BEYOND THE NUMBERS
The U.S. Department of Health and Human Services (HHS) recently proposed a rule to keep states from playing politics with federal Title X family planning funds by excluding family planning providers based on irrelevant criteria. The rule will increase millions of Americans’ access to essential health services, and HHS should quickly finalize and implement it.
Title X was established in 1970 with broad bipartisan support to provide family planning to anyone who needs it, with priority to those who can’t otherwise afford it. The program has been astoundingly successful: nearly 4,000 Title X-funded sites provided services to 4 million people last year. While offering traditional family planning services, Title X providers also offer preventive health care, such as cancer screenings. For many women, Title X providers are their main contact with the health care system.
Title X family planning services are critical: almost half of all pregnancies in America are unintended, and unintended pregnancies are associated with negative health and economic consequences for families as well as for states and the federal government. Many Title X grantees, particularly state and local health departments, provide sub-grants to providers who serve specific communities in need.
Despite the overwhelming need for family planning services, since 2011, 13 states have ended or restricted sub-grants based on criteria unrelated to a provider’s ability to effectively meet the program’s goals, such as whether the provider also performs privately funded abortions (federal funds can’t be used for abortion except in cases of danger to the life of the mother, rape, or incest). (States have tried similar tactics to exclude family planning providers from Medicaid, which the Centers for Medicare & Medicaid Services took recent action to prevent.) These actions have limited access to Title X services for many people without other options, and they wouldn’t be allowed under the proposed rule.
For example, in 2011 Texas slashed state funding for family planning services and changed its Title X sub-grant criteria. The state’s Title X network fell from 48 to 36 providers, and the number of Title X clients served fell sharply from 259,600 in 2011 to 166,500 in 2015. An analysis of maternal mortality in Texas from 2000 to 2012 showed a small increase in maternal deaths from 2000 to 2010, followed by a near doubling in the reported rate of maternal deaths from 2011 to 2012. While the study’s authors didn’t analyze the causes of this extreme increase in maternal mortality — defined by the World Health Organization as death of a woman while pregnant or within 42 days after pregnancy termination for causes related to the pregnancy — they note access to women’s health services as a possible factor.
By preventing states from imposing arbitrary limits on who gets Title X funds, the proposed rule will boost needed health care access and make Title X more efficient.