Title X family planning clinics confront escalating costs, increasing needs.

Since 1970, the Title X family planning program of the US Public Health Service act has helped low-income American women avoid unintended pregnancies, abortions, and unwanted births. In addition to averting a million pregnancies (and half as many abortions) each year, the 4400 Title X clinics provide an array of reproductive health services. Funding for the program, however, has never recovered from Reagan-era cuts, and President Clinton's proposal for a $25 million increase will only begin to allow the program to achieve Clinton-administration objectives. The clinics face a financial challenge in maintaining the full range of contraceptive choices, especially in light of the high up-front costs of long-acting contraceptives, such as Depo-Provera, which can consume 50% of a budget for 15% of the clients. New diagnostic technologies have made routine screening desirable but expensive, and clinics must struggle to maintain quality of care. Title X clinics also have a clear need to expand their service capacity to reach the million low-income women who continue to risk unintended pregnancy and to serve low-income salaried workers without health insurance. Currently, two-thirds of Title X clients are so impoverished that their care is totally subsidized, and only 20% are covered by Medicaid. A portion of the $25 million increase has also been earmarked to promote reproductive health among the hard-to-reach population, such as substance abusers and the homeless, and to expand service provision to males. While the increase is needed, it represents only a portion of the cost of facing these challenges.