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Updated October 5, 2018
Title X Family Planning Program
Overview
care. In 2017, 42% of Title X clients were uninsured
The Title X Family Planning Program (Title X) was
(compared with 63% in 2013). Figure 1 provides
enacted in 1970 as Title X of the Public Health Service Act.
demographic data.
It provides grants to public and nonprofit agencies for
Figure 1. Title X Clients by Age and by Race
family planning services, research, and training.
Administered by the U.S. Department of Health and Human
Services (HHS), it is the only domestic federal program
devoted solely to family planning and related preventive
health services.
What Is the Federal Funding Level? FY2019 funding is
$286.5 million, the same as the FY2018 level.
FY2019 Appropriations:
$286.5 million
Clients Served (2017):
4.0 million
Number of Title X Clinics (2017):
3,858
What Clinical Services Are Provided? Clinical services
provided through Title X include contraceptive services and
supplies; natural family planning methods; cervical and
breast cancer screening; preconception health services;
pregnancy testing and counseling; sterilization services,
basic infertility services; testing and treatment for sexually
transmitted diseases, including HIV testing and prevention;
and other patient education and referrals. All services are
confidential.
Source: Figure created by CRS; data from HHS, Title X Family
Planning Annual Report: 2017 National Summary, pp. 9 and 13,
Does Title X Fund Abortions? By law, Title X funds may
https://www.hhs.gov/opa/sites/default/files/title-x-fpar-2017-national-
not be used for abortions. Current guidance states that a
summary.pdf.
grantee’s abortion activities must be “separate and distinct”
Notes: 33% of clients (all races) identified as Latino/Hispanic. Due to
from its Title X project activities.
rounding, percentages may not sum to 100%.
What Do Clients Pay? Priority for services is given to
The number of Title X clients served in 2017 was 12%
persons with family income at or below 100% of the federal
lower than in 2013 and 23% lower than in 2010. According
poverty guidelines, who may not be charged for care.
to the Title X Family Planning Annual Report, the decrease
Clients from families with income between 100% and
in demand could be explained in part by newly insured
250% of the federal poverty guidelines are charged on a
clients’ ability to seek care from other providers, by
sliding scale based on their ability to pay. Clients from
increased use of long-acting reversible contraception, and
families with income higher than 250% of the federal
by recent clinical guideline changes (e.g., Pap tests are now
poverty guidelines are charged fees designed to recover the
recommended every three years instead of annually).
reasonable cost of providing services.
Other Family Planning Programs
For unemancipated minors who request confidential
services, eligibility for discounts is based on the minor’s
Do Other Federal Programs Fund Family Planning?
own income.
Although Title X is the only federal domestic program
primarily focused on family planning, other programs also
Who Are Title X Clients? In 2017, Title X-funded clinics
finance family planning, among their other services. These
served 4 million clients, primarily low-income women and
programs include Medicaid, the Health Center Program
adolescents. Of those clients, 88% were female, 12% were
under Section 330 of the Public Health Service Act,
male, 87% had incomes at or below 200% of the federal
Maternal and Child Health Block Grants, Social Services
poverty guidelines, and 67% had incomes at or below the
Block Grants, and Temporary Assistance for Needy
federal poverty guidelines. For 61% of clients, Title X
Families. In FY2015, Medicaid accounted for 75% of U.S.
clinics were their “usual” or only regular source of health
public family planning expenditures (including federal,
https://crsreports.congress.gov
Title X Family Planning Program
state, and local government spending). In comparison, Title
Services to Adolescents. Opponents argue that by
X accounted for 10%.
providing contraception to adolescents, the government is
implicitly sanctioning nonmarital sexual activity among
Figure 2. Public Family Planning Expenditures
teens.
by Funding Source
Confidentiality for Minors. Opponents are concerned that
Title X projects do not require parental notification or
parental consent for services to minors. Opponents contend
that Title X confidentiality rules interfere with parents’
rights to know of and guide their children’s health care.
Legislative Mandates
The Department of Defense and Labor, Health and Human
Services, and Education Appropriations Act, 2019 and
Continuing Appropriations Act, 2019 (P.L. 115-245)
continues requirements on the use of Title X funds included
Source: Figure created by CRS; data from Guttmacher Institute,
in previous years’ appropriations laws:
https://www.guttmacher.org/report/public-funding-family-planning-
Title X funds may not be spent on abortions.
abortion-services-fy-1980-2015.
All pregnancy counseling must be nondirective.
Are Private Health Plans Required to Cover Family
Planning Services? Patient Protection and Affordable Care
Funds may not be spent on “any activity (including the
Act (ACA; P.L. 111-148, as amended) regulations and
publication or distribution of literature) that in any way
guidance require most non-grandfathered health plans to
tends to promote public support or opposition to any
cover contraceptive services without cost-sharing. There are
legislative proposal or candidate for public office.”
some exemptions and accommodations for religious
Grantees must certify that they encourage family
objections. Interim final rules promulgated in October 2017
participation when minors decide to seek family
would expand exemptions to the contraceptive mandate.
planning services.
Courts have preliminarily enjoined the interim final rules
from being implemented.
Grantees must certify that they counsel minors on how
to resist attempted coercion into sexual activity.
Health plans in the ACA exchanges (marketplaces) are
Family planning providers are not exempt from state
required to have a sufficient number and geographic
notification and reporting laws on child abuse, child
distribution of “essential community providers,” which
molestation, sexual abuse, rape, or incest.
include Title X projects.
Supporting Views
The requirements are in addition to statutory mandates in
Title X of the Public Health Service Act, which, among
Health Benefits. Supporters argue that Title X prevents
other things, require family planning participation to be
unintended and high-risk pregnancies, thereby preventing
voluntary and prohibit the use of Title X funds in programs
abortions and reducing fetal, infant, and maternal mortality
in which abortion is a method of family planning.
and morbidity.
2018 Proposed Rule
Cost-Effectiveness. Supporters see public family planning
In June 2018, HHS published a proposed rule that would
programs as cost-effective, saving money for public
prohibit Title X projects from referring patients to abortion
programs (such as Medicaid dollars that otherwise would be
services and would require physical and financial
spent on prenatal, maternity, and newborn care).
separation between Title X projects and abortion-related
activities, among other changes to Title X regulations
Economic Benefits. Supporters contend that family
(https://go.usa.gov/xQvn2).
planning, by allowing women to plan whether and when to
have children, contributes to women’s educational
More Information
attainment, labor force participation, and financial
independence.
For more information, see CRS Report R45181, Family
Planning Program Under Title X of the Public Health
Opposing Views
Service Act and CRS Report R45284, Title X Family
Planning: Proposed Rule on Statutory Compliance
Funds to Abortion Providers. Opponents are concerned
Requirements.
that some Title X funds go to abortion providers (such as
some Planned Parenthood clinics). Although Title X funds
may not be used for abortions, opponents argue that Title X
Angela Napili, Senior Research Librarian
funding frees up Planned Parenthood’s other resources for
IF10051
its abortion activities.
https://crsreports.congress.gov
Title X Family Planning Program
Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
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