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History of Title X
Beginnings
The Food and Drug Administration's approval of the birth control pill in 1960 marked a dramatic development in contraception available to couples wishing to space their children or avoid pregnancy. By 1965, the pill was the leading method of reversible contraception used in the United States.
But Americans, especially low-income families, continued to have more children than they desired.1 Studies revealed a vicious cycle from which many women and men could not escape, where poverty impeded access to contraception, resulting in unintended childbearing that further increased poverty and reliance upon public assistance.
President Johnson's War on Poverty spawned the first federal effort to specifically address the issue. His Office of Economic Opportunity began offering grants for family planning services in 1965, the same year the Supreme Court struck down a Connecticut law that prohibited the use of contraceptives by married couples in Griswold v. Connecticut.
Other efforts in the late '60s included amending the Social Security Act to require state welfare agencies to make family planning services and information available to recipients. During this time, President Richard Nixon (R) took a special interest in family planning as a remedy for the burst of population growth.
On July 18, 1969 President Nixon pledged his commitment in a message to Congress, stating:
"It is my view that no American woman should be denied access to family planning assistance because of her economic condition. I believe, therefore that we should establish as a national goal the provision of adequate family planning services within the next five years to all those who want them but cannot afford them. This we have the capacity to do."2
His next step was to create a commission in 1970, chaired by John D. Rockefeller, III. This commission concluded that:
"All Americans, regardless of age, marital status, or income, should be enabled to avoid unwanted births. Major efforts should be made to enlarge and improve the opportunity for individuals to control their own fertility, aiming toward the development of a basic ethical principle that only wanted children are brought into the world."3
Soon Congress responded, enacting Title X (ten) of the Public Health Service Act, the first - and to this day, only - federal program dedicated to providing family planning services nationwide. Signed into law by President Nixon on December 26, 1970, champions of the program during its enactment included then-Congressman George H.W. Bush, who said in 1969:
"We need to make population and family planning household words. We need to take sensationalism out of this topic so that it can no longer be used by militants who have no real knowledge of the voluntary nature of the program but, rather are using it as a political steppingstone. If family planning is anything, it is a public health matter."4
Title X Today
The United States family planning program, Title X, is now administered within the Department of Health and Human Services' Office of Public Health and Science, Office of Population Affairs (OPA) by the Office of Family Planning. By law, priority is given to low-income or uninsured women and men who may otherwise lack access to health care.
In addition to contraception, Title X funds a range of preventive health care services free of charge to individuals at or below the poverty level. A sliding fee scale ensures that low to moderate income women are also able to access these services, including:
Comprehensive, culturally competent counseling and services Breast and pelvic examinations Breast and cervical cancer screening Healthy body weight screening and counseling HIV testing Screening for and treatment of sexually transmitted infections Screening for high blood pressure and high cholesterol Pregnancy testing and counseling
A 2005 government review of Title X by the White House Office of Management and Budget (OMB) confirms that the program serves a unique and valuable purpose, is cost-effective, and is effectively managed. Over two decades, services provided at Title X-funded health centers:
Prevented 20 million unintended pregnancies and nine million abortions Helped to prevent 5.5 million adolescent pregnancies Provided an estimated 54.4 million breast exams and 57.3 million Pap tests, resulting in the early detection of as many as 55,000 cases of invasive cervical cancer.5
But despite its impeccable credentials, funding for Title X has languished when compared with the need: increasing numbers of uninsured and low-income people need its services, and the cost of birth control has increased dramatically. Had Title X funding kept pace with medical inflation since FY 1980, it would now be funded at more than $725 million instead of the FY 2007 level of $283 million. In other words, taking inflation into account, funding for Title X in constant dollars is 61 percent lower today than it was in FY 1980.6
Title X is a core component of the U.S. public health care system and an important source of primary health care for millions of men and women. Every public dollar spent to provide family planning services saves almost $4 in Medicaid costs for pregnancy-related and newborn care alone.7 Especially in this time of tight state and federal budgets, further investments made to strengthen the Title X system will pay hefty dividends.
1. National Women's Law Center and Planned Parenthood Federation of America. Proprietary research. 2006-2007.
2. Nixon, Richard. Special Message to the Congress on Problems of Population Growth. President Richard Nixon, July 18, 1969. The Nixon Foundation and Library. Click here (August 2007)
3. Center for Research on Population and Security. Report from the Commission on Population Growth and the American Future. March 27, 1972. Click here (August 2007)
4. Planned Parenthood Federation of America. America's Family Planning Program: Title X. Deborah Friedman, MPH. March 2003
5. Gold, Rachel Benson, "Title X: Three Decades of Accomplishment," Guttmacher Report on Public Policy, 4, no. 1 (February 2001) Click here (August 2007)
6. The Alan Guttmacher Institute. Memo, February 12, 2007
7. Frost, J. et al, ?Estimating the Impacts of Serving New Clients by Expanding Funding for Title X.? Guttmacher Institute, Occasional Report No. 33, November 2006.
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