2026年4月16日 / 美国东部时间早上5:00 / KFF健康新闻
美国去年的新生儿数量再次下滑。
根据美国疾病控制与预防中心的最新数据，2025年全美新生儿数量为360万，较2024年下降1%。生育率降至每1000名15至44岁女性生育53.1个婴儿，较2007年下降23%。
特朗普政府表示希望扭转这一趋势。特朗普总统呼吁“迎来新一轮婴儿潮”，助手们已向外部倡导者和政策团体征集提案，内容涵盖婴儿奖金、扩大生育规划等。政府还提议重塑联邦政府唯一的专职计划生育项目：《第十号标题法案》（Title X）。
五十多年来，两党支持下的《第十号标题法案》一直致力于为低收入女性提供避孕服务、性传播感染筛查和生殖医疗服务，无论其支付能力如何。该保障项目在鼎盛时期每年服务超过500万名患者。每10名《第十号标题法案》服务对象中就有6人称，该项目是他们某一年唯一的医疗保健来源。
4月初，美国卫生与公众服务部邀请非营利组织申请2027财年的《第十号标题法案》拨款，该财年将于10月开始。这份长达67页的资助机会公告仅提及一次避孕措施，将其描述为过度开具、存在负面副作用，并属于更广泛的“过度依赖药物和手术治疗”的一部分。
这份拨款通知将项目从传统的公共卫生干预工作转向聚焦生育、家庭组建以及多囊卵巢综合征、子宫内膜异位症、睾酮水平低和勃起功能障碍等生殖健康病症。
尽管《第十号标题法案》将继续帮助女性“实现健康妊娠”，但拨款文件并未明确提及预防意外怀孕——这一直是该项目的长期目标。
曾在拜登政府担任高级官员并监管《第十号标题法案》的杰西卡·马塞拉表示，新的资助通知相当于对计划生育进行了全面重新定义。
“我们看到的是试图将我们国家的计划生育作为一个特洛伊木马，服务于完全不同的议程，”马塞拉说道，她还指出特朗普总统曾提议彻底取消《第十号标题法案》。
出生率与生育趋势
政府在出生率下滑的背景下对《第十号标题法案》进行全面改革。但研究生育趋势的研究人员表示，出生率下滑的驱动因素与避孕服务获取几乎无关，限制避孕服务不太可能增加新生儿数量。
加州大学洛杉矶分校人口统计学家艾莉森·杰米尔表示，最重要的因素与生育时机相关。“随着成年关键节点普遍延后，包括稳定就业、离开父母家以及结婚，生育年龄也越来越晚，”她说道。
她说，大多数美国女性最终仍会生育平均两个孩子，这表明家庭规模在缩小，而非越来越多的女性选择不生育。
“生育变得更具偶然性，也更需要提前规划，”她说道。
2007年以来的生育率下滑很大程度上反映了女性推迟生育，而非完全放弃生育。
“女性一生平均生育的婴儿数量并未下降。45岁女性的平均生育数仍超过2.0，”马里兰大学社会学教授菲利普·科恩说道。
韦尔斯利学院经济学家菲利普·莱文表示，出生率下降是因为女性在工作、休闲和育儿方面的观念发生了转变。“如果能让生育更具吸引力，而非更难避孕，那么扭转这些趋势的努力会更成功，”他说道。
当被问及避孕措施在降低孕产妇死亡率中的作用，以及新的资助通知如何推进这一目标时，美国卫生与公众服务部新闻秘书艾米丽·希利亚德在一份声明中表示：“2027财年《第十号标题法案》拨款周期的申请人，将被要求符合已发布的资助机会公告中政府明确的优先事项。在肯尼迪部长和特朗普总统的领导下，卫生与公众服务部将继续支持保护生命、家庭福祉、孕产妇健康以及应对慢性病流行的政策。该部门仍专注于改善孕产妇结局，确保项目的实施符合相关法律。”
马塞拉表示，新的资助通知是两股汇聚力量的产物：一是“让美国再次健康”运动，该运动对传统医学持怀疑态度，强调生活方式和行为干预；二是支持生育的议程，旨在通过将政策导向家庭组建来提高出生率。
文件中的语言同时体现了这两点：它反复提及“最佳健康状态”和“慢性病”，却将定义了《第十号标题法案》半个世纪的避孕服务边缘化。
代表专注于计划生育的医疗专业人员的美国家庭计划与生殖健康协会主席兼首席执行官克莱尔·科尔曼表示，将《第十号标题法案》与出生率目标挂钩，会用政府目标取代个人决策。她说，该项目“旨在促进获得计划生育服务，包括实现和预防怀孕的服务”。
《第十号标题法案》的新重点
政府的改革得到了右翼人士的欢迎。
保守派智库传统基金会高级政策分析师艾玛·沃特斯曾倡导她所谓的“修复性生殖医学”，她表示新的资助通知反映了对被忽视的女性健康领域的应有重视。
“看到提及子宫内膜异位症等病症诊断延误的内容，看到强调女性需要切实了解自身周期和生育能力，以及确保通过《第十号标题法案》推广真正的根本疗法，我尤其感到鼓舞，”沃特斯说道。
她将这份通知描述为对项目使命的扩展，而非收缩：“我认为这一版《第十号标题法案》实现了其初衷。目标从来不仅仅是‘提供更多避孕措施’，而是全面赋予女性掌控自身生育能力的权力。”
沃特斯还辩称，未经治疗的生殖健康问题可能会拉低出生率。
“这场辩论中一个有趣且常被忽视的方面是，痛苦且未得到治疗的生殖健康问题在多大程度上会抑制或让女性对生育孩子产生矛盾心理，”她说道，并以子宫内膜异位症为例。
据估计，5%至10%的育龄女性患有子宫内膜异位症，其中30%至50%会出现不孕问题。从科学角度来说，两者只是存在关联，而非已证实的因果关系。如果没有症状，女性不会接受子宫内膜异位症筛查，而且该病症的实际患病率可能比已知的更高。研究人员仍未完全明白，为什么有些子宫内膜异位症患者难以受孕，而有些则不会，治疗该疾病也不能可靠地恢复生育能力。
与此同时，美国的不孕率并未上升。一项针对联邦调查数据的分析发现，1995年至2019年间，不孕率基本保持平稳，尽管全国出生率大幅下降——这一差异表明，未经治疗的生殖疾病并非出生率下滑的原因。
与此同时，美国妇产科医师学会于2月发布了新的临床指南，允许无需手术即可更早诊断子宫内膜异位症，这是朝着解决沃特斯提到的诊断延误问题迈出的一步。但美国妇产科医师学会推荐的一线治疗方法是激素疗法，这属于资助通知中被斥为“过度依赖药物和手术治疗”的同一类护理。生殖健康专家表示，这造成了一种矛盾：《第十号标题法案》现在优先考虑子宫内膜异位症的诊断，却不重视临床医生用于治疗该疾病的药物。
已被证实可改善子宫内膜异位症女性生育能力的治疗方法，如腹腔镜手术和体外受精，并不在《第十号标题法案》的覆盖范围内。1970年理查德·尼克松总统签署《第十号标题法案》时，将其描述为扩大计划生育服务获取渠道的一种方式——通过让避孕和相关预防性护理更易于获得，尤其是针对那些负担不起的人群，帮助女性决定生育数量和生育间隔。医疗补助计划而非《第十号标题法案》是为低收入女性提供医疗保健的主要政府医疗保险项目，但和许多商业保险计划一样，它也不覆盖体外受精费用。
曾帮助撰写该计划生育项目更新指南的美国卫生与公众服务部人口事务办公室前首席临床顾问莉兹·罗默表示，资助通知中优先考虑的许多病症确实值得关注。但这些病症超出了《第十号标题法案》能够实际提供服务的范围。
“甚至没有足够的资金来支撑避孕服务这一核心前提，”罗默说道。“因此，如果你想扩大《第十号标题法案》的覆盖范围，你可以扩展其范畴，但不能脱离其根基。”
她说，联邦卫生政策中出现反避孕意识形态令人震惊，因为公众普遍支持获取避孕措施。2024年KFF开展的一项调查显示，每10名育龄女性中就有8人称在过去12个月内使用过某种形式的避孕措施。
罗格斯大学公共卫生学院性与生殖健康、权利与正义研究中心主任劳拉·林德伯格表示：“如果避孕措施在《第十号标题法案》中被边缘化，这不仅会改变书面文字，还会让患者的选择更少、障碍更多。”她补充道，资金可能会从提供全面避孕护理的提供商，“转向在意识形态上反对避孕、无法提供同等标准医疗服务的组织”。
风险极高
美国已经是富裕国家中孕产妇死亡率最高的国家之一——2024年的数据为每10万活产产妇死亡17.9人。根据美国疾病控制与预防中心的数据，美国每10例与妊娠相关的死亡中就有8例可能是可以预防的。医学研究表明，与激素避孕相比，妊娠带来血栓、中风和心血管并发症的风险要高得多。
自2022年最高法院做出“多布斯诉杰克逊妇女健康组织案”判决，推翻了“罗伊诉韦德案”确立的宪法堕胎权以来，美国大部分地区的堕胎服务获取渠道已大幅缩减。尽管在远程医疗和跨州就医的推动下，全国堕胎数量有所上升，但研究显示，实施堕胎禁令的州出生率有所增加，每年估计新增3.2万名新生儿，其中年轻女性和有色族裔女性占比过高。
加州大学旧金山分校以人为中心的生殖健康项目主任克里斯汀·德尔endorf博士表示：“没有任何证据表明限制避孕服务会带来任何积极结果。”限制避孕服务反而会增加对堕胎服务的需求，让女性更难预防高风险妊娠。
自特朗普重新执政以来，已有十多家《第十号标题法案》拨款受助者的拨款被冻结，迫使一些医疗中心停止提供服务、裁员或关闭。在特朗普第一任期内，监管改革导致《第十号标题法案》服务患者数量从400多万人下降到150万人。在拜登政府时期，该项目缓慢增长，服务客户约300万人，随后又出现了当前这一轮 disruption。
马塞拉表示，特朗普第二届政府对该项目的全面改革“直接破坏了我国计划生育项目的公共卫生初衷，可能会让数百万人无法获得他们依赖了数十年的医疗服务。这是糟糕的政策”。
KFF健康新闻是一家全国性新闻编辑部，专注于健康问题深度报道，也是KFF的核心运营项目之一——KFF是独立的健康政策研究、民意调查和新闻资讯来源机构。
As U.S. birth rate falls, Trump officials downplay contraception in family planning program
April 16, 2026 / 5:00 AM EDT / KFF Health News
The number of babies born in the United States fell again last year.
According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a 1% decline from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.
The Trump administration has said it wants to reverse this trend. President Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also proposing to reshape the federal government’s only dedicated family planning program: Title X.
For more than five decades, Title X has been geared — with bipartisan support — toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the safety net program served more than 5 million patients a year. Six in 10 Title X clients have reported the program as their sole source of health care in a given 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 Notice of Funding Opportunity included only one mention of contraception — describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”
The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.
While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies — a long-standing goal of the program.
Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.
“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that President Trump has proposed eliminating Title X altogether.
Birth rates and fertility trends
The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.
The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later adult milestones, including stable employment, leaving the parental home, and marriage,” she said.
Most American women, she said, still complete their childbearing years with an average of two children, suggesting a shift toward smaller families rather than an increase in childlessness.
“Having children has become more contingent and more planned,” she said.
Much of the decline since 2007 reflects women postponing births rather than forgoing them.
“The average number of babies women are having in their whole lives has not fallen. It’s still more than 2.0 for women aged 45,” said Philip Cohen, a professor of sociology at the University of Maryland.
Phillip Levine, an economist at Wellesley College, said the birth rate has declined due to shifts in how women approach work, leisure, and parenting. “Efforts to reverse those patterns would be more successful if they can make childbearing more desirable, not make it harder to prevent a pregnancy,” he said.
Asked about the role of contraception in reducing maternal mortality and how the new funding notice advances that goal, HHS press secretary Emily Hilliard said in a statement: “Applicants for the 2027 Title X funding cycle will be expected to align with the administration’s stated priorities in the released Notice of Funding Opportunity. HHS, under the leadership of Secretary Kennedy and President Trump, will continue to support policies that support life, family well-being, maternal health, and address the chronic disease epidemic. HHS remains focused on improving maternal outcomes and ensuring programs are administered consistent with applicable law.”
Marcella said the new funding notice is the product of two converging forces: the Make America Healthy Again movement, with its skepticism of conventional medicine and emphasis on lifestyle and behavioral interventions, and a pronatalist agenda that seeks to boost birth rates by steering policy toward family formation.
The document’s language reflects both: It repeatedly invokes “optimal health” and “chronic disease” while sidelining the contraceptive services that have defined Title X for half a century.
Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, which represents health professionals focused on family planning, said tying Title X to birth-rate goals replaces individual decision-making with a government objective. The program “is designed to facilitate access to family planning services, including services to achieve and prevent pregnancy,” she said.
Title X’s new focus
The administration’s changes have been welcomed on the right.
Emma Waters, a senior policy analyst at the conservative Heritage Foundation, who has advocated for what she calls “restorative reproductive medicine,” said the new funding notice reflects overdue attention to neglected aspects of women’s health.
“I was particularly encouraged to see language that spoke to the delays in diagnosis for conditions like endometriosis, the need for women to practically understand how their cycle and fertility works, and to ensure that real root-cause was promoted through Title X,” Waters said.
She described the notice as an expansion, not a narrowing, of the program’s mission: “I see this iteration of Title X as the fulfillment of its purpose. The goal was never just ‘more contraception’ but a wholesale empowerment of women to govern their own fertility.”
Waters also argued that untreated reproductive health problems may contribute to lower birth rates.
“One of the interesting aspects of this debate, and one that is often overlooked, is the degree to which painful and unaddressed reproductive health problems may suppress or create ambivalence around a woman’s desire to have kids,” she said, pointing to endometriosis.
An estimated 5% to 10% of women of reproductive age have endometriosis, and of those, 30%-50% experience infertility. Scientifically speaking, the relationship is an association, not a proven cause. Women aren’t screened for endometriosis if they don’t have symptoms, and the condition may be more prevalent than is recognized. Researchers still do not fully understand why some women with endometriosis struggle to conceive while others do not, and treating the disease does not reliably restore fertility.
Infertility rates in the U.S., meanwhile, have not risen. An analysis of federal survey data found them essentially flat between 1995 and 2019, even as the national birth rate fell sharply — a divergence that points away from untreated reproductive disease as an explanation.
Meanwhile, in February, the American College of Obstetricians and Gynecologists issued new clinical guidelines enabling earlier diagnosis of endometriosis without surgery, a step toward addressing the delays Waters described. But the first-line treatment ACOG recommends is hormonal therapy, part of the same category of care the funding notice dismisses as part of an “overreliance on pharmaceutical and surgical treatments.” The effect, reproductive health experts say, is a contradiction: Title X is now prioritizing diagnosis of endometriosis while deemphasizing the drugs clinicians use to treat it.
Treatments that have been shown to improve fertility in women with endometriosis, such as laparoscopic surgery and in vitro fertilization, are not covered by Title X. When President Richard Nixon signed Title X into law in 1970, he described it as a way to expand access to family planning services — helping women determine the number and spacing of their children by making contraception and related preventive care more widely available, particularly for those who could not afford it. Medicaid, not Title X, is the primary government health insurance program covering health care for low-income women, but, like many commercial insurance plans, it does not cover IVF.
Many of the conditions prioritized in the funding notice deserve attention, said Liz Romer, a former chief clinical adviser for the HHS Office of Population Affairs who helped write updated guidelines for the family planning program. But they fall outside the scope of what Title X can realistically provide.
“There’s not even enough funding to support the core premise of contraception,” Romer said. “And so, if you want to expand Title X funding, you can expand the scope, but you can’t move away from the foundation.”
The emergence of an anticontraception ideology within federal health policy is striking, she said, given how broadly the public supports access to birth control. Eight in 10 women of childbearing age surveyed by KFF in 2024 reported having used some form of contraception in the previous 12 months.
Laura Lindberg, director of the Concentration in Sexual and Reproductive Health, Rights and Justice at Rutgers School of Public Health, said, “If contraception is sidelined in Title X, it won’t just change language on paper but will show up as fewer options and more barriers for patients.” Funding could move away from providers who offer a full range of contraceptive care, she added, “toward organizations that are ideologically opposed to contraception and don’t deliver the same standard of health care services.”
The stakes are high
The United States already has one of the highest maternal mortality rates among wealthy nations — 17.9 deaths per 100,000 live births as of 2024. According to the CDC, 4 in 5 pregnancy-related deaths in the U.S. may be preventable. Medical research shows that pregnancy carries substantially higher risks of blood clots, stroke, and cardiovascular complications than hormonal contraception.
And since the Supreme Court’s Dobbs decision in 2022, which overturned the constitutional right to abortion established by Roe v. Wade, access to abortion has been significantly curtailed across much of the country. While national abortion numbers have risen, driven largely by telehealth and interstate access, research shows births have increased in states with bans, with an estimated 32,000 additional births annually, disproportionately among young women and women of color.
Dr. Christine Dehlendorf, who directs the Person-Centered Reproductive Health Program at the University of California-San Francisco, said “there is absolutely no evidence for any positive outcome of restricting access to contraception.” Restrictions would instead increase demand for abortion care and make it harder for women to prevent high-risk pregnancies.
Since Mr. Trump returned to office, more than a dozen Title X grantees have had their grants frozen, forcing some health centers to stop delivering services, lay off staff, or close. During the first Trump administration, regulatory changes led to a decline in Title X participation from more than 4 million patients to 1.5 million. The program grew slowly under the Biden administration, reaching about 3 million clients, before the current round of disruptions began.
The second Trump administration’s overhaul of the program, Marcella said, “directly undermines the public health intent of our nation’s family planning program and will potentially exclude millions of individuals from getting the care they have relied on for decades. It’s bad policy.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.