally flawed. Violating the privacy of a personal, moral decision, Title X policy has told three generations of low-income women that they should “plan” their families — code for having fewer children.
Based on archaic Cold War theories of population explosion, with a subtext of eugenics for the poor, this program is beyond outdated. It is biased, paternalistic, and based on numerous false premises.
Presently, many support Title X, likely because they believe that contraception is unaffordable for low-income women, and they want the government to offer a helping hand. But birth control is not unaffordable. Priced around $9 per month across the United States, birth control costs less than two Big Macs. Other recommended policy changes could drop cost and access barriers even lower.
Another unfair, underlying Title X assumption is that poor children are a burden on society. But in fact, the average person has more years of productivity than dependency. Most lower-income women and men work hard to independently support their children and raise them to become self-sustaining members of society.
Furthermore, some estimate that about 2 million couples are waiting to adopt — meaning there are as many as 36 waiting families for every child placed for adoption.
Other programs duplicate funding options for women’s family planning. In 2019, seven states were completely independent of Title X funding for family planning clinics. Six more had dropped below 50% dependence.
Given Title X conflicts with national interests and women’s private lives, the responsible federal health policy is to stop trying to reduce fertility and leave this personal decision to individuals. Congress has proposed eliminating Title X six times in the past, according to the National Family Planning and Reproductive Health Association.
Ultimately, responsibility for pregnancy belongs to parents. The government should not be playing a role here. While many people who call themselves “pro-choice” will cheer Biden’s latest move to bolster abortion clinics with Title X money, we should be wary of how this program erodes human resources and perniciously influences women’s personal autonomy and relationships.