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 in 1970 as part of the Public Health Service Act. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. Title X is legally designed to prioritize the needs of low-income families or uninsured people (including those who are not eligible for Medicaid) 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 (OPA) by the Office of Family Planning (OFP). The statute and regulations of Title X require that 90 percent of congressional appropriations be used for clinical family planning purposes. In FY2010, Congress appropriated around $317 million for the Title X Family Planning program.
The first federal subsidies to help low-income families with birth control came in 1965 as part of President Lyndon Johnson’s War on Poverty program. In 1970 during the presidency of Richard Nixon, the Senate passed Title X unanimously, and the House voted 298 to 32 to pass the bill on to Nixon, who signed it into law. There was strong bipartisan support for Title X; Nixon noted as much in a statement he made upon signing the bill.
In 1972, Congress passed another bill to draw funds from each state’s Medicaid program to help pay for family planning for low income families, the states to be 90% repaid by the federal government. A third bill was passed in 1975 authorizing a network of family planning centers to be built across the U.S., in 2014, some 4,400 centers were in operation. Title X and the subsequent supporting bills were funded by $2.4 billion in 2010.
In 2006, publicly funded family planning services (Medicaid, Title X, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens; the number of unintended pregnancies among poor women would nearly double. The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed.
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, with most patients in their 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 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. Nearly 90% also received preventive gynecological 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 and around 66% had no health insurance. 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.
The first Title X clinic in Nebraska was established in Omaha in April 1935 under the auspices of the American Birth Control League, which became the Planned Parenthood Federation. The University of Nebraska Medical Center began providing family planning services through its Maternal & Infant Care Project in August 1965. The Lincoln Family Planning Center was opened in 1970 and the Scottsbluff Center in1971.
In 1972 the Nebraska Health Association began establishing clinics throughout rural Nebraska. In 1974 all family planning programs in Nebraska were brought under the direct administration of the State Department of Health. NDOH is now technically the grantee for Title X funds to Nebraska with 11 sub-grantees and 3 special projects.