Title X (ten)

The National Family Planning Program

The national family planning program, Title X (ten) of the Public Health Service Act, was established in 1970 with broad bipartisan support. For more than three decades, the Title X program has been an integral component of our nation’s health care system, providing high-quality contraceptive services and other preventive health care to millions of Americans, most of whom are low income and uninsured and otherwise would lack access to such services.

The Title X program provides project grants to public and nonprofit organizations. Title X-supported clinics provide services that:

Prevent unintended pregnancies;

Reduce the number of abortions;

Lower rates of STDs, including HIV; and

Improve women’s health.

Public funding for family planning enjoys nearly unanimous (90%) support among American voters; in fact, a majority of voters (72%) support increased public funding for family planning services (1).

What services does Title X provide?

• Clinics receiving Title X funds must provide a range of preventive health services, including contraceptive services; gynecological exams; pregnancy testing; screening for cervical and breast cancer; screening for high blood pressure, anemia, and diabetes; screening for STDs, including HIV; basic infertility services; health education; and referrals for other health and social services (2).
• The Title X statute prohibits the use of program funds to pay for abortions.3 Women facing an unintended pregnancy must receive non-directive counseling regarding all of their available options, including prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination (3).

Where do people receive Title X services?

• Title X services are provided through a network of 4600 clinics nationwide, including state and local health departments, hospitals, community health centers, Planned Parenthood affiliates, and independent clinics (4).
• State, county, and local health departments run the majority (57%) of clinics that receive Title X funds; Planned Parenthood affiliates operate 14% of Title X-supported clinics (5).
• Title X-funded clinics are located in every state, nearly three-quarters of U.S. counties, and every Congressional district in the nation (6).

Who receives Title X services?

• Title X clinics primarily serve low-income Americans. Sixty percent of Title X clients have incomes below the federal poverty level and 92% have incomes below 250% of the poverty level (5).
• The vast majority of Title X clients are uninsured and do not qualify for Medicaid (7).
• Title X clinics provide services free of charge to individuals with incomes up to 100% of the federal poverty level and on a sliding fee scale for those with incomes up to 250% of poverty.2 No one is denied services because of an inability to pay.
• Seventy percent of women receiving subsidized family planning services are age 20 or over and 61% are white (7).

What is the framework of the Title X program?

• The Title X program provides the framework for family planning service delivery throughout the United States, while recognizing the need for local flexibility.
• Clinics that receive Title X funds are required to follow uniform regulations and guidelines that guarantee women access to contraceptive counseling, a range of contraception options, related preventive health care, confidentiality of services, and referrals for other health and social services, as indicated (2).
• Federal funds flow through approximately 85 regional grantees that then determine which local providers will receive funding (4).
• In 1998, Title X-supported clinics received about one-fourth of their funds from the program (8).

Title X is cost effective yet underfunded

• Each public dollar spent to provide family planning services saves an average of $3 in Medicaid costs for pregnancy-related and newborn care alone (9).
• The program’s FY2001 appropriation of $254 million will enable more than 5 million Americans to receive services at Title X clinics in 2001 (10).
• Taking inflation into account, funding for the Title X program declined 58% between 1980 and 2001. In 1980, the Title X program was funded at $162 million. Had the program’s funding increased at the rate of inflation as determined by the medical care services index, Title X would currently be funded at $564 million, which is more than twice its current funding level of $254 million (11).
• As inflation-adjusted funding for Title X declined in the 1980s and 1990s, health care costs soared, the ranks of the uninsured swelled, and the cost of contraceptive supplies rose dramatically, placing tremendous strains on clinics’ budgets. Some clinics have been forced to curtail services, shorten their hours of operation, and/or place patients on waiting lists.

Title X’s Impact

• Title X services enabled women to prevent one million unintended pregnancies last year—and a total of 20 million unintended pregnancies over the past two decades—nearly half of which would have ended in abortion (5).
• The Title X program is a critical component in efforts to reduce teen pregnancy in the United States. Over the past 20 years, Title X services have enabled teenagers to prevent 5.5 million unintended pregnancies (5).
• Title X-supported clinics play a crucial role in stemming the STD epidemic in this country. Between 1995 and 1998, Title X clinics provided 19 million STD tests, including 1.4 million HIV tests (5).
• Over the past 20 years, women have obtained approximately 54.4 million screenings for breast cancer and 57.3 million screenings for cervical cancer at Title X clinics (5).
• Title X clinics are often an entry point into the health care system for women and families who otherwise lack access to health services.

References
1. Planned Parenthood Federation of America (PPFA), The PPFAct Book: A Resource Guide to Reproductive Health Issues and Services, New York: PPFA, 1996.
2. 42 CFR part 59, subpart A (2000); Department of Health and Human Services (DHHS), "Program Guidelines for Project Grants for Family Planning Services," Bethesda, MD, Jan., 2001.
3. Public Health Service Act, sec. 1008, 42 USC 300a-6 (2000).
4. Office of Population Affairs, DHHS, "Office of Family Planning,"
( accessed 2/19/01).
5. The Alan Guttmacher Institute (AGI), Fulfilling the Promise: Public Policy and
U.S. Family Planning Clinics, New York: AGI, 2000.
6. Frost JJ, "Family planning clinic services in the United States, 1994," Family Planning Perspectives, 1996, 28(2): 92-100.
7. Frost JJ & Bolzan M, "The provision of public-sector services by family planning agencies in 1995," Family Planning Perspectives, 1997, 29(1), 6-14.
8. AGI, Family planning annual report: 1998 summary, submitted to the Office of Population Affairs, DHHS, 1999.
9. Forrest JD & Samara R, "Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures," Family Planning Perspectives, 1996, 28(5): 188-195.
10. Office of Population Affairs, DHHS, "About OPA,"
( accessed 2/19/01).
11. AGI, Title X funding chart, memorandum from Cynthia Dailard to interested parties, February 26, 2001.