X-ing out Title X

Earlier this week, the US House of Representatives Committee on Appropriations released its 2016 budget proposal for funding the Department of Health and Human Services. As part of that proposal, the Republican-dominated Committee recommended eliminating funding for the Title X (ten) family planning program.

For those of you who may not be familiar with the Title X family planning program, it is the only federal program that provides family planning and reproductive health services for low-income Americans. Enacted in 1970 with broad bipartisan support and signed into law by Republican President Richard Nixon, the program subsidizes nearly 4,200 clinics nationwide. Those clinics provide contraception and family planning services at little to no cost for individuals who earn less than $25,000 a year. Most patients are women. A disproportionate number are women of color.

All told, over 5 million people use Title X-funded clinics annually. According to the Guttmacher Institute, a non-profit organization that works to advance sexual and reproductive health and rights, these clinics serve one in five American women who seek birth control counseling. Over 15% of all the contraceptive prescriptions written and a third of the family planning supplies used in the US come via these clinics, preventing an estimated 1.2 million unintended pregnancies yearly.

More importantly, these millions of women (and men) don’t just use these clinics for family planning. That’s because Title X-supported clinics provide more than just contraceptive services. They provide a variety of health-related services, including: screening for breast cancer, cervical cancer and testicular cancer; testing and treatment for sexually transmitted diseases; prenatal, postpartum and well-child care; and even preventative medical exams. Over the past 20 years, for example, these clinics have conducted nearly 60 million Pap tests, providing early detection of as many as 55,000 cases of invasive cervical cancer.

The services provided by Title X clinics don’t just prevent unwanted pregnancies, these services save lives. This comes at the modest annual cost of just $60 per patient. Last year, the federal government spent a mere $300 million on the Title X family planning program. That same year, the services provided by Title X clinics saved the government an estimated $2.1 billion in downstream health care costs. By contrast, the fiscal conservatives who control Congress appropriated over $4 billion for unnecessary pork barrel projects, including $120 million to upgrade the M1 Abrams tank despite the objections of military officials. Over 2,000 of those tanks are currently sitting idle in the California desert as the Pentagon has no use for them.

For many low-income Americans, Title X-funded centers may be the only place they receive care. One survey found that nearly two-thirds of women who received services at a Title X-supported clinic had no other source of primary medical care.

So why are Republicans so eager to do away with a modestly priced but widely successful program? The reason can be summed up with one word: abortion. Specifically, the Title X family planning program subsidizes some Planned Parenthood clinics that also offer abortion services. Planned Parenthood is the largest single recipient of Title X funding, and that is enough for conservative lawmakers to put the program to the hatchet.

Keep in mind that federal law prevents Title X funding from being used to pay for abortions. Also keep in mind that many Planned Parenthood clinics do not provide abortion services; abortion accounts for only 3% of the total number of procedures performed at all Planned Parenthood clinics. So the logic behind the decision to cut Title X funding is somewhat convoluted: the public money that is provided to a large number of clinics for family planning services frees up other private money at a small number of clinics that can then be used to pay for abortion. The absurdity of that line of reasoning makes my head hurt.

This line of reasoning is also flawed. If the goal of Republican congressmen is to prevent abortion, then they should increase funding for Title X rather than cut it. As I mentioned earlier, the family planning and contraceptive services provided by Title X-funded clinics prevent an estimated 1.2 million unintended pregnancies yearly. Should these unwanted pregnancies occur, statistically they would result in about 200,000 miscarriages, 600,000 births, and 400,000 abortions. The number of abortions in the US will actually increase should the Title X family planning program be scrapped.

There will be other deleterious effects as well. Many Title X-funded clinics provide desperately needed health care services to millions of poor men and women, including pregnancy testing and prenatal care, cancer screening, HIV testing and education, and testing and treatment for sexually-transmitted diseases.

Without these subsidies, many of these clinics will be forced to close. In those communities, we can expect to see increasing rates of maternal morbidity and of negative birth outcomes like low birth weight, premature birth, and infant mortality. We can also expect to see outbreaks of HIV and other sexually transmitted diseases, as recently happened in Scott County, Indiana when that county’s HIV testing clinic closed.

The personal and economic costs of cutting Title X are likely to be staggering, particularly at a time when conservative lawmakers are also actively trying to dismantle the Affordable Care Act, eliminate funding for comprehensive sex education and teen pregnancy prevention programs, and give employers the right to deny employees access to birth control. Unfortunately, these ideologues are likely to succeed, leaving 5 million Americans without care and the rest of us footing the tab.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on June 18, 2015, and is available on the WAMC website.]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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