Title X: A Q&A with NFPRHA’s Clare Coleman

The Trump administration has been far behind schedule in releasing its annual application allowing entities to apply for and receive Title X family planning funding. This delay has created uncertainty for our nation’s publicly funded family planning providers and could jeopardize access to health care for the 4 million people who rely on the safety net program for subsidized family planning and sexual health care every year. Public Health Newswire spoke to Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, a member organization representing publicly funded family planning providers and administrators, to understand the role of the Title X program and the impact a delay in funding, and other policies targeting the program, could have on the public’s health.

Q: What is the Title X program and why was it created?

The Title X (ten) family planning program – crafted with the overwhelming support of both parties in Congress and signed into law in 1970 by President Richard Nixon – was created to ensure high-quality family planning and sexual health care for low-income, uninsured and underinsured individuals. A federal grant program, Title X supports health centers’ capacity to deliver a range of preventive health care, including breast and cervical cancer screening, screening and treatment for sexually transmitted diseases, HIV testing, infertility screening and contraception.

Q: How is the Title X network organized?

Title X providers are a diverse group. They include state government and non-profit health centers that specialize in women’s health; community health centers; and non-profit hospitals that work in partnership with the public health workforce to deliver high-quality services. For example, in Georgia, the Title X network consists of a consortium of federally qualified health centers. In Montana, the state provides family planning care through its network of health departments. Family planning networks vary by state because they were established to meet the unique health care needs of each community. To offer a better sense of how services are organized, this month we at NFPRHA released a new online tool that provides a snapshot of what the Title X network looks like in every state.

Q: A core mission of Title X is to provide family planning care to low-income people. How else has this imperative been challenged in recent years?

Since 2010, nearly every state across the country has experienced funding cuts to the Title X program, impacting the diverse provider network and making it harder for patients to receive the care they need. In the wake of persistent funding cuts, the Title X program has sustained a dramatic decline in patient volume, despite a growing need for services. The White House’s fiscal year 2018 budget request calls for flat funding the program, which is already significantly underfunded. Today, Title X can only meet the demand of about one-third of the women in need.

Q: According to recent reports, the annual funding opportunity announcement that allows agencies to apply for service delivery grants is behind schedule. What impact has that had on Title X-funded health centers?

The administration’s delay in the funding announcement is making it difficult for the grantees that administer the program to continue to maintain their diverse provider networks, while simultaneously forecasting how to preserve services if funding lapses. These disruptions strain the family planning safety’s capacity to provide timely, high-quality care for the patients who rely on Title X.

Q: What is at stake when lawmakers seek to compromise this network?

The health of millions of low-income women and men is at stake. Six in 10 women say a Title X-funded health center is their regular source of medical care and 4 in 10 women say it’s their only source of care. In 2015, service sites provided 769,807 Pap tests, over 1 million clinical breast exams, nearly 5 million STD tests and 1.1 million confidential HIV tests. Funding Title X is also a wise economic investment – public spending for the U.S. family planning program prevents unintended pregnancies and reduces preterm and low-birthweight births, sexually transmitted infections, infertility and cervical cancer. In fact, every dollar invested in publicly funded family planning services saves $7 in Medicaid costs associated with unplanned births.

Q: What can APHA members do to support the Title X program?

There are lots of ways APHA members can engage. Support your local family planning health center through volunteerism or financial contributions. Use your voice by telling your members of Congress how important it is to protect the Title X program and the people who rely on it for care. Talk to your friends and colleagues about how important it is to ensure highly qualified providers can deliver family planning and sexual health care services. Protecting Title X is a health equity issue that public health leaders can and should support.