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The Title X Family Planning Program is the only
federal grant In the United States, federal grants are economic aid issued by the United States government out of the general federal revenue. A federal grant is an award of financial assistance from a federal agency to a recipient to carry out a public purp ...
program dedicated to providing individuals with comprehensive
family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
and related preventive health services. It was enacted under President
Richard Nixon Richard Milhous Nixon (January 9, 1913April 22, 1994) was the 37th president of the United States, serving from 1969 to 1974. A member of the Republican Party, he previously served as a representative and senator from California and was ...
in 1970 as part of the
Public Health Service Act The Public Health Service Act is a United States federal law enacted in 1944. The full act is codified in Title 42 of the United States Code (The Public Health and Welfare), Chapter 6A (Public Health Service). Contents The act clearly establis ...
. Title X is legally designed to prioritize the needs of low-income families or
uninsured Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to Hedge ( ...
people (including those who are not eligible for
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
) 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.Office of Population Affairs Clearinghouse
“Fact Sheet: Title X Family Planning Program.”
January 2008.
Its overall purpose is to promote positive birth outcomes and healthy families by allowing individuals to decide the number and
spacing Spacing may refer to: * ''Spacing'' (magazine), a Canadian magazine * Spacing effect in psychology; the opposite of cramming * The usage of spaces in typography ** Letter-spacing, the amount of space between a group of letters ** Line spacing or ...
of their children. In 2018, the program served 3.9 million people, 87% of them women. Between 2014 and 2019, Title X Family Planning program received $286 million per year. From the start, Title X funds could not be used to support
abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
. In 2019, the regulations were revised, making it harder for clinics that refer women to an abortion provider to receive Title X funds. In January 2021, President Joe Biden signed a presidential memorandum that called for the repeal of former President
Donald Trump Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who served as the 45th president of the United States from 2017 to 2021. Trump graduated from the Wharton School of the University of Pe ...
's Title X rule changes.


History

The first federal subsidies to help low-income families with birth control came in 1965 as part of President
Lyndon Johnson Lyndon Baines Johnson (; August 27, 1908January 22, 1973), often referred to by his initials LBJ, was an American politician who served as the 36th president of the United States from 1963 to 1969. He had previously served as the 37th vice ...
's
War on Poverty The war on poverty is the unofficial name for legislation first introduced by United States President Lyndon B. Johnson during his State of the Union address on January 8, 1964. This legislation was proposed by Johnson in response to a national p ...
program. By 1969, both
Congress A congress is a formal meeting of the representatives of different countries, constituent states, organizations, trade unions, political parties, or other groups. The term originated in Late Middle English to denote an encounter (meeting of a ...
and President
Richard Nixon Richard Milhous Nixon (January 9, 1913April 22, 1994) was the 37th president of the United States, serving from 1969 to 1974. A member of the Republican Party, he previously served as a representative and senator from California and was ...
supported a bill that will provide adequate Family Planning services. In 1970, the
Senate A senate is a deliberative assembly, often the upper house or chamber of a bicameral legislature. The name comes from the ancient Roman Senate (Latin: ''Senatus''), so-called as an assembly of the senior (Latin: ''senex'' meaning "the el ...
passed Title X unanimously, and the
House A house is a single-unit residential building. It may range in complexity from a rudimentary hut to a complex structure of wood, masonry, concrete or other material, outfitted with plumbing, electrical, and heating, ventilation, and air condi ...
voted 298 to 32 to pass the bill on to Nixon, who signed it into law. While in 1971 the federal budget for Family Planning was only six million dollars, by 1972 it was almost 62 million. In 1972, Congress passed a bill requiring state's
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
program to cover family planning services for low income families. Under this provisions, the federal government covers 90% of the states' expenditures. A third bill was passed in 1975 authorizing a network of family planning centers to be built across the U.S., resulting in almost 4,000 service sites in 2018.


Mandate

Title X is administered by the
Office of Population Affairs The Office of Population Affairs (OPA) is part of the Office of Public Health and Science in the United States Department of Health and Human Services (HHS). It is responsible for reproductive health topics, including adolescent pregnancy, family ...
(OPA). According to OPA, Title X operates by granting funds to a network of community-based clinics that provide
contraceptive Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
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. In 2018, 99 agencies received Title X funding, supporting almost 4,000 service sites in the U.S., including 8 U.S. territories. OPA estimates that there is at least one clinic receiving Title X funding in 75% of counties in the U.S.U.S. Department of Health and Human Services Office of Population Affairs
“Family Planning.”
/ref> Ten
Public Health Service In public relations and communication science, publics are groups of individual people, and the public (a.k.a. the general public) is the totality of such groupings. This is a different concept to the sociological concept of the ''Öffentlichkei ...
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 receive about 60 million annually through the federal programs, serving 40 percent of all Title X patients. According to the CDC, family planning services include contraception to reduce unintended pregnancy, pregnancy testing and counseling, basic infertility services, preconception health care, and sexually transmitted disease (STD) services. services provided by Title X grantees include family planning and provision of contraception, education and counseling,
breast The breast is one of two prominences located on the upper ventral region of a primate's torso. Both females and males develop breasts from the same embryological tissues. In females, it serves as the mammary gland, which produces and secret ...
and
pelvic exam A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, dis ...
s, breast and
cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
screening, screenings and treatment for
sexually transmitted infection Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are Transmission (medicine), spread by Human sexual activity, sexual activity, especi ...
s (STIs) and Human Immunodeficiency Virus (
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
), education about preventing STIs 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. In FY2010, it received approximately $317 million in appropriations and enacted spending. Since then, the appropriated budget has been below $300 million per year, with a $286 million yearly budget between 2014 and 2019. 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.


Impact

Title X has served millions of people throughout the years; according to HHS estimates, in 2018 alone Title X served 3.9 million family planning clients seen through 6.5 million encounters. Title X program serves mainly low income and young population. In 2015 it has helped reduce teenage pregnancies by 44% and prevented more than 188,000 unintended pregnancies. 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 as well as teens; the number of unintended pregnancies among poor women would nearly double. In 2018, Title X funding was used to cover more than 600,000 tests for cervical cancer, more than 800,000 tests for breast cancer, and almost 5 million tests for STDs. 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 White House Office of Management and Budget
“Helping Women and Girls Win the Future.”
/ref> The OPA describes their clientele as racially and
ethnically diverse The term multiculturalism has a range of meanings within the contexts of sociology, political philosophy, and colloquial use. In sociology and in everyday usage, it is a synonym for " ethnic pluralism", with the two terms often used interchang ...
, 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 National Public Radio (NPR, stylized in all lowercase) is an American privately and state funded nonprofit media organization headquartered in Washington, D.C., with its NPR West headquarters in Culver City, California. It differs from other n ...
(NPR) article evaluated the impact of Title X. NPR cites a
Guttmacher Institute The Guttmacher Institute is a research and policy NGO that aims to improve sexual and reproductive health and rights worldwide. This research organization was started in 1968 and works to study, educate, and advance sexual and reproductive health ...
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 Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
. Nearly 90% also received preventive
gynecological Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined area ...
attention, and over 50% were treated for STIs or
reproductive tract infection A reproductive system disease is any disease of the reproductive system. Types Infections Reproductive tract infection (RTI) are infections that affect the reproductive tract, which is part of the Reproductive System. For females, reproductive tra ...
s or related conditions.Julie Rovner, National Public Radio
“At-Risk Federal Funds Cover Far More Than the Pill.”
April 1, 2011.
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 The poverty threshold, poverty limit, poverty line or breadline is the minimum level of income deemed adequate in a particular country. The poverty line is usually calculated by estimating the total cost of one year's worth of necessities for t ...
and around 66% had no
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
. 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.


Abortion

Since its inception, Title X has not directly provided funds for programs that use abortion as a family planning method. At the same time, by preventing unintended pregnancies, Title X has decreased the number of
abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
s in the United States. 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 The abortion debate is a longstanding, ongoing controversy that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate most visibly polarizes around adherents of the self-describ ...
, during negotiations about funding for the government's programs, as well as the proposed FY2012 budget. Abortion opponents took issue with Title X since 25% of all Title X money went to
Planned Parenthood The Planned Parenthood Federation of America, Inc. (PPFA), or simply Planned Parenthood, is a nonprofit organization that provides reproductive health care in the United States and globally. It is a tax-exempt corporation under Internal Reve ...
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. Representative, and later Vice President,
Mike Pence Michael Richard Pence (born June 7, 1959) is an American politician who served as the 48th vice president of the United States from 2017 to 2021 under President Donald Trump. A member of the Republican Party, he previously served as the 50th ...
, a
Republican Republican can refer to: Political ideology * An advocate of a republic, a type of government that is not a monarchy or dictatorship, and is usually associated with the rule of law. ** Republicanism, the ideology in support of republics or agains ...
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. In June 2019, the
Trump administration Donald Trump's tenure as the List of presidents of the United States, 45th president of the United States began with Inauguration of Donald Trump, his inauguration on January 20, 2017, and ended on January 20, 2021. Trump, a Republican Party ...
was allowed by a federal court of appeals to implement, while legal appeals continue, a policy restricting taxpayer dollars given to family planning facilities through Title X. The final Title X Rule, as issued by the Department of Health and Human Services on 22 February 2019, prohibited the use of Title X funds to perform, promote, refer for, or support abortion as a method of family planning. However, nondirective pregnancy counseling, including nondirective counseling on abortion, was permitted. More details on the final rules can be found on the Fact Sheet released by the Department of Health and Human Services. As a result of the new rule, some groups withdrew from the program in August 2019, including Maine Family Planning and Planned Parenthood, which had been providing Title X birth control services to 1.5 million women.


Sterilization

Marie Sanchez, chief tribal judge on the Northern Cheyenne Reservation, arrived in Geneva in 1977 with a clear message to deliver to the United Nations Convention on Indigenous Rights. American Indian women, she argued, were targets of the “modern form” of genocide—sterilization. Over a six-year period following passage of the act, "physicians sterilized perhaps 25% of Native American women of childbearing age, and there is evidence suggesting that the numbers were actually even higher."


Restoration

On January 28, 2021, President Joe Biden signed a
presidential memorandum A presidential memorandum is a type of directive issued by the president of the United States to manage and govern the actions, practices, and policies of the various departments and agencies found under the executive branch of the United State ...
instructing the United States Department of Health and Human Services to review "undue restrictions" to Title X and to then "suspend, revise, or rescind" the Trump-era overhaul to Title X. On April 14, 2021, the U.S. Department of Health and Human Services released its Title X revision proposals. On October 4, 2021, the United States Department of Health and Human Services would issue regulation repealing the Title X gag rule effective November 8, 2021.


See also

*
Contraceptive mandate A contraceptive mandate is a government regulation or law that requires health insurers, or employers that provide their employees with health insurance, to cover some contraceptive costs in their health insurance plans. In 1978, the United Sta ...


Notes


References


External links


History of Title X
Administers the U.S. Title X Family Planning program.
Text of the act PUBLIC LAW 91-572-DEC. 24, 1970
{{Authority control Birth control in the United States United States Public Health Service 1970 in law United States federal health legislation 1970 in the United States