Title X and the U.S. Family Planning Effort. (Issues in Brief).

Although a woman's ability to become pregnant spans almost half her lifetime, American women today typically want only two children--a goal that, for most, is unrealistic without contraception. One of the United States' key public health goals has long been to expand access to contraceptive services to all those who need and want them, with a special emphasis on reaching those traditionally hindered in their attempts to obtain care by income or other factors, such as age or geography. This Issues in Brief examines the 30-year record of the nation's voluntary family planning effort, outlining its origins, describing its current structure and funding, and assessing the impact it has had in preventing unintended pregnancies, births and abortions.

Origins of the Program

Studies conducted during the 1960s showed that rates of unwanted childbearing among low-income women were at least twice as high as those among the more affluent--a phenomenon traceable in large part to inequalities in access to family planning services. By the end of the decade, a sizable, bipartisan consensus had emerged favoring government support of voluntary family planning programs as a means of expanding economic development, alleviating poverty, avoiding welfare dependency and improving the health of women and their families.

Even as this consensus was forming, Congress amended a number of federal laws to allow family planning services to be provided under existing programs. In 1965, as part of the "War on Poverty," federal funds were made available for family planning through the Office of Economic Opportunity. In 1967, Title IV-A of the Social Security Act was amended to require state welfare agencies to offer and provide family planning services to women receiving public assistance.

Then, in 1970, with broad bipartisan support, legislation establishing Title X of the Public Health Service Act was signed into law by President Richard Nixon, creating for the first time a comprehensive federal program devoted entirely to the provision of family planning services on a national basis. The new program sought to fulfill the president's promise that "no American woman should be denied access to family planning assistance because of her economic condition."

Public expenditures for family planning grew rapidly in the early 1970s, as the clinics Title X helped to create became established across the country. In 1972, in recognition of disparities in services across states, Congress amended the Medicaid statute (Title XIX of the Social Security Act) to mandate inclusion of family planning services in all state Medicaid programs. By the early 1980s, almost $340 million in federal and state funds was being spent to provide family planning services to five million women at nearly 5,200 service sites.

Since then, however, a persistent combination of conservative politics and fiscal pressures has forced family planning clinics to confront both budget cuts and new administrative restrictions. Despite these ongoing struggles, publicly funded agencies continue to provide services to large numbers of low- and moderate-income women and teenagers.