Title X: The Lynchpin Of Publicly Funded Family Planning In The United States

Kinsey Hasstedt
Reproductive rights are under attack. Will you help us fight back with facts?

First published on Health Affairs Blog:

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 its sights for severe funding cuts or even elimination.

The U.S. House of Representatives has proposed ending the program for the fifth year in a row, and the U.S. Senate is recommending a sizable reduction to Title X’s budget. In addition, while legislation aimed at defunding Planned Parenthood and its affiliates, whose health centers serve one-third of Title X clients nationally, failed to pass in the Senate in August, many in Congress remain committed to defunding the organization. These ideologically driven proposals come despite a wealth of evidence demonstrating the tremendous benefits of investing in Title X and the publicly funded family planning network writ large.

The Impact of Title X

According to the Office of Population Affairs, which administers the program, nearly 4,200 individual service sites—including Planned Parenthood health centers, sites operated by health departments, community health centers, and independent family planning agencies—were supported by Title X grant funding in 2013; those sites served 4.6 million clients (See the infographic Title X Makes a Difference).

Guttmacher research released in July 2015 on the need for and delivery of publicly supported family planning services shows that in 2013, the Title X network met one-fifth of U.S. women’s need for publicly funded family planning services. (This analysis is based on tabulations of population data from the census bureau, the American Community Survey and the nationally representative National Survey of Family Growth to estimate the numbers of women needing publicly funded care; it draws upon the 2013 Family Planning Annual Report, published by the Office of Population Affairs, for data on numbers of women receiving services from Title X-funded sites.)

The contraceptive services and supplies provided at family planning centers that receive Title X funding helped women prevent one million unintended pregnancies in 2013; of those, 501,000 would have resulted in unplanned births and 345,000 in abortion. Without the contraceptive care provided by these safety-net centers, unintended pregnancy, abortion, and teen pregnancy would be 30 percent higher.

Moreover, Title X–supported centers are a major source of other preventive sexual and reproductive health services, including preconception health care and counseling, sexually transmitted infection (STI) testing and treatment, vaccines to prevent human papillomavirus (HPV), and Pap tests to head off cases of cervical cancer. In 2010 (the most recent year for which this data is available), the services provided within the Title X network prevented 87,000 preterm or low-birthweight births, 63,000 STIs, and 2,000 cases of cervical cancer.

And Title X is not just good individual and public health policy—it results in considerable savings to taxpayers. The nation’s investment in Title X in 2010 resulted in net federal and state government savings of $7 billion. Put a different way, the services Title X supports save $7 for every public dollar invested.

Beyond the Numbers

In addition to Title X’s quantifiable—and hugely positive—impact, the program occupies a unique niche that continues to be critically valuable to safety-net family planning centers and the millions of people who rely on them.

Because Title X funds go to providers as up-front grants (rather than as reimbursement for direct client services, as with Medicaid or private insurance), these dollars can be used in a variety of ways to support a health center’s infrastructure and ensure its doors stay open. For instance, Title X can enable providers to serve clients on evenings and weekends, implement electronic health records or online appointment scheduling, train staff to meet a community’s unique needs, better contract with and bill health plans, and stock the range of contraceptive supplies women need.

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

Plus, women report choosing family planning centers because they feel respected, know the services they receive are confidential, and appreciate the time staff takes to talk with them. This all makes Title X providers natural enrollment assisters, helping people navigate the confusing world of health insurance.

Of course, even with the ACA’s coverage advances and improvements, which are already reducing out-of-pocket costs for those covered by insurance, many people remain ineligible for public or private coverage. This includes individuals in the 20 states that have yet to expand Medicaid under the ACA who have incomes too high for their state’s public program, but too low to qualify for subsidies and tax credits on the private insurance marketplace.

There are also millions of immigrants who remain completely ineligible for coverage because of their immigration status—including those who are undocumented and those granted relief from deportation under President Obama’s deferred action initiatives.

Additionally, some people with insurance coverage may not feel they can use it because of concerns about confidentiality. This issue is most common among those insured as dependents on someone else’s policy, particularly teens and young adults, and women experiencing or threatened by interpersonal violence. The Title X program is designed specifically to meet the needs of all of these individuals, emphasizing confidential delivery 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 family planning service delivery. This means ensuring that care is voluntary, confidential, affordable, and effective. Title X requires that individuals receive quality care regardless of their ability to pay. Clients must also be offered a broad range of contraceptive methods from which they can choose, and Title X expressly prohibits conditioning the receipt of government assistance on the acceptance of any particular contraceptive method or other services.

Investing In Success

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

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

This article was originally published on Health Affairs Blog.