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Members of Congress are still fighting over cuts in this year's federal budget. Among the proposed trims are dozens of programs House Republicans want to eliminate completely. NPR's Julie Rovner looks at one of them, the Federal Family Planning Program, known as Title X.
JULIE ROVNER: It's a typically busy Wednesday afternoon at the Unity Health Care's Upper Cardozo Clinic. It's located in a heavily Hispanic neighborhood in northwest Washington D.C.
Dr. ANDREA ANDERSON (Family Physician): (Spanish Spoken)
Unidentified Woman (Patient): (Spanish Spoken)
Dr. ANDERSON: (Spanish Spoken)
ROVNER: Family physician Andrea Anderson is seeing a patient for a sinus problem. But as long as she's here, Anderson asks her if she's happy with the birth control method she's using. Thanks to the Title X program, Unity has available a wide array of contraceptive options. Anderson keeps a sample of each in a plastic Ziploc bag for easy demonstrations.
Dr. ANDERSON: And also I have in here the patch, which is what she ended up changing to.
ROVNER: Anderson says one of her favorite things about the family planning program is the way it lets her integrate contraceptive choices into her everyday practice.
Dr. ANDERSON: Patients come in for a cold, they come in for their blood pressure check. We say what type of family planning method are you using, you know, is that working well for you? Oh, do you need something different? Not just for women, but also for men as well, because the men are also part of the decision making process.
ROVNER: Karen Klauss, a certified nurse midwife at Unity, says it works the other way, too. Sometimes the family planning program is the entry point for patients to get other health care services they might need.
Ms. KAREN KLAUSS (Certified Nurse Midwife, Unity): They come in, thinking that they need to get their pap smear, or they're interested in a family planning method, but as soon as I see them I see that their blood pressure is completely out of control; or based on the family history that I've gathered, they're at really high risk for diabetes, and I check their blood sugar and it's sky high.
ROVNER: The Title X family planning program was created in 1970 - signed by President Richard Nixon and championed by then Congressman George H.W. Bush. Its goal was to provide low-cost family planning services.
Abortion has been banned as an allowed service since the program began. But even so, Title X has long been entangled in abortion politics. Among the many reasons for that, is that Planned Parenthood Affiliates get about a quarter of all Title X dollars. Planned Parenthood clinics are also the nation's largest abortion providers, although they use don't use federal funding for that.
The controversy surrounding the program is a shame, says Doctor Mark Hathaway, Unity's Title X Medical Director. That's because of the roughly six million pregnancies in the U.S. every year, half are unintended.
Dr. MARK HATHAWAY (Unity's Title X Medical Director): And of that half, half of those end up as abortions. And that's a ridiculously, ridiculously high level of abortions in a country like ours where we have, supposedly, the best technologies and the best available methods to help women avoid pregnancy when they don't want to be pregnant.
ROVNER: And if reducing abortion is a goal, then getting rid of the Title X program is not the way to accomplish it, says Unity nurse midwife, Karen Klauss.
Ms. KLAUSS: If the Title X program goes away, there's no question that the unintended pregnancies would go up and, as a consequence of that, abortions across the country would go up.
ROVNER: Some religious conservatives oppose the entire idea of the government handing out contraceptives, particularly to people who aren't married. But others oppose the program for other reasons. Chuck Donovan is a senior research fellow with the conservative Heritage Foundation.
Mr. CHUCK DONOVAN (Senior Research Fellow, Heritage Foundation): At the end of the day there's just a question of how many things can you afford and is this one a national priority.
ROVNER: Donovan says Heritage isn't against contraception. He just thinks the program should be funded through people's individual insurance.
Mr. DONOVAN: And then it would be a matter of individuals deciding what their needs are and using their insurance dollars to purchase those services rather than all of the cost and bureaucracy of a federal program.
ROVNER: In the meantime, however, as more and more people are losing their health insurance, the demand for services under the Title X program has been rising. In 2009, the program served just over five million patients. If it actually is cancelled, how those patients will get care remains a question yet to be addressed.
Julie Rovner, NPR News, Washington.
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