Forced Parental Involvement Defeats the Goals of the Title X Program

Adolescents in America must continue to have access to affordable and confidential family planning services. Although there have been declines in teen pregnancy rates, due in part to contraceptive use, the United States still has one of the highest rates in the industrialized world.¹ Adolescents and young adults are at a higher risk for acquiring sexually transmissible infections (STIs) than other adults, and teens account for one-quarter of the approximately 15 million new STI cases in this country each year.² Yet high costs, lack of access and concerns about confidentiality keep teens from seeking reproductive health services that are crucial to their well-being.³

The Title X (Ten) program eliminates many of the obstacles that prevent teens from accessing reproductive health-care services. Title X funds health-care facilities across the country to provide low-cost and confidential services for adolescents and adults. Currently, minors can obtain family planning services without parental consent or notification in most circumstances. But some proposals in Congress, such as the Parent’s Right to Know Act (H.R. 2444), would force teens to either notify or obtain the consent of a parent, or win the approval of a judge, before they can receive contraceptives from a Title X provider. These initiatives would drive teens away from Title X family planning services.

What Is Title X?

Title X is a federal program that funds public and non-profit health-care providers across the country for the provision of family planning and other reproductive health-care services.⁴ Each year approximately 4,600 clinics, public health departments and hospitals receive Title X funds and serve more than 4.5 million patients.⁵ Title X services include contraception, infertility management, prenatal information and counseling, programs to inform and promote participation in Title X services, and treatment of STIs. Title X family planning services do not include pregnancy care or abortion services. Fees for Title X services are based on income, and no one is turned away because of the inability to pay.⁶

Adolescent Access Is a Congressional Priority

Since its inception in 1970, the Title X program has 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.⁷ Congress recognized that teen pregnancies “are often unwanted, and are likely to have adverse health, social, and economic consequences for the individuals involved.”⁸

Title X Guarantees Confidentiality

Title X requires participating health-care providers to maintain patient-physician confidentiality.⁹ Under the law, minors can access services without notification or consent of parents or guardians.¹⁰ The cost of Title X services is based on the income of the minor, not the parents.¹¹ While confidentiality is required, Title X programs must, to the extent practical, encourage family participation.¹²

Only once in the history of the Title X program has adolescent access to confidential care been called into question. In 1981, based on a misinterpretation of the language encouraging “family participation,” the Department of Health and Human Services (HHS) issued regulations calling for parental notification when adolescents received family planning services. Two federal courts of appeal found that the parental notification requirement contravened the goal of the Title X program and were inconsistent with Congressional intent. As one court noted, “Congress made clear that confidentiality was essential to attract adolescents to the Title X clinics, without such assurances, one of the primary purposes of Title X—to make family planning services readily available to teenagers—would be severely undermined.”¹³ As a result of these decisions, the invalid regulations were never implemented.¹⁴

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Forced Parental Involvement Undermines Public Health

Studies demonstrate that adolescents will forgo or delay seeking reproductive health care, but not sexual activity, if their parents must be notified.¹⁶ In addition, some teens would face violence or other severe consequences if forced to tell their parents that they are sexually active and want contraceptive services. Minors who worry about their parents’ reactions may not use contraception at all.

The Medical Community Opposes Forced Parental Involvement

Medical and public health organizations that oppose forced parental involvement for minors seeking contraceptives include the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women’s Association, and the Society of Adolescent Medicine. When HHS attempted to require parental notification for Title X contraceptive services in 1981, the American Medical Association and the American Psychiatric Association opposed the regulations and supported confidentiality for adolescents.

Attempts to Undermine Title X Family Planning Have Been Rebuffed

Family planning opponents often attempt to use the annual appropriations process to restrict young women’s access to Title X services. In 1996, an unsuccessful amendment was proposed to force young women to either notify or obtain the consent of a parent, or win the approval of a judge, before seeking Title X services. In 1997 and 1998, unsuccessful amendments targeted Title X contraceptive services.¹⁷ To date, Congress has opposed these amendments. In 1996 and 1997, Congress supported amendments that encouraged, rather than mandated, parental involvement in teens’ decisions to seek Title X services.¹⁸

Proposals to Deny Adolescents Confidential Services Should Be Rejected

Attempts to undermine the availability of family planning services at Title X clinics to minors are contrary to the goals of the Title X program. Requiring parental involvement will lead some adolescents to delay their use of contraception and testing and treatment for STIs, while others will forgo family planning services altogether. If adopted, these restrictions will increase unintended pregnancies and spread STIs, and hurt efforts to minimize the impact on those already infected. Congress should reaffirm its longstanding commitment to the reproductive health of all Americans, including minors, by rejecting measures that would deny adolescents access to confidential Title X services.

Endnotes
1. Teen Pregnancy: Trends and Lessons Learned, 2002 Issues In Brief 1, The Alan Guttmacher Institute (April 2002).
2. Sexually Transmitted Disease Surveillance 2001, Centers For Disease Control and Prevention (Sept. 2002), Tracking the Hidden Epidemics 2000, Trends in STDs in the United States, Centers for Disease Control and Prevention.
3. Zabin, L.S. and Clark, S.D., Why They Delay: A Study of Teenage Family Planning Clinic Patients, Vol. 13, No. 5 Family Planning Perspectives (Sept./Oct. 1981).
4. 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. (2001)).
5. Department of Health and Human Services, Office of Public Health and Science, Office of Population Affairs, Office of Family Planning. opa.osophs.dhhs.gov/titlex/ofp.html.
6. For more information, see Title X Family Planning: America Must Continue Its Commitment to Reproductive Health, reprorights.org . . . add cite when this is ready to go
7. S. Rep. No. 95-822, at 24 (1978).
8. H.R. Rep. No. 95-1191, at 31 (1978).
9. 42 C.F.R. § 59.11.
10. “Program Guidelines for Project Grants for Family Planning Services,” Department of Health and Human Services, § 8.7 (January 2001).
11. 42 C.F.R. § 59.2.
12. 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)).
13. Planned Parenthood Federation of America v. Heckler, 712 F.2d 650, 660 (D.C. Cir. 1983).
14. New York v. Heckler, 719 F.2d 1191 (2d Cir. 1983), Planned Parenthood Federation of America v. Heckler, 712 F.2d at 665.
15. The Alan Guttmacher Institute, Teen Sex and Pregnancy (September 1999), The Alan Guttmacher Institute, Facts in Brief: Title X and the U.S. Family Planning Effort (1997), Henshaw, “Unintended Pregnancy in the United States,” Family Planning Perspectives (1998):30(1):24-29, 46, Table 1, National Center for HIV, STD and TB Prevention, Division of Sexually Transmitted Diseases, Chlamydia in the United States (April 2001) and Gonorrhea (May 2001).
16. 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).
17. 142 Cong. Rec. H7348 (daily ed. July 11, 1996) (amendment offered by Rep. Istook), 15 3 Cong. Rec. H7052-53 (daily ed. Sept. 9, 1997) (amendment offered by Rep. Istook), 144 Cong. Rec. H10142 (daily ed. Oct. 8, 1998) (substitute amendment offered by Rep. Istook).
18. 142 Cong. Rec. H7349, H7366 (daily ed. July 11, 1996) (substitute amendment offered by Rep. Obey), 143 Cong. Rec. H7053, H7079 (daily ed. Sept. 9, 1997) (substitute amendment offered by Rep. Castle).