Title X Family Planning Services: Impactful but at Severe Risk

Rachel Benson Gold, Guttmacher Institute Adam Sonfield, Guttmacher Institute
The time is now. Will you stand up for reproductive health and rights?

First published online:

The Title X national family planning program has for decades been a central component of the safety net for millions of low-income and otherwise marginalized patients who are seeking contraceptive services and supplies, STI testing and treatment, and related preventive care. Yet, the Trump administration has markedly weakened the program through new regulations—collectively known as the domestic gag rule—that have driven numerous health care providers, including those affiliated with Planned Parenthood, out of the program.

New data from the Guttmacher Institute released in October 2019 illustrate the benefits of Title X–supported services—benefits that are now threatened. Importantly, all of the new Guttmacher data are from 2016, well before the Trump administration’s domestic gag rule was even proposed. So while these statistics speak to the crucial importance of Title X, they do not provide insights into the specific damage done by the gag rule.

Quantifying Title X’s Impact

The impact of Title X has been substantial over time, and the most recent data once again confirm it: In 2016, Title X–supported clinics provided contraceptive services to about 3.5 million female patients. Women who obtained contraceptive services from these clinics were able to postpone or avoid some 755,000 pregnancies that they would have been unable to prevent without access to publicly supported care.

By identifying and treating thousands of STIs that would otherwise have gone undetected, these clinics also prevented about 44,000 chlamydia infections, 7,200 gonorrhea infections and 370 cases of HIV among the partners of women obtaining this care. In addition, the screening and vaccination services provided by Title X–supported clinics at family planning visits helped patients avoid an estimated 4,600 cases of pelvic inflammatory disease, 780 cases of infertility, 410 ectopic pregnancies and 740 cases of cervical cancer.

Beyond the primary benefit of helping individuals to determine whether and when to become pregnant and to maintain their health, public investments in family planning are cost effective. In 2016, Title X–supported services to help patients prevent or delay pregnancies and to protect themselves and their partners against reproductive cancers and STIs resulted in net government savings of $4.4 billion, or nearly $5 for every public dollar invested.

Central to the Safety Net, But for How Long?

Title X–supported clinics have always been an important part of a broader family planning safety net, which also includes clinics that do not receive Title X dollars and private clinicians who serve Medicaid enrollees. Together, these safety-net clinics and clinicians provided publicly supported contraceptive and related services to an estimated 9.3 million female patients in 2016. Those services helped women to postpone or avoid 2 million pregnancies and helped prevent about 125,000 STI cases and nearly 2,000 cervical cancer cases.

Title X’s role in this safety net had already been weakened in recent years by declining federal and state investments in the program, which in some cases have led to clinic closures and reductions in services. Now, the Trump administration’s moves to implement the Title X gag rule are threatening the family planning safety net on which millions of women depend for their care.