In Support of Title X

IN BRIEF: ABOUT TITLE X

Congress established Title X of the federal Public Health Service Act in 1970 to ensure all individuals have access to quality, comprehensive family planning and related health services, with priority for low-income, vulnerable and hard-to-reach populations. Title X funding is distributed by the US Department of Health and Human Services to a range of health providers in every state, including public health departments, federally qualified health centers, hospitals and community and nonprofit clinics. Title X services can be found in most U.S. counties, including in urban and rural areas.    

Federal regulations establish rules for the delivery of family planning services provided through Title X. These rules address the scope and quality of services that must be made available, patient confidentiality and clinician training, among other things. Health services are delivered within nationally-recognized standards of care, and in 2018 included: 

• A comprehensive array of effective, medically approved contraceptive services and information 
• Basic preventive health care such as breast and cervical cancer screening
• Sexually transmitted disease (STD) and HIV testing and referral 
• Prevention education, and 
• Other related health services 

 Title X dollars cannot be used, and never have been used, to provide abortion care. 

TITLE X’S IMPACT ON ADOLESCENT HEALTH

One of Congress’s goals in creating Title X was to meet the reproductive health needs of young people and “prevent unwanted pregnancies among sexually active adolescents.” Indeed, adolescents have a critical need for access to effective and proven family planning and sexual health education. While the US has made progress, it still maintains one of the highest unintended adolescent pregnancy rates in the developed world, and half of all new STIs are in people between the ages of 15 and 24. The outcomes for youth who face inequities in healthcare access, including youth of color and youth who are homeless or in foster care, are even worse.  Title X plays a vital role in addressing the health needs of these young people:

• It is the only federal program dedicated to family planning services for young, low-income women. In 2017, about 20% of the 4 million patients treated at Title X health centers were age 19 or younger. 
• It makes it much easier for young people - particularly vulnerable youth - to access care, as services are available in multiple locations, easing access for youth without transportation or in remote locations and they are available at low or no cost and they do not require co-pays. 
• It allows youth to consent to their own health care. Although most minors can and do involve their families in their reproductive health decisions, the ability to consent to their own care at Title X-funded centers ensures that they can receive immediate access to care when it is needed. This is particularly important for our most vulnerable populations. For many youth, Title X is the difference between obtaining health care and not. 
• It requires extensive training for providers on how to identify and report possible trafficking and abuse of minors. This training is critical in ensuring each site’s ability to provide sensitive, client-centered, non-coercive care.

TITLE X UNDER ATTACK

In February, 2019, the U.S. Department of Health and Human Services (HHS) issued revisions to the regulations governing the Title X. Taken together, these revisions will result in the following: 

• Many clinics and licensed health providers dropping out of the Title X program because they can no longer provide competent medical care
• Clinic closures and reductions in services in remaining clinics that can no longer provide family planning for free 
• Lower standards of care at remaining Title X clinics 
• Less access to care from trained providers who can identify and compassionately respond to instances of neglect or abuse
• New agencies joining Title X that provide abstinence-only contraception education instead of an array of medically approved contraception methods that meet the specific needs of each individual patient 

These changes will severely harm adolescents across the nation by: 

• Seriously limiting adolescent access to basic health care 
• Disproportionately limiting access to care for youth in rural or remote areas or with limited access to transportation 
• Disproportionately limiting access to care for youth who do not have immediate access to family support 
• Failing to address the acute reproductive and sexual health needs of youth who are at high risk of sexual assault and trafficking or in abusive family or partner relationships 
• Increased rates of unintended teen pregnancy, abortion and STIs  

Read more about the impact of these revisions on one particularly vulnerable group, youth in foster care, at The Imprint. 

The revisions were set for implementation starting May 3, however, several states and health care organizations filed lawsuits challenging the legality of the revisions and asking courts to enjoin their implementation until the lawsuits can be heard.  In response, federal district courts in California, Oregon and Washington each issued preliminary injunctions in April, 2019 temporarily limiting implementation. Health and Human Services appealed these decisions to the Ninth Circuit Court of Appeals, asking the appellate court to stay the preliminary injunctions and allow it to proceed implementing the new regulations. 

LATEST DEVELOPMENTS

Find all Title X procedures and rules for admission to proceedings, as well as access to case information at the web site for the Ninth US Circuit Court of Appeals.

September 23, 2019: The Ninth Circuit en banc panel heard oral arguments on whether to reinstate the nationwide Preliminary Injunction.

August 5, 2019: The National Center for Youth Law files Amicus Brief in the 4th Circuit of Appeals in support of an injunction filed in Baltimore, MD in support of Title X. Read the Amicus Brief here.

July 16, 2019: Health and Human Services formally announces that Title X regulations will go into effect immediately. Read more.

July 11, 2019: Eleven 9th US Circuit Court of Appeals judges issue a notice clarifying that the prior ruling to temporarily allow regulations to go into effect is still in effect even as the motion for reconsideration is pending. Read more.

July 5 – 8, 2019: The National Center for Youth Law files Amicus Briefs in the 9th Circuit Court of Appeals to support upholding the integrity of Title X, which has made quality reproductive health care available to countless young people. Read our Amicus Briefs: 

• California
• Oregon
• Washington v. Azar - NCYL Amicus Brief 

June 25, 2019: The plaintiffs file a motion to ask the full Circuit Court to reconsider .

June 20, 2019: A three-judge panel of the 9th US Circuit Court of Appeals rules to lift the preliminary injunctions issued in Oregon, Washington and California, allowing the revised regulations to go into effect even as the lawsuits challenging the regulations proceed. Read more.

May 10, 2019: U.S Department of Health and Human Services files a motion to stay the district court decisions.

April 26, 2019: U.S. district court in California grants preliminary injunction in the cases State of California, et al. vs. Azar and Essential Access Health Inc., et al. vs. Azar. 

April 25, 2019: U.S. district court in Washington judge grants preliminary injunction in the case State of Washington, et al. vs. Azar. 

April 23, 2019: U.S. district court in Oregon grants preliminary injunction in the cases State of Oregon, et al. vs. Azar and American Medical Association, et al. vs. Azar.  

March 2019: Multiple states and medical organizations, including the states of Oregon, Washington and California, and the American Medical Association, Planned Parenthood, and Essential Access Health, file lawsuits in federal court to block implementation of the Trump administration’s new regulations for the Title X federal family planning program. Read more. 

February 22, 2019: The US Department of Health and Human Services issues Title X regulation revisions. 

July 2018: The National Center for Youth Law submits comments to the US Department of Health and Human Services outlining our grave concerns regarding the human and fiscal impact of the proposed regulation changes on adolescents. 

May 2018: The US Department of Health and Human Services issues proposed Title X regulation changes.