Final Project
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SamplePaperofFinal.pdf
Running Head: ACCESS TO FAMILY PLANNING 1
Access to Family Planning – Sexual Health Services
Student Name
HHPH 492: Global Health Policy
June 29, 2019
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Background
Sexually transmitted diseases (STDs) are one of the many major health issues in public
health. The goal of family planning services is to combat this issue and to promote positive and
healthy sexual behaviors which will help to strengthen community capacity and increase access
to quality services which assist in the prevention of sexually transmitted diseases along with their
complications (Healthy People 2020, 2014). Biological, social, economic and behavioral factors
affect and contribute to the spread of STDs.
Providing access to sexual health services is important because according to Healthy
People 2020 the Centers for Disease Control and Prevention (CDC) receive around 20 million
new cases of sexually transmitted disease infections annually, almost half of them among the
youth with an estimated cost of $16 million being spent (2014). The risk factors that contribute
to this issue include unsafe sex, medical barriers, racial and ethnic disparities, poverty, lack of
education and substance abuse. Almost half of the individuals affected range between the ages of
15-24 specifically those in rural areas. According to the American Sexual Health Association
(ASHA), young people between the ages of 15-24 have five times the reported rate of chlamydia
out of the total population and regarding gonorrhea the rate is four times as high (2019). African
American, Hispanic and American Indian communities are most affected. There is a lack of
access to family planning services for women in rural areas especially among minorities. Family
planning services aid in three different areas which include avoiding unintended pregnancies,
reduce the spread of STDs and by addressing the problem of STDs which in turn help with
reducing infertility rates (Institute of Medicine, 2009).
Individuals can become infected by having unprotected sex. Biological factors that affect
the spread of sexually transmitted diseases and complications include the asymptomatic nature of
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STDs, gender and age disparities. Social, economic and behavioral factors cause major obstacles
in preventing STDs because of their various influences on social networks, access to and
provision of care, the individual's willingness to seek care, social norms regarding sex and a
person's sexuality (Healthy People 2020, 2014). The social, economic, and behavioral factors
that play a role in why people do not have access to family planning services include but are not
limited to poverty, access to health care, secrecy, racial and ethnic disparities.
Family planning is one of the many achievements made in public health during the
twentieth century along with vaccinations and motor vehicle safety. Family planning gives
individuals a choice to determine the size of their family as well as the timing and spacing out of
their children which has improved the overall well-being of individuals socially and
economically. Family size declined between the 1800s and 1900s from 7 children to
approximately 4 children. By the 1920s and 1930s more clinics were opening which promoted
family planning. In the 1960s there was an increase in demand for contraceptives that would be
effective in preventing sexually transmitted diseases and unwanted pregnancy since the modern
birth control movement began in 1912. During this time women wanted to have smaller families
which led to the formation of many groups to bring awareness to family planning services
specifically geared towards low income women and families. In 1970 Title X of the Public
Health Service Act was established. This act provided funds to family planning clinics. Funds for
Title X declined in the 1980s and Medicaid now is the largest source of funding for family
planning services. Today, there are many efforts being made by policy makers and program
managers to make STD prevention services more accessible for everyone. Between 1995-2008,
the yearly incidence rate of STDs, not HIV has increased by almost 50% (Ortayli et al, 2014).
Response to the problem
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STD surveillance is being used to effectively respond to the various threats these diseases
bring. It is also used with other tools to take on new challenges and direct the tools that will have
the greatest impact in any given situation. According to an article written by D’ann Lawrence
White, the targeted efforts being made include strengthening the congenital syphilis response
with focused efforts to improve diagnosis and treatment of pregnant woman, helping state and
local health departments quickly test for drug resistant gonorrhea and quickly find and treat the
affected individuals, lastly to assist state health departments and health clinics integrate STD
prevention into care for people living with STDs and the Human Immunodeficiency virus (HIV)
(2018). The 2007-2012 Department of Health and Human Services (HHS) Strategic Plan has
several goals which include increasing the availability of health care services, preventing the
spread of infectious diseases through testing, promoting and encouraging preventative health
care, as well as fostering the economic independence and social well-being of individuals and
families (Institute of Medicine, 2009). Title X which was established in 1970 greatly contributes
to these goals.
The Center for American Progress (CAP) is an independent nonpartisan policy institute.
This policy institute focuses primarily on improving the lives of Americans through progressive
ideas and strong leadership. They also aim to not only bring awareness to the importance of
access to sexual health care for all but to one day change the country. The goal for their policy is
to improve access to sexual and reproductive health services and to help people attain superior
sexual health. Many women rely on publicly funded clinics which are mainly funded through
Title X. Nearly 42% of women in 2006 to 2010 received any type of sexual or reproductive
health service from a publicly funded clinic (Center for American Progress, 2019). Within these
years according to CAP almost half of the women who sought services at a publicly funded
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clinic received service while 31% of women who visited a private provider or HMO for sexual
and reproductive health care received treatment (2019). Although not all publicly funded clinics
do not receive funding from Title X, most do. Title X funds clinics that serve over 5 million
patients who would not seek treatment due to medical barriers such as the cost and those who are
not insured or qualify for Medicaid. This policy also offers a comprehensive package of all the
services provided compared to other health care providers which will ensure patients are
receiving comprehensive sexual and reproductive health care.
Landscape
Individuals who are greatly affected by a lack of access to sexual and reproductive health
services are young people and certain racial and ethnic groups, mainly African American,
Hispanic, and American Indian/Alaska Native populations compared to whites according to the
CDC. In the United States, there is a correlation with other determinants of health, race and
ethnicity. Healthy People 2020 states that young people make up only 25% of the sexually
experienced population and young females are at a higher risk of getting infected from a sexually
transmitted disease due to an increased cervical ectopy (2019). These individuals affected by this
issue may experience distrust in the healthcare system due to fears of discrimination from
healthcare providers which in turn can create negative feelings about receiving any type of STD
health services.
The World Health Organization (WHO) has made efforts to ensure that all people have
access to quality STD health services. This organization’s goal is to provide better health for
everyone around the world primarily focusing on combating chronic diseases such as cancer and
infectious diseases such as HIV. In 2001, WHO organized a consultation on adolescent friendly
health services, meaning there was a meeting held that discussed many reasons as to why
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adolescents were not able or willing to obtain these health services. "A 2005 review of research
through 1999 focused on the adequate STI services and identified barriers that adolescents
experience in obtaining needed STI services (Newton-Levinson et al, 2016).” By these
researchers taking the time to understand these barriers even on a global level helps to provide a
better understanding of the challenges that still exist today.
Another group that has attempted to address this problem in the past would be the
American Sexual Health Association (ASHA). This association was founded in 1914 as the
American Social Hygiene Association by a group of public health reformers. They focused on
fighting STDs and prostitution. One hundred years later, ASHA remains America’s nonprofit
authority for sexual health (2019). ASHA believes that everyone has the right to receive sexual
and reproductive health services and wants to make them more accessible for everyone.
Although ASHA has made many efforts in the past to combat this issue such as making it their
mission to delivery people with the facts provided by support and resources, they continue to
make an impact today. The American Sexual Health Association specialized in public outreach
which includes patients, press, providers and policy makers by creating and distributing health
sensitive information through many avenues.
A political influence that attempted to modify Title X is the Trump administration. The
changes that the Trump administration enforced has a great potential of decreasing access for
women to receive health services related to their reproductive and sexual health who are covered
by the funds Title X provides. Because of Title X, teen pregnancy, infertility, and cervical cancer
rates have decreased. The new change that Trump is trying to enforce made it clear that any
medical provider who discusses abortion in any aspect with patients or provide abortions will not
receive any Title X funds according to an article from the American Public Health Association
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(APHA) (2019). Title X can already not be used for abortions. The effects of this new rule will
cease the full range of health services provided to the patient such as STD testing, contraception
and cancer screening which will jeopardize women’s health. This rule not only disrupts the
family planning infrastructure, but it will also widen the gap between the accessibility of these
needed health services.
Institutions of Government
As previously stated, Title X was established in 1970 as part of the Public Health Service
Act while President Richard Nixon was elected into office. Congress created this policy as the
nation’s first federal program which focused on family planning services. The Title X Family
Planning program is administered within the Office of the Assistant Secretary for Health by the
Office of Population Affairs (OPA) according to the United States Department of Human Health
Services (2019). OPA advises the Secretary also the Assistant Secretary for Health on a wide
range of sexual health and reproductive topics, including adolescent health, family planning,
sterilization, and other population issues. The Office of Population Affairs operates under the
direction of the Deputy Assistant Secretary for Population Affairs, who also serves as the
Director of the Office of Adolescent Health (2019).
Pros and Cons
There are many obvious benefits that come from the Title X policy. Title X has played a
major role in the access patients are having to clinics as well as taking care of their overall
health. By continuing funding for this program, it has been proven to reduce the number of
abortions that women are having, and it saves taxpayers dollars according to the article, Power to
Decide (2017). Because of the recent changes the Trump administration has made to govern the
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program, they have received backlash for these destructive changes. As stated previously, the
changes include the prohibit of abortion referrals, impose coercive counseling standards for
pregnant patients and impose unnecessary and stringent requirements of Title X. This affects
individuals' access to sexual health and reproductive services because if the providers discuss
abortion topics, they will no longer receive funding from Title X which in turn jeopardizes the
health of women and limits the type of services patients from low income families can receive.
Health Implications of Title X
Many low-income women still struggle with receiving access to family planning services.
By the Trump Administration finalizing the new proposed regulation, the impact will be great
and further limit access rather than expanding access. Research has shown that over 40% of
women who visit Planned Parenthood clinics that are publicly funded receive contraceptives and
sexual health services but by banning federal funds from Title X to Planned Parenthood will
reduce low income woman’s access to these contraceptives and services (Sobel et al, 2019). This
will then reflect in higher rates of STDs and unintended pregnancies in adolescents and young
women. The proposed restrictions on referrals for abortions can affect the quality of family
planning care as well as puts the health clinics at risk of medical liability.
Recommendations for modifications
In conclusion, the Trump administration should not enforce the new rule for Title X
funding that has the potential of prohibiting doctors who receive federal funding from referring
their patients to abortion providers. As said before, it can affect low income and uninsured
women who visit these clinics because they are not able to afford visits let alone have regular
doctors. With the loss of Title X funding due to the new rule Trump’s administration has sought
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to set in place, Planned Parenthood clinics could close further eroding access to health services.
Because of so many negative outcomes that could result from these new changes to Title X, the
new rule should not be implemented. Instead the policy should be kept as is because it is very
cost effective for poor families and efforts made by Title X is a great approach to fight against
sexual and reproductive health issues that plague America.
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References
Achievements in Public Health, 1900-1999: Family Planning. (1999, December 3). Retrieved
June 26, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm
APHA opposes Title X changes restricting access to basic reproductive and sexual health
services. (2019, February 25). Retrieved June 26, 2019, from https://apha.org/news-and-
media/news-releases/apha-news-releases/2019/title-x
CDC Newsroom. (2017, September 26). Retrieved June 26, 2019, from
https://www.cdc.gov/media/releases/2017/p0926-std-prevention.html
Institute of Medicine (US) Committee on a Comprehensive Review of the HHS Office of Family
Planning Title X Program. (2009). Overview of Family Planning in the United States.
Retrieved June 26, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK215219/
Newton-Levinson, A., Leichliter, J. S., & Chandra-Mouli, V. (2016). Sexually Transmitted
Infection Services for Adolescents and Youth in Low- and Middle-Income Countries:
Perceived and Experienced Barriers to Accessing Care. The Journal of adolescent health
: official publication of the Society for Adolescent Medicine, 59(1), 7–16.
doi:10.1016/j.jadohealth.2016.03.014
Ortayli, N., Ringheim, K., Collins, L., & Sladden, T. (2014, June 14). Sexually transmitted
infections: Progress and challenges since the 1994 International Conference on
Population and Development (ICPD). Retrieved June 26, 2019, from
https://www.sciencedirect.com/science/article/pii/S0010782414003242
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Sexually Transmitted Diseases. (2014). Retrieved June 20, 2019, from
https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-
diseases
Sobel, L., Rosenzweig, C., Salganicoff, A., & Long, M. (2018, November 21). Proposed
Changes to Title X: Implications for Women and Family Planning Providers. Retrieved
June 26, 2019, from https://www.kff.org/womens-health-policy/issue-brief/proposed-
changes-to-title-x-implications-for-women-and-family-planning-providers/
Statistics. (2019). Retrieved June 26, 2019, from
http://www.ashasexualhealth.org/stdsstis/statistics/
Teitelbaum, J.B., & Wilensky, S.E (2018). Essentials of Health Policy and Law, 4th edition.
Burlington, MA: Jones and Bartlett Learning.
The Benefits of the Title X Family Planning Program. (2017). Retrieved June 26, 2019, from
https://powertodecide.org/what-we-do/information/resource-library/benefits-of-title-x
U.S. Department of Health and Human Services. (2019). Office of Population Affairs. Retrieved
June 26, 2019, from https://www.hhs.gov/opa/
White, D. L. (2018, April 06). CDC Warns: Sexually Transmitted Disease Reaching Record
Levels. Retrieved June 26, 2019, from https://patch.com/florida/southtampa/cdc-warns-
sexually-transmitted-disease-reaching-record-levels
Your Source For Sexual Health Information. (2019). Retrieved June 26, 2019, from
http://www.ashasexualhealth.org/
