Hundreds of millions of dollars that help low-income people access reproductive health care are at risk. The House Appropriations Committee approved discretionary funding for the Labor, Health and Human Services, and Education departments for 2018 last week, and in the process, eliminated $286 million in Title X funding for family planning services.
Hospitals and clinics receive Title X funds for provision of contraception, screening for breast and cervical cancer as well as sexually transmitted infections and HIV, and education and outreach. This funding disproportionately helps low-income people and people of color, said Amy Friedrich-Karnik, senior federal policy adviser for the Center for Reproductive Rights. Although no clinics operate solely with funding from Title X, many clinics would have to reduce services.
“If Title X were to be defunded, the impact would be extraordinary and a lot of people would lose these services and clinics have to pick and choose and make choices about how and what services they can offer. They definitely would suffer,” Friedrich-Karnik said.
Tile X provides family planning and other health services to an estimated four million low-income uninsured and underinsured people each year. Title X funds supported a network of nearly 4,000 service sites in the U.S. in 2015, according to a report released by the Office of Population Affairs last year.
Cuts to the program will seriously hurt poor and low-income Americans. The majority of 20 million women who need publicly funded contraceptive care — 77 percent — are poor or low-income adults, according to the Guttmacher Institute. And already, the program’s budget isn’t large enough. An American Journal of Public Health article published last year found that Title X would actually need at least $737 million for its annual budget to cover care for all of the women who need publicly funded family planning.
Current Title X funds reach areas of the country that desperately need assistance in family planning services, said Friedrich-Karnik.
“Half of [the programs] are state and local health departments, so those are able to reach rural counties because the money is able to go directly to the local health department,” said Friedrich-Karnik. “The other half goes to hospitals, family planning councils, Planned Parenthood and others, so it does have a broad reach across the country.”
The government sets an “unparalleled standard of clinical care” for providers to receive the funds, said Audrey Sandusky, director of advocacy and communications for the National Family Planning and Reproductive Health Association. “That means that if a health center receives even $1 of Title X funding, it must follow a rigorous set of requirements that ensure patient confidentiality and the provision of a wide range of contraceptive methods for all patients regardless of ability to pay,” Sandusky said.
A Republican-controlled Congress that is hostile to reproductive rights has a partner in the Trump administration, which hired a professor who doesn’t believe in the effectiveness of birth control to administer the Title X program. The House committee made the decision to eliminate this funding during the same week that the Trump administration axed $213 million in teen pregnancy prevention programs. Some of the programs affected were counseling and testing for sexually transmitted infections and the Choctaw Nation’s program to reduce teen pregnancy in Oklahoma, Reveal of The Center for Investigative Reporting found.
The elimination of Title X has yet to be approved by the House, but the Senate has not been friendly to Title X either. Earlier this year, Senate Republicans nixed an Obama administration rule requiring state and local governments to distribute Title X funds to health providers for family planning services and cervical cancer screenings without any consideration of whether those providers also perform abortions. Vice President Mike Pence, who is deeply opposed to reproductive rights, cast the tie-breaking procedural vote to let states stop clinics that perform abortions from receiving those funds for other services, such as breast cancer and sexually transmitted infection screenings.
Title X wasn’t always this political, Friedrich-Karnik said, since it was originally a bipartisan effort. The program is in greater danger now that Republicans are making more targeted attacks contraception and women’s access to reproductive services, she said.
“Ever since the [Affordable Care Act] passed, and it broadened access to contraception, we have seen contraception and birth control come back on the scene as a target by elected officials who have no interest in investing in women’s health,” Friedrich-Karnik said. “It’s just becoming increasingly a political target where women’s reproductive rights are constantly under attack.”
The decision to eliminate this funding, and deny many low-income people health care, is essentially a human rights violation, said Friedrich-Karnik, who recounted a visit to the Texas region of the Rio Grande Valley to talk to women who lost family planning services. The Rio Grande Valley, where many residents lack basic services such as electricity, saw its abortion clinics close due to the state’s abortion restrictions. These clinics also provided Pap smears and birth control, so residents also lost that preventive care. Friedrich-Karnik presents this regional crisis as a cautionary tale for the rest of the country.
“We talked to women who had an irregular pap smear result and had absolutely no way to do anything about that and were just sitting on that for three years, hoping symptoms wouldn’t develop or finding a lump in their breast and not being able to get care,” Friedrich-Karnik said. “The personal toll that takes is hugely impactful on women’s lives, and it means something for their community when women of reproductive age cannot access healthcare.”