This Commentary is written by Sarah Blake and Andrea Swartzendruber
For nearly 50 years, Title X, the national family planning program, has provided millions of low-income and uninsured people access to high-quality health care in line with national medical and ethical practice standards.
This important program has helped health providers, like public health departments and community clinics, offer a wide range of preventive health services, including contraception, breast and cervical cancer screenings, sexually transmitted disease testing and pre-conception health care, to 4 million clients each year.
Final regulations published in March by the federal government profoundly conflict with the foundational principles that have guided Title X for decades, and they will have serious negative consequences in Georgia as well as in other places.
The recently announced changes will limit access to critical health care services, threaten the health and well-being of Georgians who rely on safety-net providers for their health care, and exacerbate the state’s already extraordinarily high rates of unintended pregnancy, maternal mortality, infant mortality, preterm birth, HIV, and other sexually transmitted diseases.
Title X providers can be the most important, and sometimes only, source of care for the medically underserved in Georgia.
Currently 130 community health centers in Georgia provide Title X services such as highly effective contraception. In 2015, Title X providers served about 86,000 clients in Georgia, 46 percent of whom lived below the federal poverty line (or who had an annual salary lower than $12,500). Family planning services at Georgia’s health centers funded by Title X helped prevent 23,600 unintended pregnancies.
The new regulations make organizations that avoid promoting and providing contraceptives, such as crisis pregnancy centers, eligible for Title X funding. A crisis pregnancy center in California was recently awarded more than $5 million. Ninety crisis pregnancy centers currently operate in Georgia and could compete for future funding.
Research in Georgia shows that these centers fail to adhere to national medical guidelines and frequently provide biased, misleading information about contraception by emphasizing and misstating failure rates, risks and side effects.
The new Title X regulations also no longer require providers to offer or counsel clients about comprehensive and evidence-based family planning methods. In fact, new Title X providers who oppose contraception would be allowed to withhold information about FDA-approved family planning methods and to counsel clients about only sexual abstinence and natural family planning methods, such as the “rhythm method” — the least effective family planning methods. This means that clients seeking family planning services in Georgia may not actually have any real clinical services or contraceptive methods offered to them. Clients may be pushed into avoiding contraception altogether.
An important and historical tenet of the Title X program is its guarantee of confidential services. This safeguard aligns with the program’s responsibility to protect the “integrity of individuals” requesting family planning, without regard to age or marital status, and is in line with recommendations of leading professional medical organizations.
The new Title X regulations impose new orders related to family involvement in the care of young people that appear to violate confidentiality laws in Georgia and many other states. This could deter young people from seeking needed health care, potentially leading to increased rates of unintended pregnancy and sexually transmitted diseases.
In recent years, the birth rate among teenagers in Georgia decreased by 12 percent, resulting in savings of between $400 million and $500 million in taxpayer costs. Such progress can be attributed to comprehensive sexual health education and access to family planning services and birth control, provisions no longer fully supported through the Title X program.
For decades, Title X has served as a critical backbone to Georgia’s public health system. The federal government’s changes will reverse the progress made in Georgians’ health, punish low-income Georgians seeking necessary health care, and waste our tax dollars on medically inaccurate provision of health care. Repealing the new regulations to protect safe, evidence-based family planning and prevention services is essential to protecting and promoting a healthier Georgia.
Sarah Blake, PhD, MA, is a faculty member and reproductive health researcher at Emory University’s Rollins School of Public Health. Andrea Swartzendruber, PhD, MPH, is a faculty member and reproductive health researcher at the University of Georgia College of Public Health. This article reflects their views and not necessarily those of any organization.