Title X

Title X, formally known as the Title X Family Planning Program and officially known as Public Law 91-572, is a federal grant program enacted by President Richard Nixon as part of the Public Health Service Act in 1970. The program provides American individuals access to comprehensive family planning and related preventative health services and is the only federal grant program that offers such services. Title X focuses on the needs of low-income families and individuals, particularly those without health insurance who do not have access to adequate family planning and related services. Title X provides funding to provide such services at little to no cost to individuals or families. Each year, more than four million people access critical healthcare services through Title X. Examples of services covered under Title X funding include access to birth control and sexual and reproductive health education. Other services covered under Title X include wellness exams, breast cancer and cervical cancer screenings, and testing for sexually transmitted diseases (STDs). Title X is regulated by the federal government to require that 90 percent of its budget is used for clinical family planning purposes. In early 2019, President Donald Trump's administration announced sweeping changes to the Title X program that made any organization providing or referring patients for abortion services ineligible for funding. These changes were largely reversed in 2021 under President Joe Biden’s administration.

Background

Prior to the creation of Title X, birth control services were provided to low-income families in the mid-1960s as part of President Lyndon Johnson's War on Poverty legislation. When Richard Nixon became president, his administration decided funding for family planning services for low income individuals would be a priority. Nixon stated domestic family planning services supported by the federal government were not adequate enough to ensure all Americans in need received proper care. He asked for expanded research into contraceptive development and behavioral sciences, reorganization of family planning services within the federal government, and greater financial support for such a program. Shortly after announcing his intentions, Nixon created the National Center for Family Planning Services in the Department of Health, Education, and Welfare (now known as the United States Department of Health and Human Services).

Nixon introduced the Family Planning Services and Population Research Act in early 1970 and the bill was voted on in December of the same year. Alongside the expansion to family planning and related health services, Nixon also designed the bill to include the development of a system for family planning and population growth information and education. The bill received unanimous support from the Senate and enthusiastic support from the House, earning strong bipartisan backing in both houses. Nixon signed the bill into law on December 26, 1970. Two years later, Congress revised the bill to include the withdrawal of funds from state Medicaid programs to help pay for these services. It then passed a new bill in 1975 that called for the development of family planning centers across the country, leading to the emergence of thousands of centers over the next several decades.

Overview

Title X provides funds to community-based sexual and reproductive health clinics, offering services related to birth control, preventative health, and mental health. Grantees of Title X funding typically include state and local health departments as well as hospitals, university health centers, community health centers, tribal organizations, and qualifying independent clinics. By 2018, According to the US Department of Health and Human Services, at least one Title X clinic exists in about three-quarters of all counties in the United States. Title X funds are distributed by the Office of the Assistant Secretary for Health, Office of Population Affairs (OPA) by the Office of Family Planning (OFP). Funding allocation is determined by ten Public Health Service regional offices located across ten distinct regions of the country. Awarding of funds is competitive and based on program performance. Further funding is subsidized through Medicaid reimbursements and other federal resources. Historically, one of the largest grantees of Title X funding was Planned Parenthood, whose affiliates received approximately one-quarter of all Title X dollars each year. Title X funding accounts for only about half of grantee operational costs, however, with state, local, and private, as well as minor patient fees, providing the remaining funding.

Services provided under Title X funding involve family planning and related preventative healthcare services, including birth control, sexual and reproductive health education and counseling, breast and cervical cancer screenings, and screening and treatment for sexually transmitted diseases. Organizations are also granted authority to refer to other healthcare resources. The primary goal of Title X is to ensure low- to moderate-income Americans have access to quality family planning services while safeguarding patient needs through comprehensive training programs for all grantees.

Title X has had a major impact on the sexual and reproductive health of its beneficiaries since its introduction. The services provided through Title X funding have prevented millions of unintended pregnancies over the years, decreasing the number of abortions in the country. A common misconception about Title X is that it provides funding for abortion services. Title X does not directly provide funds to any programs that use abortion as a family planning method. Despite these clear limitations, Title X funding has been referenced by anti-abortion activists as an indirect supporter of organizations that provide abortions. The debate primarily focuses on Title X funding of Planned Parenthood, which provides abortions but does not use Title X funding for such services. Abortion opponents argue that any money Planned Parenthood receives from Title X allows the use of more nonfederal money to perform abortions.

This debate heightened in June 2019 when the Trump administration announced plans to strip Title X funding from any organization that provides or offers information about abortion services to patients. This resulted in Planned Parenthood and other similar institutions withdrawing from the program, and thousands of family planning centers nationwide lost crucial funding. Title X funding supported the family planning services of four million individuals in previous years, in 2020, only 1.5 million people received benefits from the program. In 2021, President Biden's administration instructed the Department of Health and Human Services to revise the changes made during the Trump administration. During this reestablishment, Title X was expanded, but some states and individuals challenged the program's expansion, and disagreements over the use of funds for abortions continued.

Bibliography

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"Family Planning Annual Report (FPAR)." U.S. Department of Health & Human Services, opa.hhs.gov/research-evaluation/title-x-services-research/family-planning-annual-report-fpar. Accessed 17 Jan. 2025.

Chuck, Elizabeth. "Planned Parenthood Withdraws from Title X Family Planning Program." NBC News, 19 Aug. 2019, www.nbcnews.com/news/us-news/planned-parenthood-withdraws-title-x-family-planning-program-n1044041. Accessed 17 Jan. 2025.

Darling, Mackenzie. "The Current State of Title X." Physicians for Reproductive Health, Oct. 2024, prh.org/wp-content/uploads/2024/06/policy-primer-current-state-title-x.pdf. Accessed 17 Jan. 2025.

"Family Planning Program Under Title X of the Public Health Service Act." Congressional Research Service, 27 Apr. 2018, crsreports.congress.gov/product/pdf/R/R45181/5. Accessed 17 Jan. 2025.

McCammon, Sarah. "Trump Administration Announces Sweeping Changes to Federal Family Planning Program." NPR, 22 Feb. 2019, www.npr.org/2019/02/22/690544297/trump-administration-proposes-sweeping-changes-to-federal-family-planning-progra. Accessed 17 Jan. 2025.

"Publicly Supported Family Planning Services in the United States." Guttmacher Institute, Oct. 2019, www.guttmacher.org/fact-sheet/publicly-supported-FP-services-US. Accessed 17 Jan. 2025.

"Statement on Signing the Family Planning Services and Population Research Act of 1970." American Presidency Project, 26 Dec. 1970, www.presidency.ucsb.edu/documents/statement-signing-the-family-planning-services-and-population-research-act-1970. Accessed 17 Jan. 2025.

"Title X: The Nation’s Program for Affordable Birth Control and Reproductive Health Care." Planned Parenthood, www.plannedparenthoodaction.org/issues/health-care-equity/title-x. Accessed 17 Jan. 2025.

"What is Title X?" Physicians for Reproductive Health, June 2024, prh.org/what-is-title-x-an-explainer. Accessed 17 Jan. 2025.