Title X: A Delicate Balance.(reproductive health and family planning service funding)(Public Health Service Act)(Brief Article)

In the summer of 1995, Rep. Bob Livingston (R.-La.) proposed to eliminate Title X of the Public Health Service Act, which supports family planning and closely related reproductive health services for more than four million American women. (1) His attempt precipitated the first congressional confrontation in years over the continued validity of a federally funded, discrete family planning program. The proposal by Representative Livingston, the chair of the House Appropriations Committee, would have reallocated Title X funding to the maternal and child health (MCH) block grant and community and migrant health centers.

Representative Livingston maintained that his amendment to abolish the 25-year-old Title X program, which has been the cornerstone of the national family planning program, was not designed to undermine family planning. But the implications of his attempt to turn over Title X funding to broader health programs--without any requirement that the funds be used for family planning--quickly became apparent. The House of Representatives rejected the measure and kept Title X intact.

Nevertheless, some of the issues the Livingston proposal raised deserve serious consideration. Should the provision of family planning services still be a federal priority? Is there a need for a federal program whose sole purpose is to provide family planning and related reproductive health services to low-income women and teenagers? Is there merit in transferring to the states total responsibility for "mature" federal programs, such as Title X?

The Livingston measure was not introduced in a vacuum. It was one of the myriad proposals offered in Congress during 1995--with the strong support of many of the nation's governors--to give the states responsibility for numerous federally funded programs. These efforts have revived the long-standing debate over whether overall responsibility for the nation's social programs should rest with the federal government or the states. At the moment, support seems to have swung away from centralized, "categorical" programs administered at the federal level, and toward "block grants" to the states. (*)

Proponents of block grants argue that ...