Title X and its critics.

Introduction

On April 5, 1984, Senator Jesse Helms (R.N.C.) was the lead witness at a hearing before the Senate Labor and Human Resources Subcommittee on Family and Human Services. The subcommittee was considering the renewal of Title X of the Public Health Service Act, the main national family planning legislation. Helms's prepared text (reprinted on pp. 114-115) was noteworthy not only for its hyperbole, but also for its tone of intense frustration and for its repetition of the main themes enunciated by those less well known and less powerful who have opposed the program ever since its inception.

Title X was first enacted in 1970 and was reenacted in 1973, 1975, 1977, 1978 and 1981. It survived the proposals by President Nixon for state administration of the service programs, the impoundment of appropriated funds, proposals for budget cuts and, most recently, repeated proposals by President Reagan for inclusion of the funds in block grants to the states. The program had always had its share of critics, but they had mainly been from groups considered to be on the political fringe; however, in the late 1970s, with the emergence of what has come to be known as the New Right, such groups moved into positions of political power. It is this configuration of forces that makes the activism of Helms--and that of Senators Jeremiah Denton (R.-Ala.) and Orrin Hatch (R.-Utah), who have acceded to the chairmanship of key committees (*)-- significant for the future of family planning programs. To facilitate a better understanding of the full implications of these political developments, it is perhaps worthwhile to recapitulate some of the early history of the Title X program and to describe more fully the nature of the controversy that has surrounded the program throughout its existence.

The creation of a new federal program to help equalize access to effective contraceptive methods between the poor and the more affluent in our society was proposed by Nixon as part of his July 1969 Message on Population Growth and The American Future, which also recommended increased emphasis and support for human reproduction research and contraceptive development. The legislation that became Title X of the Public Health Service Act was introduced that same year by Senator Joseph Tydings (D.-Md.) and a large bipartisan group of his senatorial colleagues. In the House, Representatives James Scheuer (D.-N.Y.), Tim Lee Carter (R.-Ky.), George Bush (then a Republican congressman from Houston) and close to 100 other members supported its passage.

The program's main features have remained the same since its inception: Title X provided for project grants to be made to public and private nonprofit agencies to provide contraceptive services along with training, technical assistance and other support activities; it also spelled out government responsibilities and functions in relation to human reproduction and population research (both more specific and broader than those that come within the regular purview of the National Institute of Child Health and Human Development); and it created the post of Deputy Assistant Secretary for Population Affairs, with direct responsibility for both types of activities within what is now the DHHS. Eligibility for services was broad-applying to all who need and want services, with priority for low-income persons--and the federal government was prepared to assume complete financial responsibility, that is, there were no state or local matching requirements. A requirement of voluntary participation and a prohibition of the use of Title X funds for abortion as a family planning method were both clearly spelled out.

Criticism of Title X

The Senate passage of Title X in 1970 caused some trepidation on the part of its sponsors but elicited little formal opposition, even from the Catholic bishops, to federal aid for services long considered to be religious and political taboos. When the measure seemed ready to clear the House, Monsignor James T. McHugh, the director of the Family Life Division of the United States Catholic Conference, did remind a House subcommittee of statements by the National Conference of Catholic Bishops that expressed "opposition to the increased activity of the federal government in programs of birth control" and "strong opposition to liberal abortion laws and the trend to abortion on demand."