Title X

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The Family Planning Services and Population Research Act of 1970 (enacted as Title X of Public Health Service Act) is the only federal grant program dedicated to providing individuals with comprehensive family planning and related preventive health services. It was signed into law under President Richard Nixon on December 24, 1970.

Contents

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. [1] Its overall purpose is to promote positive birth outcomes and healthy families by allowing individuals to decide the number and spacing of their children. In 2018, the program served 3.9 million people, 87% of them women. [2]

Between 2014 and 2019, Title X Family Planning program received $286 million per year. [3] From the start, Title X funds could not be used to support abortion. In 2019, the regulations were revised, making it harder for clinics that refer women to an abortion provider to receive Title X funds. [4] [5] In January 2021, President Joe Biden signed a presidential memorandum that called for the repeal of former President Donald Trump's Title X rule changes. [6]

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. By 1969, both Congress and President Richard Nixon supported a bill that will provide adequate Family Planning services. [7] [8] In 1970, 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 the non-consensual sterilization of Indigenous women while in their childbearing years. While in 1971 the federal budget for Family Planning was only six million dollars, by 1972 it was almost 62 million. [3]

In 1972, Congress passed a bill requiring a state's Medicaid program to cover family planning services for low income families. [9] Under this provision, the federal government covers 90% of the states' expenditures. [10] 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. [11] [12]

Mandate

Title X is administered by the Office of Population Affairs (OPA). 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. In 2018, 99 agencies received Title X funding, supporting almost 4,000 service sites in the U.S., including 8 U.S. territories. [11] OPA estimates that there is at least one clinic receiving Title X funding in 75% of counties in the U.S. [13]

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. [1] Planned Parenthood clinics and affiliates receive about 60 million annually through the federal programs, serving 40 percent of all Title X patients. [14]

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. [15] 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 infections (STIs) and Human Immunodeficiency Virus (HIV), 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. [3]

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. [1]

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. [16] 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. [17] 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. [18] 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. [11]

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. [18] Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed. [7] [18]

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. [19] The OPA describes their clientele as racially and ethnically diverse, with most patients in their 20s. [20] 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. [1]

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. [21]

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. [21]

Abortion

Since its inception, Title X has not directly provided funds for programs that use abortion as a family planning method. [7] [22] [23] At the same time, by preventing unintended pregnancies, Title X has decreased the number of abortions in the United States. [18]

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. [7]

Abortion opponents took issue with Title X since 25% of all Title X money went[ when? ] 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. [21] Representative, and later Vice President, 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. [24]

In June 2019, the Trump administration was allowed by a federal court of appeals to implement, while legal appeals continued, a policy restricting taxpayer dollars given to family planning facilities through Title X. [25] [26]

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. [27] More details on the final rules can be found on the Fact Sheet released by the Department of Health and Human Services. [27]

As a result of the new rule, some groups withdrew from the program in August 2019, including Maine Family Planning [28] and Planned Parenthood, which had been providing Title X birth control services to 1.5 million women. [29]

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." [30]

Restoration

On January 28, 2021, President Joe Biden signed a presidential memorandum 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. [6] On April 14, 2021, the U.S. Department of Health and Human Services released its Title X revision proposals. [31] On October 4, 2021, the United States Department of Health and Human Services issued a regulation repealing the Title X gag rule effective November 8, 2021. [32]

See also

Notes

    Related Research Articles

    <span class="mw-page-title-main">Family planning</span> Planning when to have children

    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 marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

    The Planned Parenthood Federation of America, Inc. (PPFA), or simply Planned Parenthood, is an American nonprofit organization that provides reproductive and sexual healthcare and sexual education in the United States and globally. It is a member of the International Planned Parenthood Federation (IPPF).

    Rust v. Sullivan, 500 U.S. 173 (1991), was a case in the United States Supreme Court that upheld Department of Health and Human Services regulations prohibiting employees in federally funded family-planning facilities from counseling a patient on abortion. The department had removed all family planning programs that involving abortions. Physicians and clinics challenged this decision within the Supreme Court, arguing that the First Amendment was violated due to the implementation of this new policy. The Supreme Court, by a 5–4 verdict, allowed the regulation to go into effect, holding that the regulation was a reasonable interpretation of the Public Health Service Act, and that the First Amendment is not violated when the government merely chooses to "fund one activity to the exclusion of another".

    <span class="mw-page-title-main">Crisis pregnancy center</span> Organization that persuades pregnant women against having abortions

    A crisis pregnancy center (CPC), sometimes called a pregnancy resource center (PRC) or a pro-life pregnancy center, is a type of nonprofit organization established by anti-abortion groups primarily to persuade pregnant women not to have an abortion.

    An abortion fund is a non-profit organization that provides financial and logistical assistance to individuals who cannot afford the costs of an abortion. Abortion funds play a role in financing abortion services in countries where abortion is legal but not accessible. For example, health insurance may not cover abortion or transportation to abortion clinics may be financially or logistically infeasible. Abortion funds also provide assistance in cities, states, provinces or countries where abortion is illegal and women travel elsewhere to obtain a legal abortion.

    In U.S. politics, the Hyde Amendment is a legislative provision barring the use of federal funds to pay for abortion, except to save the life of the woman, or if the pregnancy arises from incest or rape. Before the Hyde Amendment took effect in 1980, an estimated 300,000 abortions were performed annually using federal funds.

    <span class="mw-page-title-main">Susan Orr</span> American government official

    Susan Orr headed the United States Children's Bureau, a federal agency organized under the United States Department of Health and Human Services' Administration for Children and Families, Administration for Children and Families, as Associate Commissioner.

    Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, also known as unplanned pregnancies.

    The objective of family planning in the United States is to enable individuals to determine the number and spacing of their children and to select the means by which that target may be achieved. Doing so can bring many benefits including improved maternal health, the prevention of the spread of STDs, and decreased infant and child mortality rates.

    Abortion is the termination of human pregnancy, often performed in the first 28 weeks of pregnancy. In 1973, the United States Supreme Court in Roe v. Wade recognized a constitutional right to obtain an abortion without excessive government restriction, and in 1992 the Court in Planned Parenthood v. Casey invalidated restrictions that create an undue burden on people seeking abortions. Since then, there has continued to be an abortion debate in the United States, and some states have passed laws in the form of regulation of abortions but which have the purpose or effect of restricting its provision. The proponents of such laws argue they do not create an undue burden. Some state laws that impact the availability of abortions have been upheld by courts. In 2022, Roe and Casey were overturned by the Supreme Court in Dobbs v. Jackson Women's Health Organization, meaning that states may now regulate abortion in ways that were not previously permitted.

    <span class="mw-page-title-main">Pregnancy options counseling in the United States</span>

    Pregnancy options counseling is a form of counseling aimed to counsel women on decision-making for a troubling or unintended pregnancy.

    <span class="mw-page-title-main">Maternal healthcare in Texas</span>

    Maternal healthcare in Texas refers to the provision of family planning services, abortion options, pregnancy-related services, and physical and mental well-being care for women during the prenatal and postpartum periods. The provision of maternal health services in each state can prevent and reduce the incidence of maternal morbidity and mortality and fetal death.

    Abortion in Texas is illegal in most cases. There are nominally exceptions to save the mother's life, or prevent "substantial impairment of major bodily function", but the law on abortion in Texas is written in such an ambiguous way that life-threatening or harmful pregnancies do not explicitly constitute an exception. Attempts to clarify and codify these exceptions into law have been rejected by Republican lawmakers in Texas.

    Abortion in Hawaii is legal. 66% of adults in Hawaii said in a poll by the Pew Research Center that abortion should be legal in all or most cases. Hawaii began allowing abortion care de jure in 1970, the first state to do so. State law enacted at that time stated said, "the State shall not deny or interfere with a female's right to choose or obtain an abortion of a nonviable fetus or an abortion that is necessary to protect the life or health of the female."

    Abortion in Oregon is legal at all stages of pregnancy. The Center for Reproductive Rights classifies Oregon as highly protective of abortion rights.

    Abortion is legal in Pennsylvania up to the 24th week of pregnancy. 51% of Pennsylvania adults said in a 2014 poll by the Pew Research Center that abortion should be legal and 44% said it should be illegal in all or most cases.

    Abortion in Vermont is legal at all stages of pregnancy. A 2014 Pew Research Center poll showed 70% of adults in the state believed abortion should be legal in most or all cases, the second highest percentage in the country. The state funds abortions deemed medically necessary for low-income women via Medicaid.

    Abortion in Maryland is legal at all stages of pregnancy. The first laws regulating abortion in the state were passed in 1867 and 1868, banning abortion except by a physician to "secure the safety of the mother." Abortion providers continued to operate both within and outside of the law. Legal enforcement became more strict from the 1940s through 60s, with numerous police raids on abortion providers. In 1968, Maryland passed a liberalized abortion law that clarified the wording of the previous law, allowing abortion in hospital settings in cases of rape, severe fetal deformity, or when life and health were endangered.

    Abortion in New Mexico is legal at all stages of pregnancy. The number of abortion clinics in New Mexico has declined over the years, with 26 in 1982, 20 in 1992 and 11 in 2014. There were 4,500 legal abortions in 2014. There were 7 facilities providing abortion in New Mexico in 2017, and 6 of those were clinics. In 2017, 91% of New Mexico counties had no clinics that provided abortions, and 48% of New Mexico women lived in those counties.

    Abortion in Wyoming is currently legal due to a temporary court injunction.

    References

    1. 1 2 3 4 Office of Population Affairs Clearinghouse. “Fact Sheet: Title X Family Planning Program.” Archived 2012-04-05 at the Wayback Machine January 2008.
    2. ↑ Fowler, C. I., Gable, J., Wang, J., Lasater, B., & Wilson, E. (August 2019). Family Planning Annual Report: 2018 National Summary (PDF) (Report). Retrieved May 4, 2020.{{cite report}}: CS1 maint: multiple names: authors list (link)
    3. 1 2 3 "Funding History". HHS.gov. April 4, 2019. Retrieved May 4, 2020.
    4. ↑ Affairs, Office of Population (February 22, 2019). "Fact Sheet: Final Title X Rule Detailing Family Planning Grant Program". HHS.gov. Retrieved May 9, 2020.
    5. ↑ Belluck, Pam (August 19, 2019). "Planned Parenthood Refuses Federal Funds Over Abortion Restrictions". The New York Times. ISSN   0362-4331 . Retrieved May 9, 2020.
    6. 1 2 "Memorandum on Protecting Women's Health at Home and Abroad". The White House. January 28, 2021. Retrieved January 31, 2021.
    7. 1 2 3 4 Sarah L. Henderson (2014). "Family Planning and Government". In Brent S. Steel (ed.). Science and Politics: An A-to-Z Guide to Issues and Controversies. CQ Press. pp. 210–211. ISBN   9781483346311.
    8. ↑ Nixon, Richard (December 26, 1970). "Statement on Signing the Family Planning Services and Population Research Act of 1970". The American Presidency Project. University of California, Santa Barbara. Retrieved July 1, 2014.
    9. ↑ "State Governments Should Help Preserve and Improve Family Planning Under Medicaid". Guttmacher Institute. May 5, 2017. Retrieved May 10, 2020.
    10. ↑ National Family Planning and Reproductive Health Association (July 2014). Medicaid: A Cornerstone of Publicly Funded Family Planning Care (Report). Retrieved May 9, 2020.
    11. 1 2 3 Office of Population Affairs (August 2019). Title X Family Planning Annual Report: 2018 National Summary (PDF) (Report). Retrieved May 10, 2020.
    12. ↑ "Community Health Centers and Family Planning: What We Know". Guttmacher Institute. September 22, 2004. Retrieved May 10, 2020.
    13. ↑ U.S. Department of Health and Human Services Office of Population Affairs. “Family Planning.”
    14. ↑ Belluck, Pam (August 19, 2019). "Planned Parenthood Refuses Federal Funds Over Abortion Restrictions". The New York Times. ISSN   0362-4331 . Retrieved May 22, 2020.
    15. ↑ Center for Disease Control and Prevention (CDC) (April 25, 2014). Providing Quality Family Planning Services Recommendations of CDC and the U.S. Office of Population Affairs (PDF) (Report). Vol. 63. Retrieved May 10, 2020.
    16. ↑ "Title X Family Planning Annual Report Summary". HHS.gov. September 13, 2019. Retrieved May 11, 2020.
    17. ↑ Napili, Angela (October 15, 2018). Family Planning Program Under Title X of the Public Health Service Act (PDF) (Report). Retrieved May 4, 2020.
    18. 1 2 3 4 "Facts on Publicly Funded Contraceptive Services in the United States". Guttmacher Institute. February 2011. Retrieved August 12, 2011.
    19. ↑ The White House Office of Management and Budget. “Helping Women and Girls Win the Future.”
    20. ↑ https://www.hhs.gov/opa/title-x-family-planning, "The majority of clients were in their 20s (51%)."
    21. 1 2 3 Julie Rovner, National Public Radio. “At-Risk Federal Funds Cover Far More Than the Pill.” April 1, 2011.
    22. ↑ Department of Health and Human Services (July 3, 2000). "Title X Program Instruction Series" (PDF). Federal Register. 65 (128).
    23. ↑ "Title X of Public Law 91-572, Section 1008" (PDF). Title 42 – The Public Health and Welfare. U.S. Government Printing Office. December 24, 1970. Retrieved July 1, 2014. None of the funds appropriated under this subchapter shall be used in programs where abortion is a method of family planning.
    24. ↑ Laura Bassett. Huffington Post. “What Exactly is Title X Funding?” April 8, 2011.
    25. ↑ Belluck, Pam (February 22, 2019). "Trump Administration Blocks Funds for Planned Parenthood and Others Over Abortion Referrals". The New York Times. ISSN   0362-4331 . Retrieved June 22, 2019.
    26. ↑ "Trump abortion rules on referrals, clinic locations can take effect during appeals, court rules". NBC News. June 22, 2019. Retrieved August 25, 2019.
    27. 1 2 "Fact Sheet: Final Title X Rule Detailing Family Planning Grant Program". Department of Health and Human Services. Department of Health and Human Services. February 22, 2019. Retrieved January 5, 2020.
    28. ↑ Planned Parenthood leaves federal family planning program over abortion restrictions
    29. ↑ Chuck, Elizabeth (August 19, 2019). "Planned Parenthood withdraws from Title X family planning program". NBC News. Retrieved August 25, 2019.
    30. ↑ "A 1970 Law Led to the Mass Sterilization of Native American Women. That History Still Matters". Time. Retrieved March 27, 2020.
    31. ↑ "Fact Sheet: Notice of Proposed Rulemaking Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services". U.S. Health and Human Services. April 14, 2021. Retrieved February 24, 2022.
    32. ↑ "HHS Issues Final Regulation Aimed at Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services". U.S. Department of Health and Human Services. October 4, 2021. Retrieved February 24, 2022.
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