More than 85% of maternal deaths in the United States are preventable. Yet last week, Health and Human Services Secretary Robert F. Kennedy Jr. testified before the Senate, defending a budget that would eliminate Title X, Healthy Start, and the CDC’s Safe Motherhood and Infant Health Portfolio: the very programs designed to prevent maternal deaths and keep infants healthy. Earlier this year, the House passed legislation to funnel federal dollars toward unregulated pregnancy centers that largely lack medical licensure and rarely provide actual prenatal care. The Supreme Court also recently ruled that anti-abortion centers can proceed with a legal challenge to a state subpoena of fundraising records.
What’s being built is not a pro-family policy. It’s a crisis—one that will fall hardest on Black women and their children. Instead of fueling this crisis, policymakers should focus on the evidence-based policy path to support healthy moms and babies: protect Medicaid, strengthen programs like Title X and Healthy Start, and direct public funds to providers that meet clinical standards for care.
The prenatal and maternity care crisis
The United States already has the highest rate of maternal deaths of any high-income country, the majority of which are considered preventable with early, consistent prenatal care. This care reduces the risk of hypertension, anemia, gestational diabetes, low birthweight, and death. Yet access to early prenatal care has been declining overall, with the sharpest drops among women of color. In 2024, only about 68% of Hispanic women and just over 65% of Black women accessed early prenatal care, compared to more than 82% of white women.
Barriers to prenatal care existed long before the current administration. A 2023 March of Dimes report found that one in 12 women live in maternity care deserts, areas devoid of necessary perinatal care. In 2024, more than a quarter of women of reproductive age with young children reported difficulty finding reliable maternity care, with even higher rates in states with abortion restrictions.
Dismantling the coverage infrastructure
Despite the maternal health crisis facing Americans, the Trump administration is dismantling the federal health insurance infrastructure that covers the majority of pregnancies in the highest-risk communities, while targeting Title X, the only federal program designed to extend family planning services to low-income women.
Medicaid is the single largest source of coverage for births in the United States, financing more than 40% of births nationally, rising to nearly 50% in rural areas, more than 58% among Hispanic mothers, and 64% among Black mothers. Over the last few years, nearly every state has extended postpartum Medicaid coverage to 12 months in response to the maternal mortality crisis. Those gains are now threatened.
The Trump administration’s signature legislation, the One Big Beautiful Bill Act, is projected to leave more than 14 million additional Americans uninsured by 2034. The bulk of that loss comes from Medicaid cuts, projected to strip coverage from at least 10 million people. These estimates of lost coverage are based on experience: similar state-level requirements have led to widespread loss in coverage, even for people who meet the requirements of the program, due to bureaucratic red tape.
Simultaneously, the Trump Administration has escalated its campaign against Title X, the federal family planning program established by President Richard Nixon in 1970 to ensure low-income individuals could access voluntary, comprehensive reproductive health services. Today’s roughly 4,000 Title X sites provide not only contraception but cancer screenings, STI testing and treatment, infertility counseling, and early prenatal services. Despite serving millions of patients annually, funding has remained flat since 2015 at under $300 million.
The administration’s first term offers a preview of what’s ahead. Regulatory changes included the “domestic gag rule,” which prohibited abortion counseling and referrals at federally funded clinics, and physical separation mandates, which forced nearly 1,000 service sites out of the Title X program.
Between 2019 and 2020, as the number of Title X sites contracted, so did the numbers of men and women receiving contraception through the program, and the number of women receiving cervical and breast cancer screenings. For example, nearly 300,000 fewer women received breast cancer screenings at Title X clinics. While some portion of this decrease was due to COVID-19, HHS estimated at the time that the majority of the decrease (63%) was due to the Trump administration’s policy.
The second Trump Administration is pursuing the same playbook, seeking to eliminate the Title X program outright, and recently issued new guidance shifting the program’s focus from family planning to pronatalism.
Shifting public dollars to unregulated pregnancy centers
Earlier this week, Kennedy defended budget cuts to health services as necessary to tackle the national debt. But not all pregnancy-related spending is being cut. Funding for unregulated pregnancy centers—often called crisis pregnancy centers—has expanded even as Title X funding has remained stagnant.
Unregulated pregnancy centers present themselves as medical facilities while operating without medical licensure or legal obligations to provide accurate health information. They are often located in close proximity to abortion clinics, and in low-income communities, with the express goal of interfering with a patient’s choice to terminate their pregnancy.
Largely supported and staffed by national and international religious and anti-abortion organizations, unregulated pregnancy centers now outnumber abortion providers by more than three to one, with over 2,600 unregulated pregnancy centers in the U.S. in 2024, operating outside the clinical and regulatory frameworks that govern licensed medical facilities. Many are not subject to federal privacy protections. Staff are not required to have medical training. And while they are often designed to resemble healthcare clinics, complete with medical branding and staff in clinical attire, their core purpose is not comprehensive care.
Importantly, unregulated pregnancy centers rarely offer prenatal care or even referrals to prenatal care, although they target the women who face the greatest barriers to accessing this care, with the promise of material support like diapers and other pregnancy and baby supplies.
Federal dollars have been flowing to these centers at scale, largely through Temporary Assistance for Needy Families (TANF), a program originally designed to provide direct cash support to low-income families, but increasingly directed toward loosely defined "non-assistance" services with limited oversight. One recent analysis found nearly $1.3 billion in government grants were awarded to unregulated pregnancy centers between 2019 and 2024, largely through TANF.
Federal TANF dollars flow through states, so states play an important role in deciding where the funding should go. Despite the influx of taxpayer dollars, the Government Accountability Office and watchdog agencies have repeatedly flagged weak oversight, poor transparency, and possible misuse of TANF funds flowing to unregulated pregnancy centers. Just this month, the Government Accountability Office again flagged insufficient oversight of state spending of TANF funding and recommended that HHS require more detailed reporting from states.
What this means for maternal and reproductive health
The Trump Administration is cutting federal funding for reproductive healthcare, while Congressional and State leaders are working to redirect federal taxpayer dollars to unregulated pregnancy centers, whose primary goal is to discourage women from having abortions.
The result is a resource shift with measurable human consequences: comprehensive reproductive health providers are losing funding and capacity, while unregulated pregnancy centers expand their reach, without meeting basic standards of care. Meanwhile, for the majority of clients accessing unregulated pregnancy centers who are planning to remain pregnant, delayed prenatal care increases the risk of complications for both mothers and infants. Many in politics have echoed the sentiment that budgets, not rhetoric, are a reflection of the values of politicians. By that measure, the Trump administration’s values are clear. They are cutting the budget in ways that would put the lives of pregnant women and babies at risk.
