Title X at 25. Balancing national family planning needs with state flexibility.

Title X of the Public Health Service Act supports family planning and closely related reproductive health services for more than four million women in the US. It is the cornerstone of the national family planning program. In the summer of 1995 however amid calls to give states greater control over the allocation of federal funds for social programs Republican Representative Bob Livingston of Louisiana proposed to eliminate Title X. The US House of Representatives instead rejected the measure and kept Title X intact. Proponents claims on the merits of block grants to states are not necessarily true. This paper examines the role Title X has played in providing publicly-funded family planning services and the degree of state involvement in the effort. It then briefly reviews the recent history of block grants with attention to whether they have fulfilled their objectives and examines the likely consequences of converting Title X into a block grant. It is concluded that Title X strikes a delicate balance as a targeted but largely decentralized federal program which ensures that its grantees have the flexibility needed to provide family planning services efficiently. Far more could be lost than gained by mandating exclusive state administration of the program.