Order Code RL33644
Title X (Public Health Service Act)
Family Planning Program
Updated August 4November 21, 2008
Angela Napili
Information Research Specialist
Knowledge Services Group
Title X (Public Health Service Act)
Family Planning Program
Summary
The federal government provides grants for voluntary family planning services
through the Family Planning Program, Title X of the Public Health Service Act,
codified at 42 U.S.C. § 300 to § 300a-6. The program, enacted in 1970, is the only
domestic federal program devoted solely to family planning and related preventive
health services. Title X is administered through the Office of Population Affairs
(OPA) under the Office of Public Health and Science in the Department of Health
and Human Services (DHHS). It receives its funding, however, through
through appropriations for the
Health Resources and Services Administration (HRSA) in
DHHS.
Although the authorization for Title X ended with FY1985, funding for the
program has continued to be provided through appropriations bills for the
Departments of Labor, Health and Human Services, and Education, and Related
Agencies (Labor-HHS-Education). The Title X program received $300 million for
FY2008, 6% more than the FY2007 level of $283.1 million.
On September 30, 2008, the President signed P.L.110-329, the Consolidated
Security, Disaster Assistance, and Continuing Appropriations Act, 2009. P.L.110329 provides temporary FY2009 funding, at the FY2008 funding level, through
March 6, 2009. For FY2009, the For FY2009, the
President’s budget requestsrequested $300 million, the
same as the FY2008 level. The SenatereportedSenate-reported Labor-HHS-Education
Appropriations bill (S. 3230; S.Rept. 110-410)
would also provide $300 million for
Title X in FY2009.
The law (42 U.S.C. § 300a-6) prohibits the use of Title X funds in programs
where abortion is a method of family planning. According to OPA, family planning
projects that receive Title X funds are closely monitored to ensure that federal funds
are used appropriately and that funds are not used for prohibited activities such as
abortion. The prohibition on abortion does not apply to all the activities of a Title X
grantee, but only to activities that are part of the Title X project. A grantee’s abortion
activities must be “separate and distinct” from the Title X project activities.
Several bills addressing Title X have been introduced in the 110th Congress.
The Prevention First Act (S. 21/H.R. 819) and the Reducing the Need for Abortion
and Supporting Parents Act (H.R. 1074) would authorize Title X appropriations of
$700 million for FY2008 and “such sums as may be necessary for each subsequent
fiscal year.” Other introduced bills include H.R. 104 and H.R. 5968, which would
require assurances that family planning projects will provide pamphlets with
adoption centers’ contact information; S. 351 and H.R. 4133, which would prohibit
Title X grants to abortion-performing entities; H.R. 1095, which would prohibit
federal spending for any family planning activities; H.R. 2134, which would require
parental notification before providing certain family planning services to minors; and
H.Con.Res. 232, which would express the sense of Congress that confidentiality
mandates for minors should be removed from Title X and Medicaid family planning
programs. This report was originally written by Sharon Coleman. It has been revised
by Angela Napili.
Contents
Title X Program Administration and Covered Services . . . . . . . . . . . . . . . . . . . . 1
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
FY2009 Funding Proposals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
FY2008 Appropriations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Abortion and Title X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Teenage Pregnancy and Title X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Planned Parenthood and Title X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Legislation in the 110th Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Bills: Reauthorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Bills: Abortion Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Bills: Elimination of Title X Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Bills: Adoption Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Bills: Information on Pregnancy Support Services . . . . . . . . . . . . . . . . . . . 11
Bills: Parental Notification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Amendments to FY2008 Appropriations Bills . . . . . . . . . . . . . . . . . . . . . . 12
Summary of Title X of the Public Health Service Act . . . . . . . . . . . . . . . . . . . . . 1216
List of Tables
Table 1. Title X Family Planning Program Appropriations . . . . . . . . . . . . . . . . . 6
Title X (Public Health Service Act)
Family Planning Program
Title X Program Administration
and Covered Services
Title X is administered through the Office of Population Affairs (OPA) under
the Office of Public Health and Science in the Department of Health and Human
Services (DHHS). It receives its funding through the appropriation for the Health
Resources and Services Administration. OPA administers three types of project
grants under Title X: family planning services;1 family planning personnel training;2
and family planning service delivery improvement research grants.3
Grants for family planning services fund contraceptive services and supplies,
and related preventive health services, such as infertility services; natural family
planning methods; special services to adolescents; adolescent abstinence counseling;
breast and cervical cancer screening and prevention; and sexually transmitted disease
(STD) and HIV prevention education, counseling, testing, and referral.4 Priority for
the provision of these services is to be given to lower-income families; grantees may
use a sliding fee schedule for determining client contributions for care, but grantees
may not charge low-income persons for care. The services must be provided
“without coercion and with respect for the privacy, dignity, social, and religious
beliefs of the individuals being served.”5
Grants for family planning personnel training are to be used to train staff and “to
improve utilization and career development of paraprofessional and paramedical
manpower in family planning services, particularly in rural areas.”6 Staff are trained
through 10 regional general training programs, one national clinical training program,
one national training center, and one national training program focused on improving
Title X services for males.7 The family planning service delivery improvement
1
Catalog of Federal Domestic Assistance (CFDA) 93.217, [http://www.cfda.gov].
2
CFDA 93.260
3
CFDA 93.974
4
DHHS, OPA, Program Priorities, at [http://www.hhs.gov/opa/familyplanning/
policyplanningeval/programpriorities/index.html].
5
CFDA 93.217
6
CFDA 93.260
7
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
(continued...)
CRS-2
research grants are to be used to develop studies to improve the delivery of family
planning services. These research grants target projects that enhance effectiveness
and efficiency of the service delivery system.
Title X clinics provide confidential screening, counseling, and referral for
treatment. In this regard, OPA has indicated that the program is committed to
maintaining the integration of HIV-prevention services in all family planning clinics,
particularly in areas where racial and ethnic minorities are disproportionately
affected.8 OPA provides supplemental funding for grants to help Title X projects
implement the Centers for Disease Control and Prevention’s “Revised
Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in
Health Care Settings.”9 OPA has also affirmed that Title X’s HIV/AIDS education
activities should incorporate the “ABC” message: “extramarital abstinence”(A);”be
faithful in marriage or committed relationships” (B); and “correct and consistent
condom use” (C).10
In 2006, Title X grantees reported that 5% of their clients were male.11
Common services that family planning agencies offer to males include condom
provision, STD counseling, contraceptive counseling, and STD treatment and
testing.12
Ninety percent of Title X funds are used for clinical services.13 At the start of
FY2008, there were 88 Title X family planning services grantees. Such grantees
included 43 state or local health departments, 6 territorial health departments, 10
Planned Parenthood affiliates, and 29 other nonprofit organizations, such as
7
(...continued)
Committees, p. 249, at [ftp://ftp.hrsa.gov/about/budgetjustification09.pdf].
8
DHHS, OPA, HIV Prevention and Integration in Family Planning, at
[http://www.hhs.gov/
opa/initiatives/hivprevention/].
in
Family
Planning,
at
9
Centers for Disease Control and Prevention (CDC), “Revised Recommendations for HIV
Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings,” MMWR
Recommendations and Reports, vol. 55, no. RR-14 (September 26, 2006), pp. 1-17, at
[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm]. See also CDC, HIV Testing
in Healthcare Settings, at [http://www.cdc.gov/hiv/topics/testing/healthcare/].
10
DHHS, OPA, Key Issues, at [http://www.hhs.gov/opa/familyplanning/policyplanningeval/
keyissues/keyissues.html].
11
Family Planning Annual Report: 2006 National Summary, February 2008, p. 9, at
[http://www.hhs.gov/opa/familyplanning/toolsdocs/FPAR2006NatlSum.pdf].
12
“Services for Men at Publicly Funded Family Planning Agencies, 1998-1999,”
Perspectives on Sexual and Reproductive Health, vol. 35, no. 5, September/October 2003.
DHHS, OPA/Office of Family Planning, FY 2003 Office of Family Planning Male Grantees
Program Summaries, at [http://www.hhs.gov/opa/familyplanning/grantees/male
involvement
maleinvolvement/].
13
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
Committees, pp. 249, 286.
CRS-3
hospitals, community health centers, family planning councils and universities.14
Title X grantees can provide family planning services directly or they can delegate
Title X monies to other agencies to provide services. Although there are no matching
requirements for grants, regulations specify that no clinics may be fully supported by
Title X funds.15 Title X provides services through more than 4,400 clinics
nationwide.16
In FY2006, Title X served 4.992 million clients, primarily low-income women
and adolescents. Ninety percent of clients had incomes at or below 200% of the
federal poverty level. For many clients, Title X clinics are their only continuing
source of health care.17 In 2006, the latest year for which data is available, 61% of
Title X clients had no health insurance.18
More information on the Title X program, including regional contacts, can be
found on the Internet at [http://www.hhs.gov/opa/familyplanning/].
Funding
Although the program is administered by OPA, funding for Title X activities is
provided through the Health Resources and Services Administration (HRSA) in
DHHS. Authorization of appropriations expired at the end of FY1985, but the
program has continued to be funded through appropriations bills for the Departments
of Labor, Health and Human Services, and Education, and Related Agencies (LaborHHS-Education).
FY2009 Funding Proposals
On July 8, 2008, the Senate Appropriations Committee reported its proposed
bill for FY2009 Labor-HHS-Education appropriations (S. 3230; S.Rept. 110-410).
It would provide $300.0 million for Title X, the same as the FY2008 funding level
and the President’s Budget Request.19 The bill repeats previous years’ language
requiring grantees to certify that they encourage “family participation” when minors
decide to seek family planning services, and to certify that they counsel minors on
September 30, 2008, the President signed P.L.110-329, the Consolidated
Security, Disaster Assistance, and Continuing Appropriations Act, 2009. It provides
temporary FY2009 funding, at the FY2008 funding level, through March 6, 2009.
Under the continuing resolution, funds are made available under the same authority
and conditions provided during FY2008.
On July 8, 2008, the Senate Appropriations Committee reported its proposed
bill for FY2009 Labor-HHS-Education appropriations (S. 3230; S.Rept. 110-410).
14
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
Committees, p. 249. Email correspondence between the author and Maurice Huguley,
Office of the Assistant Secretary for Legislation, U.S. Department of Health and Human
Services, October 30, 2007.
15
42 C.F.R. 59.7(c)
16
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
Committees, p. 249. A searchable directory of Title X providers is at
[http://www.opa
clearinghouseopaclearinghouse.org/db_search.asp].
17
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
Committees, pp. 249, 252.
18
19
Family Planning Annual Report: 2006 National Summary, February 2008, p. 21.
S.Rept. 110-410, p. 59.
CRS-4
CRS-4
It would provide $300.0 million for Title X, the same as the FY2008 funding level
and the President’s Budget Request.19 The bill repeats previous years’ language
requiring grantees to certify that they encourage “family participation” when minors
decide to seek family planning services, and to certify that they counsel minors on
how to resist attempted coercion into sexual activity. The bill also repeats a
clarification that family planning providers are not exempt from state notification and
reporting laws on child abuse, child molestation, sexual abuse, rape, or incest.20 In
S.Rept. 110-410, the Senate Appropriations Committee instructs that family planning
funds be distributed to regional offices within 60 days of the appropriation bill’s
enactment. The report also states the committee’s intention that “the regional offices
should retain the authority for the review, award and administration of family
planning funds, in the same manner and timeframe as in fiscal year 2006.” In
addition, the committee intends that at least 90% of appropriated Title X funds, as
well as any remaining year-end funds, should be spent on clinical services.
On February 4, 2008, the President submitted the FY2009 Budget, which
requested $300.0 million for Title X, the same as the FY2008 funding level. The
Budget Justification explained that the program would continue to seek ways “to
increase efficiencies” in the face of increasing medical care prices, and to “increase
competition” for funds, targeting areas that lack access to family planning services.
The Budget Justification noted, “Rising costs of medical care will make it difficult
to maintain service delivery at FY2008 levels.” The Administration expected the
proposed FY2009 level to fund services to 4.985 million clients and to avert 978,000
unintended pregnancies (compared with serving an expected 5.000 million clients
and preventing an expected 981,000 unintended pregnancies in FY2008).21
FY2008 Appropriations
On December 26, 2007, the President signed the Consolidated Appropriations
Act, 2008 (P.L. 110-161), which provided $300.0 million for Title X in FY2008, 6%
more than the FY2007 level of $283.1 million. This figure includes the act’s
across-the-board reduction of 1.747% for items in the Labor-HHS-Education
division.22
The FY2008 Consolidated Appropriations Act repeated previous years’
language that Title X funds not be spent on abortions, that all pregnancy counseling
be nondirective, and that funds not be spent on “any activity (including the
publication or distribution of literature) that in any way tends to promote public
support or opposition to any legislative proposal or candidate for public office.”23
The law also repeated language requiring grantees to certify that they encourage
“family participation” when minors decide to seek family planning services, and to
certify that they counsel minors on how to resist attempted coercion into sexual
19
S.Rept. 110-410, p. 59.
20
S. 3230 as placed on Senate Calendar, July 8, 2008, §§ 209-210.
21
DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations
Committees, pp. 249-252.
22
The Consolidated Appropriations Act (P.L. 110-161) Division G, on Labor-HHSEducation appropriations, includes an across-the-board reduction of 1.747% to accounts,
items, programs, projects, and activities in the bill text and the Explanatory Statement
narrative, with some exceptions (Title V, § 528).
23
P.L. 110-161, Division G, Title II.
CRS-5
CRS-5
support or opposition to any legislative proposal or candidate for public office.”23
The law also repeated language requiring grantees to certify that they encourage
“family participation” when minors decide to seek family planning services, and to
certify that they counsel minors on how to resist attempted coercion into sexual
activity.24 The law also repeated a clarification that family planning providers are not
exempt from state notification and reporting laws on child abuse, child molestation,
sexual abuse, rape, or incest.25
The FY2008 Consolidated Appropriations Act’s Explanatory Statement stated
that in implementing the act, agencies should be guided by language and instructions
in H.Rept. 110-231 and S.Rept. 110-107.26 In S.Rept. 110-107, the Senate
Appropriations Committee instructed that family planning funds be distributed to
regional offices within 60 days of the appropriation bill’s enactment. The report also
stated the committee’s intention that “the regional offices should retain the authority
for the review, award and administration of family planning funds, in the same
manner and timeframe as in fiscal year 2006.” In addition, the committee intended
that at least 90% of appropriated Title X funds, as well as any remaining year-end
funds, should be spent on clinical services.27
23
P.L. 110-161, Division G, Title II.
24
P.L. 110-161, Division G, Title II, sec. 210. A recent evaluation of family involvement
strategies found that “Barriers to parental participation are quite pronounced, with logistics,
psychosocial factors, relationship dynamics and cultural issues among the obstacles.” See
RTI International, An Assessment of Parent Involvement Strategies in Programs Serving
Adolescents: Interim Report, 2006, at [http://www.rti.org/pubs/assess_parent.pdf]; and
DHHS, HRSA, Fiscal Year 2009 Online Performance Appendix, p. 156, at
[ftp://ftp.hrsa.gov/about/performanceappendix09.pdf].
25
P.L. 110-161, Division G, Title II, sec. 211. The DHHS Office of Inspector General
recently reviewed OPA’s activities to address state reporting requirements. It found that
“OPA has informed and periodically reminds Title X grantees of their responsibilities”
regarding these requirements, and that OPA addresses state reporting requirements in its site
visits and reviews of grantees. See DHHS, Office of the Inspector General, Federal Efforts
to Address Applicable Child Abuse and Sexual Abuse Reporting Requirements for Title X
Grantees, Report no. OEI-02-03-00530, April 25, 2005, at
[http://oig.hhs.gov/oei/reports/
oei-02-03-00530.pdf].
26
Consolidated Appropriations Act, 2008 Committee Print of the House Committee on
Appropriations on H.R. 2764/Public Law 110-161, pp. 1461-1462, at
[http://www.gpo
accessgpoaccess.gov/congress/house/appropriations/08conappro.html].
27
S.Rept. 110-107, pp.62-63.
CRS-6
Table 1. Title X Family Planning Program Appropriations
(in millions)
FY
Appropriation
FY
Appropriation
FY
Appropriation
1971
$6.0
1984
$140.0
1997
$198.5
1972
$61.8
1985
$142.5
1998
$203.5
1973
$100.6
1986
$136.4
1999
$215.0
1974
$100.6
1987
$142.5
2000
$238.9
1975
$100.6
1988
$139.7
2001
$253.9
1976
$100.6
1989
$138.3
2002
$265.0
1977
$113.0
1990
$139.1
2003
$273.4
1978
$135.0
1991
$144.3
2004
$278.3
1979
$135.0
1992
$149.6
2005
$286.0
1980
$162.0
1993
$173.4
2006
$282.9
1981
$161.7
1994
$180.9
2007
$283.1
1982
$124.2
1995
$193.3
2008
$300.0
1983
$124.1
1996
$192.6
2009
a
Sources: FY1971-FY2005: Department of Health and Human Services, Office of Population Affairs,
[http://www.hhs.gov/opa/about/budget/]; FY2006: Senate Appropriations Committee, S.Rept. 109287 (p. 325); FY2007-FY2008: Consolidated Appropriations Act, 2008 Committee Print of the House
Committee on Appropriations on H.R. 2764/Public Law 110-161, p. 1793, at
[http://www.gpo
accessgpoaccess.gov/congress/house/appropriations/08conappro.html]; FY2009: DHHS, HRSA,
Fiscal Year
2009 Justification of Estimates for Appropriations Committees, p. 249; Senate Appropriations
Appropriations Committee, S.Rept. 110-410 (p. 59).
a. Continuing resolution P.L.110-329, signed into law September 30, 2008, provides temporary
funding at the FY2008 level through March 6, 2009. The President’s FY2009 Budget requested
$300.0 million for Title X. The Senate-reported LaborHHSLabor-HHS-Education bill (S. 3230; S.Rept.
110-410) would provide $300.0 million for Title X in FY2009.
Abortion and Title X
The law prohibits the use of Title X funds in programs where abortion is a
method of family planning.28 On July 3, 2000, OPA released a final rule with respect
to abortion services in family planning projects.29 The rule updated and revised
regulations that had been in effect since 1988.30 The major revision revoked the “gag
rule,” which restricted family planning grantees from providing abortion-related
information. The regulation at 42 C.F.R. § 59.5 had required, and continues to
require, that abortion not be provided as a method of family planning. The July 3,
28
42 U.S.C. § 300a-6. In addition, so-called “Hyde amendments” to Departments of Labor,
Health and Human Services, and Education, and Related Agencies Appropriations bills have
also restricted federal abortion funding. For more background, see CRS Report RL33467,
Abortion: Legislative Response, by Jon O. Shimabukuro and Karen J. Lewis.
29
“Standards of Compliance for Abortion-Related Services in Family Planning Services
Projects,” 65 Federal Register 41270, July 3, 2000, and “Provision of Abortion-Related
Services in Family Planning Services Projects,” 65 Federal Register 41281, July 3, 2000.
30
42 C.F.R. Part 59, “Grants for family planning services.”
CRS-7
CRS-7
regulations that had been in effect since 1988.30 The major revision revoked the “gag
rule,” which restricted family planning grantees from providing abortion-related
information. The regulation at 42 C.F.R. § 59.5 had required, and continues to
require, that abortion not be provided as a method of family planning. The July 3,
2000 rule amended the section to add the requirement that a project must give
pregnant women the opportunity to receive information and counseling on each of
the following options: prenatal care and delivery; infant care, foster care, or adoption;
and pregnancy termination. If the woman requests such information and counseling,
the project must give “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.”
According to OPA, family planning projects that receive Title X funds are
closely monitored to ensure that federal funds are used appropriately and that funds
are not used for prohibited activities such as abortion. The prohibition on abortion
does not apply to all the activities of a Title X grantee, but only to activities that are
part of the Title X project. The grantee’s abortion activities must be “separate and
distinct” from the Title X project activities.31 Safeguards to maintain this separation
include (1) careful review of grant applications to ensure that the applicant
understands the requirements and has the capacity to comply with all requirements;
(2) independent financial audits to examine whether there is a system to account for
program-funded activities and non-allowable program activities; (3) yearly
comprehensive reviews of the grantees’ financial status and budget report; and (4)
periodic and comprehensive program reviews and site visits by OPA regional offices.
It is unclear exactly how many Title X clinics also provide abortions through
their non-Title X activities. In 2004, following appropriations conference report
directions, DHHS surveyed its Title X grantees on whether their clinic sites also
provided abortions with non-federal funds.32 Grantees were informed that responses
were voluntary and “without consequence, or threat of consequence, to nonresponsiveness.” The survey did not request any identifying information. DHHS
mailed surveys to 86 grantees and received 46 responses. Of these, nine indicated
that at least one of their clinic sites (17 clinic sites in all) also provided abortions with
non-federal funds, and 34 indicated that none of their clinic sites provided abortions
with non-federal funds; three responses had no numerical data or said the information
was unknown.
Title X supporters argue that family planning reduces unintended pregnancies,
thereby reducing abortion.33 On the other hand, Title X critics argue that federal
30
42 C.F.R. Part 59, “Grants for family planning services.”
31
65 Federal Register 41281-41282, July 3, 2000.
32
DHHS, Report to Congress Regarding the Number of Family Planning Sites Funded
Under Title X of the Public Health Service Act That Also Provide Abortions with NonFederal Funds, 2004. The DHHS was directed to conduct the survey by FY2004
appropriations conference report H.Rept. 108-401, pp. 800-801.
33
An example of this argument can be found in U.S. Senate, Committee on Appropriations,
Subcommittee on Departments of Labor, Health and Human Services, and Education, and
Related Agencies, Threat to Title X and Other Women’s Health Services, Hearing, 104th
Cong., 1st sess., August 10, 1995. S.Hrg. 104-416 (Washington: GPO, 1996), pp. 16-21. See
also Rachel Benson Gold, “Title X: Three Decades of Accomplishment,” The Guttmacher
Report on Public Policy, vol. 4, no. 1 (February 2000), p. 7. According to DHHS, in
(continued...)
CRS-8
CRS-8
Title X supporters argue that family planning reduces unintended pregnancies,
thereby reducing abortion.33 On the other hand, Title X critics argue that federal
funds should be withheld from any organization that performs or promotes abortions,
such as the Planned Parenthood Federation of America. These critics argue that if
a family planning program is operated by an organization that also performs
abortions, the implicit assumption and the message to clients is that abortion is a
method of family planning.34
Teenage Pregnancy and Title X
In 2006, 25% of Title X clients were aged 19 or younger.35 Critics argue that
by funding Title X, the federal government is implicitly sanctioning nonmarital
sexual activity among teens. These critics argue that a reduced teenage pregnancy
rate could be achieved if family planning programs emphasized efforts to convince
teens to delay sexual activity, rather than efforts to decrease the percentage of
sexually active teens who become pregnant.36 (See CRS Report RS20873, Reducing
Teen Pregnancy: Adolescent Family Life and Abstinence Education Programs, by
Carmen Solomon-Fears, for a broader discussion of teen pregnancy.)
The program’s supporters, on the other hand, argue that the Title X program
should be expanded to serve more people in order to reduce the rate of unintended
pregnancies. According to DHHS, in FY2005, Title X family planning services
helped avert more than 254,000 unintended teen pregnancies.37 Supporters of
expanding family planning services argue that the United States has a higher teen
pregnancy rate than some countries (such as Sweden) where a similar percentage of
teens are sexually active, in part because U.S. teens use contraception less
consistently.38
33
(...continued)
33
An example of this argument can be found in U.S. Senate, Committee on Appropriations,
Subcommittee on Departments of Labor, Health and Human Services, and Education, and
Related Agencies, Threat to Title X and Other Women’s Health Services, Hearing, 104th
Cong., 1st sess., August 10, 1995. S.Hrg. 104-416 (Washington: GPO, 1996), pp. 16-21. See
also Rachel Benson Gold, “Title X: Three Decades of Accomplishment,” The Guttmacher
Report on Public Policy, vol. 4, no. 1 (February 2000), p. 7. According to DHHS, in
FY2006, Title X family planning services helped avert 975,080 unintended pregnancies
(DHHS, HRSA, Fiscal Year 2009 Justification of Estimates for Appropriations Committees,
p. 252).
34
An example of these arguments can be found in Threat to Title X and Other Women’s
Health Services, pp. 22-35.
35
Family Planning Annual Report: 2006 National Summary, February 2008, p. 9.
36
An example of these arguments can be found in Threat to Title X and Other Women’s
Health Services, pp. 22-35.
37
DHHS, HRSA, Fiscal Year 2008 Justification of Estimates for Appropriations
Committees, p. 429, at [ftp://ftp.hrsa.gov/about/budgetjustification08.pdf]. See also the
discussion of publicly funded family planning services in “Programs to Reduce Unintended
Pregnancy,” in The Institute of Medicine, The Best Intentions: Unintended Pregnancy and
the Well-Being of Children and Families (Washington: National Academy Press, 1995), p.
220, at [http://www.nap.edu/catalog.php?record_id=4903].
38
An example of these arguments can be found in Threat to Title X and Other Women’s
Health Services, pp. 16-21. See also Jacqueline E. Darroch, et al., “Differences in Teenage
Pregnancy Rates Among Five Developed Countries: The Roles of Sexual Activity and
Contraceptive Use,” Family Planning Perspectives, vol. 33, no. 6 (November/December
2001), pp. 244-251.
CRS-9
CRS-9
teens are sexually active, in part because U.S. teens use contraception less
consistently.38
Planned Parenthood and Title X
In May 2003, the General Accounting Office (GAO; now named the
Government Accountability Office) updated a report on federal funds provided to
several nonprofit organizations and their affiliates involved in health-related
activities during FY2001.39 The report provided information on the Planned
Parenthood Federation of America, the Population Council, the International Planned
Parenthood Federation, the Alan Guttmacher Institute, Advocates for Youth, and the
Sexuality Information and Education Council of the United States (SIECUS).
Information was collected from each organization with respect to their expenditure
of federal funds. Only Planned Parenthood and the Alan Guttmacher Institute
reported spending Title X funds.
Planned Parenthood operates through a national office and 103 affiliates.
Affiliates participating in Title X receive funds directly and indirectly from other
Title X grantees, such as their state or local health departments. Planned Parenthood
also operates more than 860 local health centers.40 The Alan Guttmacher Institute is
an affiliate of the Planned Parenthood Federation and provides policy analysis and
conducts research. According to the GAO report, in FY2001 Planned Parenthood
spent $58.7 million of Title X funds, and the Alan Guttmacher Institute spent
$315,320 of such funds; together this amounts to approximately 23% of Title X
appropriations for that year.
Legislation in the 110th Congress
Several bills on the Title X program have been introduced in the 110th Congress.
Bills: Reauthorization
S. 21/H.R. 819, the Prevention First Act, was introduced in the Senate January
4, 2007, and in the House February 5, 2007. These companion bills would authorize
38
An example of these arguments can be found in Threat to Title X and Other Women’s
Health Services, pp. 16-21. See also Jacqueline E. Darroch, et al., “Differences in Teenage
Pregnancy Rates Among Five Developed Countries: The Roles of Sexual Activity and
Contraceptive Use,” Family Planning Perspectives, vol. 33, no. 6 (November/December
2001), pp. 244-251.
39
U.S. General Accounting Office, Federal Funds: Fiscal Year 2001 Expenditures by
Selected Organizations Involved in Health-Related Activities, GAO-03-527R, May 16, 2003,
at [http://www.gao.gov/cgi-bin/getrpt?GAO-03-527R]. This report has not been updated.
40
Planned Parenthood Services, at [http://www.plannedparenthood.org/issues-action/birthcontrol/access-to-condoms/reports/pp-services-17317.htm].
CRS-10
Title X appropriations of $700 million for FY2008 and “such sums as may be
necessary for each subsequent fiscal year.” S. 21 was referred to the Senate
Committee on Health, Education, Labor, and Pensions. H.R. 819 was referred to the
House Committees on Energy and Commerce, Ways and Means, and Education and
Labor.
H.R. 1074, the Reducing the Need for Abortion and Supporting Parents Act,
was introduced in the House February 15, 2007. One of its provisions would
authorize Title X appropriations of $700 million for FY2008 and “such sums as may
be necessary for each subsequent fiscal year.” H.R. 1074 was referred to the House
Committees on Energy and Commerce, Ways and Means, and Education and Labor.
39
U.S. General Accounting Office, Federal Funds: Fiscal Year 2001 Expenditures by
Selected Organizations Involved in Health-Related Activities, GAO-03-527R, May 16, 2003,
at [http://www.gao.gov/cgi-bin/getrpt?GAO-03-527R]. This report has not been updated.
40
Planned Parenthood Services, at [http://www.plannedparenthood.org/issues-action/
birth-control/access-to-condoms/reports/pp-services-17317.htm].
CRS-10Bills: Abortion Restrictions
S. 351, the Title X Family Planning Act, was introduced January 22, 2007. It
would prohibit Title X funds from going to entities that perform abortions or whose
subgrantees perform abortions, except in certain physician-certified cases where the
woman is “in danger of death unless an abortion is performed.” This prohibition
would not apply to hospitals, unless the hospital subgrants to a non-hospital entity
that performs abortions. S. 351 would require Title X grant applicants to certify that
they and their subgrantees adhere to the abortion prohibition. It would also require
the DHHS to provide Congress with an annual list of Title X grantees that perform
abortions; if an entity appears on the list, it would be ineligible for subsequent fiscal
year Title X funds unless it certifies that it no longer performs abortions. S. 351 was
referred to the Senate Committee on Health, Education, Labor, and Pensions.
H.R. 4133, the Title X Abortion Provider Prohibition Act, was introduced
November 9, 2007. The bill would prohibit Title X assistance to any entity unless
it certifies that it will not perform, nor provide funds to any other entity that
performs, an abortion during the period of assistance. The prohibition would not
apply to hospitals, unless the hospital provides funds to a non-hospital entity that
performs an abortion. The bill has exceptions for abortions performed in cases of
rape, incest against a minor, or certain physician-certified cases where the woman is
“in danger of death unless an abortion is performed.” H.R. 4133 would also require
the DHHS Secretary to provide Congress an annual report listing, for each entity
receiving a Title X grant: information on any abortions it performed, the date that
it last certified that it would not perform abortions, and any other entities to which
it makes available funds received through Title X grants. H.R. 4133 was referred to
the House Committee on Energy and Commerce.
Bills: Elimination of Title X Funds
H.R. 1095, the Taxpayers’ Freedom of Conscience Act, was introduced
February 15, 2007. It would prohibit federal officials from expending federal
funding for “any population control or population planning program or any family
planning activity (including any abortion procedure), irrespective of whether such
program or activity is foreign or domestic.” H.R. 1095 was referred to the House
Committees on Foreign Affairs and Energy and Commerce.
CRS-11
H.R. 6712, America’s Commitment to Veterans Act of 2008, was introduced
July 31, 2008. Its official title is “To provide for increased funding for veterans
health care for fiscal year 2009 by transferring funds from the Legal Services
Corporation and certain title X family planning funds, and for other purposes.” For
FY2009, H.R. 6712 would transfer all funds appropriated for voluntary family
planning projects under Title X, to the “Medical Services” appropriation account
within the Department of Veterans Affairs. H.R. 6712 was referred to the House
Committees on Veterans’ Affairs, the Judiciary, and Energy and Commerce.
Bills: Adoption Promotion
H.R. 104, the Adoption Information Act, was introduced January 4, 2007. An
identical bill, H.R. 5968, was introduced May 5, 2008. They would require the
DHHS Secretary to annually prepare, update, and distribute to each Title X service
grantee pamphlets listing contact information for all adoption centers in the state
where services are provided. Title X service projects would be required to provide
“assurances satisfactory to the Secretary” that they will (1) give the pamphlet to each
family planning client at the time the person inquires about services, (2) orally inform
the client that the pamphlet is from DHHS and has a comprehensive list of adoption
CRS-11
centers in the state, and (3) give the client “an opportunity to read the pamphlet.”
H.R. 104 and H.R. 5968 were referred to the House Committee on Energy and
Commerce.
Bills: Information on Pregnancy Support Services
H.R. 7091, the Care for Life Act of 2008, was introduced September 25, 2008.
The bill would “encourage and assist women throughout pregnancy by providing
services that will alleviate the financial, social, emotional, and other difficulties that
may otherwise lead to an abortion.” H.R. 7091 would express the sense of Congress
that Title X clients should be aware of services available to assist them throughout
pregnancy and following childbirth. One of the bill’s provisions would require the
DHHS Secretary to develop and implement a public outreach campaign to Title X
facilities to provide information on pregnancy support services. H.R. 7091 was
referred to the House Committees on Energy and Commerce, Ways and Means, and
Education and Labor.
Bills: Parental Notification
H.R. 2134, the Parent’s Right to Know Act of 2007, was introduced May 3,
2007. It would prohibit Title X service providers from providing contraceptive drugs
or prescription devices to a minor unless one of the following criteria is met: (a) the
provider has notified a parent or guardian in writing at least five business days
earlier, (b) the minor has a parent or guardian’s written consent, (c) the minor is
emancipated, or (d) a court has directed that the minor may receive the contraceptive
drugs or prescription devices. Each Title X provider would be required to annually
certify compliance with these requirements. H.R. 2134 was referred to the House
Committee on Energy and Commerce.
CRS-12
H.Con.Res. 232, “It is the Sense of the Congress that the confidentiality
mandates for minors should be removed from family planning services programs
operating under Title X of the Public Health Services Act and Medicaid,” was
introduced October 10, 2007. It notes that Title X services “were extended to minors
under the age of 16 as a result of the United States Supreme Court decision in Carey
v. Population Services International;41 consequently, Title X clinics can provide
minors with free contraceptives without a parent’s knowledge or consent.”
H.Con.Res. 232 was referred to the House Committee on Energy and Commerce.
Amendments to FY2008 Appropriations Bills
Proposed during Senate consideration of the FY2008 Labor-HHS-Education
Appropriations bill (H.R. 3043), S.Amdt. 3330 would have prohibited the bill’s funds
(including Title X funds) from going to any grantees who perform abortions or whose
subgrantees perform abortions, except in certain physician-certified cases where the
woman is “in danger of death unless an abortion is performed.” The prohibition
would not have applied to hospitals, unless the hospital subgrants to a non-hospital
entity that performs abortions. S.Amdt. 3330 was defeated by roll call vote on
October 18, 2007.
Also during Senate consideration of the FY2008 Labor-HHS-Education
Appropriations bill (H.R. 3043) in October 2007, several floor amendments
pertaining to Title X were submitted but no further action was taken.
!
!
41
S.Amdt. 3329 would have prohibited the bill’s funds from going to
Planned Parenthood “for any purpose” under Title X.
!
S.Amdt. 3392 would have amended Title X to require funding
recipients to annually report on and certify their compliance with
state reporting requirements on child abuse, child molestation,
sexual abuse, rape, and incest. Recipients found not complying with
state reporting requirements would have lost Title X eligibility for
three subsequent years.
431 U.S. 678 (1977). The case is discussed briefly in Kenneth R. Thomas, ed., “Privacy
after Roe: Informational Privacy, Privacy of the Home or Personal Autonomy?,” United
States Constitution, Analysis and Interpretation, 2005, at [http://www.crs.gov/products/
conan/Amendment14/topic_S1_4_17_3.html].
CRS-12
!
S.Amdt. 3413, S.Amdt. 3421, S.Amdt. 3422, S.Amdt. 3423,
S.Amdt. 3424, and S.Amdt. 3425 would have prohibited the bill’s
funds (including Title X funds) from going to local education
agencies that allow birth control distribution to certain minors
without a parent’s or guardian’s separate, prior, written consent.
During House consideration of the FY2008 Labor-HHS-Education
Appropriations bill (H.R. 3043), two floor amendments pertaining to Title X were
offered.
!
41
431 U.S. 678 (1977). The case is discussed briefly in Kenneth R. Thomas, ed., “Privacy
after Roe: Informational Privacy, Privacy of the Home or Personal Autonomy?,” United
States Constitution, Analysis and Interpretation, 2005, [http://www.crs.gov/products/conan/
Amendment14/topic_S1_4_17_3.html].
CRS-13
!
H.Amdt. 594 would have prohibited the bill’s funds from going to
Planned Parenthood “for any purpose” under Title X. H.Amdt. 594
was offered and subsequently defeated by roll call vote on July 19,
2007.
H.Amdt. 554 would have prohibited Title X funds to providers that
in the previous 36 months had violated state notification and
reporting laws related to child abuse, child molestation, sexual
abuse, rape, or incest. H.Amdt. 554 was offered and subsequently
withdrawn by unanimous consent on July 18, 2007
!
H.Amdt. 554 would have prohibited Title X funds to providers that
in the previous 36 months had violated state notification and
reporting laws related to child abuse, child molestation, sexual
abuse, rape, or incest. H.Amdt. 554 was offered and subsequently
withdrawn by unanimous consent on July 18, 2007.
The FY2008 Labor-HHS-Education appropriations law (P.L.110-161, Division
G) contained a provider conscience clause, which does not explicitly mention Title
X, but which could potentially conflict with Title X regulations on abortion referrals,
according to some critics. Sometimes referred to as the Weldon Amendment, the
clause states that “None of the funds made available in this Act may be made
available to a Federal agency or program, or to a State or local government, if such
agency, program, or government subjects any institutional or individual health care
entity to discrimination on the basis that the health care entity does not provide, pay
for, provide coverage of, or refer for abortions.”42 The Weldon Amendment was
originally adopted as part of the FY2005 Labor-HHS-Education appropriations law,
and has been attached to each subsequent Labor-HHS-Education appropriations
law.43
Some have argued that the Weldon Amendment potentially conflicts with
regulations that require Title X family planning services projects to give pregnant
women the opportunity to receive information, counseling, and referral upon request
for several options including “pregnancy termination.”44 The regulation states that
if the woman requests such information and counseling, the project must
42
Consolidated Appropriations Act, 2008, P.L. 110-161, Division G, Departments Of Labor,
Health And Human Services, and Education, and Related Agencies Appropriations Act,
2008, §508(d), 121 Stat. 1844.
43
P.L.108-447, Division F, §508(d), 118 Stat. 3163 (FY2005); P.L. 109-149, § 508(d), 119
Stat. 2879 (FY2006). Under P.L.110-5, §2, 121 Stat. 8, FY2007 appropriations were
subject to the same conditions as during FY2006.
44
Examples of this argument appear in “Weldon Amendment,” Congressional Record,
daily edition, vol. 151, no. 51 (April 25, 2005), p. S4222; and “Federal Refusal Clause,”
Congressional Record, daily edition, vol. 151, no. 52 (April 26, 2005), p. S425. The
National Family Planning and Reproductive Health Association (NFPRHA), many of whose
members provide Title X services, filed a lawsuit challenging the Weldon Amendment in
the U.S. District Court for the District of Columbia. The court found that “While Weldon
may not provide the level of guidance that NFPRHA or its members would prefer, may
create a conflict with pre-existing agency regulations, and may impose conditions that
NFPRHA members find unacceptable, none of these reasons provides a sufficient basis for
the court to invalidate an act of Congress in its entirety.” Upon appeal, the U.S. Court of
Appeals for the District of Columbia Circuit found that the plaintiff lacked the standing to
challenge the Weldon Amendment. See National Family Planning and Reproductive Health
Association, Inc., v. Alberto Gonzales, et al., 468 F.3d 826 (D.C. Cir. 2006), and 391 F.
Supp. 2d 200, 209 (D.D.C. 2005).
CRS-14
give “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.”45
Proposed Rule on Provider Conscience
In the August 26, 2008 Federal Register, DHHS proposed the rule “Ensuring
That Department of Health and Human Services Funds Do Not Support Coercive or
Discriminatory Policies or Practices in Violation of Federal Law.”46 The rule’s stated
purpose is to provide for the implementation and enforcement of several conscience
clause laws (including the Weldon Amendment) that “protect the rights of health care
entities/entities, both individuals and institutions, to refuse to perform health care
services to which they may object for religious, moral, ethical, or other reasons.”47
The proposed rule states that entities carrying out DHHS health service
programs shall not require individuals “to perform or assist in the performance of any
part of a health service program or research activity funded by the Department if such
service or activity would be contrary to his religious beliefs or moral convictions.”48
The proposed rule defines “assist in the performance” as participating in any activity
with a “reasonable connection” to the objectionable procedure or health service,
including “counseling, referral, training, and other arrangements” for the procedure
or health service.49
The proposed rule would require certain recipients and subrecipients of DHHS
funds, including recipients of grants under the Public Health Service Act, to certify
that they will not discriminate against entities for refusing to assist in the
performance of abortion or sterilization. These recipients and subrecipients would
also have to certify that they “will not require involvement in procedures that violate
an individual’s conscience as part of any part of any health service program.”50 The
proposed rule does not explicitly mention contraception or the Title X program.
DHHS solicited public comments on the proposed rule.51 In these comments,
some critics argued that the proposed rule could affect Title X clients’ access to
45
42 C.F.R. 59.5(a)(5).
46
U.S. Department of Health and Human Services, “Ensuring that Department of Health and
Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In
Violation of Federal Law,” 73 Federal Register 50274-50285, August 26, 2008, at
[http://edocket.access.gpo.gov/2008/pdf/E8-19744.pdf].
47
73 Federal Register 50282.
48
73 Federal Register 50283.
49
73 Federal Register 50282.
50
73 Federal Register 50284.
51
Comments may be viewed at [http://www.regulations.gov/fdmspublic/component/
main?main=DocketDetail&d=HHS-OS-2008-0011].
CRS-15
requested abortion counseling or referrals. Title X grantees are currently required to
provide pregnant women, upon request, nondirective counseling and referrals on
several options including abortion.52 In its comment, the Guttmacher Institute argued
that the regulation could allow Title X grantees to ignore this requirement: “If DHHS
is going to undercut this important, long-standing requirement, it has an obligation
to indicate how it will ensure that every Title X client will be able to receive the
counseling and referrals to which they are entitled if individual providers and whole
programs, even states, are allowed to refuse.”53 Similarly, the ACLU argued that the
proposed rule could potentially “permit entities that perform pregnancy tests to seek
Title X funding even if they refuse to provide information and counseling.”54
Some commenters also argued that the proposed rule could make it more
difficult for Title X clients to obtain contraception. For example, the National
Family Planning and Reproductive Health Association argued that “the rule provides
no guidance about whether it is impermissible ‘discrimination’ for a Title X family
planning clinic that serves primarily women seeking contraceptive services not to
hire a receptionist because she refuses to make contraceptive appointments or a nurse
because he refuses to provide contraceptive services?”55 The ACLU wrote: “the
Proposed Rule may make it difficult for Title X clinics to ensure that their staff is
willing to participate in the primary purpose of the Title X program, namely the
provision of contraceptive services. Moreover, the Rule, depending on how it is
interpreted, could make it easier for entities that refuse to provide women with
contraceptive services to compete for scarce family planning resources.”56
Other commenters supported the proposed rule by arguing that health care
practitioners are not likely to specialize in areas (such as family planning) where they
object to the vast majority of the work, and that problems of access to contraception
“can be solved by measures far short of forcing health care practitioners to violate
their conscience.”57
52
42 C.F.R. 59.5(a)(5).
53
Letter from Sharon L. Camp, President and CEO, Guttmacher Institute, to DHHS,
September 24, 2008, at [http://www.guttmacher.org/media/resources/2008/09/24/
GuttmacherInstitute-re-ConscienceRegulation.pdf].
54
Letter from Caroline Fredrickson, Director, Washington Legislative Office, American
Civil Liberties Union (ACLU), Louise Melling, Director, Reproductive Freedom Project,
ACLU, and Vania Leveille, Washington Legislative Office, ACLU, et al. to DHHS,
September 25, 2008, at [http://www.aclu.org/images/asset_upload_file467_36942.pdf].
55
Letter from Mary Jane Gallagher, President and CEO, National Family Planning and
Reproductive Health Association, to Michael Leavitt, Secretary, DHHS, September 25,
2008, at [http://www.nfprha.org/images/contraception%20regs/NFPRHA%20Comments%
20FINAL%209%2025%2008.pdf].
56
Letter from Caroline Fredrickson, Director, Washington Legislative Office, American
Civil Liberties Union (ACLU), Louise Melling, Director, Reproductive Freedom Project,
ACLU, and Vania Leveille, Washington Legislative Office, ACLU, et al. to DHHS,
September 25, 2008, at [http://www.aclu.org/images/asset_upload_file467_36942.pdf].
57
An example of this argument can be found in Letter from Kevin Hasson, President, The
(continued...)
CRS-16
More background about the proposed rule is in the CRS Report RL34703, The
History and Effect of Abortion Conscience Clause Laws, by Jon O. Shimabukuro.
As of November 21, 2008, DHHS has not yet published a final rule on provider
conscience.
Summary of Title X of the Public Health Service Act
Below is a summary of Title X of the Public Health Service Act, codified at 42
U.S.C. § 300 to § 300a-6, Population Research and Voluntary Family Planning
Programs:
Section 1001. Project Grants and Contracts for Family Planning Services
The Secretary may make grants to and enter into contracts with public or
nonprofit private entities to assist in the establishment and operation of voluntary
family planning projects to offer a broad range of acceptable and effective family
planning methods and services (including natural family planning methods, infertility
services, and services for adolescents). Entities which receive grants or contracts
must encourage family participation in their projects.
Section 1002. Formula Grants to States for Family Planning Services
The Secretary may make grants to state health authorities to assist in planning,
establishing, maintaining, coordinating, and evaluating family planning services. The
state health authority must have an approved state plan for a coordinated and
comprehensive program of family planning services.
Section 1003. Training Grants and Contracts
The Secretary may make grants to public or nonprofit private entities and enter
into contracts with public or private entities and individuals to provide the training
for personnel to carry out family planning service programs.
CRS-13
Section 1004. Research
The Secretary may conduct and make grants to public or nonprofit private
entities and enter into contracts with public or private entities and individuals for
projects for research in the biomedical, contraceptive development, behavioral, and
program implementation fields related to family planning and population.
Section 1005. Informational and Educational Materials
The Secretary may make grants to public or nonprofit private entities and enter
into contracts with public or private entities and individuals to assist in developing
57
(...continued)
Becket Fund for Religious Liberty, to
[http://www.becketfund.org/files/e2e1b.pdf].
DHHS,
September
26,
2008,
at
CRS-17
and making available family planning and population growth information (including
educational materials) to all persons desiring such information.
Section 1006. Regulations and Payments
The Secretary may promulgate regulations and must determine the conditions
for making payments to grantees to assure that such grants will be effectively utilized
for the purposes they were made.
Grantees must assure that (1) priority will be given to the furnishing of 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 the charge.
The Secretary must be satisfied that informational or educational materials
developed or made available under the grant or contract will be suitable for the
purposes of this title and for the population or community to which they are to be
made available.
In the case of any grant or contract under Section 1001, such assurances shall
provide for the review and approval of the suitability of such materials, prior to their
distribution, by an advisory committee established by the grantee or contractor in
accordance with regulations.
Section 1007. Voluntary Participation
The acceptance by any individual of family planning services or family planning
or population growth information (including educational materials) shall be voluntary
and shall not be a prerequisite to eligibility for or receipt of any other service or
assistance from, or to participation in, any other program of the entity or individual
that provided such service or information.
Section 1008. Prohibition of Abortion
None of the funds appropriated under this title shall be used in programs where
abortion is a method of family planning.