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By Lisa Kaeser, JD
The Alan Guttmacher Institute
For the third consecutive year, conservatives in the U.S. House of Representatives mounted a major attack on the Title X family planning program. Although this year’s effort, an amendment to require notification to the parents of minors seeking contraceptive services, was defeated, supporters of Title X wonder just how many more attacks the program can stave off without serious, long-term damage eventually being done.
Title X has not been formally reauthorized by Congress since 1985, leaving its continuation solely to the discretion of the annual appropriations process. There is generally some protection against a slate of amendments that would unduly prolong the debate. All programs funding health, education, and labor are consolidated into one huge bill (the largest of all the 13 appropriations measures funding the federal government), and Congress usually is anxious to finish the funding bills before the end of the fiscal year. Recently, however, the Title X program has become more of a lightening rod than ever, as evidenced by a review of the events in the last three years.
Two years ago, Rep. Bob Livingston (R-LA) offered an amendment to the appropriations measure funding Title X that would have completely defunded the family planning program. Instead, his amendment would have turned the money over to the Maternal and Child Health block grant and federally funded community health centers. The debate that followed represented the first time since Title X’s inception in 1970 that the question was placed squarely before Congress on whether the federal government should even have a family planning program to help low-income women and others have control over their reproductive lives. The answer proved to be affirmative; the amendment was soundly defeated.
Last year, opponents of family planning narrowed their target somewhat. Rep. Ernest Istook (R-OK) offered an amendment to require that minors seeking any of the services provided by a Title X funded family planning clinic first have parental consent. Similar amendments had been offered and rejected on various bills in committee and on the House or Senate floor seven times during the previous 20 years, despite language adopted in 1978 that made it clear that parental involvement should be strongly encouraged in Title X funded clinics.
This time around, however, family planning proponents were not so sanguine about maintaining confidential services for all of their clients, including adolescents. Consequently, they threw their support behind a "substitute" amendment put forward by Rep. Dave Obey (D-WI) that requires Title X grantees to formally certify to the federal government that they make every effort to encourage, rather than mandate, parental involvement. The substitute strategy, which is often invoked in order to give members something positive to vote for, succeeded, and the amendment was adopted by more than 40 votes.
Somewhat surprisingly, another amendment that would require Title X clinics to inform parents that their children were seeking contraceptive services was offered to this year’s appropriations bill. In an attempt to garner more support, its sponsors modified the amendment to require "only" parental notification (or consent or judicial permission), rather than mandatory consent.
Supporters of the amendment focused on the values that would be codified in the language, including parent-child communication and chastity outside of marriage. They also pointed to a recent tragic situation in Illinois in which a high school teacher, who had been sexually involved with his 13-year-old student for more than a year, eventually took her to a county health department clinic (which receives some Title X funds) to obtain confidential contraceptive services.
Title X supporters countered by again offering a substitute that reiterated the requirement that parental involvement be encouraged and requiring that minors receiving services at a clinic be counseled on how to resist coercive sexual advances. This approach was strongly supported by many of the mainstream medical and health organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists.
Many members who argued in favor of the amendment also pointed out that the most likely outcome of mandatory parental notification would be that sexually active adolescents would merely stop seeking contraceptive services, rather than becoming abstinent. Others emphasized the essential counseling and health care provided in family planning clinics.
Although this latest version also failed, the vote count was closer than last year’s, proving to family planning supporters that complacency would indeed be misplaced.
Title X was not left untouched this year. Opponents of family planning were somewhat more successful with a new approach: deleting funds from Title X in favor of popular programs such as senior meals and breast cancer research.
As we go to press, the final fiscal year 1998 funding level for Title X is still undetermined, although key appropriators are strong Title X supporters. All that is certain at this point is that many policy-makers have yet to be convinced of the importance of family planning.