Family planning

Title X: The Keystone of Publicly Funded Family Planning in the United States

The Title X national family planning program was created 45 years ago with broad bipartisan support. Today, Congress has Title X — still the only federal grant program dedicated entirely to family planning and related preventive health care — in the crosshairs for deep funding cuts or even elimination.

The United States House of Representatives has propose ending the program for the fifth consecutive year, and the U.S. Senate is recommending a considerable reduction to the Title X budget. Further, while legislation to defund Planned Parenthood and its affiliates, whose health centers serve one-third of Title X clients nationwide, did not pass the Senate in August, many in Congress stay engaged to defund the organization. These ideological proposals come despite a wealth of evidence demonstrating the enormous benefits of investing in Title X and the publicly funded family planning network as a whole.

According to Bureau of Population Affairs, which administers the program, nearly 4,200 individual service sites — including Planned Parenthood Health Centers, health service-run sites, community health centers and independent family planning agencies — have been supported by a Title X grant in 2013; these sites served 4.6 million customers (Table 1).

Guttmacher Research published in July 2015 on the need for and provision of publicly funded family planning services shows that in 2013, the Title X Network met one-fifth of American women’s needs for publicly funded family planning services . (This analysis uses population data tables from the Census Bureau, the American Community Survey, and the Nationally Representative Survey of Family Growth to estimate the number of women in need of publicly funded care; it draws on the 2013 Family Planning Annual Report, published by the Bureau of Population Affairs, for data on the number of women receiving services from Title X-funded sites.)

Contraceptive services and supplies provided at family planning clinics that receive Title X funding helped women prevent one million unwanted pregnancies in 2013; of these, 501,000 would have resulted in unplanned births and 345,000 in abortion. Without the contraceptive care provided by these welfare centers, unwanted pregnancies, abortions and teenage pregnancies would be 30% higher.

In addition, Title X supported centers are a major source other preventive sexual and reproductive health services, including preconception health care and counseling, screening and treatment for sexually transmitted infections (STIs), vaccines to prevent human papillomavirus (HPV), and testing Pap to prevent cases of cervical cancer. In 2010 (the most recent year for which this data is available), the services provided within the Title X network stop 87,000 premature or low birth weight births, 63,000 STIs and 2,000 cases of cervical cancer.

And Title X is not only good individual and public health policy, it translates into huge savings for taxpayers. The nation’s investment in Title X in 2010 resulted in net savings of $7 billion for the federal government and states. In other words, the services supported by Title X save $7 for every public dollar invested.

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In addition to Title X’s quantifiable and overwhelmingly positive impact, the program fills a unique niche that continues to be extremely valuable to safety net family planning clinics and the millions of people who depend on them.

Since Title X funds go to providers in the form of upfront grants (rather than reimbursement for direct client services, as with Medicaid or private insurance), these dollars can be used in a in various ways to support the infrastructure of a health center and ensure that its doors remain open. For example, Title X can allow providers to serve evening and weekend clients, set up electronic health records or online appointments, train staff to meet the unique needs of a community, better contract and bill health plans, and stock the range of contraceptive supplies women need.

Title X supported centers are also single position to connect eligible customers to newly available public or private coverage options under the Affordable Care Act (ACA). These providers often serve as the entry point to the health care system, six out of 10 women who seek contraception at a Title X site considering it their usual source of medical care.

Moreover, women report choose family planning clinics because they feel respected, know that the services they receive are confidential, and appreciate the time the staff takes to talk to them. All of this makes Title X providers natural enrollment assistants, helping people navigate the confusing world of health insurance.

Of course, even with ACAs hedging advances and improvements, which are already reduce personal expenses for those covered by insurance, many people remain ineligible for public or private coverage. This includes individuals in the 20 States who have not yet expanded Medicaid under the ACA and who have incomes too high for their state’s public program but too low to qualify for subsidies and tax credits in the insurance market private.

There is also millions of immigrants who remain totally ineligible for coverage because of their immigration status, including those who are undocumented and those who have been granted a waiver of deportation under President Obama’s Deferred Action initiatives.

Also, some people with insurance coverage may not think they can use it due to concerns about confidentiality. This problem is more common among those insured as dependents of the policy of others, particularly adolescents and young adults, as well as women experiencing or threatened with interpersonal violence. The Title X program is designed specifically to meet the needs of all of these people, with an emphasis on the confidential provision of care to those who are disadvantaged by age or income.

Finally, the Title X program sets national policies and medical standards of care for the provision of family planning services. This means ensuring care is voluntary, confidential, affordable and effective. Title X requires individuals to receive quality care regardless of their ability to pay. Clients must also be offered a wide range of contraceptive methods from which they can choose, and Title X expressly prohibits conditioning receipt of government assistance on acceptance of a particular contraceptive method or other services.

Everyone should have the means to make fundamental choices about whether and when to have children. By enabling young women and low-income women to plan their own pregnancies, the Title X program has also help to move forward the health and well-being of women and their children and to empower these women to achieve their educational and professional goals. Women themselves have long reported that contraception allows them to take better care of themselves and their families, to support themselves financially, to complete their education and to obtain or keep a job.

Accessible, quality family planning care is essential in women’s lives, and the health and economic benefits of these services begin with women and extend to families and society as a whole. In short, public investment in Title X is smart government at its best and should be increased, not decreased.