Title X Family Planning
01.01.04 - America Must Continue Its Commitment to Reproductive Health
Family planning clinics are vital to the provision of reproductive health care and often serve as an entry point into the health-care system for young women and low-income people in this country. They offer contraceptive services and education that prevent unintended pregnancy, testing and treatment for sexually transmissible infections (STIs), and other primary reproductive health care.
The U.S. government’s Title X (Ten) program funds low-cost, confidential family planning services that would otherwise be out of reach for many women. Title X not only benefits millions of Americans each year, but also serves important public health goals. Unless the program is adequately funded, however, many Americans will be unable to obtain these important services.
The Title X Program
The Title X program provides public funding for family planning and preventive health screening services. Established by Congress in 1970, the aim of the program is "to assist in making comprehensive voluntary family planning services readily available to all persons desiring such services."1 The U.S. Department of Health and Human Services administers the Title X program through its Office of Family Planning. Approximately 4,600 public and private entities, including non-profit family planning clinics, hospitals and public health departments, receive Title X funds each year.2
Services at Title X facilities are provided on a sliding scale based on income; people at or below the federal poverty level receive services at no cost. No one is refused services because of inability to pay.
The Title X program has always provided family planning services to adolescents. In 1978, Congress amended Title X to place "a special emphasis on preventing unwanted pregnancies among sexually active adolescents," adding services specifically for teenagers. 3
Title X Funds a Range of Reproductive Health Services
Family planning services provided through Title X include contraception, treatment of STIs, preventive services, such as screening for breast and cervical cancer, pregnancy tests and counseling, and educational programs. Title X funding does not cover pregnancy care, such as obstetric or prenatal care.
Title X funds cannot be used to provide abortions.4 However, Title X projects must offer pregnant women neutral and factual information, non-directive counseling and referrals upon request for all of their pregnancy options. This includes prenatal care and delivery; infant care, foster care or adoption; and abortion.5
Title X Guarantees Confidentiality
Title X requires that all participants, including adolescents, receive confidential care. Regulations governing the program mandate that health care providers maintain the patient-physician confidentiality that is crucial for providing timely, appropriate services.6 In 1981, Congress amended Title X to require grantees "to the extent practical" to "encourage family participation in the decision of minors to seek family planning services," thus encouraging, but not mandating, parental involvement. 7
Title X Facilities Serve Millions of Americans
Each year approximately 4.5 million people receive health-care services at Title X-funded clinics. The vast majority of those using Title X clinics are women, and 60% are less than 25 years of age. Nearly two-thirds of Title X clients come from households with incomes below the poverty level.8
Additional Funding for Title X Programs Is Vital
Title X family planning clinics have served an important need in communities throughout the United States for more than thirty years. The services provided have reduced the number of unintended pregnancies and improved the health of the population.
Unfortunately, the Title X program does not receive enough funding to meet the goal of "making comprehensive voluntary family planning services readily available."9 Nearly half of the pregnancies occurring each year in the United States are unintended, and approximately half of those pregnancies are terminated by abortion.10 If Title X funding had been increased at the rate of inflation from its FY 1980 funding level of $162 million, it would have been funded at over $590 million in FY 2002. Yet the Bush Administration proposed level funding for the program at a mere $265 million for the 2003 and 2004 budgets, and Congress appropriated $275 million in 2003.11 At the same time, the rising costs of contraceptives and diagnostic tests are straining the limited financial resources of Title X providers. 12
By under-funding the Title X program, Congress is denying men and women the basic reproductive health services that help to reduce the number of unintended pregnancies and prevent the spread of STIs . The Center for Reproductive Rights urges Congress to show its commitment to the reproductive health of all Americans by funding the Title X program at a level that, at a minimum, reflects inflation and rising costs. This would ensure that Title X can continue to provide services at their current level.
Attempts to Undermine the Success of Title X Should Be Rejected
The effectiveness of the Title X program is also threatened by proposals that would reduce access and deter potential clients. One such restriction, the Parent’s Right to Know Act (H.R. 2444), would require minors to either notify or obtain the consent of a parent, or approval from a judge, before obtaining contraceptives from a Title X provider. Denying minors confidential care at Title X clinics would drastically reduce the ability of those facilities to serve them. Studies demonstrate that minors will forgo or delay seeking reproductive health care--but not sexual activity--if their parents must be notified.13 This proposal undermines the goals of Title X, and in particular the emphasis that Congress has previously placed on reducing unintended pregnancies among adolescents.
A second restriction, previously proposed by Representative David Vitter (R-LA), would disqualify any private grantee that provides abortions with non-Title X funds from receiving Title X funds for contraceptive or other preventive health-care services. If adopted, this restriction would deny funding to an estimated six hundred Title X clinics, which serve nearly one million low-income women. This misguided proposal would increase the number of unintended pregnancies and abortions.
For more than thirty years the Title X program has made it possible for millions of Americans to obtain reproductive health care. For the program to remain effective, Congress must increase its funding and reject attempts to restrict or limit access to Title X services. The Center for Reproductive Rights urges strong support for Title X.
1. Family Planning Services & Population Research Act of 1970, Pub. L. No. 91-572, 84 Stat. 1504 (1970) (codified as amended at 42 U.S.C. §§ 300 et seq. (1991 & Supp. 2000)).
2. Department of Health and Human Services, Office of Public Health and Science, Office of Population Affairs, Office of Family Planning. http://opa.osophs.dhhs.gov/titlex/ofp.html.
3. S. Rep. No. 95-822, at 24 (1978).
4. Consolidated Appropriations Act, Pub. L. No. 108-7 (2003) ("[A]mounts provided to said [Title X] projects under such title shall not be expended for abortions, that all pregnancy counseling shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for public office"). See also, 42 C.F.R. § 59.5 (Title X projects must "[n]ot provide abortion as a method of family planning").
5. 42 C.F.R. § 59.5. In 1988, a restriction known as the "Gag Rule" was imposed on Title X services, which prohibited counseling about, or referrals for, abortions and required physical and financial separation of abortion-related activities from Title X funded services. In 1991 the Supreme Court held that the Gag Rule did not violate the First Amendment. Rust v. Sullivan, 500 U.S. 173 (1991). Despite this ruling, the Gag Rule remained extremely controversial and was never implemented nationwide. In 1993, President Clinton ordered the Secretary of Health and Human Services to suspend the Gag Rule and promulgate new rules. Title X regulations issued in 2000 officially revoked the Gag Rule and clarified that the provision of information about abortion services does not "promote or encourage" abortion and is therefore permissible. "Provision of Abortion-Related Services in Family Planning Services Projects," 65 Fed. Reg. 41281 (2000).
6. 42 C.F.R. § 59.11.
7. Omnibus Budget Reconciliation Act of 1981, Pub. L. No. 97-35, § 931(b)(1), 95 Stat. 570 (1981) (codified at 42 U.S.C. § 300(a) (1991)).
8. Department of Health and Human Services, Office of Public Health and Science, Office of Population Affairs, Office of Family Planning, http://opa.osophs.dhhs.gov/titlex/ofp.html.
9. Family Planning Services & Population Research Act of 1970, Pub. L. No. 91-572, 84 Stat. 1504 (1970) (codified as amended at 42 U.S.C. §§ 300 et seq. (1991 & Supp. 2000)).
10. The Alan Guttmacher Institute, Facts In Brief, Induced Abortion (2003).
11. National Family Planning and Reproductive Health Association, "Title X--America's Federal Family Planning Program," Aug. 8, 2003. See http://www.nfprha.org.
12. Issues In Brief, Nowhere But Up: Rising Costs for Title X Clinics," The Alan Guttmacher Institute (2003).
13. Reddy, D., et al., Effect of Mandatory Parental Notification on Adolescent Girls’ Use of Sexual Health Care Services, JAMA, Vol. 288, No. 6 (Aug. 14, 2002).