Title X Health Centers Share the Impacts of Withheld Funds – Part 2

Find part 1 of this episode here.

In April 2025, some organizations and health centers receiving Title X funding were given sudden notice by the current administration that critical funding would be withheld. This action by the federal government threatens roughly $65.8 million in Title X funds and implicates an estimated 846,000 patients. It has resulted in massive layoffs, stopped contracts, mental strain, and confusion for both employees and patients. As patients are not receiving the care they need due to a stop in funding, possible results could include rising rates of unintended pregnancies, rising rates of STIs, poorer maternal health outcomes, and later diagnoses of breast and cervical cancers. 

 We sit down with CEOs and executive directors of some of these impacted organizations, including: 

Stephanie McDowell, Executive Director of Bridgercare in Montana

Ayana Bradshaw, President and CEO of AccessMatters in Pennsylvania

Amy Moy, Co-CEO with Essential Access Health in California and Hawaii

Transcript

Jennie: 0:03

Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. Hi, rePROs. How's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/ her. So y'all, I have dropped a big ball the last two weeks for you. I'm so sorry. We had big and exciting news. And if you weren't following us on social media, you don't know about it. Oh my goodness, I'm so sorry. But that is one, a reminder that you should absolutely be following us on social media. You can find us at rePROs Fight Back on Facebook, Blue sky, and Twitter, and at @repros fb on Instagram. So, find us there. Never miss out on a moment like this again. But anywho, the exciting news is we've officially launched a merch store. Woo! That means you can get all of our really fun rePROs Fight Back swag for yourself now on Bonfire so if you go to Bonfire and search up "rePROs Fight Back," it'll pull up our merch and you can go to our specific page on Bonfire we'll have links in the show notes and we have so many fun things we have mugs and water bottles and t-shirts and bags and these cute little pouches and we have designs from Liberal Jane that we have that you may have seen if you've seen some of our stickers before We have designs from our in-house designer, which was our previous bag design, which is "abortion is a human right, not a dirty word." You can order all of these things for yourself now. Y'all, I love all of it so much. I have been, keep going back on what I want to prioritize for ordering myself first and not buy all the things because seriously, I can't buy all the things at once. But I'm going to go and buy a couple of things for myself because I'm so excited to rock some of this great rePROs Fight Back swag out in the world. So, I hope you will as well. You can find us on Bonfire again. The link is in the show notes. And if you are following us on social media, we've also shared it there as well. So yeah, make sure to check out our really fun swag. It's really great. You may have seen the designs before. If you have seen us out and about, it's our really great stickers that we have, fun to Thank you so much. Super cute. Liberal Jane, as always, does such an amazing job designing things. I hope y'all will go and check out the store and buy yourself some stuff so you can rock your rePROs Fight Back swag out in the world. That is the biggest thing. And y'all, it launched on earlier this month and it really, as I recorded my intros, I felt like I had all these other things to talk about and kept forgetting to tell you about the store. I am so sorry. But please, please check it out. I hope you love the stuff as much as we all do I guess maybe let me think if there's any other housekeeping... if you also want to support us by donating you can do that as well. If you donate $25, you get our array of wonderful stickers that Liberal Jane designed. For $50, you get the stickers and the bag that says abortion is human right not a dirty word. Or you can go buy the stuff on the merch store although the stickers aren't in the merch store because bonfire didn't have a stickers option. So, if you want stickers, the only way to get them is by donating specifically through our website. So yeah, I hope you enjoy all that. And I guess the only other last thing I would share around housekeeping is I feel like it's also been a while since we talked about rating and reviewing. If you love the podcast, it would be really great if you could drop us a rate or review and whatever podcast platform you are listening on. It helps other people find and enjoy the podcast. Okay, I feel like that is enough. Mostly, I'm just still super excited about the store. It still feels pretty surreal. Thank you to the people who have already bought things. We're very excited to see that. And I hope you all will check it out as well. I think I'm going to keep the intro really short and maybe not talk about anything else. We have a wonderful episode. We have three more Title X providers coming on to share their stories about their funding being frozen by the Trump administration. And so, I think I'm just going to turn the episode over to them so you can hear from them what this funding freeze has meant for them. And this is a really important moment and to think about how they are all working together to prevent those who are the most marginalized from accessing sexual and reproductive health care services. So with that, let's turn to the amazing Title X providers who shared their stories with us.

Stephanie: 5:11

Hi, my name is Stephanie McDowell. My pronouns are she/her. I'm the executive director of Bridger care and Montana Family Planning. First, as a fan of the pod, this is so cool. I think most people wouldn't consider my job glamorous, though I totally love my job, so that's okay. But today feels pretty dang glamorous, so that's really cool to have our story shared on this platform. So, thank you again for having me today. First, I want to explain Montana Family Planning and Bridgercare and what we do. So, Bridger care has served as a subrecipient of Title X funding since 1972, and we took over management of the Family Planning Clinic Network in Montana in 2022 and protected access to care for over 15,000 patients annually when we did that. So, Bridgercare not only supports 20 clinics to provide care across the state, but we are also a direct service provider in Bozeman, Montana, and we serve over 5,500 patients a year. 55% of our patients receive services on the sliding fee scale. So, we feel really fortunate to have the experience of being direct service providers, who understand what the other 19 clinics in our state experience as sexual and reproductive health care experts every day. Bridgercare's Title X program is called Montana Family Planning. And we started this program when Bridgercare competed the state of Montana for the Title X grant in the year 2021, after Montana's legislature passed a bill that was in direct conflict with the terms of the federal Title X grant. So, in winning the Title X grant in Montana, we were able to protect funding for our 20 clinics across Montana. And so, that means that Bridgercare receives $2 million from the federal government each year to support 20 clinics across the state of Montana, including our own Bridgercare, or Planned Parenthoods and some smaller rural clinics spread around the state. These clinics provide services like birth control, annual wellness exams, STI testing and treatment, options counseling for pregnancy, infertility care, cancer screening, biological pain management, and more. And all of the Title X services are offered on a sliding fee scale with the fees that are based on patient's income. So, Montana Family Planning is Bridgercare's program and is Montana's statewide network of family planning clinics that provide access to sexual and reproductive health care. We focus on removing barriers so that everyone can receive the high quality care they deserve. And we do this with federal Title X money. So, Title X is the nation's only dedicated source of federal funding for family planning services. And the mission is simple. It's to provide high quality sexual and reproductive health services for people who are uninsured or who have low incomes who may otherwise lack access to health care. So annually, the National Title X Network provides health care to nearly 4 million adults and teens. And Title X is administered by the Federal Office of Population Affairs within the U.S. Department of Health and Human Services. So, the challenge that we are facing at Bridgercare and Montana Family Planning and our 20 clinics is that we have been operating without federal funding for three months now. So this is critical, life-changing care that has a profound impact on our patients. And every day that it is threatened impacts real people in Montana. In Montana, the Title X Network is comprised of, as I mentioned, 20 clinics who provide expert information safety net care to over 15,000 Montanans a year. And the vast majority of those patients are people who are low income between the ages of 18 and 45. And alarmingly, 60% of the women who received contraceptive services from our network had no other contact with the healthcare provider that year. So we are the only source of care for 60% of the patients who sought care with us. In Montana, 51 out of 56 counties are considered healthcare provider shortage areas. So the loss of Title X funding truly threatens to create devastating gaps in care in our state. I am happy to say that despite the funding freeze, Bridgercare's network of 20 clinics continues to provide services with the support of private donations. So, we have not had to close any of our clinics or lay off any staff thanks to the support of private donations. So, so grateful for our allies and supporters out there. And we really want our patients to know that we are still providing care and they are our priority. Right now, our primary concern is ensuring that access to family planning and sexual and reproductive health care is uninterrupted for our most vulnerable Montanans. We don't want them to be impacted by these power grabs in Washington. So BridgerCare and our network of 20 family planning clinics across Montana, we provide contraception and other sexual and reproductive health services to people who want it but can't afford it. So this is, again, critical, life-changing care, and it has a profound impact on our patients. So, Title X has really served as the cornerstone of safety net care for millions of people across the US by providing contraceptive access that helps people avoid pregnancies they do not want and to plan and space pregnancies they do want. And in 2023, 83% of Title X clients had family incomes at or below 250% of the federal poverty level. So this really matters because high quality sexual and reproductive health care empowers people to make decisions that are right for them. It's central to their ability to make decisions about their lives, including when or whether to consider having children. And annually, we also provide preventative and sexual and reproductive health care, including in Montana, over 4,100 clinical breast exams per year, over 3,600 screenings for cervical cancer, and over 21,000 screenings for STIs. So, not only are we helping people decide when or whether to consider having children, we're also helping them with their healthcare, preventative healthcare and screenings that they need. Services are always confidential and are provided at low or no cost. We have 20 clinics across the state. Most of them are small rural health departments, but we also have independent nonprofits like Planned Parenthoods and community health centers in our network. You can find a clinic near you by visiting our website at www.montanafamilyplanning.org, if you're in Montana or in a nearby state. The services that are offered at each of our clinics might vary, and some offer additional services that go above and beyond the basics. While most of our clinics accept walk-ins, we encourage you to call ahead just to make sure that the staff and the services you need will be available. And then we also provide language translation that's available free of charge to people who need it. All of our clinics serve all identities. So, we work to be free from discrimination. That's just our starting point. We work every day to make our clinics more welcoming, safe, and inclusive, and prepare to care for people of all identities. We also serve people of all incomes. So, Title X is really intended to remove cost barriers to high quality sexual and reproductive health care. And services are always provided on a sliding fee scale, which is based on your income. So whether you make zero dollars or a million dollars, our clinics will serve you. And we serve clients with or without insurance or Medicaid and really clients across the socioeconomic spectrum. So if you don't have insurance or Medicaid or you can't use it for some reason or if a service isn't covered, we'll make sure that the cost doesn't prevent you from receiving the care you need. There's also a misconception that people who need insurance healthcare or have insurance or can afford healthcare, that they should go somewhere else. And really that's not true. We love it when our patients stay with us throughout their lives, if that's what they want to do and if they like their care. Their insurance coverage and their payments help support care for people who can't afford it or who don't have insurance. And to give you an idea of this, in the Montana Family Planning Program, 30% of our patients don't have insurance. 25% of our patients are on public insurance like Medicaid, and then 44% have private insurance, so we do see a lot of people who have insurance coverage. And it’s really important to point this out because a) what I mentioned before, you can still come to us with insurance, just like you can if you don’t have insurance, and b) many people still can’t afford healthcare because of high deductibles or co-pays. So, we really want folks to know that we will meet them where they are and provide the care that they need. And then lastly, our patients' privacy is really important to us. We take privacy seriously. We offer unparalleled confidentiality protections for clients who need them. We help you understand whether billing insurance could limit your privacy. And then we help you go the extra mile to make sure it's not minors. So, people under 18 do not need parental permission to seek care at a Title X clinic in Montana. And nobody needs a government-issued ID or to be a U.S. citizen to access our care. So, this freezing of this funding for a state like Montana really does have a profound impact. We are a very rural state. To give you an idea, we have 7.7 people per square mile in our state. Our clinics are really strategically spread across the state to ensure that people who want birth control but can't afford birth control have access to quality care. And I do want to share some stories from our clinics just to give you an idea of the people in our state providing care, but also some of the patients that would be impacted by these funding freezes. So, one rural clinic was able to accommodate a new client who needed an urgent appointment because their IUD was expelling. The client had just moved to Montana and drove multiple hours for their visit, which is a common experience in this part of the state, and they were thrilled to get the care that they need when they needed it. Another rural clinic is sharing that they're seeing a lot of clients coming in with babies and young children in tow, and the staff go the extra mile holding and watching kids during appointments so that the clients can get the care that they need. Sometimes clinics say they stay open late or they open early to accommodate people with work schedules that conflict with traditional clinic hours. We see teens coming in that are nervous and scared. So, our clinics help them with paperwork and filling out their sliding fee scale so they know they will not have to pay anything or not to worry about confidentiality. And often by the time they leave, they're confident and secure and they are relieved to have our services and be able to get the birth control from us at no charge or on their own terms. We support clients facing intimate partner violence to access care on their terms and in the way they decide they need support. This often means finding contraception or making referrals for additional care that can be kept concealed or private. We provide education in our communities and answer questions like, How do I know if I'm gay? How do I know if I have an STI? What do I do if I think I'm pregnant? And we respond with values, neutral answers, and we empower people with medically accurate information to make decisions that are right for them. So in Montana, we make room for all sorts of beliefs about family planning and contraception that are patient-centered. Many of our rural Montana family planning clinics have recently had physicians from their local hospitals calling to get help diagnosing STIs because our clinics are considered experts in these topics. One of our clinics had a patient travel two hours for care because she knew her visit would be kept private and she loved her clinician. Another rural Montana family planning clinic also shared a story about a teen patient who came in to get birth control several years ago and since then has brought in multiple teen friends to access care. And the clinic said that many of the teens had come in with her, were timid and nervous at first, and so she would help them with their intake and paperwork. And by the end of the appointment, the teens were feeling empowered and were speaking out about their own wants and needs. And so, I share these stories because these clinics are full of people who care about their patients and their communities. And their patients are real people who are impacted by the care they receive. These are people who want birth control and sexual and reproductive health care, but they can't access it because of cost or where they live. And so ultimately, Title X creates access to full bodily autonomy for people who were previously not able to access it because of economic reasons. And everyone who cares about contraception should care about Title X. So, thank you for having me on today and listening and learning more about Bridger care and Montana Family Planning. Sending lots of care out to our listeners. Take care of yourselves. We need you all. Thank you.

Ayana: 19:51

Hi, thank you so much for the opportunity to speak with you today about Title X and specifically about the withholding of our Title X family planning funding in our region. So, my name is Ayana Bradshaw. I am the president and CEO of Access Matters. We are a nonprofit organization located in Philadelphia, Pennsylvania. And our mission is to protect, expand, and enhance access to sexual and reproductive health care and information for all people. And we have had the honor and the privilege of administering the Title X family planning funding in our region for over 50 years. For over 50 years, we've had the privilege of partnering with trusted healthcare providers. And we are in the five-county area of southeastern Pennsylvania to ensure that people, regardless of their income, regardless of the insurance status or their background, can access the care they need to live healthy and full lives. But right now, our community is facing a significant crisis without warning. This was on March 31st. I remember the minute that this happened. Our Title X funding was withheld pending federal review. So, that's almost three months that we have not had this funding. And that decision has already had such devastating consequences, not just for our organization, but for the providers, the staff, and the thousands of patients across southeastern Pennsylvania that rely on these services. At Access Matters, we've actually had to temporarily lay off team members. These are amazing people, dedicated people who have spent their careers supporting community health. But the impact goes even further. Our provider network, and that's our clinics, our health centers that we fund, they are also grappling with making similar heartbreaking decisions related to laying off staff, hours being cut, And what would be most detrimental is if some of our clinics are forced to close. And the patients, well, they're the ones who are going to bear the brunt of all of this. So as I mentioned, we support a five-county area in southeastern Pennsylvania. So, that means that we support Philadelphia, Montgomery, Chester, Delaware, and Bucks counties. This is a region in Pennsylvania that already struggles with health disparities. Many of the people that we serve, they face disproportionate barriers to care, whether or not that's due to income, lack of insurance....we know that there are racial inequities, transportation issues. And Title X has been one of the few programs that they could count on. And not everyone knows this, but Title X is not just about birth control. It funds a wide range of essential health services. So, when you think of things like STI testing and treatment, cancer screenings, reproductive life planning, health education, so much more, it's oftentimes the first point of contact that someone has with the healthcare system. I like to say it's a gateway. And through that first visit, providers are often identifying other issues so if you think about it as you're going into a clinic for a first time you may find out that you have high blood pressure or providers may identify depression and food insecurity and housing instability, and really truly help connect people to the support they need. So, these visits are more than just medical care, they are a gateway to stability. And here's something else that people may not realize, but Title X guarantees affordability. So, under this program, anyone living at or below the federal poverty level receives care and they get it free of charge, completely free of charge. And for those that are just above that threshold, clinics are using sliding fee scales. So, that means that a patient is charged based on what they can actually afford. No one is going to be turned away because they don't have the money. But now, where we are right now, with this withholding, with these funds being withheld, clinics may no longer be able to honor that promise. If they can't offer the sliding scale or if they lose the support that allows them to offer free care, people who are already struggling, do you think they're going to pay for this care? They're going to stop seeking care altogether. It also affects access to affordable prescriptions. So, many Title X providers participate in a program called 340 drug pricing. This is a program that allows providers to offer discounted medications. So, that can include things like birth control and HIV prevention medications like PrEP and PEP and other essential prescriptions. And so if you don't have the Title X designation, then many of those clinics are going to lose access to 340B pricing. That means that their patients will lose access to medications they need to stay healthy. And we know this is already happening. We've talked to our providers. They are so concerned about their patients who no longer can afford these prescriptions. This is also gonna hit maternal health really hard, and especially Black maternal health. So in Pennsylvania, Black women are more than twice as likely to die from pregnancy-related causes than white women. And we know that Title X helps to fight that disparity. Title X allows for early screenings, it allows for preventive care, and it also helps to connect women in maternal health services. And so pulling this funding now, that only deepens those inequities. I want to go even beyond the individual, because we know that impact of the individuals. But what may not be realized is that this actually hurts our economy. So, for every dollar invested in Title X, we save about $7 in downstream costs. It helps people stay in school. It helps people participate in a workforce, plan their futures. So when we pull support like this, we're not just cutting care, we're actually cutting opportunity. And this is where the advocacy comes in because at Access Matters, every single day since March 31st, we have been advocating for the reinstatement of these funds. It's not just for us, but it's for the providers and the patients who rely on them. But we need more people to understand what's at stake. I always say that Title X is this silent program. For decades, Title X has been quietly protecting our communities. And because it's been here for so long, I don't think a lot of people even realized what it was or how much it did. But now is the time for everyone to pay attention. We all need to pay attention because if we don't act, the consequences are going to ripple for years. We know that there are going to be more untreated infections. There are going to be more late stage cancers. There are going to be more unplanned pregnancies, more preventable deaths. More people are going to fall through the cracks. And so that's why I'm so grateful for this opportunity today, for this platform, because we need multiple voices talking about this. We need multiple people advocating about this. And we need our Title X funding restored. We need it now. Thank you so much for this opportunity. Again, I am truly grateful.

Amy: 27:14

I'm Amy Moy, co-CEO at Essential Access Health, and our organization advances reproductive equity and champions high quality, equitable access to sexual and reproductive health care for all. We have been a Title X grantee since the program was established about 55 years ago by Congress with bipartisan support. And we have been the proud Title X grantee in the nation with the largest Title X system in the country. Our California provider network, which we have been the grantee for the state since the program was established, has over 60 healthcare organizations in our network. And we have the privilege and honor of being able to serve as the Title X grantee in the state of Hawai'i ever since 2022. Collectively, the Hawai'i and California Title X networks provide care to over 500,000 patients at more than 300 healthcare sites. The Trump administration's decision to withhold our Title X awards for California and Hawai'i was unlawful and unprecedented and caused immediate harm. The impact that we felt over the last three months when no Title X funds have been coming to Essential Access Health or the extensive provider network we support has been devastating. There have been difficult decisions to be made around our staffing structure and we know that the healthcare organizations that we fund have had to similarly look at what decisions need to be made if these funds were not released. We know that more than ninety percent of the Title X funding that is received in the Hawai'i and California provider network supports their critical staffing infrastructure. And without Title X funds, our Title X network providers have reported that there would be a reduction in the health care workforce. And we know that many service areas in Hawai'i and California were already facing provider shortages and contraceptive deserts. Many of the Title X providers also use those funds for community outreach and education that links patients to care. And without Title X funding, a lot of those activities were halted and there was a need to consider either eliminating in full or drastically reducing some of that programming. We also know that Title X funds are critical in ensuring access to care, particularly for those who face barriers to getting to a health center. Title X funds can support mobile clinics to do outreach in underserved populations and neighborhoods without a brick and mortar health center. Title X funds also support extended clinic hours and teen clinic hours for patients that might have difficulty coming during some regular nine to five hours. They support transportation to clinics. So, these funds are so critical to ensure and support the delivery of high quality sexual and reproductive health services. The funding also supports provider training and supports to make sure that access to best practices and the highest quality care is available for patients who rely on Title X-funded health centers and Title X funding for care. While we are greatly relieved that now with the release of funding for essential access for our Title X award, that release of funding is a necessary and overdue step, but it doesn't erase the harm that was caused by this arbitrary, illegal, and immediate withholding of the critical resources in the first place. And while we're greatly relieved that we will be able to get these vital funds out to the field, and we are going to be working as hard as we can to get these vital funds out as quickly as possible, we know that also this may be a temporary reprieve. We also know that the withholding of Title X funding didn't happen in a vacuum, that while the release of Title X awards for California and Hawai'i is a glimmer of hope and good news for the providers and patients who rely on this critical funding source, we know that this is also coinciding with other threats and actions that are creating distress, duress, and disruptions to accessing time-sensitive sexual and reproductive health care, particularly for patients with lower incomes, including the sweeping reconciliation bill that was just signed into law that slashes Medicaid, targets trusted providers, and takes away health care from an estimated 17 million people. And we also know that studies show that more than 70% of family planning services is actually covered by Medicaid. So, cuts to Medicaid, trusted providers being carved out and unable to be able to provide critical care for patients that rely on Medicaid for coverage of these vital health services is also going to be devastating to the family planning system. And we also know that while the release of some of the family planning dollars is a relief for the moment, and we know that the process by which it was withheld was wrong. And the administration basically did the wrong thing, the wrong way. These actions also come against a backdrop of other unprecedented and ongoing attacks and the future of Title X and also access to contraception remains at risk nationwide. We know that there's the potential for new program regulations that may hinder and put a question around what services may be provided or covered under the Title X program, what entities may be eligible for Title X funding in the future, and just the scope and breadth of the program is in question under this administration and Congress. The president's budget proposal included elimination of the Title X program completely. And we are also waiting to see how Congress moves forward with their appropriations process to see how Title X funding is going to be handled in their appropriation process for fiscal year 25 to 26. So, the withholding of funds is one piece that was and continues to be something that we did not expect for its unprecedented nature, kind of midstream funding being withheld, released for some, not for others without clear process or indication and a withholding of funds without any cause or ability to be able to make any potentially needed action that might be needed for corrective action. And we are just moving forward with these funds as best as we can now, while also being very thankful that state legislative leaders in California and Hawai'i and under the leadership of Governors Newsom and Green recognize the important role that family planning services play in our individual, family, and community health and well-being, as well as our economic security. And they move forward with how having an allocation for state investments in these vital services to be able to support the family planning provider safety net over the coming year, as well as being able to support the patients that rely on services that they need that we know are time sensitive, including contraception, STI prevention and treatment, and even cancer screenings. I think moving forward, what we are hoping is that we will be able to communicate with our congressional leaders, continue to hopefully have dialogue with this administration, as well as state leaders and our community partners about the value of Title X and how critical it is to continue to protect this vital program and ensure that patients can get the family planning care they need when and where they need it from the providers that they trust in their local communities. I think it's also important to note that the health centers and many organizations that are direct Title X grantees, it's not only Title X. Many of these healthcare organizations receive multiple federal grants because of the piecemeal nature of our federal funding system, our healthcare system. You have the big behemoth of Medicaid that is covering, and it varies, of course, by state, the number of people and their income eligibility, but covering some level of direct service for many folks with lower incomes, but then we know that Medicaid rates and reimbursement rates do not cover the full cost of providing care. And we know that not everybody is eligible to receive Medicaid across the country who may be in need of support and care that may be otherwise unaffordable to them. So, what is happening now with the cuts to Medicaid, the threats and withholding of Title X funding, it's also on top of withholding of benefits, Ryan White [HIV/AIDS] funding or other critical funding sources that make up, that are the patchwork of our healthcare delivery system. And what we're seeing across the board is not only at this time our funds being abruptly withheld with some level of notification, some funding and notices of award are just being delayed and not even without any notice or justification or reason. Just for example, the CDC released some notice of awards for HIV prevention for a program period that was set to start June 1. There was no notice, there was no indication of when or if these notices of awards were coming. So these are just two examples in a broader healthcare system, also with patients and providers suffering the stress of of worrying about will ICE agents arrive at their health centers? Is this a safe place to go? Will patients still come to get the care that they need? All of these things are happening at once and it's somewhat of a perfect storm out there. So, while maybe some health centers could navigate some level of instability with Title X funding, Title X funding alone, it's that it's also... and for some, it's absolutely devastating if they don't have other sources of resources to help provide these care, but it's also happening on top of all of the other things. One other thing to note is even when notices of awards are granted and there's technically money for organizations in the grants management system, we also have heard across the board delays in being able to draw down the funding that's been awarded. And so, the consistency and reliability of this funding is just not existent. And this has really real-world implications as you mentioned when it comes to keeping doors open keeping inventory of contraceptive methods on the shelf and available, keeping staff. And then we know that there are healthcare shortages. So when we have these moments of crisis, we have a breakdown of the system that gets harder and harder to rebuild. This is a time of... and it does seem to be somewhat interesting... for the folks that still have their funding being withheld, not having any specific clear guidelines or timelines for having to receive it, it's awful. Our hearts are with colleagues that are continuing to have the funding. But I do think that this has been a wake-up call for a field that since 1970 has largely relied on this funding stream, that it's really time to think differently, to show up differently, to focus energy in other ways, to think about if the goal is making sure that people have access to the family services they want and need. What are the other ways that we can do that? Because, you know, this kind of cycle of the pendulum shifting when it comes to these federal funds, it's just, it's no way to live. You know, we need to kind of be thinking bigger and beyond that. Title X and also be thinking about when we have moments when the Title X federal funding is at risk, when the purpose and intent of the program is being threatened and could be reshaped in a way that is not in alignment with the purpose and intent of the program by which Congress established in statute. We also have to be thinking about the future, that while Title X is a critical resource, We also know it was created in 1970. There are ways that we can and should be thinking about this program differently to meet a modern healthcare system, to really meet the needs of patients and providers. And so, I think it's also imperative and incumbent on the field as well as in those who care about family planning services to be thinking about: how do we minimize risk in this moment? How do we maximize Title X funding and protect it for as long as we can, while also envisioning and being prepared for a moment in time knowing the cyclical nature of these things when we can hopefully envision and shape a stronger program.

Jennie: 43:02

Okay, y'all. I hope you enjoyed hearing from the Title X providers. I'm so grateful to NFPRHA for helping us put this episode together. They gave us a great collection of providers from all over the country to talk about their issues. I'm just so grateful for NFPRHA for that help and to all of the providers who stood up to tell their stories. So, thank you all. And with that, don't forget to check out our merch store. The link is in the show notes. Otherwise, you can find us on Bonfire by searching for "rePROs Fight Back." And with that, I will see everybody next week. [music outro] If you have any questions, comments or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@ reprosfightback.com or you can find us on social media. We're at rePROs Fight Back on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!