Title X
Encyclopedia
The Title X Family Planning Program, officially known as Public Law 91-572 or “Population Research and Voluntary Family Planning Programs” was enacted under President Richard Nixon
Richard Nixon
Richard Milhous Nixon was the 37th President of the United States, serving from 1969 to 1974. The only president to resign the office, Nixon had previously served as a US representative and senator from California and as the 36th Vice President of the United States from 1953 to 1961 under...

 in 1970 as part of the Public Health Service Act
Public Health Service Act
The Public Health Service Act is a United States federal law enacted in 1944. The full act is captured under Title 42 of the United States Code "The Public Health and Welfare", Chapter 6A "Public Health Service"....

. Title X is the only existing federal grant program that is completely devoted to providing comprehensive family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...

 and other related preventive health services
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

 to individuals. Title X is legally designed to prioritize the needs of individuals from low-income families and/or uninsured people (including those who are not eligible for Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...

) who might not otherwise have access to these health care services. These services are provided to low-income and uninsured individuals at reduced or no cost. Its overall purpose is to promote positive birth outcomes and healthy families by allowing individuals to decide the number and spacing of their children. The other health services provided in Title X-funded clinics are integral in achieving this objective.

Title X is administered by the Office of the Assistant Secretary for Health, Office of Population Affairs
Office of Population Affairs
The Office of Population Affairs , a part of the United States Department of Health and Human Services within the Office of Public Health and Science, serves as the focal point to advise the Secretary and the Assistant Secretary for Health on a wide range of reproductive health topics, including...

 (OPA) by the Office of Family Planning (OFP). The statue and regulations of Title X require that 90 percent of congressional appropriation
Appropriation (law)
In law and government, appropriation is the act of setting apart something for its application to a particular usage, to the exclusion of all other uses....

s be used for clinical family planning purposes. In FY2010, Congress appropriated around $317 million for the Title X Family Planning program.

Title X’s mandate and administration

According to OPA, Title X operates by granting funds to a network of community-based clinics that provide contraceptive
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

 services, related counseling, and other preventive health services. Typical grantees include State and local health departments, tribal organizations, hospitals, university health centers, independent clinics, community health centers, faith-based organizations, and various public and private nonprofit entities. OPA estimates that there is at least one clinic receiving Title X funding in 75% of counties in the U.S.

Ten Public Health Service
United States Public Health Service
The Public Health Service Act of 1944 structured the United States Public Health Service as the primary division of the Department of Health, Education and Welfare , which later became the United States Department of Health and Human Services. The PHS comprises all Agency Divisions of Health and...

 Regional Offices are given the Title X funding and subsequently award regional service and training grant funds through a competitive review process. These offices also monitor program performance. Planned Parenthood clinics and affiliates are granted approximately 25% of Title X funding.

The services provided by Title X grantees include family planning and provision of contraception, education and counseling, breast
Mammography
Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....

 and pelvic exam
Pelvic examination
A pelvic examination, also pelvic exam, is a physical examination of the female pelvic organs.Broadly, it can be divided into the external examination and internal examination.It is also called "Bimanual Exam" & "Manual Uterine Palpation"....

s, breast and cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...

 screening, screenings and treatment for sexually transmitted disease
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...

s (STDs) and Human Immunodeficiency Virus (HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

), education about preventing STDs and HIV and counseling for affected patients, referrals to other health care resources, pregnancy diagnosis
Pregnancy test
A pregnancy test attempts to determine whether or not a woman is pregnant.These markers are found in urine and blood, and pregnancy tests require sampling one of these substances. The first of these markers to be discovered, human chorionic gonadotropin , was discovered in 1930 to be produced by...

, and pregnancy counseling
Pregnancy options counseling
Pregnancy options counseling is a type of psychological counseling that occurs when a client comes in due to her stress and fears of pregnancy, usually an unwanted pregnancy. This type of counseling provides information and support for a pregnant woman who is considering choices regarding the...

.

In addition to providing these services, Title X works to improve the overall quality of family planning services offered in the U.S. and help grantees better respond to patient needs. Title X funds training for family planning clinic staff in 10 regional training programs and three national programs that emphasize clinical training, improving family planning services targeted at males, and coordinating training at a national level. Title X also looks to improve the provision of family planning services by engaging in data collection and research of the program and its grantees. Finally, Title X funds also aid in disseminating information and implementing outreach and education activities in communities.

Title X funding

Title X is funded every fiscal year by Congressional appropriations. It received approximately $317 million in FY2010 appropriations and enacted spending. President Barack Obama
Barack Obama
Barack Hussein Obama II is the 44th and current President of the United States. He is the first African American to hold the office. Obama previously served as a United States Senator from Illinois, from January 2005 until he resigned following his victory in the 2008 presidential election.Born in...

’s proposed budget for FY2012 would provide Title X with $327 million, which, according to the White House Office of Management and Budget (OMB), would represent an increase of nearly $11 million over 2010 enacted spending.

Title X receives further funding from Medicaid reimbursements and additional federal sources. Combined with Congressional appropriations, these funding sources amount to over half of the operational funds provided to Title X grantees. The remainder of the funding comes from State and local funds, in addition to private sources like insurance and some patient fees.

Title X and abortion

Title X has been seen as a controversial federal program due to its family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...

 mandate, and has subsequently become entangled with the abortion debate
Abortion debate
The abortion debate refers to discussion and controversy surrounding the moral and legal status of abortion. The two main groups involved in the abortion debate are the self-described "pro-choice" movement and the "pro-life" movement...

. This has been particularly prevalent during 2011 negotiations for a continuing resolution to provide funding for the government and its programs, as well as the proposed FY2012 budget.

Title X does not fund abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...

 and never has since its establishment. However, abortion opponents often take issue with Title X since 25% of all Title X money goes to Planned Parenthood
Planned Parenthood
Planned Parenthood Federation of America , commonly shortened to Planned Parenthood, is the U.S. affiliate of the International Planned Parenthood Federation and one of its larger members. PPFA is a non-profit organization providing reproductive health and maternal and child health services. The...

 affiliates, and Planned Parenthood clinics are the nation’s biggest abortion providers. Although Planned Parenthood is prohibited from using federal funds to perform abortions, abortion opponents argue that any money given to Planned Parenthood from Title X frees up more nonfederal money that can be used to perform abortions. Representative Mike Pence
Mike Pence
Michael Richard "Mike" Pence is the U.S. Representative for Indiana's , and previously the , serving since 2001. The 6th district covers much of Eastern Indiana. He is a member of the Republican Party....

, a Republican
Republican Party (United States)
The Republican Party is one of the two major contemporary political parties in the United States, along with the Democratic Party. Founded by anti-slavery expansion activists in 1854, it is often called the GOP . The party's platform generally reflects American conservatism in the U.S...

 from Indiana, has led the charge to prevent Planned Parenthood from receiving Title X funds. House Republicans have called for cuts of over $300 million from Title X for the rest of FY2011, ostensibly in order to reduce the number of abortions.

Impact of Title X

According to President Obama’s FY2012 proposed budget and the OMB, Title X provides grants to a network of over 4,500 clinics that annually serve over 5 million individuals. The OPA describes their clientele as racially and ethnically diverse
Multiculturalism
Multiculturalism is the appreciation, acceptance or promotion of multiple cultures, applied to the demographic make-up of a specific place, usually at the organizational level, e.g...

, with most patients in their early 20s. Title X mainly serves low- to middle-income women, but has stepped up its efforts to involve men in family planning efforts and the number of male clients is on the rise.

In February 2011, a National Public Radio (NPR) article evaluated the impact of Title X. NPR cites a Guttmacher Institute
Guttmacher Institute
The Guttmacher Institute is a non-profit organization which works to advance sexual and reproductive health. The institute operates in the United States and globally "through an interrelated program of social science research, policy analysis and public education." According to their mission...

 report claiming that Title X grantee clinics serve 15% of women in the U.S. who use contraceptive prescriptions and supplies or get annual contraception check-ups. Furthermore, only five percent of patients served by Title X funding at these clinics came in solely for birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

. Nearly 90% also received preventive gynecological
Gynaecology
Gynaecology or gynecology is the medical practice dealing with the health of the female reproductive system . Literally, outside medicine, it means "the science of women"...

 attention, and over 50% were treated for STIs or reproductive tract infections or related conditions.

Title X clinics and funding may represent the sole source of health care services for many of their clients. Of the 5.2 million patients served in 2009, 70% were below the federal poverty line
Poverty threshold
The poverty threshold, or poverty line, is the minimum level of income deemed necessary to achieve an adequate standard of living in a given country...

 and around 66% had no health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...

. In 2006, over 60% of women who received health care services at a Title X clinic identified that as their usual source of health care.

External links

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