About the Title X Family Planning Program
For nearly 50 years, the Title X family planning program has played a critical role in preventing unplanned pregnancy by offering high-quality contraceptive services, preventive screenings, and health education to low-income women and men. In addition to Medicaid, Title X is an important part of the health care safety net.
What Can You Do to Protect Title X?
If you can advocate, please call or email your Senator and urge them to do the following: "As the Senate begins consideration of the FY 2020 LHHS Appropriations bill, please support $400 million for the Title X Family Planning Program and prohibit the use of FY 2020 funds to implement the Administration’s domestic gag rule, as the recently passed House bill does"
[scroll down for more background]
WHY IS CONTRACEPTIVE ACCESS IMPORTANT?
Women who decide to become pregnant, rather than having it “just happen,” are better prepared emotionally and financially for the demands of parenting. But they can’t make that decision if they lack access to contraception.
Forty-five percent of pregnancies among all women are described by the women themselves as unplanned. Women under age 30 account for the majority of these (nearly 2 million of the 2.8 million unplanned pregnancies in the US). We have seen progress in recent years—as unplanned pregnancies have begun to decline—but more work remains to ensure that everyone has the power to decide.
Unlike many other health issues, unplanned pregnancy is completely preventable. Only 5% of unplanned pregnancies occurred in women using birth control carefully and consistently. The other 95% of unplanned pregnancies occur among women who don’t contraception or who use it inconsistently.
The reasons for this are complex, but it often comes down to a lack of access to the full range of contraceptive options. This is particularly important for people who face the greatest disparities in unplanned pregnancy. For example, the unplanned pregnancy rate remains higher for black and Hispanic women than for white women, and these disparities remain even when controlling for income.
EXECUTIVE BRANCH THREATS TO TITLE X
2018 Grant Competition
In February 2018, the Trump Administration released a funding opportunity announcement (FOA) for the next round of Title X grantees, which raised several concerns:
- The FOA does not mention the word contraception once in its 60 pages;
- It fails to refer to the Quality Family Planning recommendations—the national standard of clinical care for family planning services produced by the Centers for Disease Control and Prevention and the U.S. Office of Population Affairs; and
- Funding may go to providers who do not provide the full range of contraceptive methods.
See Power to Decide’s full statement on the FOA.
In May, two lawsuits (later consolidated into one) were filed in Washington, DC in response to the FOA. In July, the court ruled in favor of the government and the plaintiffs promptly filed a notice of appeal. In August 2018, the Administration issued awards for a 7-month project period, a big departure from the customary three-year project period.
On February 22, 2019 the Trump Administration issued the final rule for the Title X Family Planning Program, commonly referred to as the "domestic gag rule." The final rule disallows Title X funding to provide high-quality, affordable contraceptive services in health centers that also offer abortion services, unless those services are offered at a physically separate site. In addition, the rule allows health providers at sites that receive Title X funds to not provide information about abortion alongside other pregnancy options, as well as effectively banning providers from referring for abortion. See Power to Decide's full statement on the final rule. The rule is the subject of numerous lawsuits. See below for the latest.
- On June 20, the Ninth Circuit Court of Appeals stayed a preliminary injunction that had blocked the final rule governing the Title X Family Planning Program from going into effect. This means the changes to the Title X Family Planning Program will take effect as the rule is being challenged in the courts. See Power to Decide's statement here.
- On April 29, Judge Michael McShane in the Oregon District Court issued a nationwide injunction blocking the entire rule, in cases brought by Oregon Attorney General Ellen Rosenblum leading 20 other state attorneys general, and the Planned Parenthood Federation of America with the American Medical Association.
- On April 26, Judge Edward Chen in the Northern District of California issued an injunction blocking the entire rule but limited the scope to California. Judge Chen’s injunction ruling was on cases brought by Essential Access Health, a Title X grantee in California, and California Attorney General Xavier Becerra.
- On April 25, Judge Stanley Bastian in the Eastern District of Washington issued a nationwide injunction blocking the entire Title X rule, effective immediately. That injunction came immediately after a hearing in two cases: one brought by NFPRHA, along with co-plaintiff Cedar River Clinics, represented by litigators from the ACLU, and another brought by Washington State Attorney General Bob Ferguson.
FY 2019 (current fiscal year that ends September 30, 2019) - Status: Funding secured, see our handy budget chart
On September 28, 2018, President Trump signed H.R. 6157 into law (P.L. No. 115-245). The bipartisan spending package provides full funding for Labor, Health and Human Services and Education (LHHS) for fiscal year (FY) 2019, which runs from October 1, 2018 to September 30, 2019. The bill includes $286.5 million (level-funding) for the Title X Family Planning Program.
FY 2020 (begins October 1, 2019) - Status: in progress
- On June 19, 2019, the House voted to pass the FY 2020 Labor, Health and Human Services, and Education (LHHS) Appropriations bill, as part of a so-called minibus package that included three other spending bills. The bill, HR 2740, passed largely along party lines (226-203). Like the bill passed by the House Appropriations Committee on May 8th, it includes increased funding for Title X and language to protect the integrity of the program.
- On May 8, 2019, the full House Appropriations Committee passed its FY 2020 LHHS bill (see page 48-49 of the draft bill). It includes $400 million for Title X, which is a $113.5 million increase, and it prohibits the use of fiscal year 2020 funds to implement the Administration’s domestic gag rule.
- On April 30, 2019, the House Labor, Health and Human Services, Education, and Related Agencies (LHHS) Appropriations Subcommittee released its version of the FY 2020 funding bill. See Power to Decide's full statement on the LHHS Subcommittee funding bill here.
- President Trump released his FY 2020 budget proposal in mid-March. It proposes insufficient funding for Title X at $286.5 million. Experts recommend the program receive at least $400 million in FY 2020. For additional details on the President’s budget proposal, see Power to Decide's statement here. Fortunately, the President’s budget proposal is just that—a proposal. Congress has the power of the purse and will ultimately determine funding for FY 2020. Still, the President’s budget request does signal the Administration’s priorities to Congress.
The Senate Appropriations Committee needs to consider their version of the LHHS Appropriations bill. At this time we don’t know when that will be, but it could be as soon as July.
- FY 2018 to FY 2020 Budget Chart
- Power to Decide’s FY 2020 Appropriations Request Letter
- Federal Funding Streams at a Glance
- Power to Decide's 2019 Federal Policy Agenda
Title X Resources
Key Points on Title X and Contraceptive Access
- 75% of adults favor continuing the Title X Program, including 66% of Republicans and 84% of Democrats.
- 78% of adults agree that birth control is a basic part of women’s health care.
- More than 90% of all Americans (across political parties, race, and ethnicity) agree that for those trying not to get pregnant, using birth control is taking personal responsibility.
- Ensuring women have the power to decide if, when, and under what circumstances to get pregnant and have a child improves educational attainment and family well being, saves taxpayer dollars, and reduces abortion.