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# **April 2006**

# **Policy Brief ...............\....................................................Title X**

RSC Contact: Sheila Cole, 202-226-9719

### Background on the Federal Title X Program

Title X (pronounced "title ten"), the only federal program exclusively
focused on contraception distribution, was established by the Family
Planning Services and Population Research Act of 1970 (P.L. 91-572).
Despite the fact that the Title X program's legal authorization to exist
expired on 9/30/85, Congress continues to appropriate money.

###### Teen Use

1/3 of Title X recipients are teens, according to U.S. Department of
Health and Human Services ([www.hhs.gov](http://www.hhs.gov/))

According to the 2004 Annual report of Title X grantees (e.g. The Family
Planning Annual Report), in 2004 14% of Title X clients were under the
age of 18.

<http://www.agi-usa.org/pubs/FPAR2004.pdf>

###### Title X Funding

**Since its inception, Title X has received approximately \$5 billion.**

(A full funding chart for Title X is available at:
<http://opa.osophs.dhhs.gov/titlex/ofp-funding-history.html>)

FY2006 \$283.103 million

FY2005 \$285.977 million

###### FY2004 \$278.348 million

###### FY2003 \$273.350 million

FY2002: \$265.085 million

FY2001: \$253.932 million

FY2000: \$238.932 million

FY1999: \$214.932 million

FY1998: \$203.452 million

FY1997: \$198.452 million

FY1996: \$192.592 million (first fiscal year of Republican Congress)

FY1995: \$193.349 million

###### Planned Parenthood

According to the General Accounting Office, Planned Parenthood
Federation of America and its affiliates spent \$58.7 million federal
Title X dollars and \$60.9 million Medicaid dollars in FY01, the last
year for which these numbers are available.

<http://www.house.gov/pence/rsc/doc/GAOabortfunding03partI.pdf>

<http://www.house.gov/pence/rsc/doc/GAOabortfunding03partII.pdf>

###### Number of Clinics

According to HHS, in 2001-2002 over 4,500 clinics (up from 4,000 in
1998-99) receivec federal family planning money (including clinics in
Guam, Puerto Rico, Marianas Islands, etc.). The current recipients are
listed by state in a directory, "Title X-Funded Family Planning
Grantees, Delegates, and Clinics available online
<http://opa.osophs.dhhs.gov/titlex/ofp-service-grantees.html>

###### Federal Regulations Require Free & Confidential Teen Services:

It is important to note that Federal [Regulations]{.underline} (not
laws) require confidentiality and teen service.

Title 42---Public Health, Chapter 1---Public Health Service, Department
of Health and Human Services, Part 59---Grants for Family Planning
Services, Subpart A\--Project Grants for Family Planning Services (42
CFR 59)

---Federal Register Vol. 65, No. 128, revised Monday, July 3, 2000, pp.
41270-41280

> "Section 59.5 What requirements must be met by a family planning
> project?
>
> ... (4) Provide services **without regard of** religion, race, color,
> national origin, handicapping condition, **age,** sex, number of
> pregnancies; or marital status."
>
> "Section 59.11 Confidentiality.
>
> All information as to personal facts and circumstances obtained by the
> project staff about individuals receiving services **must be held
> confidential and must not be disclosed without the individual's
> documented consent,** except as may be necessary to provide services
> to the patient or as required by law, with appropriate safeguards for
> confidentiality. Otherwise, information may be disclosed only in
> summary, statistical, or other form which does not identify particular
> individuals."
>
> "Section 59.2 Definitions.
>
> ***Low income family*** means a family whose total annual income does
> not exceed 100 percent of the most recent Poverty Guidelines issued
> pursuant to 42U.S.C. 9902(2). "Low-income family" also includes
> members of families whose annual family income exceeds this amount,
> but who, as determined by the project director, are unable, for good
> reasons, to pay for family planning services. For example,
> **unemancipated minors who wish to receive services on a confidential
> basis** must be considered on the basis of their own resources."

[Federal Statute (42 USC Sec. 300a-4) Grants HHS Secretary Authority to
Define *"*Low-Income Family":]{.smallcaps}

Title 42---The Public Health and Welfare Chapter 6A---Public Health
Service Subchapter VIII---Population Research and Voluntary Family
Planning Programs --

> "Sec. 300a-4. Grants and contracts

**...** (c) Prerequisites; "low-income family" defined

> A grant may be made or contract entered into under section 300 or 300a
> of this title for a family planning service project or program only
> upon assurances satisfactory to the Secretary that -
>
> \(1\) priority will be given in such project or program to the
> furnishing of such services to persons from low-income families; and

\(2\) **no charge will be made in such project or program for services
provided to any person from a low-income family** except to the extent
that payment will be made by a third party (including a government
agency) which is authorized or is under legal obligation to pay such
charge.

**For purposes of this subsection, the term "low-income family" shall be
defined by the Secretary in accordance with such criteria as he may
prescribe** so as to insure that economic status shall not be a
deterrent to participation in the programs assisted under this
subchapter."

**[Child Abuse/Sexual Abuse, & Rape Reporting
requirements:]{.smallcaps}**

Since the Fiscal Year 1999 Labor/HHS/Education Appropriations Act was
signed by President Clinton, and every subsequent year, it has been the
law of the land that Title X family planning providers must obey state
laws requiring notification or the reporting of child abuse, child
molestation, sexual abuse, rape, or incest.

Current law, signed by President Bush, states:

"SEC. 212. Notwithstanding any other provision of law, no provider of
services under title X of the Public Health Service Act shall be exempt
from any State law requiring notification or the reporting of child
abuse, child molestation, sexual abuse, rape, or incest."

--- PL108-199 (H.R.2673)

**[Abortion Referrals]{.smallcaps}**

According to federal regulations, all clinics must make abortion
referrals, upon request, as well as dispense a "broad range of
acceptable and effective medically approved family planning methods,"
including the morning-after pill. Abortion referrals were stopped under
Presidents Reagan and Bush, but Clinton lifted the so-called "Gag Rule"
in January 1993, and HHS codified President Clinton's Presidential
Memorandum in the July 3, 2000, revised regulations.

"Section 59.5 What requirements must be met by a family planning
project?

> A project must: Offer pregnant women the opportunity to \[be\]
> provided information and counseling regarding each of the following
> options: ...Pregnancy termination. If requested to provide such
> information and counseling, provide neutral, factual information and
> nondirective counseling on each of the options, and referral upon
> request, except with respect to any option(s) about which the pregnant
> woman indicates she does not wish to receive such information and
> counseling."

###### Case Studies:

The following examples are ones that could have been prevented if
taxpayer-funded clinics were required to notify parents prior to
dispensing or surgically implanting contraceptive drugs or devices.

> In 1997 it was learned that a 13-year-old girl from McHenry Country,
> Illinois was sexually molested by her junior high school teacher (37
> years old when it ended) over a period of 18 months. The teacher
> repeatedly took his victim to a Title X clinic where she received
> injections of Depo Provera, without her parents' knowledge.

---See Congressional Testimony from July 2002
[http://energycommerce.house.gov/107/hearings/07112002Hearing632/Heisler1092.htm]{.underline}

> In January of 1998, a 16-year old in Walton County, Georgia,
> unbeknownst to her parents, went to receive a pelvic exam and an
> injection of the contraceptive drug Depo Provera. The young girl
> casually mentioned to the nurse that she had a heart murmur. The nurse
> told the girl she would need a doctor's note so the clinic would be
> immune from a malpractice claim. The family's doctor subsequently told
> the mother that had the chemical contraception been administered,
> there was a great probability [her child would have gone into cardiac
> arrest and possibly died]{.underline} because of her heart condition.
>
> ---Correspondence from Georgia State Rep. Len Walker, March 18, 1998

###### Majority of Teens Say They Should have to Ask Parents:

In a Nov '96-Feb '97 Gallup survey of 500 teenagers, ages 13 to 17, 66%
of the teens that were polled believed that parental consent \[stronger
requirement than notification\] should be required before minors receive
birth control.

###### Medical journals support notion that parental involvement affects behavior

The Journal of the American Medical Association affirms that this
parental involvement affects teens becoming sexually active:

> "Significant family factors associated with delaying sexual debut
> include high levels of parent-family connectedness, parental
> disapproval of their adolescent being sexually active, and parental
> disapproval of their adolescent\'s using contraception."

---"Protecting Adolescents from Harm," *JAMA*, September 10, 1997.

###### Dangers of contraceptive use in teens include pregnancy and death

According to manufacturer's warning, included in contraceptive
packaging. Side effects from contraception can include blood clotting,
bone deterioration, and blindness. It can cause death in girls with
heart conditions, and has been the cause of brain-stem stroke in
teenagers. As to effective birth control, the Alan Guttmacher Institute,
Planned Parenthood's research arm, reports, "47 percent of all
unintended pregnancies in the US occur while the woman is using
contraceptives\..."

###### Parental Notice Amendment History

**FY99:** The Istook/Barcia/Manzullo parental notice amendment to FY99
HHS appropriations bill passed the House on 224-200 vote on October 8,
1998. <http://clerk.house.gov/evs/1998/roll504.xml>

The amendment requires:

1)  Title X clinics to follow state sexual abuse reporting laws,

2)  Parental notice before contraceptive drugs and devices are given to
    a minor,

3)  Abstinence counseling for minors to avoid HIV and STDs.

The House-Senate conference on the FY99 Omnibus (of which the HHS
appropriations bill was a part) dropped the substance of the amendment,
except the first requirement on state sexual abuse laws.

**FY98:** During the FY98 Labor/HHS/Education Appropriations House floor
vote on Sept. 9, 1997, an amendment was offered by Rep. Istook to
"require parental notification." Rep. Castle offered a second-degree
gutting amendment that deleted the word "require" in the Istook
amendment and inserted "*encourage* parental involvement." The gutting
amendment passed 220-201, Roll Call #378
<http://clerk.house.gov/evs/1997/roll378.xml>, thus nullifying true
parental involvement. There was also a gutting substitute offered by
Rep. Obey to Rep. Istook's amendment in July 12, 1996, which passed
232-193, Roll Call #310 <http://clerk.house.gov/evs/1996/roll310.xml>

###### Why They Said America Needed Title X 

From the House debate (1970) on the original Title X authorization bill:

"Mr. CARTER. Mr. Speaker, the Family Planning Services and Population
Research Act of 1970 is greatly needed. Estimates have been made by
reliable authorities that by the year 2000 our population in the United
States will reach 300 million. It is entirely possible that productivity
in a nation even as wealthy as ours may not rise sufficiently to
properly feed, clothe, and care for this gigantic increase. The quality
of life could well be diminished."

U.S. House of Representatives, Debate on H.R. 19318, November 16, 1970

Congressional Record page 37367

\[Author's Note: The United States population reached close to 300
million (281 million, not counting many illegal aliens) in 2000, up from
203 million in 1970. By all accounts, the American population was well
fed, clothed and cared for in 2000.\]

> **Congressional Record page 37370**
>
> \"Mr. BUSH.
>
> \...
>
> Of course, we cannot blame population growth for all the ills of our
> society\--which is becoming a popular position\--but, we do need
> public awareness that birth control is basic health care for the
> benefit of both parent and child. In addition, we must address
> ourselves to the fact that there are still vast numbers of Americans
> who are unfamiliar with even the most essential understanding of this
> potentially dangerous population growth rate and do not have access to
> even minimal health care facilities.
>
> \"At the same time, there must exist a great sensitivity to these
> problems which cannot be provided by the Federal Government. The
> Government can provide leadership and direction, **but should never be
> put in a position of having to enact controls of population as a
> result of public ignorance and indifference.\"**
>
> **\*\*\***
>
> **Congressional Record page 37373**
>
> \"Mr. SCHMITZ. The bill before us today, brought up under suspension
> of the rules on the very first day after a month-long recess, would
> commit the U.S. Government to the life prevention business at an
> initial cost of more than a quarter of a billion dollars. We all know
> from long experience with Federal programs how much this figure is
> certain to rise once the program is underway\--with no end in sight.\"
>
> *\[Author's note: FY1971= \$6 million appropriated. Since then Title X
> has received approx. \$5 billion\]*
>
> \"The bill contains no restrictions whatever on the age or the marital
> status of persons who may receive contraceptives paid for the by the
> funds it appropriates. Dr. Alan F. Guttmacher, president of Planned
> Parenthood -World Population admitted in testimony before the
> Interstate and Foreign Commerce Committee that his organization which
> would in all likelihood receives substantial funding from the
> appropriations provided by this bill-now gives contraceptives to young
> teen-age children in family life classes in several large cities.
> **Thus it is simple truth to say-unpalatable as a blunt statement of
> that truth may be-that in practice it will amount to officially
> condoning and sanctioning not only fornication, but statutory rape."**
>
> \*\*\*