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Family Planning and Title X

Title X of the Public Health Service Act (1970) created the first comprehensive federal program funding family planning services on a national level, following studies in the 1960s that demonstrated that low-income women had higher rates of unwanted childbearing than more affluent women. Funds from Title X helped to establish family planning clinics across the country.

In 2011, we witnessed extreme attacks on Title X and America's family planning programs. The United State House of Representatives attempted to defund TitleX and prohibit Planned Parenthood from receiving federal money for family planning and other reproductive health programs. Thankfully, the United States Senate rejected these extreme proposals.

Despite these attacks, Title X remains the centerpiece of family planning funding in the United States. Title X provides funding directly to clinics in the form of grants, which today support more than 7,000 family planning facilities serving more than four million women per year nationwide. Title X clinics provide a broad range of services, including contraceptive counseling and supplies, breast and pelvic exams, STI tests, and unbiased counseling on all options available to a pregnant woman. In the United States, one in five women who obtain birth control counseling and one in ten women who obtain Pap tests, pelvic exams, or treatment for gynecological infections will obtain these services at a Title X-funded clinic. Each year, Title X clinics enable one million women to avoid unwanted pregnancies.

Care at Title X clinics is provided for free for clients living in poverty and on a sliding scale for clients with incomes between 100% and 250% of the federal poverty level. The program has proven extremely cost effective, with every $1 spent on family planning services saving taxpayers $3.74 that would otherwise be spent on pregnancy-related care through Medicaid.

While Title X has played a significant role in helping women to prevent unintended pregnancies, the program faces perennial political and financial challenges. In 1981, President Reagan attempted to dissolve the program entirely, and social and religious conservatives were successful in reducing the amount of Title X funding throughout the 1980s.

Despite modest increases in the 1990s, the program did not recover from these setbacks. The FY 2010 funding of $317 million is actually 26% lower than the $162 million appropriated in FY 1980 – once inflation is taken into account. In 2010 dollars, that FY 1980 funding would be more than $428 million.

The financial challenges Title X clinics face are exacerbated by the rising costs associated with providing reproductive health care. Clinics are seeing increased demand for long-lasting forms of birth control, such as Depo-Provera and Implanon, which cost more than oral contraceptives. Low Medicaid reimbursement rates, high malpractice insurance costs, and an expansion of services offered beyond basic family planning care have also increased expenses.

The clinics also face staffing shortages. The Department of Health and Human Services has phased out a specialized nurse training program that helped staff Title X clinics with nurse practitioners specializing in women's health, which has reduced the pool of qualified personnel.

In Massachusetts, federal Title X funds are distributed directly to private agencies, which spread the funds over 80 sites throughout the state. All of the organizations which receive Title X funds directly also receive state funds from the Department of Public Health. For FY 2011, the Commonwealth provided $4.65 millionfor family planning services for low-income residents (learn more about family planning funding in the current FY 2012 budget debate). In Massachusetts, an estimated 333,000 women and teens need publicly funded contraceptive services, which avert approximately 32,000 unintended pregnancies per year. A list of the agencies and the clinics funded by Title X and the Department of Public Health can be found on the Department of Public Heath's Family Planning website.
 
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