Characteristics of Women Receiving Family Planning Services at Title X Clinics -- United States, 1991

In 1970, enactment of federal legislation created a national family planning program funded under Title X of the Public Health Services Act *. Since the enactment of this legislation, clinics funded entirely or partially by Title X have been the primary source of subsidized family planning services in the United States (1). Although information characterizing women who receive family planning services at Title X clinics can assist in program planning and operations, such information has not been compiled at the national level since 1981 (2). In 1992, state family planning administrators and CDC, with cooperation from Title X grantees, initiated the Family Planning Services Surveillance (FPSS) project to characterize women receiving family planning services from Title X clinics in 1991. This report presents the findings of FPSS.

Family planning data were collected from all 75 Title X grantees in the 50 states** and the District of Columbia. Each grantee was mailed a letter that requested information about selected variables for compilation at the national level. All 75 grantees responded. Because no uniform reporting system for family planning services exists nationally for Title X clinics, data collection was individualized by each grantee; however, grantees were given a set of preferred definitions for the FPSS project and asked to adhere as closely as possible to those definitions. Because not all grantees could separate male and female family planning patients for some of the characteristics reported, a small percentage (less than 1%) of male patients are included in this report. For all characteristics, data from grantees who contributed information in the specific categories requested were used to redistribute the data reported in categories other than those requested. Missing data were not imputed.

In 1991, 4,218,412 patients were reported as having received family planning services: more than one third (34.5%) were aged 20- 24 years and more than one fourth (27.3%), aged 15-19 years (Table_1). Most (71.8%) family planning patients were white; 14.9% of patients were Hispanic***. More than half (58.5%) of family planning patients had had no live births; 7.5% had had three or more live births. Live births are used by clinicians as a surrogate for pregnancy history in advising patients regarding choices for contraceptive method and other gynecologic services.

The method of contraception most frequently chosen by family planning patients was oral contraceptives (69.4%), followed by condoms (6.2%) and foam and condoms (5.1%). A total of 11.3% of patients were classified under the category "None," which comprised women who were pregnant, receiving infertility services, practicing abstinence, or receiving counseling only. The category "Other" included patients using unlisted methods of contraception (e.g., Norplant ****).

Almost two thirds (64.6%) of family planning users resided in households classified at or below the federal poverty level *****; 18.9% of users were classified from 101% to 150% of the poverty level. Reported by: State family planning administrators. Statistics and Computer Resources Br, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The FPSS project characterizes women nationwide receiving family planning services at Title X clinics. The findings in this report indicate that patients at these clinics are predominantly young, nulliparous, and poor and use oral contraceptives more than any other method of contraception. Although funding for the Title X national family planning program decreased in constant dollars by 43% during 1981-1991 and the total number of clinics participating in the program decreased by 19% (1), Title X grantees continue to deliver services to millions of women.

Differences in the percentage of family planning patients served by racial/ethnic group may be influenced by social and cultural phenomena and may be important in assessing service-delivery practices. For example, black women of reproductive age (aged 15-44 years) are disproportionately represented among family planning patients at Title X clinics; although black women constitute 13.4% of all women of reproductive age in the United States, they represent 23.0% of patients at Title X clinics (4).

The findings in this report are particularly subject to limitations related to the quality of the data. For example, although most grantees use computerized record systems, no uniform definitions, data-collection instruments, or categorization of information exist for reporting. Despite these limitations, findings from the FPSS project and related efforts by other organizations (1,5,6) will assist in characterizing the role of publicly funded family planning clinics in relation to the current and future health-care delivery systems. In addition, improvements in the quality and timeliness of information about family planning services will assist in formulating and evaluating national strategies and, at the local level, program planning and operations by grantees.

References

1. Ku L. Publicly supported family planning in the United States: financing of family planning services. Washington, DC: The Urban Institute and Child Trends, Inc., 1993.

2. The Alan Guttmacher Institute. Current functioning and future priorities in family planning services delivery. New York: The Alan Guttmacher Institute, 1983.

3. Bureau of Community Health Services. Program guidelines for project grants for family planning services. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Bureau of Community Health Services, 1990.

4. NCHS. Health, United States, 1992. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993; DHHS publication no. (PHS)93-1232.

5. Burt MR. Legislative and policy history: implications for the 1990s. Washington, DC: The Urban Institute and Child Trends, Inc., 1993.

6. The Alan Guttmacher Institute. Title X family planning clinic network. New York: The Alan Guttmacher Institute, 1992.

* Family Planning Services and Population Research Act of 1970 (Public Law no. 91-572). 

** In 39 states, the state health department is at least one of the grantees. 

*** Fifty-nine grantees, representing 71.7% of all family planning patients reported, provided data on Hispanic ethnicity. 

**** Use of trade names and commercial sources is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services. 

***** The Bureau of Common Reporting Requirements (BCRR) mandates that Title X grantees report poverty status of family planning "users" (3). Because the definition of family planning user is broader than the definition of patient, poverty status is based on 4.4 million users rather than the 4.2 million total patients reported. Poverty statistics are based on a definition originated by the Social Security Administration in 1964 and subsequently modified by federal interagency committees in 1969 and 1980 and prescribed by the Office of Management and Budget as the standard to be used by federal agencies for statistical purposes.
Table_1
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TABLE 1. Characteristics of patients  who received family planning services at Title X
clinics -- United States, 1991
=====================================================================================================
Characteristic        % Distribution    ş     Characteristic        % Distribution
---------------------------------------------------------------------------------
Age group (yrs) +                       ş    No. live births @
    <15                     1.5         ş             0                 58.5
  15-19                    27.3         ş             1                 21.5
    (15                     2.4)        ş             2                 12.5
    (16                     4.1)        ş           >=3                  7.5
    (17                     5.8)        ş      Total                   100.0
    (18                     7.1)        ş
    (19                     7.9)        ş    Poverty level **
  20-24                    34.5         ş         <=100%                64.6
  25-29                    20.1         ş      101%-150%                18.9
  30-34                    10.4         ş          >150%                13.9
   >=35                     6.1         ş      Unknown                   2.6
  Unknown                   0.1         ş      Total                   100.0
  Total                   100.0         ş
                                        ş    Contraceptive method ++
Race &                                  ş      Pill                     69.4
  White                    71.8         ş      Condom                    6.2
  Black                    23.0         ş      Foam and condom           5.1
  Other                     3.5         ş      Diaphragm                 1.4
  Unknown                   1.7         ş      Intrauterine device       0.8
  Total                   100.0         ş      Sterilization             2.7
                                        ş      Other                     2.7
                                        ş      None                     11.3
                                        ş      Unknown                   0.4
                                        ş      Total                   100.0
---------------------------------------------------------------------------------
 * Includes <1% male patients.
 + n=4,207,107 (75 grantees).
 & n=4,111,769 (71 grantees). The category "Other" includes all other races.
 @ n=2,168,828 (45 grantees). Excludes category "Unknown"; 10 grantees reported living
   children rather than live birth.
** n=4,375,620 (75 grantees). The Bureau of Common Reporting Requirements (BCRR)
   mandates that Title X grantees report poverty status of family planning "users" (3). Because
   the definition of family planning user is broader than the definition of patient, poverty status
   is based on 4.4 million users rather than the 4.2 million total patients reported. Poverty
   statistics are based on a definition originated by the Social Security Administration in 1964
   and subsequently modified by federal interagency committees in 1969 and 1980 and
   prescribed by the Office of Management and Budget as the standard to be used by federal
   agencies for statistical purposes.
++ n=3,875,415 (66 grantees). The category "Other" includes patients using unlisted methods
   of contraception (e.g., Norplant(R)).
=====================================================================================================

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