While the core mission of the program has remained clear over the years, a shifting and expanding set of operational priorities, along with a growing number of individuals requesting care and increasing expenses with no significant expansion in funding, has made it difficult for the program to fulfill that mission. This chapter begins by reviewing the original goals of the program and amendments to the law. It then examines shifts in program emphasis since 1970 and the problems associated with these shifting emphases. The third section presents the committee’s findings regarding the extent to which the program has fulfilled its mission and goals. The final section offers conclusions and recommendations.

ORIGINAL GOALS AND AMENDMENTS TO THE LAW

In establishing the Title X program, Congress made clear that one major goal was to decrease the adverse health and financial effects on children, women, and their families of inadequately spaced childbearing (S. Rep. 91-1004, 91st Cong., 2d Sess., July 7, 1970; H. Rep. No. 91-1472, 91st Cong., 2d Sess., September 26, 1970; Family Planning Services and Population Research Act of 1970, P.L. 91-572 [1970]). Congress also emphasized that services offered through Title X were to be thoroughly voluntary. The Senate commented that the program “is properly a part of comprehensive health care and should consist of much more than the dispensation of birth control devices” (S. Rep. 91-1004, 91st Cong., 2d Sess., July 7, 1970, p. 10). The Senate cited with apparent approval the recommendations of a prominent family planning director for:

  1. Medical services, including consultation, examination, prescription, and continuing supervision, supplies, instruction, and referral to other medical services as needed.

  2. Outreach/follow-up systems, including patient identification, contact, recruitment, appointment support, follow-up, and continuing education.

  3. Planning, evaluation, development, and coordination, including application of modern management technology to a goal-oriented program.

  4. Financial management to assure a cost-effective, efficiently run program.

  5. Research, both of an operational and a clinical nature, to be built into the medical and evaluation systems.

  6. Social and ancillary services, including such necessary and supportive services as gonorrhea screening and social as well as medical services for teenagers.



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