Experience, Dedication, Resiliency, and Innovative Flexibility: Title X Family Planning Program Turns 50

Title X of the Public Health Service Act established the National Family Planning Program at HHS in 1970. For 50 years, Title X clinics have ensured access to a broad range of family planning methods and related health services for millions of women, men, and adolescents with priority given to persons from low-income families. These services are voluntary, confidential, and intended to assist in preventing or achieving pregnancy. Since the program’s inception, Title X clinics have provided more than 190 million client visits1. 

Each decade has brought changes to the program but the dedication of Title X grantees to help clients meet their family planning goals has remained constant. Today, Title X grantees comprise a network of public and private nonprofit entities providing services to their communities in the U.S. and in eight U.S. territories and freely associated states.

The program’s contribution to the prevention of sexually transmitted infections and related adverse health consequences is substantial. Our Family Planning Annual Report (FPAR) data show that from 1999 to 2019, Title X clinics performed 34.1 million chlamydia tests2, 18.3 million HIV tests, and 76.5 million non-HIV STD tests. During this same period, Title X-funded cancer screenings provided 37 million Pap tests and 42 million clinical breast exams.

From 1970 to 2020, Title X grantees have served clients despite a variety of complex challenges. The U.S. Virgin Islands Department of Health Family Planning Program (VIFPP), which has received Title X funding since 1975, is an example of this resiliency. The devastating 2017 hurricanes Irma and Maria destroyed much of VIFPP’s materials and supplies. “We served patients in a flooded building on St. Thomas for weeks, and we had to evacuate our sites on both St. Thomas and St. Croix,” says the program director. “As soon as tents and tarps could be raised, we were seeing clients. We’re pretty tough.” Learn more about how Title X grantees tackle challenges.

The onset of the COVID-19 pandemic in early 2020 created widespread and unprecedented hurdles for Title X grantees across the U.S. Many grantees implemented rapid response plans to provide high-quality healthcare while stay-at-home orders were in effect. Within days of the pandemic’s onset staff began planning for telehealth services. Soon thereafter clinics accessed clinical trainings and began providing services to clients by phone, video, curbside, and other innovative technologies.

Title X grantees are the key component of the program’s success. The grantees’ experience, dedication, resilience, and innovative flexibility are the foundation that will help them tackle future challenges. 

The most recent report from the CDC highlighted the grim reality that sexually transmitted infections reached an all-time high in 2018, marking the fifth consecutive year of increases for chlamydia, gonorrhea, and syphilis3. Young women (ages 15-24) account for 44 percent of reported cases and face the most severe consequences of an undiagnosed infection. Optimal health for our clients requires that we adopt a patient-centered approach that sensitizes providers to identify and support each client’s care, recognizing that some methods very effective in preventing pregnancy, leave clients unprotected against sexually transmitted infections and make their ability to achieve pregnancy in the future more difficult.

Family planning was declared one of the top ten greatest public health achievements in the 20^th century.4  Access to these services has continued to assist many Americans achieve desired birth spacing and family size in the early years of this century. As we celebrate 50 years of Title X, we applaud the program’s accomplishments and embrace continued resiliency and innovative change.  We look with confidence and excitement towards a bright future of promoting health across the reproductive lifespan.

• 1. From 1970 through 2019, an estimated190.3 million individuals visited a Title X-funded clinic for family planning and related preventive health services. This estimated cumulative number of Title X clients is not an unduplicated count; individuals who seek Title X care over many years will be counted as a client in each of the years that they make visit.
• 2. Data reflects services provided from 2005 through 2019 and assumes 1 chlamydia test per user tested.
• 3. Sexually Transmitted Disease Surveillance 2018.  Available online at https://www.cdc.gov/std/stats18/default.htm
• 4. Centers for Disease Control and Prevention, Ten Great Public Health Achievements -- United States, 1900-1999, Morbidity and Mortality Weekly Report (April 2, 1999). Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.