A federal decision to rewrite the rules for America’s only national family planning program has been justifiably condemned by King County Executive Dow Constantine, Washington Governor Jay Inslee, the American Medical Association, and countless others concerned about health care and justice.
“This change to our family planning program threatens the whole idea that all women deserve equal access and equal choices from our health care system, and I’m afraid the consequences, from unintended pregnancies to untreated diseases, will be devastating for many women,” said Patty Hayes, Director of Public Health—Seattle & King County (PHSKC).
To better understand why the program – called “title ten” (or Title X) – matters so much, we reached out to Heather Maisen, the Family Planning Program Manager for PHSKC. King County’s Family Planning program operates four clinics dedicated full-time to family planning services and four school-based health centers, and has a team of health educators.
PHSKC also works with private health providers across King County to assure broad access to services. Maisen serves on the national board of the National Family Planning and Reproductive Health Association (NFPRHA, which represents publicly funded family planning providers and administrators).
Three things we all should know
Here are three aspects of the program that Maisen says should be widely known:
1. Title X is a great equalizer in terms of basic access to birth control and reproductive health services. For women who are either uninsured or covered by a parent’s or spouse’s insurance (who might threaten or harm them for seeking services) – Title X ensures access. Women who are independently insured might take this access for granted.
In this sense, it prevents us from having a two-tier system, where only better off women can get the full range of options and information, at a time and place when it’s needed. Those options include: pregnancy testing, options counseling and referrals, and testing for sexually transmitted diseases.
The impact was summarized in King County’s official comment letter to the federal government when the rule was proposed, signed by Executive Dow Constantine and Council members Jim McDermott and Rod Dembowski, stating the rule “would be nothing short of disastrous for overall local health systems and particularly harmful to women in need of financial support for family planning services.”
2. Title X has a proud history, locally and nationally. PHSKC has been a Title X provider since the program launched through “Title X of the Public Health Services Act” of 1970. With the help of Title X funding, King County has greatly expanded its own direct service locations and today operates Title X services in Auburn, Eastgate, Federal Way, Kent, and Seattle.
Other Title X providers in King County (in addition to PHSKC) are essential to assuring access. Planned Parenthood of the Great Northwest and Hawaiian Islands operates eight Title X clinics here, and Cedar River Clinics operates two Title X clinics. Both of these providers offer abortion services and will be forced to drop out of Title X.
Over the past decade, the teen birthrate in King County has fallen by 63% and is one of lowest teen birth rates in the country for a large metropolitan county. In fact, King County’s teen birth rate is 2.5 times lower than the national rate. Lower teen birth rates lead to greater education and career opportunities for the next generation. And a key part of this success stems from the expansion of family planning services and health education in schools (such as the FLASH curriculum).
3. Title X is foundational for one of the greatest public health successes from the 20th century. The Title X program not only provides access, it also promotes best practices and accountability by requiring clinics to meet quality family planning standards.
Title X program requirements and clinical standards have long assured that low-income people receive the full-range of family planning services. Clinics must offer all FDA-approved contraceptive options, including emergency contraception. Patients can receive the method of their choice the same day of their visit.
Clinics in the Title X program must provide pregnancy testing with options counseling and referrals, testing and treatment for STIs as well as HIV testing, and cervical and breast cancer screenings.
The new Title X rule undermines these standards. If it goes into effect (after a 60-day waiting period), people will have no assurance that the clinic they are entering really offers all options, and health care providers will not be allowed to make referrals for clients who want to find an abortion provider. (Title X clinics do not themselves provide abortions.)
What’s at stake
Ultimately, the new rule will reduce access to essential health care for low-income and uninsured populations – creating a two-tiered health care system. From a public health perspective, that is the pathway to worse health outcomes and deeper inequities.
When equitably available, family planning services play a pivotal role in women’s lives, not only preventing unintended pregnancies and the spread of diseases, but enabling significant health, economic and social benefits.
Originally published February 25, 2019