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Memo To Congress: Family Planning Needs More Funding

Memo Pad Politics

Memo To Congress: Family Planning Needs More Funding


On Thursday, March 20, Roosevelt Institute Fellow Andrea Flynn joined the National Family Planning and Reproductive Health Association for a briefing on “The Publicly Funded Family Planning Network: An Essential Partner in the New Health Care Environment.” Her prepared remarks are below.

The Affordable Care Act represents an historic investment in the health of American women and girls. It has already improved the lives of millions of Americans and will make health care accessible for many more as rollout continues. Fulfilling the promise of the ACA, however, depends on the continued support of existing programs, such as Title X, which must remain as pillars of the country’s public health infrastructure.

For more than 40 years, Title X has provided critical medical care to low-income women, immigrant women, and young women across the country.  Some have suggested that the ACA’s expanded coverage of women’s health care will obviate the need for Title X. In fact, the opposite is true. Title X will play a number of important functions in the coming years.

First, Title X will support a network of qualified family planning and reproductive health care providers who will deliver care and services to the growing ranks of insured. Clinics funded by Title X will become an even more critical building block of our nation’s health system. Even when individuals obtain coverage, many will continue to choose publicly funded clinics as their main source of care. As one of my colleagues here will further explain, during the four years following the implementation of Massachusetts’ health care reform patients continued to rely on Title X centers even after they gained insurance coverage.

Women who are already fully insured will also continue to rely on Title X clinics because they can access care with complete confidence. Issues such as intimate partner violence and religious beliefs of employers, family members, and partners, cause many women to circumvent their insurance plans when accessing family-planning services. Sadly, these concerns will persist regardless of the coverage status of American women.

Second, Title X will guarantee family-planning access to those still uninsured. The ACA was intended to provide a path to health insurance for most Americans. However, because of the Supreme Court’s decision to allow states to opt out of Medicaid expansion, fewer uninsured Americans will gain coverage than originally planned. Today, 22 states are still refusing to expand Medicaid, leaving more than 3.5 million low-income women without coverage. As a result, two-thirds of poor black and single mothers, and more than half of uninsured, low-wage workers, remain without coverage. Title X clinics will continue to be a trusted place of care for these women.

Moreover, even in states that participate in Medicaid expansion, many low-income individuals may still remain uninsured. Estimates suggest that between 25 and 35 percent of those eligible for Medicaid still do not know it, and are failing to enroll.  Many immigrants will also remain uninsured, given the federal 5-year eligibility requirement for Medicaid. And millions of others will churn among coverage plans. One study estimates that up to 29 million people under age 65 will be forced to change coverage systems from one year to the next. Individuals who fall into these categories will rely on the Title X network for quality, affordable, and confidential care.

Third, and equally important, Title X will continue to set a comprehensive standard of care for family planning and reproductive health services.

Finally, Title X clinics are a primary and trusted point of entry into the health system. Six in 10 women who receive services at a publicly funded family-planning center consider it their primary source of medical care. As such, the Title X network will continue to play an important role in ACA outreach and enrollment efforts to ensure that health coverage is realized by as many Americans as possible.

Title X is particularly important given the health challenges facing many women in the United States. However, current funding for U.S. public family-planning programs extends care and services to just over half of the women in need. Per capita, the United States spends two and a half times more on health care than other developed countries, yet Americans overall have less access to services and experience worse health outcomes. The United States reports among the highest rates of teen birth, unintended pregnancy, and maternal and infant mortality of any industrialized country. Almost half of all U.S. pregnancies – approximately 3.2 million annually – are unintended. Poor women, women of color, and immigrant women bear a disproportionate burden in this regard. They are also more likely to experience chronic disease, maternal mortality and have a lower life expectancy than women with higher incomes.

Unintended pregnancy and teen pregnancy remain persistent issues in the United States, ones that Title X has been tackling for decades. Unintended pregnancies have a number of larger health implications. Women who have unintended pregnancies are more likely to develop complications and face worse outcomes themselves and for their infants. They often receive inadequate prenatal care, and the care they do receive begins later in pregnancy. Research has shown that pregnancies that occur in rapid succession pose additional risks for both mother and child.

The U.S. teen pregnancy rate has declined dramatically over the last decade, thanks to services offered by programs like Title X. However, it is still considerably higher than in any other developed country, where rates are generally 5 to 10 births per 1,000, compared to the current U.S. rate of 29.4 per 1,000. Racial disparities are especially pronounced in relation to teen pregnancy, with teen birth rates for white women hovering around 21.8 per 1,000, while the rates for Hispanic, Black, and American Indian teens are at least twice that. Research has shown that increased access to comprehensive reproductive health information, care, and services, including a broad range of contraceptive methods, reduces rates of unplanned pregnancy among teens.

Title X has prevented these various health disparities from becoming even more troubling. With an increased investment the program could replicate its incredible results many times over, leading to significant health improvements for American women.



  1. Dominick Vila March 24, 2014

    The chances of Family Planning institutions getting more funding from the GOP controlled House are like the chances of illegal immigrants getting taller ladders. The only thing Family Planning institutions can expect from the GOP is constant attacks, threats, and insults.

    1. James Bowen March 24, 2014

      I don’t understand why family planning is even controversial. 98% of all Americans who are sexually active use contraception. This is one position that is just extremely at odds with the American public.

      1. Dominick Vila March 25, 2014

        It is controversial because some religious organizations made it so, and because some popular figures in the media have gone as far as calling women who use contraceptives whores. The irony is that using contraceptives reduces the incidence of abortion dramatically, and that the people who oppose the use of contraceptives claim to be pro-life (pro-birth).

        1. James Bowen March 25, 2014

          Absolutely. It is just hard to believe that a position that has almost no public support has gotten as far as it has.

  2. disqus_ivSI3ByGmh March 24, 2014

    Republican concept of family planning – plan on having a large family and not getting any help.

    1. paulyz March 24, 2014

      Wrong disqus, the Republican concept is: if you have children, you need to raise them responsibly, not expecting others, (taxpayers) to pay for their irresponsibility. A good economy with 2 parent families has always been the way towards upward mobility, not always making excuses & blaming others. We have seen just how the terrible economy under 6 years of Obama’s Big Spending policies have failed to help, indeed, he & the Democrats have made it much worse.

      1. Joyce March 24, 2014

        Listen Paulyz – gop’s don’t want ANYTHING that will help women. Why is the responsibility of birth control always on the woman? if men had to take birth control, those republiCONS would be distributing them in men’s bathrooms. They won’t allow women access to birth control then complain because they’re having babies that MEN are partly responsible for. I hope that when you die and see our Savior, you will see how disappointed she is at the mess the men have made in this world.

        1. Cyndi March 25, 2014

          Really?! The real answer is not having sex unless you are willing to accept the consequences of it…children.

          1. Allan Richardson March 28, 2014

            When a couple fall in love, get married, and decide to have a child, while they are living a responsibly good life, can they FORESEE that one
            day, after this child and possibly another are born, he might lose his job, one of them may get sick and run up medical bills, a CHILD may get
            sick, a disaster may occur, etc?

            According to your logic, it is irresponsible for ANY man or woman EVER to have sex, since the future
            may hold misfortune or even catastrophe at any time, requiring them to ask for help and be accused of being irresponsible.

            Or are you implying that God has it in for some people because they don’t pray enough? Read some of the Bible books you never got to: Job, Isaiah, Hosea, Amos, and the Gospels, especially the Sermon on the mount and Matthew 25 (the whole chapter).

            Enjoy your non-reproductive life in your Shaker commune if you have no compassion for people living in relationships and families who experience bad luck.

      2. Sand_Cat March 24, 2014


      3. dmhlt_66 March 24, 2014

        You couldn’t be more WRONG!!!

        My source? None other than Rupert Murdoch’s Repubican-promoting, right-wing loving newspaper – THE WALL STREET JOURNAL:

        Of all the falsehoods told about President Barack Obama, the biggest whopper is the one about his reckless spending spree.

        Although there was a big stimulus bill under Obama, federal spending is rising at the slowest pace since Dwight Eisenhower brought the Korean War to an end in the 1950s. Even hapless Herbert Hoover managed to increase spending more than Obama has.


        Please READ the article – and stop watching Faux News, listening to Rush Limpballs, logging on to Freeperville and actually educate yourself.

        As the saying goes: Facts Really DO Have a Liberal Bias

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        2. Dominick Vila March 25, 2014

          Great post. Unfortunately, our conservative cousins are not interested in facts, probably because if they were known their party would not even appeal to its most radical members. They form opinions based on 30-second commercials, what Limbaugh, Beck, Hannity and the rest of the opportunists tell them, and what the Koch brothers propaganda network concocts.

      4. Dominick Vila March 25, 2014

        Paulyz, I can tell you with absolute certainty that there are many registered Republicans, who consider themselves Tea Party supporters, who have children out of wedlock and use MEDICAID for pre-natal, birth, and post postpartum expenses. The truth is that issues like this are non-partisan and so widespread that political ideology, and what many of us consider sound family values, are irrelevant. We live in a new world, and we might as well accept it.
        Regarding Obama’s big spending policies. Do yourself a favor and do a bit of research into this subject. President Obama has reduced the Federal government civil servant workforce by about 700,000 positions. The deficit he inherited from a Republican administration has been cut in half and continues to drop. The reason our economy is not as strong as it should have been is because of the magnitude of the economic chaos President Obama inherited in 2009, not because of his policies, which helped avoid the collapse of the U.S. economy announced by former President Bush in 2008, and have helped us overcome the worst recession since the Great Depression.

  3. terry b March 24, 2014

    Only truly ignorant people would not want birth control to be used in any health care program. Intelligent people understand that nothing prevents abortion like the pill does.

  4. James Bowen March 24, 2014

    Very good article. There is perhaps not a more important program for the government to fund than family planning and contraception.

  5. Charlotte Sines March 24, 2014

    I very firmly believe that the only reason Republicans are against women accessing birth control is due to fear of losing control. They are against Blacks and Hispanics having any control over their lives because the white males would lose control over them. The same goes for women. If women can control their own lives then men lose control over them. Fortunately the number of men who believe this garbage is dropping. Most men are not scared of women who want to control their own lives. They are strong in their own right and have no reason to feel threaten by strong women.

    1. Cyndi March 25, 2014

      So why then do you continue being the victim that you say you are by allowing them to control you and your behavior. The reality is, no one controls anyone except themselves. Once you come to this eiphany all the male bashing, white bashing and republican bashing becomes meaningless bits of dribble. Focus on yourself and lifting up those around you, not trying to bring them down. Our country was founded on and thrived by our diversity and constant desire to accept others, enjoying the freedoms that our Veterans and our Constitution fight for and guarantee. Small government intrusion into our lives, businesses providing jobs and benefits that our society demands, encouragement and continued bettering of ourselves by education and community involvement…these are the things that bring us together no matter what our sex, color, ethnicity, social standing or any such superficial divisions. We are all the same and want the same things. No one is required to take care of you as an individual or your family or their health. That is for the individual to decide by making life choices toward the end that they choose for themselves and their families. Our Constitution guarantees the right to “pursue” not a guarantee that it will be given to you. Medicaid, food stamps, WIC, and others are only a means to help on a very temporary basis not for a lifetime…a Hand-up not a Hand-out.

      1. Charlotte Sines March 25, 2014

        I never said I was a victim because I’m not. No one takes care of me. I support myself and follow my own conscience. I believe that everyone is equal and should be treated that way. My mother was a social worker all her life and my childhood was filled with activities to help others in every way we could.I was brought up to see that women and men were equals and that no one should ever be allowed to control others for any reason.

      2. Sand_Cat March 26, 2014

        Aren’t you the one who suggested not having sex unless you want children? Isn’t that accepting victim status from the prudes who want to assure they control your sex life, along with everything else?
        You’re full of it, lady.

      3. Allan Richardson March 28, 2014

        Nobody can control anyone except himself or herself? Really? You mean that everyone who was killed or wounded or forcibly deported in a war, or who starved to death because someone cornered the market on some foodstuff and kept it away from those who were hungry (look up the Irish potato “famine” caused by British soldiers forcing the export of wheat that could have fed the people), or who were poisoned by air or water pollution caused by others, etc. etc. WAS CHOOSING to have those things happen to them? Could the Jews have offered any meaningful resistance to the Nazis, or for that matter to the Spanish Inquisition, the Romans or the Babylonians? Could the Cherokee have refused to walk on the Trail of Tears and kept their homes in Georgia? The life choices that individuals make are quite often overruled by nature (anything from illness to natural disasters such as hurricanes or earthquakes), carelessness or malice on the part of others, or PUNITIVE LAWS passed by those who gained power, even in a democracy, by DECEIVING voters like you. Life choices are also often based on the belief (which may be universally shared, or at least reasonable, at the time) that a certain career is the best one to be educated to pursue, and then after the investment is made, that occupation “tanks out” and workers are left with the wrong skills, and no spare cash to switch to the right ones. The life choices of a young woman may be based on the belief that the man she loves will be a dependable and faithful husband, but after becoming dependent on him to support her and her children, she learns that he is abusive (possibly a danger to her or the children), refuses to work, is unfaithful, or just decides to dump her — or all of the above — and has money to get a good lawyer.

        If you believe that everyone has complete ability to make their own environment, Cyndi, your last name must be Lauper, because you are obviously shielded by your or your parents’ money from having to worry about anything in life, so you can afford to “just wanna have fun.”

  6. Michael Nunez March 25, 2014

    Without centralized power to coerce, small groups of quacks and academics have no way to force people to chase their ever-shifting mirage of utopian illusions.

    1. Allan Richardson March 28, 2014

      Without centralized power to referee and punish bullies, those bullies will eventually BECOME the centralized power. See Attila the Hun.


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