Title X Clinics: Reproductive Health Care for Low-Income Women
What Are Title X Clinics? The federal Title X program provides public funding for family planning and preventive health care screening services. Established by Congress in 1970, the aim of the program is "to assist in making comprehensive voluntary family planning services readily available to all persons desiring such services." These clinics offer contraceptive services and education that prevent unintended pregnancy, testing and treatment for sexually transmissible infections (STIs), and other primary reproductive health care. Approximately 4,600 public and private entities, including non-profit family planning clinics, hospitals and public health departments, receive Title X funds each year. Title X funding does not cover abortion or pregnancy care, such as obstetric or prenatal care. Title X Clinics are unique because they provide services based on the patients’ income, using a sliding scale. For individuals at or below the federal poverty line, there is no cost for the services. Most importantly, no patient is ever refused services because of his or her inability to pay. Responding to the need for better reproductive health care coverage for adolescents, Congress amended Title X to emphasize “preventing unwanted pregnancies among sexually active adolescents” in 1978. How does Title X Operate Nationally? Title X clinics serves millions of Americans each year, achieving critical public health goals. The preventative services offered through Title X ultimately reduce costs to society, by preventing unintended pregnancies and STI’s, as well as detecting reproductive health care problems early. In states where funds are distributed, the Title X program requires that all participants, including adolescents, receive confidential care. Each year approximately 4.5 million people receive health care services at Title X-funded clinics. The vast majority of those using Title X clinics are women, and 60% are less than 25 years of age. Almost two-thirds of Title X clients come from households with incomes below the poverty level Despite the incredible achievements of Title X clinics, there are still many issues (especially funding) which persist each year. For example, many family planning clinics struggle to stay open for hours convenient for underserved populations.
How has Title X developed in Wisconsin? In 1971, Planned Parenthood of Wisconsin obtained Title X funds and established a clinic in Milwaukee. Several other independent providers soon followed. In 1973, the same year that Roe v. Wade was decided, the Wisconsin Family Planning Coordinating Council (WFPCC) was organized and became the grantee for Title X funding. They focused on expanding services, especially in densely populated parts of the state. In 1988, the Wisconsin State Legislature increased family planning appropriations to include cervical cancer and STD screenings. This was also the year that the Title X program began supporting all pregnancy testing services. The Title X Family Planning Waiver in Wisconsin, however, does not cover HIV Testing. In 2003, the Family Planning Medicaid Waiver went into effect in Wisconsin, providing confidential family planning services to all women ages 15-44 who are at or below 185% of the federal poverty level. This measure was critical, because 59% of sexually active girls surveyed in Wisconsin said they would stop, discontinue, or delay using certain reproductive health services (including contraception and STD/HIV testing) if their parents were informed. Studies suggest that Title X funding in Wisconsin (as nationally) is not even beginning to meet the state’s family planning needs. Last summer, the Republican assembly attempted to drastically reduce Title X funds in the state budgets, especially for adolescents. This measure would have resulted in the closing of numerous family planning clinics, and ultimately failed. What’s new with Title X? The Bush Administration’s anti-choice agenda has proved perilous for the Title X program. If Title X funding had increased with inflation, it would have be funded at over $590 million in 2008. However, the Bush Administration proposed just $265 million for the 2004 budget, with congress approving $275 million. In 2008, Congress increased Title X funding by almost $17 million, bringing the total funding level to just under $300 million. Several congressional restrictions over the past decade have threatened the vitality of the Title X program. One such restriction, the Parent’s Right to Know Act of 2003 (H.R.2444), would require minors to either notify or obtain the consent of a parent, or approval from a judge, before obtaining contraceptives from a Title X provider. Denying minors confidential care at Title X clinics would drastically reduce the ability of those facilities to serve them. A second restriction would disqualify any private grantee that provides abortions with non-Title X funds from receiving Title X funds for contraceptive or other preventive health-care services. If adopted, this restriction would deny funding to an estimated six hundred Title X clinics, which serve nearly one million low-income women.
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