by Title X of the Public Health Service Act through grants to approximately 80 public and private nonprofit grantees for the provision of family planning information and services. In 1994 the health department was the sole grantee in 27 states and seven territories and a primary grantee in another ten states (Kaesar et al., 1996). Clinic sites include state and local health departments, hospitals, university health centers, Planned Parenthood affiliates, independent clinics, and other public and nonprofit agencies. Title X clinics are community-based, located in every state and in three-fourths of U.S. counties. They serve as an important entry point into care and, for some, the only source of service.
Population served: Among those served are approximately 4 million women of reproductive age. The majority of clients are young, have never borne a child (Kaeser et al., 1996), have incomes below 150% of the federal poverty level (FPL), are uninsured, and do not qualify for Medicaid.
Services provided: These include community education and outreach, contraceptive information and services, pregnancy testing, gynecological examinations, basic lab tests, and other screening services for STDs and HIV, high blood pressure, anemia, and breast and cervical cancer.
Title X clinics operate under uniform federal regulations and guidelines that "often serve as the blueprint for state family planning programs." A 1987 directive from the federal OPA, requires clinics to "offer, at a minimum, education on HIV infection and AIDS, counseling on risks and infection prevention, and referral services." They may also provide risk assessment, counseling, and tests. The directive further notes that if testing is done, it should be targeted. It emphasizes the importance of "offering effective methods of family planning to sexually active HIV-infected women who run a high risk of perinatal transmission in pregnancy and who run a significant risk of transmitting HIV to other sexual partners." Guidelines for Title X grantees are currently under development, in collaboration with the Centers for Disease Control and Prevention (CDC).
Funding: Sources of funding for family planning clinics may include Title X funds, state funds (including state maternal and child health program funds), Medicaid, private insurance, and patient fees. There is no charge for patients under 100% of the FPL and a sliding scale fee for patients up to 250% FPL.
Supplemental foods, nutrition education, and health care referrals provided to low-income pregnant, postpartum, and breast-feeding women, and to infants and children up to their fifth birthday. Administered on the federal level by the