Title X - Title X

The Title X Family Planning Program, officially known as Public Law 91-572 or “Population Research and Voluntary Family Planning Programs”, was enacted under President Richard Nixon in 1970 as part of the Public Health Service Act. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. Title X is legally designed to prioritize the needs of low-income families or uninsured people (including those who are not eligible for Medicaid) who might not otherwise have access to these health care services. These services are provided to low-income and uninsured individuals at reduced or no cost. Its overall purpose is to promote positive birth outcomes and healthy fam ilies by allowing individuals to decide the number and spacing of their children. The other health services provided in Title X-funded clinics are integral in achieving this objective.

Title X is administered by the Office of the Assistant Secretary for Health, Office of Population Affairs (OPA) by the Office of Family Planning (OFP). The statute and regulations of Title X require that 90 percent of congressional appropriations be used for clinical family planning purposes. In FY2010, Congress appropriated around $317 million for the Title X Family Planning program.

History

The first federal subsidies to help low-income families with birth control came in 1965 as part of President Lyndon Johnson's War on Poverty program. In 1970 during the presidency of Richard Nixon, the Senate passed Title X unanimously, and the House voted 298 to 32 to pass the bill on to Nixon, who signed it into law. There was strong bipartisan support for Title X; Nixon noted as much in a statement he made upon signing the bill.

In 1972, Congress passed another bill to draw funds from each state's Medicaid program to help pay for family planning for low income families, the states to be 90% repaid by the federal government. A third bill was passed in 1975 authorizing a network of family planning centers to be built across the U.S., in 2014, some 4,400 centers were in operation. Title X and the subsequent supporting bills were funded by $2.4 billion in 2010.

Mandate and administration

According to OPA, Title X operates by granting funds to a network of community-based clinics that provide contraceptive services, related counseling, and other preventive health services. Typical grantees include State and local health departments, tribal organizations, hospitals, university health centers, independent clinics, community health centers, faith-based organizations, and various public and private nonprofit entities. OPA estimates that there is at least one clinic receiving Title X funding in 75% of counties in the U.S.

Ten Public Health Service Regional Offices are given the Title X funding and subsequently award regional service and training grant funds through a competitive review process. These offices also monitor program performance. Planned Parenthood clinics and affiliates are granted approximately 25% of Title X funding.

The services provided by Title X grantees include family planning and provision of contraception, education and counseling, breast and pelvic exams, breast and cervical cancer screening, screenings and treatment for sexually transmitted diseases (STDs) and Human Immunodeficiency Virus (HIV), education about preventing STDs and HIV and counseling for affected patients, referrals to other health care resources, pregnancy diagnosis, and pregnancy counseling.

In addition to providing these services, Title X works to improve the overall quality of family planning services offered in the U.S. and help grantees better respond to patient needs. Title X funds training for family planning clinic staff through five national training programs that focus on clinical training; service delivery; management and systems improvement; coordination and strategic initiatives; and quality assurance/improvement and evaluation. Training also emphasizes application of the quality family planning guidelines. Title X also looks to improve the provision of family planning services by engaging in data collection and research of the program and its grantees. Finally, Title X funds also aid in disseminating information and implementing outreach and education activities in communities.

Funding

Title X is funded every fiscal year by Congressional appropriations. It received approximately $317 million in FY2010 appropriations and enacted spending. President Barack Obama’s proposed budget for FY2012 would provide Title X with $327 million, which, according to the White House Office of Management and Budget (OMB), would represent an increase of nearly $11 million over 2010 enacted spending.

Title X receives further funding from Medicaid reimbursements and additional federal sources. Combined with Congressional appropriations, these funding sources amount to over half of the operational funds provided to Title X grantees. The remainder of the funding comes from State and local funds, in addition to private sources like insurance and some patient fees.

Abortion

By preventing unintended pregnancies, Title X has decreased the number of abortions in the United States. Since its inception, Title X has not provided funds for programs that use abortion as a family planning method.

Title X grantees and sub-recipients must be in full compliance with Section 1008 of the Title X statute and 42 CFR 59.5(a)(5), which prohibit abortion as a method of family planning. Grantees and sub-recipients must have written policies that clearly indicate that none of the funds will be used in programs where abortion is a method of family planning. Additional guidance on this topic can be found in the July 3, 2000, Federal Register Notice entitled Provision of Abortion-Related Services in Family Planning Services Projects, which is available at 65 Fed. Reg. 41281, and the final rule entitled Standards of Compliance for Abortion-Related Services in Family Planning Services Projects, which is available at 65 Fed. Reg. 41270.

Despite the broad bipartisan support for Title X in 1970, in 2011 Title X became entangled with the abortion debate, during negotiations about funding for the government's programs, as well as the proposed FY2012 budget.

Abortion opponents have taken issue with Title X since 25% of all Title X money goes to Planned Parenthood affiliates, and Planned Parenthood clinics are the nation's biggest private abortion providers. Although Planned Parenthood is prohibited from using federal funds to perform abortions, abortion opponents argue that any money given to Planned Parenthood from Title X frees up more nonfederal money that can be used to perform abortions. Then Representative, now Governor Mike Pence, a Republican from Indiana, has led the charge to prevent Planned Parenthood from receiving Title X funds. House Republicans called for cuts of over $300 million from Title X for FY2011 in order to reduce the number of abortions.

Impact

In 2006, publicly funded family planning services (Medicaid, Title X, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens; the number of unintended pregnancies among poor women would nearly double. The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.

According to President Obama’s FY2012 proposed budget and the OMB, Title X provides grants to a network of over 4,500 clinics that annually serve over 5 million individuals. The OPA describes their clientele as racially and ethnically diverse, with most patients in their 20s. Title X mainly serves low- to middle-income women, but has stepped up its efforts to involve men in family planning efforts and the number of male clients is on the rise.

In February 2011, a National Public Radio (NPR) article evaluated the impact of Title X. NPR cites a Guttmacher Institute report claiming that Title X grantee clinics serve 15% of women in the U.S. who use contraceptive prescriptions and supplies or get annual contraception check-ups. Furthermore, only five percent of patients served by Title X funding at these clinics came in solely for birth control. Nearly 90% also received preventive gynecological attention, and over 50% were treated for STIs or reproductive tract infections or related conditions.

Title X clinics and funding may represent the sole source of health care services for many of their clients. Of the 5.2 million patients served in 2009, 70% were below the federal poverty line and around 66% had no health insurance. In 2006, over 60% of women who received health care services at a Title X clinic identified that as their usual source of health care.