State Facts About Title X and Family Planning: Maryland
National Background and Context
Title X of the Public Health Service Act is the sole federal program devoted entirely to family planning. Through Title X the federal government sets family planning policy, and its flexible grant funds not only subsidize direct client services, but are critical to putting family planning centers in communities and to supporting their ongoing infrastructure needs.
These services are vital: U.S. women who are not using contraceptives, or who are using them inconsistently, represent one-third of all women at risk of unintended pregnancy and account for 95% of the three million unintended pregnancies that occur every year.(1) Unintended pregnancy, in turn, has been linked with numerous negative maternal and child health outcomes. More broadly, women’s ability to rely on contraception enables them to invest in higher education and to be full participants in the nation’s workforce.(2)
Title X is central to helping women meet their reproductive health goals. In 2008, an estimated 7.1 million female contraceptive clients were served at publicly funded family planning centers, two-thirds of whom—4.7 million women—were served at sites supported by Title X.(3) Contraceptive services at Title X–supported family planning centers helped women and couples avoid 973,000 unintended pregnancies, which would have resulted in 433,000 unplanned births and 406,000 abortions.(3) Without these services, unintended pregnancy and abortion in the United States would be one-third higher.(1) And by helping women avoid unintended pregnancies, Title X–supported centers saved taxpayers $3.4 billion in 2008, amounting to $3.74 saved for every $1 spent providing contraceptive care.(3)
One-quarter of all poor women who obtain contraceptive services each year do so at a site that receives Title X funding, as do 17% of poor women obtaining a Pap test or pelvic exam and 20% obtaining services for a sexually transmitted infection.(1) It is therefore not at all surprising that six in 10 women who obtain care at a Title X–supported center consider it to be their usual source of medical care.(4)
The Need for Title X in Maryland
•In 2008, 258,100 women in Maryland were in need of publicly supported contraceptive services and supplies.(3) [Such women are sexually active; aged 13–44; able to become pregnant and not pregnant, postpartum nor trying to become pregnant; and either have a family income below 250% of the federal poverty level or are younger than age 20.]
•In Maryland, 17% of women aged 15–44 are uninsured, compared with 21% nationally.(5) Title X–supported family planning centers play an especially important role in serving the uninsured, who often cannot afford to pay out-of-pocket at private health care providers.
•In 2006, 75,000 Maryland residents had an unintended pregnancy, a rate of 63 per 1,000 women aged 15–44.(6) Births resulting from these unintended pregnancies cost the state and federal governments $188 million that year.(7)
•In 2005, 28,720 Maryland residents obtained abortions, a rate of 24.1 per 1,000 women aged 15–44, compared with 19.4 per 1,000 nationally.(8)
•In 2008, there were 12740 pregnancies among Maryland teens aged 15–19, a rate of 63 pregnancies per 1,000 teen women, compared with 68 per 1,000 nationally.(9)
Title X–Supported Services
•Title X–supported centers provided contraceptive care to 74,100 women in Maryland in 2008.(3)
•These centers served 29% of women in the state in need of publicly supported contraceptive services and supplies, compared with 27% served by such centers nationally.(3)
•Of the total contraceptive clients served by these centers, 76% had incomes at or below the federal poverty level, compared with 70% nationally.(10)
•In 2006, 82 family planning centers in Maryland received support from Title X.(11,12) They included:
Health department clinics: 60
Community health centers: 1
Planned Parenthood clinics: 9
Hospital outpatient clinics: 1
Other independent clinics: 11
•These centers provided contraceptive care to the following numbers of clients:(11)
Health department clinics: 50,330
Community health centers: 110
Planned Parenthood clinics: 25,730
Hospital outpatient clinics: 380
Other independent clinics: 1,990
Impact of Services Provided by Title X– Supported Centers in Maryland
•In 2008, contraceptive services provided at Title X–supported centers in Maryland helped women avoid 15,400 unintended pregnancies, which would have resulted in 6,800 births and 6,400 abortions.(3)
•In the absence of these services, the number of unintended pregnancies in Maryland would be 22% higher, and the number of abortions would be 19% higher.(13)
•In 2006, contraceptive services provided at Title X–supported centers in Maryland helped women younger than age 20 avoid 4,620 unintended pregnancies.(14)
•In the absence of these services, the number of teen pregnancies in Maryland would be 36% higher.(13)
•By helping women avoid unintended pregnancies and the births that would follow, the services provided at Title X–supported centers in Maryland saved $67,418,000 in public funds in 2008.(15)
1. Gold RB et al., Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System, New York: Guttmacher Institute, 2009.
2. Guttmacher Institute, Testimony of Guttmacher Institute, Submitted to the Committee on Preventive Services for Women, Institute of Medicine, 2011, <http://www.guttmacher.org/pubs/CPSW-testimony.pdf>, accessed Feb. 14, 2011.
3. Frost JJ, Henshaw SK and Sonfield A, Contraceptive Needs and Services, National and State Data, 2008 Update, New York: Guttmacher Institute, 2010.
4. Frost JJ, U.S. women’s reliance on publicly funded family planning clinics as their usual source of medical care, paper presented at the 2008 Research Conference on the National Survey of Family Growth, Hyattsville, MD, Oct. 16 and 17, 2008.
7. Sonfield A et al., The public costs of births resulting from unintended pregnancies: national and state-level estimates, Perspectives on Sexual and Reproductive Health, 2011, 43(2):94–102.
9. Guttmacher Institute, U.S. Teenage Pregnancies, Births and Abortions, 2008: State Trends by Age, Race and Ethnicity,, New York: Guttmacher Institute, 2013.
10. Fowler CI et al., Family Planning Annual Report: 2009 National Summary, Research Triangle Park, NC: RTI International, 2010.
11. Guttmacher Institute, Contraceptive Needs and Services, 2006, 2009, <http://www.guttmacher.org/pubs/win/allstates2006.pdf>, accessed Feb. 14, 2011.
12. Special tabulations of data from the 2006 Guttmacher Institute Contraceptive Needs and Services Study.
13. Cohen SA, The numbers tell the story: the reach and impact of Title X, Guttmacher Policy Review, 2011, 14(2):20–23.
14. Guttmacher Institute Data Center, Number of unintended pregnancies averted to clients aged <20 by Title X–funded family planning centers, 2006, <http://www.guttmacher.org/datacenter/>, accessed Feb. 14, 2011.