ObjectivesIn 2019, the Trump administration introduced rule changes, colloquially known as the “Domestic Gag Rule,” to the federal Title X program. As a result, many grantees withdrew from the program. This study aims to assess the impact of the rule change on service provision within the Title X program, both while the rule was in place and in the period following its reversal. Study DesignWe obtained disaggregated Family Planning Annual Report data for all states from 2018-2022. Using a previously-created variable determining the proportion of each state’s Title X capacity loss from the 2019 rule (0%, 1-24%, 25-50%, 50-89%, 90-99%, 100%), we conducted mixed effects linear regression exploring outcomes of interest (number of total clients served; number of female/male contraceptive methods provided; contraceptive method mix; sexually transmitted infection (STI) services provided) pre-rule change (2018), during the rule change (2019-2021), and post-rule change (2022). ResultsDuring the rule change period, the average total number of services Title X provided decreased by 16% nationwide from the pre-rule change period. However, states with higher levels of reduced capacity saw significant additional losses in reproductive health service provision. The total number of clients, the number of female/male contraceptive methods, and the number of STI services provided did not improve in the post-rule change period. In addition, the number of moderately effective methods provided decreased significantly during the rule change period and continued to decline post-rule change. ConclusionsTitle X services were significantly impacted by the rule change and subsequent recovery is slow.