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pdfSeptember 2020
C E L E B RAT I N G T I T L E X
1970–2020
Title X
Family Planning Annual Report
2019 National Summary
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Family Planning Annual Report: 2019 National Summary
September 2020
Family Planning Annual Report:
2019 National Summary
Prepared for
Office of Population Affairs
Office of the Assistant Secretary for Health
U.S. Department of Health and Human Services
1101 Wootton Parkway, Suite 200
Rockville, MD 20852
Prepared by
RTI International
3040 East Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709
SUGGESTED CITATION
Fowler, C. I., Gable, J., Lasater, B., & Asman, K. (2020, September). Family Planning
Annual Report: 2019 National Summary. Washington, DC: Office of Population Affairs,
Office of the Assistant Secretary for Health, Department of Health and Human Services.
ADDITIONAL COPIES
This report can be viewed, downloaded, and printed from the Office of Population Affairs
Website at https://opa.hhs.gov/evaluation-research/title-x-services-research/family-planningannual-report.
ACKNOWLEDGMENTS
This report was prepared by RTI International under OPA contract number
HHSP233201500039I/75P00119F37024. RTI staff who prepared the report include Christina
Fowler (Project Director and Health Scientist), Julia Gable (Statistician), Beth Lasater
(Information Systems Analyst), and Kat Asman (Statistician). The conclusions expressed in
this report are those of the authors and do not necessarily represent the views of HHS or OPA.
Amy Morrow and Margaret Johnson (Editors); Judy Cannada and Roxanne Snaauw
(Document Preparation Specialists); and Kimberly Cone, Pam Tuck, and Teresa Bass (Web
Conversion Team) provided publications assistance. Al-Nisa Berry (FPAR Data System
Manager), Yuying Zhang (Programmer), and Vesselina Bakalov (Programmer) provided
support for web-based data collection.
For their help resolving data validation issues and reviewing the final report, the authors
thank the following U.S. Department of Health and Human Services (HHS) Office of
Population Affairs (OPA) staff: Diane Foley (Deputy Assistant Secretary for Population
Affairs), Jamie Kim and Roshni Menon (FPAR Data Coordinators), Amy Margolis (Division
Director), Karen Silver (Senior Communications Specialist), and HHS/OPA Project Officers
(LCDR Cynda Hall, Alissa Harvey, Jo Anne Jensen, CDR Rebecca McTall, and Shenena
Merchant).
Finally, publication of this report would not have been possible without the contributions of
Title X services grantees and subrecipients that ensure access to a broad range of family
planning and related preventive health services for millions of low-income or uninsured
individuals and collect, compile, and submit FPAR data to OPA.
_________________________________
RTI International is a registered trademark and a trade name of Research Triangle Institute.
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Family Planning Annual Report: 2019 National Summary
CONTENTS
Executive Summary ..................................................................................... ES-1
1
Introduction ........................................................................................................1
Title X National Family Planning Program ........................................................................... 1
Family Planning Annual Report............................................................................................. 2
Report Structure ..................................................................................................................... 3
2
FPAR Methodology ............................................................................................5
Data Collection ...................................................................................................................... 5
Data Validation ...................................................................................................................... 5
3
Title X Network Characteristics ........................................................................7
Title X Service Network Profile ............................................................................................ 7
4
Family Planning User Characteristics ..............................................................9
Demographic Profile .............................................................................................................. 9
Total Users (Exhibit 3) .................................................................................................... 9
Users by Sex (Exhibits 4 and 5) .................................................................................... 10
Users by Age (Exhibits 4 and 5) ................................................................................... 10
Users by Race (Exhibits 6 through 14) ......................................................................... 14
Users by Ethnicity (Exhibits 6 through 14) ................................................................... 14
Social and Economic Profile ................................................................................................ 23
Users by Income Level (Exhibit 15) ............................................................................. 23
Users by Insurance Coverage Status (Exhibit 16) ......................................................... 23
Users by Limited English Proficiency Status (Exhibit 17) ........................................... 24
5
Contraceptive Use ...........................................................................................29
Female Contraceptive Use (Exhibits 18 through 21) ........................................................... 29
Trends in Female Primary Contraceptive Method Use ................................................. 30
Male Contraceptive use (Exhibits 22 through 25) ............................................................... 31
6
Related Preventive Health Services................................................................41
Cervical and Breast Cancer Screening ................................................................................. 41
Cervical Cancer Screening (Exhibit 26)........................................................................ 41
Breast Cancer Screening (Exhibit 26) ........................................................................... 41
Sexually Transmitted Disease Testing ................................................................................. 43
Family Planning Annual Report: 2019 National Summary
iii
Chlamydia Testing (Exhibits 27 and 28)....................................................................... 43
Gonorrhea Testing (Exhibit 29) .................................................................................... 46
Syphilis Testing (Exhibit 29) ........................................................................................ 46
HIV Testing (Exhibit 29) .............................................................................................. 46
7
Staffing and Service Utilization.......................................................................49
Staffing and Family Planning Encounters............................................................................ 49
Clinical Services Provider Staffing (Exhibit 30) ........................................................... 49
Family Planning Encounters (Exhibit 30) ..................................................................... 49
8
Project Revenue ...............................................................................................53
Revenue................................................................................................................................ 53
Title X Services Grant ................................................................................................... 53
Payment for Services: Client Fees ................................................................................ 53
Payment for Services: Third-Party Payers .................................................................... 53
Other Revenue............................................................................................................... 54
Revenue per User and Encounter .................................................................................. 54
Trends in Project Revenue 2009 vs. 2019 ..................................................................... 58
9
References .......................................................................................................59
Appendixes
A National Trend Exhibits .............................................................................................. A-1
B State Exhibits............................................................................................................... B-1
C Field and Methodological Notes ................................................................................. C-1
Exhibits
1. U.S. Department of Health and Human Services regions ............................................... 4
2. Number of and percentage change in grantees, subrecipients, and service sites,
by year and region: 2018–2019 (Source: FPAR Grantee Profile Cover Sheet) .............. 7
3. Number, distribution, and percentage change in number of all family planning
users, by year and region: 2018–2019 (Source: FPAR Table 1) ..................................... 9
4. Number of all family planning users, by sex, age, and region: 2019 (Source:
FPAR Table 1) .............................................................................................................. 12
5. Distribution of all family planning users, by sex, age, and region: 2019
(Source: FPAR Table 1) ................................................................................................ 13
6. Number and distribution of all family planning users, by race and ethnicity:
2019 (Source: FPAR Tables 2 and 3) ............................................................................ 15
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Family Planning Annual Report: 2019 National Summary
7. Number and distribution of female family planning users, by race and
ethnicity: 2019 (Source: FPAR Table 2) ....................................................................... 15
8. Number and distribution of male family planning users, by race and ethnicity:
2019 (Source: FPAR Table 3) ....................................................................................... 15
9. Number of all family planning users, by race, ethnicity, and region: 2019
(Source: FPAR Tables 2 and 3) ..................................................................................... 16
10. Distribution of all family planning users, by race, ethnicity, and region: 2019
(Source: FPAR Tables 2 and 3) ..................................................................................... 17
11. Number of female family planning users, by race, ethnicity, and region: 2019
(Source: FPAR Table 2) ................................................................................................ 18
12. Distribution of female family planning users, by race, ethnicity, and region:
2019 (Source: FPAR Table 2) ....................................................................................... 19
13. Number of male family planning users, by race, ethnicity, and region: 2019
(Source: FPAR Table 3) ................................................................................................ 20
14. Distribution of male family planning users, by race, ethnicity, and region:
2019 (Source: FPAR Table 3) ....................................................................................... 21
15. Number and distribution of all family planning users, by income level and
region: 2019 (Source: FPAR Table 4) ........................................................................... 25
16. Number and distribution of all family planning users, by principal health
insurance coverage status and region: 2019 (Source: FPAR Table 5) .......................... 26
17. Number and distribution of all family planning users, by limited English
proficiency (LEP) status and region: 2019 (Source: FPAR Table 6) ............................ 27
18. Number of female family planning users, by primary contraceptive method
and age: 2019 (Source: FPAR Table 7)......................................................................... 32
19. Distribution of female family planning users, by primary contraceptive method
and age: 2019 (Source: FPAR Table 7)......................................................................... 33
20. Number of female family planning users, by primary contraceptive method
and region: 2019 (Source: FPAR Table 7) .................................................................... 34
21. Distribution of female family planning users, by primary contraceptive method
and region: 2019 (Source: FPAR Table 7) .................................................................... 35
22. Number of male family planning users, by primary contraceptive method and
age: 2019 (Source: FPAR Table 8) ............................................................................... 36
23. Distribution of male family planning users, by primary contraceptive method
and age: 2019 (Source: FPAR Table 8)......................................................................... 37
24. Number of male family planning users, by primary contraceptive method and
region: 2019 (Source: FPAR Table 8) ........................................................................... 38
25. Distribution of male family planning users, by primary contraceptive method
and region: 2019 (Source: FPAR Table 8) .................................................................... 39
26. Cervical and breast cancer screening activities, by screening test or exam and
region: 2019 (Source: FPAR Tables 9 and 10) ............................................................. 42
Family Planning Annual Report: 2019 National Summary
v
27. Number of family planning users tested for chlamydia, by sex, age, and region:
2019 (Source: FPAR Table 11) ..................................................................................... 43
28. Percentage of family planning users in each age group tested for chlamydia, by
sex, age, and region: 2019 (Source: FPAR Table 11) ................................................... 45
29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and
region, and number of positive HIV tests, by region: 2019 (Source: FPAR
Table 12) ....................................................................................................................... 46
30. Number and distribution of FTE CSP staff, by type of CSP and region, and
number and distribution of FP encounters, by type of encounter and region:
2019 (Source: FPAR Table 13) ..................................................................................... 51
31. Amount and distribution of Title X project revenues, by revenue source: 2019
(Source: FPAR Table 14) .............................................................................................. 55
32. Amount of Title X project revenues, by revenue source and region: 2019
(Source: FPAR Table 14) .............................................................................................. 56
33. Distribution of Title X project revenues, by revenue source and region: 2019
(Source: FPAR Table 14) .............................................................................................. 57
A–1a. Number of Title X-funded grantees, subrecipients, and service sites, by region
and year: 2009–2019 ................................................................................................... A-2
A–1b. Distribution of Title X-funded grantees, subrecipients, and service sites, by
region and year: 2009–2019 ........................................................................................ A-3
A–1c. Number of Title X-funded service sites and users per service site, by year:
2009–2019 ................................................................................................................... A-4
A–2a. Number and distribution of all family planning users, by region and year:
2009–2019 ................................................................................................................... A-6
A–2b. Number and distribution of all family planning users, by region and year:
2009–2019 ................................................................................................................... A-7
A–3a. Number and distribution of all family planning users, by age and year:
2009–2019 ................................................................................................................... A-8
A–3b. Number and distribution of all family planning users, by age and year:
2009–2019 ................................................................................................................... A-9
A–4a. Number and distribution of all family planning users, by race and year:
2009–2019 ................................................................................................................. A-10
A–4b. Number and distribution of all family planning users, by race and year:
2009–2019 ................................................................................................................. A-11
A–5a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2009–2019 ................................................................. A-12
A–5b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2009–2019 ................................................................. A-13
A–6a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2009–2019......................................................................... A-14
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Family Planning Annual Report: 2019 National Summary
A–6b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2009–2019......................................................................... A-15
A–7a. Number and distribution of all family planning users, by income level and
year: 2009–2019 ........................................................................................................ A-16
A–7b. Number and distribution of all family planning users, by income level and
year: 2009–2019 ........................................................................................................ A-17
A–8a. Number and distribution of all family planning users, by primary health
insurance status and year: 2009–2019 ....................................................................... A-18
A–8b. Number and distribution of all family planning users, by primary health
insurance status and year: 2009–2019 ....................................................................... A-19
A–9a. Number of all female family planning users, by primary contraceptive method
and year: 2009–2019 ................................................................................................. A-20
A–9b. Distribution of all female family planning users, by primary contraceptive
method and year: 2009–2019 .................................................................................... A-21
A–9c. Number and distribution of all female family planning users, by type of
primary contraceptive method and year: 2009–2019 ................................................ A-22
A–10a. Number and percentage of female users who received a Pap test, number of
Pap tests performed, and percentage of Pap tests performed with an ASC or
higher result, by year: 2009–2019 ............................................................................. A-23
A–10b. Number and percentage of female users who received a Pap test, by year:
2009–2019 ................................................................................................................. A-23
A–11a. Number and percentage of female users under 25 tested for chlamydia, by
year: 2009–2019 ........................................................................................................ A-24
A–11b. Number and percentage of female users under 25 tested for chlamydia, by
year: 2009–2019 ........................................................................................................ A-24
A–12a. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2009–2019 ............................................................. A-25
A–12b. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2009–2019 ............................................................. A-25
A–13a. Actual and adjusted (constant 2019$ and 2009$) total, Title X, and Medicaid
revenue, by year: 2009–2019 .................................................................................... A-26
A–13b. Total, Title X, and Medicaid adjusted (constant 2019$) revenue (in millions),
by year: 2009–2019 ................................................................................................... A-27
A–13c. Total actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue
(in millions), by year: 2009–2019 ............................................................................. A-28
A–13d. Title X actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue
(in millions), by year: 2009–2019 ............................................................................. A-29
A–13e. Medicaid actual (unadjusted) and adjusted (constant 2019$ and 2009$)
revenue (in millions), by year: 2009–2019................................................................ A-30
A–14a. Amount of Title X project revenue, by revenue source and year: 2009–2019 .......... A-32
Family Planning Annual Report: 2019 National Summary
vii
A–14b. Distribution of Title X project revenue, by revenue source and year: 2009–
2019 ........................................................................................................................... A-33
A–14c. Amount (unadjusted) and distribution of Title X project revenue, by revenue
source and year: 2009–2019 ...................................................................................... A-34
B–1. Number and distribution of all family planning users, by sex and state, and
distribution of all users, by state: 2019 (Source: FPAR Table 1) ................................ B-2
B–2. Number and distribution of all family planning users, by user income level and
state: 2019 (Source: FPAR Table 4)............................................................................ B-4
B–3a. Number and distribution of all family planning users, by insurance status and
state: 2019 (Source: FPAR Table 5)............................................................................ B-6
B–3b. Number and distribution of all family planning users in the 50 states and
District of Columbia, by insurance status and state according to the status of
the states’ Medicaid expansion under the Affordable Care Act (ACA): 2019
(Source: FPAR Table 5) .............................................................................................. B-8
B–4. Number and distribution of female family planning users at risk of unintended
pregnancy, by level of effectiveness of the primary method used or adopted at
exit from the encounter and state: 2019 (Source: FPAR Table 7) ............................. B-10
B–5. Number and percentage of female family planning users under 25 years who
were tested for chlamydia, by state: 2019 (Source: FPAR Table 11) ....................... B-12
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Family Planning Annual Report: 2019 National Summary
Executive Summary
The Title X National Family Planning Program, administered by the U.S. Department of
Health and Human Services (HHS), Office of Population Affairs (OPA), is the only federal
program dedicated solely to supporting the delivery of family planning and related preventive
health care. The program is designed to provide “a broad range of acceptable and effective
family planning methods and services (including natural family planning methods, infertility
services, and services for adolescents)”1, p. 1 with priority given to persons from low-income
families. In addition to offering these methods and services on a voluntary and confidential
basis, Title X-funded service sites provide contraceptive education and counseling; breast and
cervical cancer screening; sexually transmitted disease (STD) and human immunodeficiency
virus (HIV) testing, referral, and prevention education; and pregnancy diagnosis and
counseling.2,3 The program is implemented through competitively awarded grants to state and
local public health departments and family planning, community health, and other private
nonprofit agencies. In fiscal year 2019, the Title X program received approximately
$286.5 million in federal Title X funding.4
Annual submission of the Family Planning Annual Report (FPAR)5 is required of all Title X
service grantees.6 The 15-table FPAR provides grantee-level data on the demographic and
social characteristics of Title X clients, their use of family planning and related preventive
health services, staffing, and revenue. FPAR data have multiple uses, which include
monitoring performance and compliance with statutory requirements, fulfilling federal
accountability and performance reporting requirements, and guiding strategic and financial
planning. In addition, OPA uses FPAR data to respond to inquiries from policy makers and
Congress about the program and to estimate the impact of Title X on key reproductive health
outcomes.5
The purpose of the Family Planning Annual Report: 2019 National Summary is to present the
national-, regional-, and state-level findings for the 2019 reporting period (calendar year) and
trends for selected measures. Below we highlight key findings.
KEY 2019 FPAR FINDINGS
A diverse network of public and private nonprofit health and community service
agencies delivers Title X services. In 2019, Title X-funded services were implemented
through 100 grants * to 47 state and local health departments and 53 nonprofit family planning
and community health agencies. Title X funds supported a network of 3,825 service sites
operated by either grantees or 1,060 subrecipients in the 50 United States, the District of
Columbia, and eight U.S. territories and Freely Associated States. The total number of service
*
In this report, the terms “grantee” and “grant” are synonymous. If an agency receives multiple grants to
support Title X services in different geographic areas (e.g., different states), OPA will require the agency
to submit separate FPARs and the agency will appear more than once in the Title X grantee count. In
2019, 91 agencies submitted one FPAR, three agencies submitted two FPARs, and one agency submitted
three FPARs.
Family Planning Annual Report: 2019 National Summary
ES-1
sites in 2019 (3,825 sites) was 3% lower than in 2018 (3,954 sites) and 15% lower than in
2009 (4,515 sites). Of the 100 grantees that were active during 2019, 28 discontinued
participating in the program during the year and reported FPAR data for a period of less than
12 months, resulting in decreases in the numbers of family planning users served, project
revenue, and other performance measures.
Changes in Title X program regulations affect the capacity and performance of the
Title X service network. On March 3, 2019, HHS issued a Final Rule7,8 that revised Title X
regulations governing several aspects of how Title X-funded projects deliver family planning
care. OPA updated Title X regulations to “clarify and ensure compliance with the statutory
intent of the program.”9 As a condition of their continued participation in Title X and
pursuant to court orders, grantees were required to comply by July 15, 2019 with all
requirements of the Final Rule, except for the physical separation requirements. In addition,
by August 19, 2019, grantees choosing to remain in the program were required to submit an
“Assurance and Action Plan” documenting the steps they would take to comply with the Final
Rule and a written statement with supporting evidence demonstrating that their Title X
project was in compliance. Compliance with the physical separation requirements was
required starting March 4, 2020. For more information about the Title X Final Rule, please
visit the OPA website: Compliance with Statutory Program Integrity Requirements.
As a result of the Final Rule, 18 agencies representing 19 grants and 231 subrecipients
discontinued participation in the Title X program; the number of Title X service sites was
reduced by 945 sites. In September 2019, OPA awarded $33.7 million in supplemental grants
to 50 remaining grantees to offset the impact of these withdrawals. These grants were
intended to support family planning services in areas that were underserved or left unserved
by agencies that withdrew from the program. OPA plans to award new grants in
September 2020.
Title X providers serve a socioeconomically disadvantaged population, most of whom
are female, low income, and young. In 2019, Title X-funded providers served over
3.1 million family planning users (i.e., clients) through almost 4.7 million family planning
encounters. About 9 of every 10 users (87%) were female, 61% were under 30 years of age,
and 64% had family incomes at or below the poverty level ($25,750 for a family of four in the
48 contiguous states and the District of Columbia).10
The total number of family planning users served in 2019 (3.1 million users) was 21% lower
than in 2018 (3.9 million users) and 40% lower than in 2009 (5.2 million users). From 2009
to 2011, the program served over 5 million
users annually. The number of users served
A family planning user is an individual who
has at least one family planning encounter at a
subsequently decreased to about 4 million per
Title X service site during the reporting period.
year between 2012 and 2014 and remained at
A family planning encounter is a
about this level from 2014 to 2018
documented, face-to-face interaction between
(see Exhibit A–2a). In comments
an individual and a family planning provider
accompanying their FPAR data, grantees
that includes the delivery of family planning
services (alone or in conjunction with related
attribute the annual changes in user counts to
preventive health services) to avoid
economic factors affecting service demand or
unintended pregnancies or achieve intended
pregnancies.
the capacity and financial sustainability of the
network (e.g., recession, level or reduced
ES-2
Family Planning Annual Report: 2019 National Summary
funding, health reform), increased use of long-acting contraceptive methods or changes in
cervical cancer screening guidelines that reduced the number of encounters, implementation
of the Title X Final Rule, and various other factors (e.g., natural disasters, staffing).
Title X providers serve a population with low rates of health insurance. In 2019, 58% of
family planning users had either public (38%) or private (20%) health insurance, and 41%
were uninsured. Since 2015, the percentage of clients with health insurance has exceeded the
percentage without insurance. Although this increase in health insurance coverage signals
better health care access for Title X clients, the percentage of users who were uninsured
(41%) in 2019 was almost triple the national uninsured rate for adults (14%).11
Title X providers serve a racially and ethnically diverse population. Of the 3.1 million
family planning users served in 2019, 32% self-identified with at least one of the nonwhite
Office of Management and Budget race categories (black or African American, Asian, Native
Hawaiian or Pacific Islander, American Indian or Alaska Native, or more than one race),12
33% self-identified as Hispanic or Latino, and 15% were limited English proficient.
Title X providers offer clients a broad range of acceptable and effective family planning
methods and services. In 2019, 77% of the 2.7 million females served were using or adopted
a contraceptive method at their last encounter. The types of contraceptive methods used or
adopted included short-term hormonal methods like pills, injectables, the vaginal ring, or
patch (40%); long-acting reversible methods like intrauterine devices or implants (16%);
barrier methods like condoms, spermicide, or contraceptive sponge (15%); permanent
methods like female sterilization or vasectomy (3%); and fertility-based awareness (1%) and
other methods (3%). Eight percent of all female users exited their last encounter with no
contraceptive method because they were either pregnant or seeking pregnancy.
Title X-funded cervical and breast cancer screening services are necessary for early
detection and treatment. In 2019, Title X providers conducted Papanicolaou (Pap) testing
on 20% (541,661) of female users. Thirteen percent of the 561,534 Pap tests performed had
an indeterminate or abnormal result requiring further evaluation and possible treatment. In
addition, providers performed clinical breast exams on 23% (627,282) of female users and
referred 5% of those examined for further evaluation based on abnormal findings.
Title X-funded STD and HIV services provide testing necessary for preventing disease
transmission and adverse health consequences. In 2019, Title X providers tested 58%
(644,080) of female users under 25 for chlamydia. Providers also performed 1.8 million
gonorrhea tests (5.7 tests per 10 users), 961,859 confidential HIV tests (3.1 tests per
10 users), and 674,764 syphilis tests (2.2 tests per 10 users). Of the confidential HIV tests
performed, 3,685 (3.8 per 1,000 tests performed) were positive for HIV.
Title X providers deliver male-focused family planning and reproductive health services
to a growing number of male clients. In 2019, 13% (405,114) of all Title X users were men.
Most male users were in their 20s (39%) or 30s (23%), and more than two-thirds (69%)
adopted or continued use of condoms or another contraceptive method at exit from their last
encounter. In addition, Title X providers tested 61% of all male users for chlamydia and
provided testing for several other STDs, including gonorrhea (6.8 tests per 10 male users),
HIV (5.3 tests per 10 male users), and syphilis (3.9 tests per 10 male users).
Family Planning Annual Report: 2019 National Summary
ES-3
A variety of qualified health providers deliver Title X-funded clinical services. In 2019,
3,678 full-time equivalent (FTE) clinical services providers (CSPs) delivered Title X-funded
care. Nurse practitioners, certified nurse midwives, and physician assistants accounted for
67% of total CSP FTEs, followed by physicians (24%) and registered nurses with an
expanded scope of practice (9%). A CSP attended 77% of the 4.7 million family planning
encounters that took place in 2019.
Title X projects rely on revenue from a mixture of public and private sources. In 2019,
Title X grantees reported total project revenue of over $1.0 billion to support their approved
Title X services projects. Six sources accounted for 86% of total revenue: Medicaid,
including the Children’s Health Insurance Program (36%, or $370.9 million); Title X (22%,
or $229.0 million); state governments (11%, or $110.0 million); private third-party payers
(10%, or $107.5 million); client service fees (4%, or $40.1 million); and local governments
(3%, or $30.1 million). With declines in all major revenue sources, total project revenue
(constant 2019 dollars) in 2019 was 24% lower (by $322.3 million) than in 2018 and 37%
lower (by $597.6 million) than in 2009.
Summary. The 2019 FPAR data show that Title X providers continue to serve a
socioeconomically disadvantaged population and to deliver family planning and related
preventive health care meeting the highest national quality standards. During 2019, the
Title X program underwent substantial regulatory changes that affected the size and capacity
of the service network and, compared with 2018, reduced the number of clients who received
Title X-funded care. To offset the impact of the Final Rule on program services, in
September 2019, OPA redirected Title X funding to grantees that remained in the program.
Because of the timing of this additional funding, however, its impact is not reflected in the
2019 FPAR data.
ES-4
Family Planning Annual Report: 2019 National Summary
1 Introduction
TITLE X NATIONAL FAMILY PLANNING PROGRAM
The Title X National Family Planning Program, created in 1970 and authorized under Title X
of the Public Health Service Act,1 is administered by the Office of Population Affairs (OPA),
within the U.S. Department of Health and Human Services (HHS). The Title X program is the
only federal program dedicated solely to the provision of family planning and related
preventive health care. This program is designed to provide “a broad range of acceptable and
effective family planning methods and services (including natural family planning methods,
infertility services, and services for adolescents)”,1. p. 1 with priority given to persons from
low-income families. In addition to offering these methods and services on a voluntary and
confidential basis, Title X-funded centers provide contraceptive education and counseling;
breast and cervical cancer screening; sexually transmitted disease (STD) and human
immunodeficiency virus (HIV) testing, referral, and prevention education; and pregnancy
diagnosis and counseling.2,3 By law, Title X funds cannot be used by centers where abortion
is a method of family planning.2,3 In 2019, the program was implemented through grants * to a
total of 100 state and local public health departments and family planning, community health,
and other private nonprofit agencies. These grants supported delivery of Title X services in
approximately 3,800 sites. In fiscal year 2019, the Title X program received approximately
$286.5 million in federal Title X funding.4
On March 3, 2019, HHS issued a Final Rule7,8 that revised Title X regulations governing
several aspects of how Title X-funded projects deliver family planning care. OPA updated
Title X regulations to “clarify and ensure compliance with the statutory intent of the
program.”9 The Final Rule affected regulations related to the range of contraceptive method
options that projects must offer; information and services provided to women who learn that
they are pregnant (e.g., mandated referral to prenatal care and no abortion referrals);
eligibility for free or discounted care for women whose job-based insurance excludes
contraceptive coverage because of employers’ religious or moral objections; physical and
financial separation of projects from any abortion-related activities; and procedures,
assurances, and documentation requirements when serving minors.
*
In this report, the terms “grantee” and “grant” are synonymous. If an agency receives multiple grants to
support Title X services in different geographic areas (e.g., different states), OPA will require the agency
to submit separate Family Planning Annual Reports (FPARs) and the agency will appear more than once
in the Title X grantee count. In 2019, 91 agencies submitted one FPAR, three agencies submitted two
FPARs, and one agency submitted three FPARs.
Family Planning Annual Report: 2019 National Summary
1
As a condition of their continued participation in Title X and pursuant to court orders,
grantees were required to comply by July 15, 2019 with all requirements of the Final Rule,
except for the physical separation requirements. In addition, by August 19, 2019, grantees
were required to submit an “Assurance and Action Plan” documenting the steps they would
take to comply with the Final Rule and a written statement with supporting evidence
demonstrating that their Title X project was in compliance. Compliance with the physical
separation requirements was required starting March 4, 2020.
After HHS implemented the Title X Final Rule, 18 agencies representing 19 grants and 231
subrecipients discontinued participating in the program; the number of Title X-funded service
sites was reduced by 945 sites. Because of the timeline for complying with the Final Rule,
grantees that withdrew for this reason reported Family Planning Annual Report (FPAR) data
for less than the full 12-month reporting period. Additionally, nine other grants ended for
other reasons in 2019. As a result, the numbers of family planning users and encounters,
project revenue, and other performance measures decreased compared with 2018. In
September 2019, OPA awarded $33.7 million in supplemental grants to 50 existing grantees
to offset the impact of the withdrawals. These grants were intended to support providing
family planning services in areas that were underserved or left unserved by agencies that
withdrew from the program. For more information about the Title X Final Rule, please visit
the OPA website: Compliance with Statutory Program Integrity Requirements
FAMILY PLANNING ANNUAL REPORT
The FPAR5 is the only source of uniform reporting by all Title X services grantees. The
FPAR provides consistent, national-level data on program users, service providers, utilization
of family planning and related preventive health services, and sources of program revenue.
Annual submission of the FPAR is required of all Title X services grantees for purposes of
monitoring and reporting program performance.6 The FPAR data are presented in summary
form to protect the confidentiality of the persons who receive Title X-funded services.3
Title X administrators and grantees use FPAR data to
▪ monitor compliance with statutory requirements;
▪ comply with accountability and federal performance reporting requirements for Title X
family planning funds, including but not limited to the Government Performance and
Results Modernization Act and the Office of Management and Budget (OMB);
▪ guide strategic and financial planning and respond to inquiries from policy makers and
Congress about the program; and
▪ estimate the impact of Title X-funded activities on key reproductive health outcomes,
including prevention of unintended pregnancy, infertility, and invasive cervical cancer.5
2
Family Planning Annual Report: 2019 National Summary
REPORT STRUCTURE
The Family Planning Annual Report: 2019 National Summary presents data for the 100
Title X services grantees that submitted an FPAR for the 2019 reporting period
(January 1, 2019, through December 31, 2019). The National Summary has eight sections:
▪ Section 1—Introduction—describes the Title X National Family Planning Program and
the role of FPAR data in managing and monitoring the performance of the Title X
program.
▪ Section 2—FPAR Methodology—describes the procedures for collecting, reporting, and
validating FPAR data and presents the definitions for key FPAR terms.
▪ Sections 3 through 7—present the results for each FPAR table and include a discussion of
national and regional patterns and trends for selected indicators. These sections also
include text boxes with the definitions for key FPAR terms and selected guidance specific
to each FPAR table. Please see the Title X Family Planning Annual Report: Forms and
Instructions (Reissued October 2016)5 for complete FPAR reporting instructions.
▪ Section 8—References—is a list of National Summary references.
Additional data for the National Summary are included in three appendices: Appendix A
presents trend data for selected indicators for 2009 through 2019. Appendix B presents 2019
data for selected indicators by state, which includes the 50 states, the District of Columbia,
and the eight U.S. territories and Freely Associated States (American Samoa, Commonwealth
of the Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico,
Republic of the Marshall Islands, Republic of Palau, and the U.S. Virgin Islands).
Appendix B exhibits present state-level information on the characteristics of the Title X
network (number of grantees, subrecipients, and service sites) and the number and
distribution of Title X family planning users served by sex, income level, health insurance
coverage status (overall and by Medicaid expansion status), contraceptive use, and chlamydia
testing. Appendix C contains general and table-specific notes about the data presented in this
report.
Throughout this report, we use the term “table” when referring to an FPAR reporting table
and “exhibit” when referring to both the tabular and graphical presentations of the 2019 or
trend data. The exhibits throughout the report present results for Title X overall and for each
of the 10 HHS regions (Exhibit 1); the source of data (i.e., FPAR reporting table) for each
exhibit is noted. The 10 HHS regions (and regional office locations) are as follows:
▪ Region I (Boston, MA)—Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
▪ Region II (New York, NY)—New Jersey, New York, Puerto Rico, and the U.S. Virgin
Islands
▪ Region III (Philadelphia, PA)—Delaware, Maryland, Pennsylvania, Virginia, West
Virginia, and Washington, DC
▪ Region IV (Atlanta, GA)—Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, and Tennessee
Family Planning Annual Report: 2019 National Summary
3
▪ Region V (Chicago, IL)—Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
▪ Region VI (Dallas, TX)—Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
▪ Region VII (Kansas City, MO)—Iowa, Kansas, Missouri, and Nebraska
▪ Region VIII (Denver, CO)—Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming
▪ Region IX (San Francisco, CA)—Arizona, California, Hawaii, Nevada, American Samoa,
Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam,
Republic of the Marshall Islands, and Republic of Palau
▪ Region X (Seattle, WA)—Alaska, Idaho, Oregon, and Washington
Exhibit 1.
U.S. Department of Health and Human Services regions
Note:
Due to rounding, percentages cited in text may not match summed percentages from the
exhibits.
4
Family Planning Annual Report: 2019 National Summary
2 FPAR Methodology
DATA COLLECTION
The Title X Family Planning Annual Report (FPAR): Forms and Instructions (Reissued
October 2016)5 consists of 15 reporting tables. The FPAR instructions provide definitions for
key FPAR terms to ensure uniform reporting by Title X grantees. The key terms describe the
individuals receiving family planning and related preventive health services at Title X-funded
service sites, the range and scope of the services provided, and the family planning providers
that render care.
Title X services grantees are required to submit the FPAR by February 15 for the recently
completed reporting period (January 1 through December 31). In February 2020, FPARs for
100 grantees were submitted for the 2019 reporting period. Almost all (88%) FPARs were
submitted by the due date, and all were submitted using the web-based FPAR Data System
(https://fpar.opa.hhs.gov/).
DATA VALIDATION
FPAR data undergo both electronic and manual validations prior to tabulation. During data
entry, the FPAR Data System performs a set of automated validation procedures that ensure
consistency within and across tables. These validation procedures include calculation of row
and column totals and cross-table comparisons of selected cell values. Each validation
procedure is based on a validation rule that defines which table cells to compare and what
condition or validation test to apply.
After a grantee submits an FPAR, it goes through two levels of review by HHS staff. First,
OPA Project Officers review the FPAR and either accept it or return it to the grantee for
correction or clarification. Once the OPA Project Officer accepts the FPAR, the FPAR Data
Coordinator performs a second and final review, either accepting the FPAR or returning it to
the OPA Project Officer and the grantee for correction or clarification. When the FPAR Data
Coordinator has accepted all FPARs, RTI International extracts the FPAR data from the
FPAR Data System database and performs further electronic validations to identify potential
reporting errors and problems, including missing and out-of-range values for selected
measures (e.g., STD test-to-user ratios). RTI also performs a manual review of all comments
entered into the FPAR table “Note” fields.
RTI summarizes the results of the electronic and manual validations in a grantee-specific
report, compiled by region, which RTI sends to the FPAR Data Coordinator for follow-up
and resolution. Once OPA staff and grantees address all outstanding validation issues in the
FPAR Data System, RTI extracts the final data file for tabulation and analysis.
Family Planning Annual Report: 2019 National Summary
5
Selected Key Terms and Definitions for FPAR Reporting
Family Planning User—An individual who has at least one
family planning encounter at a Title X service site during the
reporting period. The same individual may be counted as a
family planning user only once during a reporting period.
Family Planning Encounter—A documented, face-to-face
contact between an individual and a family planning provider
that takes place in a Title X service site. The purpose of a
family planning encounter is to provide family planning and
related preventive health services to female and male clients
who want to avoid unintended pregnancies or achieve
intended pregnancies. Laboratory tests and related
counseling and education do not constitute a family planning
encounter unless the encounter is face-to-face, documented,
and includes family planning counseling or education.
The two types of family planning encounters are classified
based on the type of family planning provider who renders
the care: encounter with a Clinical Services Provider or
encounter with an Other Services Provider.
Family Planning Provider—The individual who assumes
primary responsibility for assessing a client and documenting
services in the client record. Providers exercise independent
judgment as to the services rendered to the client during an
encounter. There are two types of family planning providers:
■
Clinical Services Providers (CSPs) include physicians,
physician assistants, nurse practitioners, certified nurse
midwives, and registered nurses with an expanded scope
of practice who are trained and permitted by state-specific
regulations to perform all aspects of the user (male and
female) physical assessments recommended for
contraceptive, related preventive health, and basic
infertility care. CSPs offer a range of clinical, counseling,
and educational services relating to a client’s proposed or
adopted method of contraception, general reproductive
health, or infertility treatment, in accordance with Title X
program requirements.2
■
Other Services Providers include other agency staff
(e.g., registered nurses, public health nurses, licensed
vocational or licensed practical nurses, certified nurse
assistants, health educators, social workers, or clinic
aides) that offer client education, counseling, referral, or
follow-up services relating to the client’s proposed or
adopted method of contraception, general reproductive
health, or infertility treatment, in accordance with Title X
program requirements.2
Other Services Providers (continued) Other Services
Providers may also perform or obtain samples for routine
laboratory tests (e.g., urine, pregnancy, STD, and
cholesterol and lipid analysis), give contraceptive injections
(e.g., Depo-Provera), and perform routine clinical procedures
that may include some aspects of the user physical
assessment (e.g., blood pressure evaluation), in accordance
with Title X program requirements.2
Family Planning Service Site—A family planning service
site is an established unit where grantee or subrecipient
agency staff provide Title X services (clinical, counseling,
educational, or referral) that comply with Title X program
requirements2 and where at least some of the encounters
between the family planning providers and the individuals
served meet the requirements of a family planning
encounter. Established units include clinics, hospital
outpatient departments, homeless shelters, detention and
correctional facilities, and other locations where Title X
agency staff provide these family planning services. Service
sites may also include equipped mobile vans or schools.
Client Records—Title X projects must establish a medical
record for every client who is counted as a Title X user,
including but not limited to those who obtain clinical services
or other screening or laboratory services (e.g., blood
pressure check, urine-based pregnancy, or STD test). The
medical record contains personal data; a medical history;
physical exam data; laboratory test orders, results, and
follow-up; treatment and special instructions; scheduled
revisits; informed consent forms; documentation of refusal of
services; and information on allergies and untoward
reactions to identified drug(s). The medical record also
contains clinical findings; diagnostic and therapeutic orders;
and documentation of continuing care, referral, and
follow-up. The medical record allows for entries by
counseling and social service staff. The medical record is a
confidential record, accessible only to authorized staff and
secured by lock when not in use. The client medical record
must contain sufficient information to identify the client,
indicate where and how the client can be contacted, justify
the clinical impression or diagnosis, and warrant the
treatment and end results. If a family planning user receives
no clinical services, the provider still must establish a client
record that enables the site to complete the required FPAR
data reporting.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 7–10.5
6
Family Planning Annual Report: 2019 National Summary
3 Title X Network Characteristics
TITLE X SERVICE NETWORK PROFILE
In 2019, Title X-funded services were implemented through grants to 100 agencies: 47 (47%)
state and local health departments and 53 (53%) nonprofit family planning and community
health agencies. This funding supported a service network that included 1,060 subrecipients
and 3,825 service sites in the 50 United States, the District of Columbia, and the eight U.S.
territories and Freely Associated States (Exhibit 2). In 2019, the Title X program had 1 more
grantee than in 2018 (100 vs. 99), 68 fewer subrecipients (1,060 vs. 1,128), and 129 fewer
service sites (3,825 vs. 3,954) (Exhibit 2).
During 2019, 28 grantees discontinued participation in the Title X program and contributed
less than 12 months of FPAR data, which resulted in decreases in the numbers of users,
encounters, and other performance measures. Of the 28 grants that did not continue, 19 grants
(administered by 18 agencies) exited because of the Final Rule and 9 grants (administered by
8 agencies) reached the end of their funding period.
Comparing data from 2019 and 2009 shows that the number of grantees increased by 12%
(100 in 2019 and 89 in 2009), the number of subrecipients decreased by 8% (1,060 vs. 1,157),
and the number of service sites decreased by 15% (3,825 vs. 4,515). As noted in Section 1,
implementation of the Final Rule also resulted in the withdrawal of 231 subrecipients and loss
of 945 service sites. Exhibits A–1a and A–1b in Appendix A present trends (2009–2019) in
the number of grantees, subrecipients, and service sites overall and by region.
Exhibit 2.
Number of and percentage change in grantees, subrecipients, and service sites, by year and
region: 2018–2019 (Source: FPAR Grantee Profile Cover Sheet)
Network
Feature
All
Regions
Grantees
2019
100
10
8
12
12
12
9
6
6
19
6
2018
99
12
8
12
11
13
8
5
6
18
6
Difference
1
−2
0
0
1
−1
1
1
0
1
0
% Change
1%
0%
0%
9%
−8%
13%
20%
0%
6%
0%
Subrecipients
2019
2018
Difference
% Change
Service Sites
2019
Region
I
−17%
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
1,060
61
68
173
271
134
46
92
62
86
67
1,128
75
72
218
267
131
48
93
68
89
67
−68
−14
−4
−45
4
3
−2
−1
−6
−3
0
−19%
−6%
−21%
1%
2%
−4%
−1%
−9%
−3%
0%
−6%
3,825
214
237
614
910
394
466
197
157
391
245
2018
3,954
242
241
626
900
388
468
202
170
478
239
Difference
−129
−28
−4
−12
10
6
−2
−5
−13
−87
6
−12%
−2%
−18%
3%
% Change
−3%
−2%
Family Planning Annual Report: 2019 National Summary
1%
2%
0%†
−2%
−8%
7
Selected Guidance for Reporting User Demographic Profile Data in FPAR Tables 1 through 3
In FPAR Table 1, grantees report the unduplicated number
of female and male users by age group. Grantees
categorize users by age group base on the users’ age as
of June 30 of the reporting period.
In FPAR Table 2 and Table 3, grantees report the
unduplicated number of female (Table 2) and male
(Table 3) users by ethnicity and race.
The FPAR categories for reporting ethnicity and race
conform to the OMB 1997 Revisions to the Standards for the
Classification of Federal Data on Race and Ethnicity12 and
are used by other HHS programs and compilers of such
national data sets as the National Survey of Family Growth.
The two minimum OMB categories for reporting ethnicity are:
■
■
Hispanic or Latino (All Races)—A person of Cuban,
Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.
Not Hispanic or Latino (All Races)—A person not of
Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of
race.
The five minimum OMB categories for reporting race:
■
American Indian or Alaska Native—A person having
origins in any of the original peoples of North and South
America (including Central America) and who maintains
tribal affiliation or community attachment.
■
Asian—A person having origins in any of the original
peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
■
Black or African American—A person having origins in
any of the black racial groups of Africa.
■
Native Hawaiian or Other Pacific Islander—A person
having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
■
White—A person having origins in any of the original
peoples of Europe, the Middle East, or North Africa.
OMB encourages self-identification of race, and the FPAR
tables allow grantees to report the number of users who
self-identify with two or more of the OMB race categories.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 15–17, A-1–A-2.5
8
Family Planning Annual Report: 2019 National Summary
4 Family Planning User Characteristics
DEMOGRAPHIC PROFILE
Total Users (Exhibit 3)
In 2019, Title X-funded sites served almost 3.1 million family planning users. Grantees in
Regions IV and IX combined to serve more than 2 of every 5 Title X users, while in each of
Regions II, III, V, and VI, grantees served between 10% and 12% of all Title X users. The
number of users served in 2019 was 21% lower (by 844,083 users) than in 2018. Nine regions
reported a decline in users, with Region IX grantees reporting the largest numeric decline (by
377,909) (Exhibit 3). On average, the number of users per service site decreased by 187, from
996 (2018) to 809 (2019) (Exhibit A–1c).
Compared with 2009, the number of family planning users served in 2019 (3.1 million) was
40% lower than in 2009 (5.2 million) and 41% lower than the highest number of users
(5.2 million) ever served by the program in a single year (2010) (Exhibits A–2a and A–2b).
Exhibit 3.
Number, distribution, and percentage change in number of all family planning users, by year and
region: 2018–2019 (Source: FPAR Table 1)
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
3,095,666 145,737
308,031
374,499
648,599
295,108 321,395
110,363
104,814
666,147
120,973
2018
3,939,749 201,188
436,971
472,832
642,224
403,080 334,107
116,928
131,148
1,044,056
157,215
Difference
−844,083 −55,451
−128,940
−98,333
−6,565 −26,334
−377,909
−36,242
Users
Number
2019
All
Regions
Region
I
6,375 −107,972 −12,712
% Change
−21%
−28%
−30%
−21%
1%
−27%
−4%
−6%
−20%
−36%
−23%
Distribution
2019
100%
5%
10%
12%
21%
10%
10%
4%
3%
22%
4%
100%
5%
11%
12%
16%
10%
8%
3%
3%
27%
4%
2018
Note: Due to rounding, percentages may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
9
Users by Sex (Exhibits 4 and 5)
Of the 3.1 million family planning users served in 2019, 87% (2.7 million) were female, and
13% (405,114) were male (Exhibits 4 and 5). The percentage of total users who were female
was high across all regions (82% to 92%) and states (70% to 100%) (Exhibit B–1).
From 2009 through 2019, the percentage of users who were female declined from 93% to
87%, and the percentage of users who were male increased from 7% to 13%. Numerically, the
number of female users decreased 44%, from 4.8 million (2009) to 2.7 million (2019), while
the number of male users increased 8%, from 374,576 (2009) to 405,114 (2019)
(Exhibits A–2a and A–2b).
Users by Age (Exhibits 4 and 5)
In 2019, 17% (530,411) of all family planning users were under 20 years of age, 44%
(1.4 million) were 20 to 29 years of age, and 39% (1.2 million) were 30 years of age or older.
The same percentages of female and male users were in their teens (17%), a higher
percentage of female (44%) than male (39%) users was in their 20s, and a higher percentage
of male (44%) than female (38%) users was 30 or over. Across regions, there was wider
variation in the age distribution of male users than of female users (Exhibits 4 and 5).
From 2009 through 2019, there were changes in the age composition of Title X users. During
this period, the percentage of users in their teens decreased from 24% to 17% of total users,
the percentage in their 20s decreased from 50% to 44%, and the percentage 30 or older
increased from 26% to 39%. Numerically, the number of teen users decreased 57%, from
1.2 million (2009) to 530,411 (2019); the number in their 20s decreased 48%, from
2.6 million (2009) to 1.4 million (2019); and the number of users 30 or older decreased 10%,
from 1.3 million (2009) to 1.2 million (2019). Exhibits A–3a and A–3b present trends (2009
through 2019) in the distribution of all family planning users by age group.
10
Family Planning Annual Report: 2019 National Summary
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Family Planning Annual Report: 2019 National Summary
11
12
Exhibit 4.
Number of all family planning users, by sex, age, and region: 2019 (Source: FPAR Table 1)
Age Group (Years)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
1,167
Female Users
Under 15
34,021
2,067
2,425
7,659
8,503
2,434
3,268
1,208
1,227
4,063
15 to 17
180,610
9,608
15,090
26,381
36,655
18,172
18,767
7,813
7,839
30,418
9,867
18 to 19
248,502
10,780
23,640
28,736
50,129
27,255
25,637
10,183
10,492
49,870
11,780
20 to 24
643,155
26,971
64,799
66,593
126,616
69,840
63,809
22,971
24,019
148,057
29,480
25 to 29
552,984
24,516
56,987
60,445
114,335
54,954
56,419
18,308
15,698
128,037
23,285
30 to 34
405,404
18,933
42,696
47,666
89,695
35,554
44,678
13,838
11,008
85,879
15,457
35 to 39
281,785
13,179
29,416
33,817
63,006
23,384
33,677
10,253
7,702
57,281
10,070
40 to 44
175,973
8,517
17,981
21,854
38,314
13,444
20,830
6,315
4,609
38,261
5,848
Over 44
Family Planning Annual Report: 2019 National Summary
168,118
7,769
16,608
26,049
38,991
10,736
18,020
6,186
3,562
36,033
4,164
Subtotal
2,690,552
122,340
269,642
319,200
566,244
255,773
285,105
97,075
86,156
577,899
111,118
Male Users
Under 15
13,815
1,117
1,025
4,184
4,215
393
722
174
436
1,513
36
15 to 17
25,695
2,329
2,715
6,238
4,770
1,324
1,996
657
1,082
4,101
483
18 to 19
27,768
1,716
3,409
4,140
4,260
2,618
2,793
1,236
1,307
5,615
674
20 to 24
81,430
4,188
8,772
9,382
11,890
10,490
6,902
3,717
4,354
19,609
2,126
25 to 29
76,526
4,149
7,744
8,182
11,707
9,435
6,486
2,754
4,239
19,788
2,042
30 to 34
54,777
3,116
5,676
5,999
9,576
5,828
5,040
1,815
2,833
13,334
1,560
35 to 39
38,400
2,141
3,307
4,422
8,016
3,531
4,120
1,202
1,696
8,826
1,139
40 to 44
26,424
1,503
2,112
3,091
6,642
2,169
3,096
666
1,076
5,332
737
Over 44
60,279
3,138
3,629
9,661
21,279
3,547
5,135
1,067
1,635
10,130
1,058
Subtotal
405,114
23,397
38,389
55,299
82,355
39,335
36,290
13,288
18,658
88,248
9,855
All Users
Under 15
47,836
3,184
3,450
11,843
12,718
2,827
3,990
1,382
1,663
5,576
1,203
15 to 17
206,305
11,937
17,805
32,619
41,425
19,496
20,763
8,470
8,921
34,519
10,350
18 to 19
276,270
12,496
27,049
32,876
54,389
29,873
28,430
11,419
11,799
55,485
12,454
20 to 24
724,585
31,159
73,571
75,975
138,506
80,330
70,711
26,688
28,373
167,666
31,606
25 to 29
629,510
28,665
64,731
68,627
126,042
64,389
62,905
21,062
19,937
147,825
25,327
30 to 34
460,181
22,049
48,372
53,665
99,271
41,382
49,718
15,653
13,841
99,213
17,017
35 to 39
320,185
15,320
32,723
38,239
71,022
26,915
37,797
11,455
9,398
66,107
11,209
40 to 44
202,397
10,020
20,093
24,945
44,956
15,613
23,926
6,981
5,685
43,593
6,585
Over 44
228,397
10,907
20,237
35,710
60,270
14,283
23,155
7,253
5,197
46,163
5,222
3,095,666
145,737
308,031
374,499
648,599
295,108
321,395
110,363
104,814
666,147
120,973
Total All Users
Family Planning Annual Report: 2019 National Summary
Exhibit 5.
Distribution of all family planning users, by sex, age, and region: 2019 (Source: FPAR Table 1)
Age Group (Years)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal
1%
7%
9%
24%
21%
15%
10%
7%
6%
100%
2%
8%
9%
22%
20%
15%
11%
7%
6%
100%
1%
6%
9%
24%
21%
16%
11%
7%
6%
100%
2%
8%
9%
21%
19%
15%
11%
7%
8%
100%
2%
6%
9%
22%
20%
16%
11%
7%
7%
100%
1%
7%
11%
27%
21%
14%
9%
5%
4%
100%
1%
7%
9%
22%
20%
16%
12%
7%
6%
100%
1%
8%
10%
24%
19%
14%
11%
7%
6%
100%
1%
9%
12%
28%
18%
13%
9%
5%
4%
100%
1%
5%
9%
26%
22%
15%
10%
7%
6%
100%
1%
9%
11%
27%
21%
14%
9%
5%
4%
100%
Male Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal
3%
6%
7%
20%
19%
14%
9%
7%
15%
100%
5%
10%
7%
18%
18%
13%
9%
6%
13%
100%
3%
7%
9%
23%
20%
15%
9%
6%
9%
100%
8%
11%
7%
17%
15%
11%
8%
6%
17%
100%
5%
6%
5%
14%
14%
12%
10%
8%
26%
100%
1%
3%
7%
27%
24%
15%
9%
6%
9%
100%
2%
6%
8%
19%
18%
14%
11%
9%
14%
100%
1%
5%
9%
28%
21%
14%
9%
5%
8%
100%
2%
6%
7%
23%
23%
15%
9%
6%
9%
100%
2%
5%
6%
22%
22%
15%
10%
6%
11%
100%
0%†
5%
7%
22%
21%
16%
12%
7%
11%
100%
All Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Total All Users
2%
7%
9%
23%
20%
15%
10%
7%
7%
100%
2%
8%
9%
21%
20%
15%
11%
7%
7%
100%
1%
6%
9%
24%
21%
16%
11%
7%
7%
100%
3%
9%
9%
20%
18%
14%
10%
7%
10%
100%
2%
6%
8%
21%
19%
15%
11%
7%
9%
100%
1%
7%
10%
27%
22%
14%
9%
5%
5%
100%
1%
6%
9%
22%
20%
15%
12%
7%
7%
100%
1%
8%
10%
24%
19%
14%
10%
6%
7%
100%
2%
9%
11%
27%
19%
13%
9%
5%
5%
100%
1%
5%
8%
25%
22%
15%
10%
7%
7%
100%
1%
9%
10%
26%
21%
14%
9%
5%
4%
100%
87%
13%
84%
16%
88%
12%
85%
15%
87%
13%
87%
13%
89%
11%
88%
12%
82%
18%
87%
13%
92%
8%
Female Users
Male Users
13
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Users by Race (Exhibits 6 through 14)
In 2019, 54% (1.7 million) of all family planning users identified themselves as white, 24%
(732,825) as black or African American, 3% (89,045) as Asian, and 1% each as either
American Indian or Alaska Native (29,373) or Native Hawaiian or Other Pacific Islander
(22,327). Four percent (110,372) of all users self-identified with two or more of the five
minimum race categories specified by OMB,12 and race was either unknown or not reported
for 14% (434,100). Of the 434,100 users with an unknown race, 70% self-identified as
Hispanic or Latino ethnicity (Exhibit 6).
▪ By sex, the racial composition of female (Exhibits 7, 11, and 12) and male users
(Exhibits 8, 13, and 14) differed slightly in terms of the percentages in each group that
self-identified as white (55% of female users vs. 49% of male users) and black or African
American (23% of female users vs. 31% of male users).
▪ By region, the distribution of users by race varied widely (Exhibits 9 and 10). The
percentage of users who self-identified as white ranged from 43% to 75%, 5% to 40%
self-identified as black or African American, 1% to 6% self-identified as Asian, and 2% to
8% self-identified with two or more race categories.
Exhibits A–4a and A–4b present trends (2009 through 2019) in the distribution of all family
planning users by self-identified race.
Users by Ethnicity (Exhibits 6 through 14)
In 2019, 33% (1.0 million) of users self-identified as Hispanic or Latino ethnicity (Exhibit 6).
▪ By sex, 34% of female users and 27% of male users self-identified as Hispanic or Latino,
while ethnicity was unknown for 4% of female users and 6% of male users
(Exhibits 7, 8, 11–14).
▪ By region, the percentage of users that self-identified as Hispanic or Latino ranged from
17% to 52%, with grantees in Regions II, VI, and IX reporting the highest percentages
(44% to 52%) of Hispanic or Latino users (Exhibits 9 and 10).
See Exhibits A–5a and A–5b for trends (2009 through 2019) in the distribution of all family
planning users by self-identified Hispanic or Latino ethnicity.
See Exhibits A–6a and A–6b for trends (2009 through 2019) in the distribution of all family
planning users by self-identified race and Hispanic or Latino ethnicity.
14
Family Planning Annual Report: 2019 National Summary
Exhibit 6.
Number and distribution of all family planning users, by race and ethnicity: 2019
(Source: FPAR Tables 2 and 3)
Hispanic
or Latino
Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total All Users
Not
Hispanic or
Latino
Ethnicity
UK/NR
Total
%
Hispanic
or Latino
%
%
Not Hispanic Ethnicity
UK/NR
or Latino
%
Total
11,713
16,476
1,184
29,373
0%†
1%
0%†
1%
3,538
80,588
4,919
89,045
0%†
3%
0%†
3%
32,189
679,361
21,275
732,825
1%
22%
1%
24%
4,780
16,778
769
22,327
1%
0%†
1%
618,498
1,004,060
55,066
1,677,624
20%
0%†
32%
2%
54%
61,815
42,730
5,827
110,372
2%
1%
0%†
4%
304,268
80,235
49,597
434,100
10%
3%
2%
14%
1,036,801
1,920,228
138,637
3,095,666
33%
62%
4%
100%
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Exhibit 7.
Number and distribution of female family planning users, by race and ethnicity: 2019
(Source: FPAR Table 2)
Hispanic
or Latino
Race
Am Indian/Alaska Native
Not
Hispanic or
Latino
Ethnicity
UK/NR
Total
%
Hispanic
or Latino
%
%
Not Hispanic Ethnicity
UK/NR
or Latino
%
Total
10,430
14,495
922
25,847
0%†
1%
0%†
1%
3,123
72,231
4,208
79,562
0%†
3%
0%†
3%
Black/African American
26,994
563,847
16,936
607,777
1%
21%
1%
23%
Nat Hawaiian/Pac Island
4,117
15,069
667
19,853
0%†
1%
0%†
1%
558,401
876,498
45,806
1,480,705
21%
33%
2%
55%
Asian
White
More than one race
53,054
37,502
4,700
95,256
2%
1%
0%†
4%
Unknown/not reported
270,552
68,827
42,173
381,552
10%
3%
2%
14%
Total Female Users
926,671
1,648,469
115,412
2,690,552
34%
61%
4%
100%
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Exhibit 8.
Number and distribution of male family planning users, by race and ethnicity: 2019
(Source: FPAR Table 3)
Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total Male Users
Hispanic
or Latino
1,283
Not
Hispanic or
Latino
1,981
Ethnicity
UK/NR
262
Total
%
Hispanic
or Latino
3,526
0%†
%
%
Not Hispanic Ethnicity
UK/NR
or Latino
%
Total
0%†
0%†
1%
0%†
2%
0%†
2%
1%
29%
1%
31%
0%†
1%
415
8,357
711
9,483
5,195
115,514
4,339
125,048
663
1,709
102
2,474
60,097
127,562
9,260
196,919
15%
31%
2%
49%
8,761
5,228
1,127
15,116
2%
1%
0%†
4%
33,716
11,408
7,424
52,548
8%
3%
2%
13%
110,130
271,759
23,225
405,114
27%
67%
6%
100%
0%†
0%†
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
15
16
Exhibit 9.
Number of all family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Tables 2 and 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII Region VIII
Region IX
Region X
11,713
16,476
1,184
29,373
204
432
80
716
1,706
777
3
2,486
1,213
3,596
250
5,059
2,930
1,424
27
4,381
863
1,329
65
2,257
541
2,645
197
3,383
351
614
36
1,001
774
1,254
48
2,076
2,578
2,938
473
5,989
553
1,467
5
2,025
3,538
80,588
4,919
89,045
97
7,262
157
7,516
479
8,990
49
9,518
259
6,585
708
7,552
294
6,329
105
6,728
155
6,202
240
6,597
151
2,799
41
2,991
98
1,921
125
2,144
59
2,043
84
2,186
1,780
32,935
3,401
38,116
166
5,522
9
5,697
32,189
679,361
21,275
732,825
3,617
23,267
572
27,456
13,245
69,710
554
83,509
4,088
113,297
8,311
125,696
3,354
249,330
4,038
256,722
1,484
73,131
2,046
76,661
1,671
69,557
431
71,659
1,078
18,757
854
20,689
357
7,152
267
7,776
2,850
49,854
4,195
56,899
445
5,306
7
5,758
4,780
16,778
769
22,327
590
181
16
787
663
343
3
1,009
401
407
76
884
973
679
74
1,726
373
412
26
811
390
551
6
947
120
213
11
344
69
360
25
454
971
12,499
529
13,999
230
1,133
3
1,366
618,498
1,004,060
55,066
1,677,624
19,821
58,361
4,252
82,434
55,374
75,943
472
131,789
34,704
114,356
21,503
170,563
108,677
226,554
4,091
339,322
28,852
142,231
2,842
173,925
139,935
83,238
404
223,577
22,443
55,116
1,636
79,195
24,445
52,775
1,693
78,913
169,483
127,168
18,121
314,772
14,764
68,318
52
83,134
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
61,815
42,730
5,827
110,372
7,177
4,272
293
11,742
16,445
3,405
107
19,957
5,863
2,295
430
8,588
6,577
5,237
1,545
13,359
3,574
7,931
349
11,854
3,913
4,344
60
8,317
1,325
1,680
223
3,228
598
1,155
80
1,833
15,590
9,198
2,735
27,523
753
3,213
5
3,971
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
304,268
80,235
49,597
434,100
9,618
3,064
2,404
15,086
48,347
10,466
950
59,763
34,116
14,088
7,953
56,157
14,981
6,740
4,640
26,361
15,726
4,737
2,540
23,003
2,868
888
6,765
10,521
2,292
937
533
3,762
8,356
2,152
1,068
11,576
155,811
30,336
22,702
208,849
12,153
6,827
42
19,022
1,036,801
1,920,228
138,637
3,095,666
41,124
96,839
7,774
145,737
136,259
169,634
2,138
308,031
80,644
254,624
39,231
374,499
137,786
496,293
14,520
648,599
51,027
235,973
8,108
295,108
149,469
164,022
7,904
321,395
27,707
79,238
3,418
110,363
34,658
66,891
3,265
104,814
349,063
264,928
52,156
666,147
29,064
91,786
123
120,973
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2019 National Summary
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
Family Planning Annual Report: 2019 National Summary
Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Tables 2 and 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
0%†
1%
0%†
1%
0%†
0%†
0%†
0%†
1%
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
1%
1%
0%†
2%
0%†
0%†
0%†
1%
0%†
1%
0%†
2%
0%†
3%
0%†
3%
0%†
5%
0%†
5%
0%†
3%
0%†
3%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
2%
0%†
2%
0%†
5%
1%
6%
0%†
5%
0%†
5%
2%
16%
0%†
19%
4%
23%
0%†
27%
0%†
7%
0%†
7%
0%†
7%
1%
9%
0%†
4%
0%†
5%
0%†
0%†
0%†
1%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
2%
0%†
2%
0%†
1%
0%†
1%
1%
22%
1%
24%
0%†
1%
0%†
1%
20%
32%
2%
54%
2%
1%
0%†
4%
14%
40%
3%
57%
5%
3%
0%†
8%
10%
3%
2%
14%
7%
2%
2%
10%
33%
62%
4%
100%
28%
66%
5%
100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Region I
18%
25%
0%†
43%
5%
1%
0%†
6%
16%
3%
0%†
19%
44%
55%
1%
100%
1%
30%
2%
34%
0%†
0%†
0%†
0%†
9%
31%
6%
46%
2%
1%
0%†
2%
1%
38%
1%
40%
0%†
0%†
0%†
0%†
17%
35%
1%
52%
1%
25%
1%
26%
0%†
0%†
0%†
0%†
10%
48%
1%
59%
1%
22%
0%†
22%
0%†
0%†
0%†
0%†
44%
26%
0%†
70%
1%
17%
1%
19%
0%†
0%†
0%†
0%†
20%
50%
1%
72%
1%
1%
0%†
2%
1%
3%
0%†
4%
1%
1%
0%†
3%
1%
2%
0%†
3%
9%
4%
2%
15%
2%
1%
1%
4%
5%
2%
1%
8%
1%
0%†
2%
3%
2%
1%
0%†
3%
22%
68%
10%
100%
21%
77%
2%
100%
17%
80%
3%
100%
47%
51%
2%
100%
25%
72%
3%
100%
23%
50%
2%
75%
1%
1%
0%†
2%
25%
19%
3%
47%
2%
1%
0%†
4%
12%
56%
0%†
69%
1%
3%
0%†
3%
8%
2%
1%
11%
23%
5%
3%
31%
10%
6%
0%†
16%
33%
64%
3%
100%
52%
40%
8%
100%
24%
76%
0%†
100%
17
18
Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 2)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2019 National Summary
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
10,430
14,495
922
25,847
173
353
59
585
1,537
672
0
2,209
1,129
3,094
188
4,411
2,713
1,276
24
4,013
771
1,102
42
1,915
473
2,517
181
3,171
292
512
25
829
657
1,078
36
1,771
2,184
2,545
364
5,093
501
1,346
3
1,850
3,123
72,231
4,208
79,562
89
6,687
123
6,899
416
7,967
44
8,427
233
5,882
637
6,752
272
5,385
69
5,726
144
5,451
204
5,799
129
2,485
35
2,649
65
1,788
115
1,968
52
1,789
70
1,911
1,564
29,527
2,905
33,996
159
5,270
6
5,435
26,994
563,847
16,936
607,777
2,897
19,046
409
22,352
11,644
59,933
387
71,964
3,159
91,034
6,834
101,027
2,979
210,390
3,347
216,716
1,272
61,367
1,633
64,272
1,429
56,922
303
58,654
606
15,029
695
16,330
279
4,972
130
5,381
2,336
40,492
3,191
46,019
393
4,662
7
5,062
4,117
15,069
667
19,853
441
149
13
603
565
292
2
859
326
349
70
745
889
601
73
1,563
351
363
21
735
338
521
4
863
74
189
8
271
47
303
18
368
865
11,263
455
12,583
221
1,039
3
1,263
558,401
876,498
45,806
1,480,705
17,147
48,534
3,276
68,957
50,471
66,634
378
117,483
30,369
101,772
19,053
151,194
99,503
200,051
3,531
303,085
26,210
123,749
2,318
152,277
127,790
74,301
339
202,430
21,064
49,144
1,315
71,523
21,165
42,913
1,221
65,299
150,625
106,931
14,336
271,892
14,057
62,469
39
76,565
53,054
37,502
4,700
95,256
6,298
3,819
220
10,337
13,880
2,986
92
16,958
4,673
1,940
357
6,970
5,600
4,475
1,243
11,318
3,174
6,982
294
10,450
3,423
3,970
56
7,449
1,190
1,483
183
2,856
496
957
67
1,520
13,673
7,893
2,183
23,749
647
2,997
5
3,649
270,552
68,827
42,173
381,552
8,196
2,495
1,916
12,607
42,007
8,917
818
51,742
29,480
11,889
6,732
48,101
13,628
6,175
4,020
23,823
14,342
4,080
1,903
20,325
2,546
753
6,590
9,889
2,009
837
452
3,298
7,302
1,750
854
9,906
139,815
25,903
18,849
184,567
11,227
6,028
39
17,294
926,671
1,648,469
115,412
2,690,552
35,241
81,083
6,016
122,340
120,520
147,401
1,721
269,642
69,369
215,960
33,871
319,200
125,584
428,353
12,307
566,244
46,264
203,094
6,415
255,773
136,128
141,469
7,508
285,105
25,300
68,982
2,793
97,075
29,998
53,762
2,396
86,156
311,062
224,554
42,283
577,899
27,205
83,811
102
111,118
Family Planning Annual Report: 2019 National Summary
Exhibit 12. Distribution of female family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 2)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
0%†
1%
0%†
1%
0%†
0%†
0%†
0%†
1%
0%†
0%
1%
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
1%
1%
0%†
2%
0%†
0%†
0%†
1%
0%†
1%
0%†
2%
0%†
3%
0%†
3%
0%†
5%
0%†
6%
0%†
3%
0%†
3%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
2%
0%†
2%
0%†
5%
1%
6%
0%†
5%
0%†
5%
2%
16%
0%†
18%
4%
22%
0%†
27%
0%†
24%
1%
25%
1%
20%
0%†
21%
0%†
6%
0%†
6%
0%†
7%
1%
8%
0%†
4%
0%†
5%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
2%
0%†
2%
0%†
1%
0%†
1%
1%
21%
1%
23%
0%†
1%
0%†
1%
21%
33%
2%
55%
2%
1%
0%†
4%
14%
40%
3%
56%
5%
3%
0%†
8%
10%
3%
2%
14%
7%
2%
2%
10%
34%
61%
4%
100%
29%
66%
5%
100%
Note: Due to rounding, percentages may not sum to 100%.
19
† Percentage is less than 0.5%.
Region I
19%
25%
0%†
44%
5%
1%
0%†
6%
16%
3%
0%†
19%
45%
55%
1%
100%
1%
29%
2%
32%
0%†
0%†
0%†
0%†
10%
32%
6%
47%
1%
1%
0%†
2%
1%
37%
1%
38%
0%†
0%†
0%†
0%†
18%
35%
1%
54%
10%
48%
1%
60%
45%
26%
0%†
71%
1%
15%
1%
17%
0%†
0%†
0%†
0%†
22%
51%
1%
74%
1%
1%
0%†
2%
1%
3%
0%†
4%
1%
1%
0%†
3%
1%
2%
0%†
3%
9%
4%
2%
15%
2%
1%
1%
4%
6%
2%
1%
8%
1%
0%†
2%
3%
2%
1%
0%†
3%
22%
68%
11%
100%
22%
76%
2%
100%
18%
79%
3%
100%
48%
50%
3%
100%
26%
71%
3%
100%
25%
50%
1%
76%
1%
1%
0%†
2%
26%
19%
2%
47%
2%
1%
0%†
4%
13%
56%
0%†
69%
1%
3%
0%†
3%
8%
2%
1%
11%
24%
4%
3%
32%
10%
5%
0%†
16%
35%
62%
3%
100%
54%
39%
7%
100%
24%
75%
0%†
100%
20
Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Region I
Region II
1,283
1,981
262
3,526
31
79
21
131
169
105
3
277
84
502
62
648
217
148
3
368
92
227
23
342
68
128
16
212
59
102
11
172
117
176
12
305
394
393
109
896
52
121
2
175
415
8,357
711
9,483
8
575
34
617
63
1,023
5
1,091
26
703
71
800
22
944
36
1,002
11
751
36
798
22
314
6
342
33
133
10
176
7
254
14
275
216
3,408
496
4,120
7
252
3
262
5,195
115,514
4,339
125,048
720
4,221
163
5,104
1,601
9,777
167
11,545
929
22,263
1,477
24,669
375
38,940
691
40,006
212
11,764
413
12,389
242
12,635
128
13,005
472
3,728
159
4,359
78
2,180
137
2,395
514
9,362
1,004
10,880
52
644
0
696
663
1,709
102
2,474
149
32
3
184
98
51
1
150
75
58
6
139
84
78
1
163
22
49
5
76
52
30
2
84
46
24
3
73
22
57
7
86
106
1,236
74
1,416
9
94
0
103
60,097
127,562
9,260
196,919
2,674
9,827
976
13,477
4,903
9,309
94
14,306
4,335
12,584
2,450
19,369
9,174
26,503
560
36,237
2,642
18,482
524
21,648
12,145
8,937
65
21,147
1,379
5,972
321
7,672
3,280
9,862
472
13,614
18,858
20,237
3,785
42,880
707
5,849
13
6,569
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
8,761
5,228
1,127
15,116
879
453
73
1,405
2,565
419
15
2,999
1,190
355
73
1,618
977
762
302
2,041
400
949
55
1,404
490
374
4
868
135
197
40
372
102
198
13
313
1,917
1,305
552
3,774
106
216
0
322
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
33,716
11,408
7,424
52,548
1,422
569
488
2,479
6,340
1,549
132
8,021
4,636
2,199
1,221
8,056
1,353
565
620
2,538
1,384
657
637
2,678
322
135
175
632
283
100
81
464
1,054
402
214
1,670
15,996
4,433
3,853
24,282
926
799
3
1,728
110,130
271,759
23,225
405,114
5,883
15,756
1,758
23,397
15,739
22,233
417
38,389
11,275
38,664
5,360
55,299
12,202
67,940
2,213
82,355
4,763
32,879
1,693
39,335
13,341
22,553
396
36,290
2,407
10,256
625
13,288
4,660
13,129
869
18,658
38,001
40,374
9,873
88,248
1,859
7,975
21
9,855
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2019 National Summary
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Family Planning Annual Report: 2019 National Summary
Exhibit 14. Distribution of male family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
0%†
0%†
0%†
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
1%
1%
0%†
2%
0%†
0%†
0%†
1%
1%
1%
0%†
2%
0%†
2%
0%†
2%
0%†
2%
0%†
3%
0%†
3%
0%†
3%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
4%
1%
5%
0%†
3%
0%†
3%
1%
29%
1%
31%
0%†
0%†
0%†
1%
15%
31%
2%
49%
2%
1%
0%†
4%
3%
18%
1%
22%
1%
0%†
0%†
1%
11%
42%
4%
58%
4%
2%
0%†
6%
8%
3%
2%
13%
6%
2%
2%
11%
27%
67%
6%
100%
25%
67%
8%
100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Region I
4%
25%
0%†
30%
0%†
0%†
0%†
0%†
13%
24%
0%†
37%
7%
1%
0%†
8%
17%
4%
0%†
21%
41%
58%
1%
100%
2%
40%
3%
45%
0%†
0%†
0%†
0%†
8%
23%
4%
35%
2%
1%
0%†
3%
0%†
47%
1%
49%
0%†
0%†
0%†
0%†
11%
32%
1%
44%
1%
30%
1%
31%
0%†
0%†
0%†
0%†
7%
47%
1%
55%
1%
35%
0%†
36%
0%†
0%†
0%†
0%†
33%
25%
0%†
58%
4%
28%
1%
33%
0%†
0%†
0%†
1%
10%
45%
2%
58%
0%†
12%
1%
13%
0%†
0%†
0%†
0%†
18%
53%
3%
73%
1%
11%
1%
12%
0%†
1%
0%†
2%
1%
7%
0%
7%
0%†
1%
0%
1%
21%
23%
4%
49%
7%
59%
0%†
67%
1%
1%
0%†
2%
1%
2%
0%†
4%
1%
1%
0%†
2%
1%
1%
0%†
3%
1%
1%
0%†
2%
2%
1%
1%
4%
1%
2%
0%
3%
8%
4%
2%
15%
2%
1%
1%
3%
4%
2%
2%
7%
1%
0%†
0%†
2%
2%
1%
1%
3%
6%
2%
1%
9%
18%
5%
4%
28%
9%
8%
0%†
18%
20%
70%
10%
100%
15%
82%
3%
100%
12%
84%
4%
100%
18%
77%
5%
100%
25%
70%
5%
100%
43%
46%
11%
100%
19%
81%
0%†
100%
37%
62%
1%
100%
21
Selected Guidance for Reporting User Social and Economic Profile Data in FPAR Tables 4 through 6
In FPAR Table 4, grantees report the unduplicated number
of users by income level as a percentage of the HHS
Poverty Guidelines. Grantees are required to collect family
income data from all users to determine charges based on
the schedule of discounts.2,3 In determining a user’s family
income, agencies should refer to the poverty guidelines
updated periodically in the Federal Register by HHS under
the authority of 42 USC 9902(2).10
In FPAR Table 5, grantees report the unduplicated number
of users based on whether they have principal health
insurance covering primary medical care.
Principal health insurance covering primary medical
care refers to public and private health insurance plans that
provide a broad set of primary medical care benefits to
enrolled individuals. Grantees report the most current health
insurance coverage information available for the client even
though he or she may not have used this health insurance to
pay for family planning services received during his or her
last encounter. For individuals who have coverage under
more than one health plan, principal insurance is defined
as the insurance plan that the agency would bill first
(i.e., primary) if a claim were to be filed.
Categories of principal health insurance covering primary
medical care include the following:
■
Public Health Insurance—Refers to federal, state, or
local government health insurance programs that provide
a broad set of primary medical care benefits for eligible
individuals. Examples of such programs include Medicaid
(both regular and managed care), Medicare, the
Children’s Health Insurance Program (CHIP), and other
state or local government programs that provide a broad
set of benefits. Also included are public-paid or
public-subsidized private insurance programs.
■
Private Health Insurance—Refers to health insurance
coverage through an employer, union, or direct purchase
that provides a broad set of primary medical care benefits
for the enrolled individual (beneficiary or dependent).
Private insurance includes insurance purchased for public
employees or retirees or military personnel and their
dependents (e.g., TRICARE or CHAMPVA).
■
Uninsured—Refers to users who do not have a public or
private health insurance plan that covers broad, primary
medical care benefits. Clients whose services are
subsidized through state or local indigent care programs
or clients insured through the Indian Health Service who
obtain care in a nonparticipating facility are considered
uninsured.
In FPAR Table 6, grantees report the unduplicated number
of family planning users with limited English proficiency.
Limited English proficient (LEP) users are those family
planning users who do not speak English as their primary
language and who have a limited ability to read, write,
speak, or understand English. Because of their limited
English proficiency, LEP users derive little benefit from
Title X services and information provided in English. LEP
users include those who require language assistance
services (interpretation or translation) to optimize their use of
Title X services, those who received Title X services from
bilingual staff in the user’s preferred non-English language,
those who were assisted by a competent agency or
contracted interpreter, or those who opted to use a family
member or friend as an interpreter after refusing the
provider’s offer of free language assistance services. Unless
they are also LEP, do not include users who are visually or
hearing impaired or have other disabilities.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 21–23.5
22
Family Planning Annual Report: 2019 National Summary
SOCIAL AND ECONOMIC PROFILE
Users by Income Level (Exhibit 15)
Federal regulations2,3 require Title X-funded providers to give priority in the delivery of care
to persons from low-income families. These regulations specify that individuals with family
incomes at or below the HHS poverty guideline (poverty) for 2019 ($25,750 for a family of
four in the 48 contiguous states and the District of Columbia)10 receive services at no charge
unless a third party (government or private) is authorized or obligated to pay for these
services. For individuals with incomes between 101% and 250% of the poverty guideline,
Title X-funded agencies are required to charge for services using a sliding fee scale based on
family size and income. For unemancipated minors seeking confidential services, the
assessment of income level is based on their own rather than their family’s income, on the
condition that the Title X provider has documented taking specific actions to encourage the
minor to involve a parent or guardian in his or her decision to seek family planning services.3
In 2019, 88% (2.7 million) of users had family incomes that qualified them for either
no-charge (<101% of poverty) or subsidized (101% to 250% of poverty) services.
Sixty-four percent (2.0 million) of users with family incomes at or below 100% of poverty
qualified for no-charge services, while 24% (741,641) with family incomes between 101%
and 250% of poverty qualified for subsidized care. Seven percent (226,957) of users had
incomes over 250% of poverty, and family income data were unknown or not reported for 5%
(158,192) of users (Exhibit 15).
▪ By region, 82% to 94% of users had family incomes qualifying them for either no-charge
(51% to 75% of users) or subsidized (19% to 33% of users) services (Exhibit 15).
▪ By state, 33% to 100% of users had family incomes qualifying them for no-charge
services, and 0% to 45% had incomes qualifying them for subsidized care (Exhibit B–2).
See Exhibits A–7a and A–7b for trends (2009 through 2019) in the distribution of family
planning users by income level.
Users by Insurance Coverage Status (Exhibit 16)
Title X regulations2,3 require Title X-funded agencies to bill all third parties authorized or
legally obligated to pay for services and to make reasonable efforts to collect charges without
jeopardizing client confidentiality. On the FPAR, grantees report the health insurance
coverage status for a client even though an insured client may not have used their health
insurance to pay for services received during their last family planning encounter. Users
whose family planning care was paid by a Medicaid family planning eligibility expansion but
who had no other public or private health insurance plan covering broad primary medical care
benefits are considered uninsured, as are users with single-service plans (e.g., vision or
dental) or those with coverage through the Indian Health Service (IHS) who received care in
non-IHS facilities.
In 2019, 58% (1.8 million) of family planning users had either public (38%, 1.2 million) or
private (20%, 607,961) insurance covering broad primary medical care benefits; 41%
Family Planning Annual Report: 2019 National Summary
23
(1.3 million) were uninsured. Health insurance coverage status was unknown or not reported
for 1% (45,684) of users (Exhibit 16).
▪ By region, 20% to 49% of family planning users had public coverage, 8% to 34% had
private coverage, and 18% to 58% were uninsured (Exhibit 16).
▪ By state, there was wide variation in the percentage of users who were publicly insured
(0% to 95%), privately insured (0% to 53%), and uninsured (2% to 100%) (Exhibit B–3a).
See Exhibits A–8a and A–8b for trends (2009 through 2019) in the distribution of family
planning users by primary health insurance status.
See Exhibit B–3b for 2019 state-level information on the distribution of family planning
users by primary health insurance status according to states’ Medicaid expansion status.
Users by Limited English Proficiency Status (Exhibit 17)
As recipients of HHS funding, Title X grantees and subrecipients, including those operating
in U.S. territories and Freely Associated States where English is an official language, are
required to ensure that limited English proficient (LEP) individuals have meaningful access to
the health and social services they provide.13
In 2019, 15% (461,829) of family planning users were LEP. By region, the percentage of
users who were LEP ranged from 7% to 23% (Exhibit 17). The percentage of family planning
users who were LEP in 2009 was 14% compared with 15% in 2019. During this period, the
number of LEP users decreased 37%, from 737,044 (2009) to 461,829 (2019) (not shown).
24
Family Planning Annual Report: 2019 National Summary
Family Planning Annual Report: 2019 National Summary
Exhibit 15. Number and distribution of all family planning users, by income level and region: 2019 (Source: FPAR Table 4)
Income Levela
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Under 101%
1,968,876
73,726
192,611
221,068
412,417
172,510
240,958
63,682
67,596
458,171
66,137
101% to 150%
426,239
24,736
50,865
51,263
76,952
45,398
39,527
15,446
13,003
89,191
19,858
151% to 200%
211,586
13,602
21,816
23,043
36,789
24,632
16,345
8,529
8,298
45,832
12,700
201% to 250%
103,816
7,886
13,274
14,888
18,157
13,926
6,598
4,826
5,199
11,682
7,380
Over 250%
226,957
17,715
26,325
25,939
59,896
29,964
7,059
13,128
10,158
23,569
13,204
Unknown/not reported
158,192
8,072
3,140
38,298
44,388
8,678
10,908
4,752
560
37,702
1,694
3,095,666
145,737
308,031
374,499
648,599
295,108
321,395
110,363
104,814
666,147
120,973
Under 101%
64%
51%
63%
59%
64%
58%
75%
58%
64%
69%
55%
101% to 150%
14%
17%
17%
14%
12%
15%
12%
14%
12%
13%
16%
151% to 200%
7%
9%
7%
6%
6%
8%
5%
8%
8%
7%
10%
201% to 250%
3%
5%
4%
4%
3%
5%
2%
4%
5%
2%
6%
Over 250%
7%
12%
9%
7%
9%
10%
2%
12%
10%
4%
11%
Unknown/not reported
5%
6%
1%
10%
7%
3%
3%
4%
1%
6%
1%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Total All Users
Total All Users
Note: Due to rounding, percentages may not sum to 100%.
a
Title X-funded agencies calculate and report user family income as a percentage of poverty based on guidelines issued by the U.S. Department of Health and Human Services
(HHS). Each year, HHS announces updates to its poverty guidelines in the Federal Register and on the HHS Website at https://aspe.hhs.gov/2019-poverty-guidelines.
25
26
Exhibit 16. Number and distribution of all family planning users, by principal health insurance coverage status and region: 2019
(Source: FPAR Table 5)
Insurance Status
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Public health insurance
1,186,684
69,408
150,662
164,250
228,228
108,990
86,591
22,438
24,207
288,486
43,424
607,961
49,257
64,317
85,217
146,655
72,375
45,329
29,603
27,131
53,997
34,080
1,255,337
26,019
90,193
106,599
269,043
109,497
187,823
57,522
52,366
314,364
41,911
45,684
1,053
2,859
18,433
4,673
4,246
1,652
800
1,110
9,300
1,558
3,095,666
145,737
308,031
374,499
648,599
295,108
321,395
110,363
104,814
666,147
120,973
Public health insurance
38%
48%
49%
44%
35%
37%
27%
20%
23%
43%
36%
Private health insurance
20%
34%
21%
23%
23%
25%
14%
27%
26%
8%
28%
Uninsured
41%
18%
29%
28%
41%
37%
58%
52%
50%
47%
35%
1%
1%
1%
5%
1%
1%
1%
1%
1%
1%
1%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Private health insurance
Uninsured
Unknown/not reported
Total All Users
Unknown/not reported
Total All Users
Note: Due to rounding, percentages may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Family Planning Annual Report: 2019 National Summary
Exhibit 17. Number and distribution of all family planning users, by limited English proficiency (LEP) status and region: 2019 (Source: FPAR Table 6)
LEP Status
Region I
Region IIa
Region III
Region IV
Region V
Region VI
461,829
22,197
71,575
52,691
73,525
19,395
68,260
12,646
14,032
117,149
10,359
2,583,016
123,515
236,384
304,856
545,553
272,386
253,020
97,118
90,734
548,849
110,601
50,821
25
72
16,952
29,521
3,327
115
599
48
149
13
3,095,666
145,737
308,031
374,499
648,599
295,108
321,395
110,363
104,814
666,147
120,973
LEP
15%
15%
23%
14%
11%
7%
21%
11%
13%
18%
9%
Not LEP
83%
85%
77%
81%
84%
92%
79%
88%
87%
82%
91%
2%
0%†
0%†
5%
5%
1%
0%†
1%
0%†
0%†
0%†
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
LEP
Not LEP
Unknown/not reported
Total All Users
Unknown/not reported
Total All Users
All Regions
Region VII
Region VIII
Region IXb
Region X
LEP=limited English proficient.
Note: Due to rounding, percentages may not sum to 100%.
a
Includes family planning users served by grantees in Puerto Rico and the U.S. Virgin Islands.
b
Includes family planning users served by grantees in American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the
Marshall Islands, and Republic of Palau.
† Percentage is less than 0.5%.
27
Selected Guidance for Reporting Primary Contraceptive Method Use in FPAR Tables 7 and 8
In FPAR Tables 7 and 8, grantees report the unduplicated
number of female (Table 7) and male (Table 8) family
planning users according to their primary method of family
planning and age group (as of June 30 of the reporting
period).
■
Lactational Amenorrhea Method (LAM)—Refers to the
proactive application of exclusive breastfeeding—meaning
full (i.e., no other liquid or solid given to infant) or nearly
full (i.e., infrequent supplementation in small amounts, but
not by bottle)—during the first 6 months after delivery14
A user’s primary method of family planning is the
contraceptive method—adopted or continued—at the time
of exit from the user’s last encounter in the reporting
period. If the user reports that he or she is using more than
one family planning method, the grantee reports the most
effective one as the primary method.
■
Abstinence—Refers to refraining from oral, vaginal, and
anal intercourse15 and includes users who are not
currently sexually active and therefore not using
contraception
■
Withdrawal and Other Methods—Refers to the use of
withdrawal or other method to prevent pregnancy that is
not listed in Table 7 or 8
■
Vasectomy—Refers to conventional incisional or
no-scalpel vasectomy performed on a male user or the
male partner of a female user in the current or any
previous reporting period
■
Male condom—Used with or without spermicidal foam or
film by a male user or the male partner of a female user
■
Rely on Female Method(s)—Male family planning users
who rely on female partners’ family planning methods as
their primary method are reported on this row. “Female
methods” include female sterilization, IUD/IUS, hormonal
implants, 1- and 3-month hormonal injections, oral
contraceptives, the contraceptive patch, the vaginal ring,
cervical cap or diaphragms, the contraceptive sponge,
female condoms, LAM, and spermicides.
■
Method Unknown or Not Reported—Users whose
primary method at exit from the last encounter is unknown
or not reported (i.e., missing from the client record)
The categories for reporting the primary method in Table 7
(female users) and Table 8 (male users) vary and include:
■
Female Sterilization—Refers to a contraceptive surgical
[tubal ligation] or nonsurgical [implant] procedure
performed on a female user in the current or any previous
reporting period
■
Intrauterine Device or System (IUD/IUS)—Refers to
long-term hormonal or other type of IUD or IUS
■
Hormonal Implant—Refers to the long-term, subdermal
implant
■
1- or 3-Month Hormonal Injection—Refers to 1- or
3-month injectable hormonal contraception
■
Oral Contraceptive—Refers to combination and
progestin-only (“mini-pills”) formulations
■
Contraceptive Patch
■
Hormonal Vaginal Ring
■
Cervical Cap or Diaphragm—Used with or without
spermicidal jelly or cream
Reasons for not using a method in both tables are:
■
Contraceptive Sponge
■
■
Female Condom—Used with or without spermicidal foam
or film
■
Spermicide—Refers to spermicidal jelly, cream, foam, or
film used alone, i.e., not in conjunction with another
method of contraception
[Partner] Pregnant or Seeking Pregnancy—Female
(Table 7) or male (Table 8) users who are not using any
method to avoid pregnancy because they (female users)
or their female partners (male users) are either pregnant
or seeking pregnancy.
■
No Method–Other Reason—Female (Table 7) or male
(Table 8) users who are not using any method to avoid
pregnancy for reasons that include: either partner is sterile
without having been sterilized surgically, either partner
has had a noncontraceptive surgical procedure that has
rendered him or her unable to conceive or impregnate, or
the user has a sexual partner of the same sex.
■
Fertility Awareness Method (FAM)—Refers to family
planning methods, e.g., Standard Days®, Calendar
Rhythm, TwoDay, Billings Ovulation, and SymptoThermal,
that rely on identifying the fertile days in each menstrual
cycle when intercourse is most likely to result in a
pregnancy
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 27–30.5
28
Family Planning Annual Report: 2019 National Summary
5 Contraceptive Use
Federal regulations2,3 specify that Title X projects are required to provide a broad range of
acceptable and effective family planning methods (including contraceptives and natural
family planning or other fertility awareness-based methods [FAMs]) and services (including
infertility services, information about or referrals for adoption, and services for adolescents).
Individual service sites may offer a single or limited number of methods as long as the project
as a whole offers a broad range.2 In addition to offering a full range of methods for clients to
consider, the Quality Family Planning (QFP) Recommendations16 advise providers to identify
methods that are safe for the client, provide counseling to help the client choose a method and
use it correctly and consistently, conduct any physical assessments warranted by the selected
method, and provide the method on site (preferable) or by referral. The QFP
Recommendations also note that providers should ensure that services for adolescent clients
are provided in a “youth-friendly” way.
FEMALE CONTRACEPTIVE USE (EXHIBITS 18 THROUGH 21)
In 2019, 77% (2.1 million) of all female users adopted or continued use of a most,
moderately, or less effective contraceptive method (see text box) at their last encounter in the
reporting period. Eight percent (207,880) of females exited the encounter with no method
because they were pregnant or seeking pregnancy, and another 6% (167,834) exited with no
method for other reasons. Three percent (90,729) of female users reported that they were
abstinent, and the type of primary method used was unknown or not reported for the
remaining 5% (146,367) (Exhibits 18 and 19).
▪
Contraceptive Methods by Level of
By level of effectiveness in preventing
Effectiveness in Preventing Pregnancy18
pregnancy, 19% of all female users relied
■ Most effective: vasectomy, female
on a most effective method, 40% used a
sterilization, implant, or intrauterine
moderately effective method, and 18%
device (IUD)
used a less effective method
■ Moderately effective: injectable
(Exhibits 18 and 19). The grouping of
contraception, vaginal ring, contraceptive
methods by level of effectiveness aligns
patch, pills, diaphragm, or cervical cap
with the OPA-developed and National
■ Least effective: male condom, female
Quality Forum-endorsed performance
condom, sponge, withdrawal, a FAM or
measures for contraceptive care.17 See
lactational amenorrhea method (LAM), or
spermicide used alone
Table 7 comments in the Field and
Methodological Notes (Appendix C) for
more information about the performance measures17 and method-effectiveness
categories.18
▪
By type of method, the contraceptive pill was used by 22% of all female users, followed
by injectable contraception (15%), male condoms (14%), IUDs (9%), hormonal implants
Family Planning Annual Report: 2019 National Summary
29
(7%), female sterilization (3%), the vaginal ring (2%), the contraceptive patch (1%), and
a FAM or LAM (1%). Three percent of female users reported using withdrawal or other
methods not listed in FPAR Table 7, and less than 0.5% of female users relied on each of
the following methods: vasectomy, female condom, spermicide (used alone), cervical cap
or diaphragm, and the contraceptive sponge (Exhibits 18 and 19).
▪
By age group, from 50% (under 15) to 82% (18 to 19) of female users adopted or
continued use of a most, moderately, or less effective method (Exhibits 18 and 19).
Nonuse of contraception because of pregnancy or the desire for pregnancy ranged from
6% to 10% among females 18 to 39 and was 4% or less among female users in the
younger and older age groups. The three leading methods by age group were as follows:
-
Females under 18: Pills, injectables, and implants
-
Females 18 to 44: Pills and either injectables or male condoms
-
Females over 44: Female sterilization, male condoms, and pills
▪ By region, from 68% to 87% of female users exited the encounter with a most, moderately,
or less effective contraceptive method. Exhibits 20 and 21 present additional information
on contraceptive method mix for female users in each region.
▪ By state, there was wide variation in the percentage of female users at risk of unintended
pregnancy who relied on most effective (0% to 42%), moderately effective (17% to 72%),
or less effective (1% to 44%) contraceptive methods (Exhibit B–4). Female users at risk of
unintended pregnancy were defined as those who were not pregnant, not seeking
pregnancy, and not abstinent.
Trends in Female Primary Contraceptive Method Use
From 2009 through 2019, the percentage of all female users relying on most, moderately, or
less effective methods ranged from 77% to 84%. Between 13% and 14% used no method
because they were either pregnant, seeking pregnancy, or for other reasons, and 1% to 3%
were abstinent (Exhibits A–9a, A–9b, and A–9c).
Use of most effective methods: Among all female users, the percentage relying on the most
effective methods increased from 7% (2009) to 19% (2019) (Exhibits A–9a, A–9b, and A–9c).
Numerically, the number of female users relying on the most effective methods, especially
IUDs and implants, increased 50%, from 346,046 (2009) to 517,828 (2019).
Use of moderately effective methods: The percentage of all female users relying on
moderately effective methods decreased from 54% (2009) to 40% (2019)
(Exhibits A–9a, A–9b, and A–9c). Numerically, the number of female users relying on
moderately effective methods decreased 59%, from 2.6 million (2009) to 1.1 million (2019).
During all years in this period, the pill was the leading method among female users.
Use of less effective methods: The percentage of all female users relying on less effective
methods was 18% in both 2009 and 2019 (Exhibits A–9a, A–9b, and A–9c). Across the
different methods in this category, there were small or no changes in the percentage of female
users who relied on each type of method. Females relying on male condoms for pregnancy
30
Family Planning Annual Report: 2019 National Summary
prevention accounted for about 8 of every 10 female users in this category in both 2009
(84%) and 2019 (80%).
MALE CONTRACEPTIVE USE (EXHIBITS 22 THROUGH 25)
In 2019, grantees reported that 69% (278,056) of all male users adopted or continued use of a
most, moderately, or less effective primary method at their last encounter in the reporting
period. Thirteen percent (50,766) of males used no primary method, either because their
partners were pregnant or seeking pregnancy (1%) or for other reasons (11%), and another
9% (35,183) reported that they were abstinent. The type of primary contraceptive method
used was unknown or not reported for 10% (41,109) of male users (Exhibits 22 and 23).
▪
By type of method, over one-half (56%) of all male users relied on male condoms,
followed by reliance on a female method (8%), withdrawal (3%), a FAM or LAM (1%),
or vasectomy (1%) (Exhibits 22 and 23).
▪
By age group, from 14% (under 15) to 79% (20 to 24) of male users relied on a most,
moderately, or less effective method. (Exhibits 22 and 23). Nonuse of contraception
because a partner was pregnant or seeking pregnancy was less than 0.5% among males
under 15 and 1% to 2% among males 15 or over. Among males, the two leading methods
by age group were as follows:
▪
-
Males under 18: Male condoms and withdrawal or other methods not listed on
FPAR Table 8
-
Males 18 and over: Male condoms and reliance on a female method
By region, the percentage of males who exited the encounter with a most, moderately, or
less effective method ranged from 49% to 83%. Exhibits 24 and 25 present additional
information on contraceptive method mix for male users in each region.
Family Planning Annual Report: 2019 National Summary
31
32
Exhibit 18. Number of female family planning users, by primary contraceptive method and age: 2019 (Source: FPAR Table 7)
Primary Method
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
82,472
237,073
190,615
398,894a
598,304
32,714
46,021
877
377
3,159
995
17,370
90,729
75,253
0
261
2,507
5,416a
5,613
379
134
2
10
17
2
102
10,911
485
0
6,032
19,608
42,416a
50,361
3,034
1,837
27
27
151
40
461
14,701
2,857
0
14,090
24,364
47,043a
71,585
3,933
3,626
42
22
200
74
864
7,312
4,793
815
52,600
54,768
94,061a
171,203
9,270
12,264
124
50
600
228
3,236
12,849
15,667
6,061
55,578
40,752
74,387a
123,173
7,125
12,940
194
70
555
196
3,789
11,075
15,233
12,996
44,914
25,107
56,185a
80,191
4,754
8,912
187
75
489
171
3,234
9,049
12,103
17,776
32,221
14,360
40,642a
49,638
2,596
4,065
151
56
419
122
2,394
7,548
8,994
17,024
19,634
6,395
23,916a
28,169
1,192
1,609
86
40
348
92
1,604
6,061
6,223
27,800
11,743
2,754
14,828a
18,371
431
634
64
27
380
70
1,686
11,223
8,898
Family Planning Annual Report: 2019 National Summary
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
7,668
385,950
0
2,089
3
19,188
44
34,052
289
96,917
724
83,476
1,393
58,203
1,891
40,087
1,643
27,069
1,681
24,869
207,880
167,834
146,367
2,690,552
364
1,517
4,212
34,021
5,525
6,306
8,036
180,610
15,642
10,723
10,093
248,502
56,578
32,711
28,925
643,155
57,495
32,688
27,473
552,984
40,312
26,193
20,936
405,404
22,497
20,192
16,136
281,785
7,615
15,378
11,875
175,973
1,852
22,126
18,681
168,118
Using Most, Moderately, or
Less Effective Methode
2,077,742
17,017
146,042
204,732
512,092
424,253
308,914
215,412
135,044
114,236
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown
517,828
1,076,810
483,104
90,729
375,714
146,367
2,768
11,544
2,705
10,911
1,881
4,212
25,643
97,675
22,724
14,701
11,831
8,036
38,498
126,229
40,005
7,312
26,365
10,093
108,472
286,922
116,698
12,849
89,289
28,925
103,115
217,819
103,319
11,075
90,183
27,473
84,410
150,229
74,275
9,049
66,505
20,936
66,248
97,092
52,072
7,548
42,689
16,136
44,696
54,972
35,376
6,061
22,993
11,875
43,978
34,328
35,930
11,223
23,978
18,681
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c
User refrained from oral, vaginal, and anal intercourse.
d
Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2019 National Summary
Exhibit 19. Distribution of female family planning users, by primary contraceptive method and age: 2019 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or
Less Effective Methode
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
3%
9%
7%
15%a
22%
1%
2%
0%†
0%†
0%†
0%†
1%
3%
3%
0%
1%
7%
16%a
16%
1%
0%†
0%†
0%†
0%†
0%†
0%†
32%
1%
0%
3%
11%
23%a
28%
2%
1%
0%†
0%†
0%†
0%†
0%†
8%
2%
0%
6%
10%
19%a
29%
2%
1%
0%†
0%†
0%†
0%†
0%†
3%
2%
0%†
8%
9%
15%a
27%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
2%
1%
10%
7%
13%a
22%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
3%
3%
11%
6%
14%a
20%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
3%
6%
11%
5%
14%a
18%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
3%
10%
11%
4%
14%a
16%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
4%
17%
7%
2%
9%a
11%
0%†
0%†
0%†
0%†
0%†
0%†
1%
7%
5%
0%†
14%
0%
6%
0%†
11%
0%†
14%
0%†
15%
0%†
15%
0%†
14%
1%
14%
1%
15%
1%
15%
8%
6%
5%
100%
1%
4%
12%
100%
3%
3%
4%
100%
6%
4%
4%
100%
9%
5%
4%
100%
10%
6%
5%
100%
10%
6%
5%
100%
8%
7%
6%
100%
4%
9%
7%
100%
1%
13%
11%
100%
77%
50%
81%
82%
80%
77%
76%
76%
77%
68%
33
Most effectivee
19%
8%
14%
15%
17%
19%
21%
24%
25%
26%
Moderately effectivee
40%
34%
54%
51%
45%
39%
37%
34%
31%
20%
Less effectivee
18%
8%
13%
16%
18%
19%
18%
18%
20%
21%
Abstinence
3%
32%
8%
3%
2%
2%
2%
3%
3%
7%
Not Using a Method
14%
6%
7%
11%
14%
16%
16%
15%
13%
14%
Method Unknown
5%
12%
4%
4%
4%
5%
5%
6%
7%
11%
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c
User refrained from oral, vaginal, and anal intercourse.
d
Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
34
Exhibit 20. Number of female family planning users, by primary contraceptive method and region: 2019 (Source: FPAR Table 7)
Primary Method
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female sterilization
82,472
5,183
5,284
10,954
18,479
6,816
15,262
4,622
1,304
13,175
1,393
Intrauterine device
237,073
15,699
28,576
22,311
28,106
23,260
21,057
10,332
13,988
59,718
14,026
Hormonal implant
190,615
9,897
15,459
22,062
32,540
16,323
22,512
7,065
8,942
46,454
9,361
Hormonal injection
398,894a
14,227a
32,204
43,560a
103,500a
43,065
46,911a
19,033a
13,774a
65,002a
17,618
Oral contraceptive
598,304
26,105
64,633
63,635
123,952
64,027
55,737
21,714
22,730
125,063
Contraceptive patch
32,714
1,482
5,012
2,405
4,143
3,389
2,821
698
612
9,793
2,359
Vaginal ring
46,021
2,183
5,399
4,975
6,054
5,701
3,488
1,336
2,778
10,505
3,602
Cervical cap or diaphragm
877
72
72
93
72
117
79
17
28
215
112
Contraceptive sponge
377
17
15
55
16
6
16
1
5
238
8
3,159
50
152
618
577
151
484
64
51
986
26
Female condom
Spermicide (used alone)
FAM or LAMb
30,708
995
22
36
95
206
33
475
15
11
77
25
17,370
450
920
940
7,379
420
2,292
304
236
4,096
333
Abstinencec
90,729
7,333
8,026
13,287
22,288
5,370
11,205
2,599
1,968
15,616
3,037
Withdrawal or other methodd
Rely on Male Method
Vasectomy
75,253
2,296
6,510
4,963
25,244
4,366
14,307
1,678
1,756
9,161
4,972
Family Planning Annual Report: 2019 National Summary
Male condom
No Method
Pregnant/seeking pregnancy
7,668
561
586
1,175
1,250
530
990
349
379
1,288
560
385,950
15,653
51,878
37,871
50,651
34,592
36,525
11,656
8,065
129,014
10,045
207,880
8,183
22,586
17,817
57,294
17,927
27,195
9,110
5,515
36,811
5,442
Other reason
167,834
7,609
16,432
22,381
38,704
16,993
21,576
4,345
3,914
28,436
7,444
Method Unknown
146,367
5,318
5,862
50,003
45,789
12,687
2,173
2,137
100
22,251
47
2,690,552
122,340
269,642
319,200
566,244
255,773
285,105
97,075
86,156
577,899
111,118
Most effectivee
2,077,742
517,828
93,897
31,340
216,736
49,905
215,712
56,502
402,169
80,375
202,796
46,929
222,956
59,821
78,884
22,368
74,659
24,613
474,785
120,635
95,148
25,340
Moderately effectivee
1,076,810
44,069
107,320
114,668
237,721
116,299
109,036
42,798
39,922
210,578
54,399
483,104
18,488
59,511
44,542
84,073
39,568
54,099
13,718
10,124
143,572
15,409
90,729
7,333
8,026
13,287
22,288
5,370
11,205
2,599
1,968
15,616
3,037
Not Using a Method
375,714
15,792
39,018
40,198
95,998
34,920
48,771
13,455
9,429
65,247
12,886
Method Unknown
146,367
5,318
5,862
50,003
45,789
12,687
2,173
2,137
100
22,251
47
Total Female Users
Using Most, Moderately, or
Less Effective Methode
Less effectivee
Abstinence
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c
User refrained from oral, vaginal, and anal intercourse.
d
Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2019 National Summary
Exhibit 21. Distribution of female family planning users, by primary contraceptive method and region: 2019 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
3%
9%
7%
15%a
22%
1%
2%
0%†
0%†
0%†
0%†
1%
3%
3%
4%
13%
8%
12%a
21%
1%
2%
0%†
0%†
0%†
0%†
0%†
6%
2%
2%
11%
6%
12%
24%
2%
2%
0%†
0%†
0%†
0%†
0%†
3%
2%
3%
7%
7%
14%a
20%
1%
2%
0%†
0%†
0%†
0%†
0%†
4%
2%
3%
5%
6%
18%a
22%
1%
1%
0%†
0%†
0%†
0%†
1%
4%
4%
3%
9%
6%
17%
25%
1%
2%
0%†
0%†
0%†
0%†
0%†
2%
2%
5%
7%
8%
16%a
20%
1%
1%
0%†
0%†
0%†
0%†
1%
4%
5%
5%
11%
7%
20%a
22%
1%
1%
0%†
0%†
0%†
0%†
0%†
3%
2%
2%
16%
10%
16%a
26%
1%
3%
0%†
0%†
0%†
0%†
0%†
2%
2%
2%
10%
8%
11%a
22%
2%
2%
0%†
0%†
0%†
0%†
1%
3%
2%
1%
13%
8%
16%
28%
2%
3%
0%†
0%†
0%†
0%†
0%†
3%
4%
0%†
14%
0%†
13%
0%†
19%
0%†
12%
0%†
9%
0%†
14%
0%†
13%
0%†
12%
0%†
9%
0%†
22%
1%
9%
8%
6%
5%
100%
7%
6%
4%
100%
8%
6%
2%
100%
6%
7%
16%
100%
10%
7%
8%
100%
7%
7%
5%
100%
10%
8%
1%
100%
9%
4%
2%
100%
6%
5%
0%†
100%
6%
5%
4%
100%
5%
7%
0%†
100%
Using Most, Moderately, or
Less Effective Methode
77%
77%
80%
68%
71%
79%
78%
81%
87%
82%
86%
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown
19%
40%
18%
3%
14%
5%
26%
36%
15%
6%
13%
4%
19%
40%
22%
3%
14%
2%
18%
36%
14%
4%
13%
16%
14%
42%
15%
4%
17%
8%
18%
45%
15%
2%
14%
5%
21%
38%
19%
4%
17%
1%
23%
44%
14%
3%
14%
2%
29%
46%
12%
2%
11%
0%†
21%
36%
25%
3%
11%
4%
23%
49%
14%
3%
12%
0%†
35
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c
User refrained from oral, vaginal, and anal intercourse.
d
Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
36
Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2019 (Source: FPAR Table 8)
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
2,913
0
0
0
53
213
438
598
603
1,008
225,977
1,615
12,003
18,419
56,462
50,283
33,337
20,805
12,583
20,470
3,747
5
52
131
550
702
576
527
426
778
35,183
8,193
8,347
2,842
2,853
2,217
1,892
1,602
1,408
5,829
Withdrawal or other methodc
12,912
175
681
744
2,107
2,134
1,815
1,578
1,123
2,555
Rely on female method
32,507
114
593
1,411
5,393
5,951
4,760
3,936
3,135
7,214
4,916
62
149
204
933
1,096
925
644
369
534
Other reason
45,850
580
1,414
2,095
7,187
7,739
5,997
4,685
3,839
12,314
Method Unknown
41,109
3,071
2,456
1,922
5,892
6,191
5,037
4,025
2,938
9,577
Total Male Users
405,114
13,815
25,695
27,768
81,430
76,526
54,777
38,400
26,424
60,279
Using most, moderately, or less
effective methode
278,056
1,909
13,329
20,705
64,565
59,283
40,926
27,444
17,870
32,025
Abstinenceb
35,183
8,193
8,347
2,842
2,853
2,217
1,892
1,602
1,408
5,829
Not using a method
50,766
642
1,563
2,299
8,120
8,835
6,922
5,329
4,208
12,848
Method unknown
41,109
3,071
2,456
1,922
5,892
6,191
5,037
4,025
2,938
9,577
Primary Method
Vasectomy
Male condom
FAM or LAM
a
Abstinenceb
d
No Method
Partner pregnant/seeking pregnancy
Family Planning Annual Report: 2019 National Summary
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring, female
barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2019 National Summary
Exhibit 23. Distribution of male family planning users, by primary contraceptive method and age: 2019 (Source: FPAR Table 8)
All Age
Groups
Primary Method
Vasectomy
Under 15
Years
15 to 17
Years
18 to 19
Years
1%
0%
0%
0%
Male condom
56%
12%
47%
66%
FAM or LAM
1%
a
Abstinenceb
0%†
0%†
0%†
20 to 24
Years
25 to 29
Years
0%†
0%†
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
1%
2%
2%
2%
69%
66%
61%
54%
48%
34%
1%
1%
1%
1%
2%
1%
9%
59%
32%
10%
4%
3%
3%
4%
5%
10%
Withdrawal or other methodc
3%
1%
3%
3%
3%
3%
3%
4%
4%
4%
Rely on female method
8%
1%
2%
5%
7%
8%
9%
10%
12%
12%
No Method
Partner pregnant/seeking pregnancy
1%
0%†
1%
1%
1%
1%
2%
2%
1%
1%
Other reason
11%
4%
6%
8%
9%
10%
11%
12%
15%
20%
Method Unknown
10%
22%
10%
7%
7%
8%
9%
10%
11%
16%
Total Male Users
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
69%
14%
52%
75%
79%
77%
75%
71%
68%
53%
9%
59%
32%
10%
4%
3%
3%
4%
5%
10%
Not using a method
13%
5%
6%
8%
10%
12%
13%
14%
16%
21%
Method unknown
10%
22%
10%
7%
7%
8%
9%
10%
11%
16%
d
Using most, moderately, or less
effective methode
Abstinenceb
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring, female
barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
37
38
Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2019 (Source: FPAR Table 8)
All
Regions
Primary Method
Vasectomy
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII Region VIII Region IX
Region X
2,913
184
190
255
694
293
247
112
293
417
228
225,977
11,107
27,966
22,746
30,374
25,938
19,921
8,836
10,922
62,591
5,576
3,747
27
43
59
1,636
19
1,595
14
14
332
8
35,183
3,820
1,647
5,382
11,832
1,597
4,580
523
877
4,026
899
Withdrawal or other methodc
12,912
537
1,345
1,247
3,726
641
1,204
608
778
1,614
1,212
Rely on female method
32,507
1,984
778
3,039
10,707
3,447
2,902
1,217
3,536
4,582
315
4,916
247
260
402
1,748
238
793
157
224
737
110
Other reason
45,850
3,655
5,075
4,237
12,128
3,972
4,106
1,078
1,992
8,110
1,497
Method Unknown
41,109
1,836
1,085
17,932
9,510
3,190
942
743
22
5,839
10
Total Male Users
405,114
23,397
38,389
55,299
82,355
39,335
36,290
13,288
18,658
88,248
9,855
Using most, moderately, or less
effective methode
278,056
13,839
30,322
27,346
47,137
30,338
25,869
10,787
15,543
69,536
7,339
Abstinenceb
35,183
3,820
1,647
5,382
11,832
1,597
4,580
523
877
4,026
899
Not using a method
50,766
3,902
5,335
4,639
13,876
4,210
4,899
1,235
2,216
8,847
1,607
Method unknown
41,109
1,836
1,085
17,932
9,510
3,190
942
743
22
5,839
10
Male condom
FAM or LAM
a
Abstinenceb
d
No Method
Partner pregnant/seeking pregnancy
Family Planning Annual Report: 2019 National Summary
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring, female
barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2019 National Summary
Exhibit 25. Distribution of male family planning users, by primary contraceptive method and region: 2019 (Source: FPAR Table 8)
All
Regions
Primary Method
Vasectomy
Region I
1%
1%
Male condom
56%
47%
FAM or LAM
1%
a
Abstinenceb
0%†
Region II
0%†
73%
0%†
Region III
0%†
41%
0%†
Region IV
Region V
Region VI
Region VII Region VIII Region IX
1%
1%
1%
1%
2%
37%
66%
55%
66%
59%
0%†
71%
Region X
2%
57%
2%
0%†
4%
0%†
0%†
0%†
0%†
9%
16%
4%
10%
14%
4%
13%
4%
5%
5%
9%
Withdrawal or other methodc
3%
2%
4%
2%
5%
2%
3%
5%
4%
2%
12%
Rely on female method
8%
8%
2%
5%
13%
9%
8%
9%
19%
5%
3%
No Method
Partner pregnant/seeking pregnancy
1%
1%
1%
1%
2%
1%
2%
1%
1%
1%
1%
Other reason
11%
16%
13%
8%
15%
10%
11%
8%
11%
9%
15%
Method Unknown
10%
8%
3%
32%
12%
8%
3%
6%
Total Male Users
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
69%
59%
79%
49%
57%
77%
71%
81%
83%
79%
74%
9%
16%
4%
10%
14%
4%
13%
4%
5%
5%
9%
Not using a method
13%
17%
14%
8%
17%
11%
13%
9%
12%
10%
16%
Method unknown
10%
8%
3%
32%
12%
8%
3%
6%
d
Using most, moderately, or less
effective methode
Abstinenceb
0%†
0%†
7%
7%
0%†
0%†
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring, female
barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
39
Selected Guidance for Reporting Cervical and Breast Cancer Screening Activities in FPAR Tables 9 and 10
In FPAR Table 9, grantees report information on cervical
cancer screening activities, including the following:
■
Unduplicated number of female users who obtained a Pap
test
■
Number of Pap tests performed
■
Number of Pap tests with a result of Atypical Squamous
Cells (ASC) or higher according to the 2014 Bethesda
System.19 ASC or higher results include ASC-US; ASC-H;
LSIL; HSIL; squamous cell carcinoma; atypical glandular
cells (AGC); AGC, favor neoplastic; endocervical
adenocarcinoma in situ (AIS); adenocarcinoma; or other
malignant neoplasms. These abbreviations and terms are
defined below.
■
Number of Pap tests with a result of High-Grade
Squamous Intraepithelial Lesion (HSIL) or higher
according to the 2014 Bethesda System.19 HSIL or higher
results include HSIL; squamous cell carcinoma; AGC;
AGC, favor neoplastic; endocervical AIS;
adenocarcinoma; or other malignant neoplasms. These
abbreviations and terms are defined below.
and cervical intraepithelial neoplasia (CIN) 1 are other
terms for referring to LSILs.20
■
■
■
Atypical squamous cells of undetermined
significance (ASC-US) or atypical squamous cells,
cannot exclude HSIL (ASC-H) is a finding of abnormal
squamous cells in the tissue lining the outer part of the
cervix. ASC-US is the most common abnormal finding
in a Pap test. An ASC-US result may be caused by a
human papillomavirus (HPV), a benign growth
(e.g., cyst or polyp), or low hormone levels in
menopausal women. ASC-H may be a sign of a
high-grade squamous intraepithelial lesion (HSIL),
which may become cervical cancer if untreated.20
Low-grade squamous intraepithelial lesion (LSIL) is
a finding of slightly abnormal cells on the surface of the
cervix caused by certain types of HPV. LSIL is a
common abnormal finding on a Pap test. Mild dysplasia
Squamous cell carcinoma is a finding of cancer in the
squamous cells of the cervix.20
The 2014 Bethesda System19 classifies glandular cell
abnormalities into the following categories:
■
Atypical glandular cells (AGC) is a finding of abnormal
cells that come from glands in the walls of the cervix. The
presence of these abnormal cells may be a sign of more
serious lesions or cancer.20 The 2014 Bethesda System19
subdivides AGCs into two categories:
– AGC (endocervical, endometrial, or glandular cells),
not otherwise specified
The 2014 Bethesda System19 classifies squamous cell
abnormalities into the following categories:
■
High-grade squamous intraepithelial lesion (HSIL)
is a growth on the surface of the cervix with moderately
or severely abnormal cells. HSILs are usually caused
by certain types of HPV. If not treated, these abnormal
cells may become cancer and spread to normal tissue.
HSIL encompasses moderate dysplasia (CIN 2) or
severe dysplasia and carcinoma in situ (CIN 3).20
– AGC (endocervical or glandular cells), favor
neoplastic
■
Endocervical adenocarcinoma in situ (AIS) is a finding
of abnormal cells found in the glandular tissue lining the
endocervical canal. AIS may become cancer and spread
to nearby normal tissue.20
■
Adenocarcinoma is a finding of cancer in endocervical,
endometrial, extrauterine, or not otherwise specified
glandular tissue.20
In FPAR Table 10, grantees report the following information
on breast cancer screening and referral activities:
■
Unduplicated number of female users receiving a clinical
breast exam (CBE)
■
Unduplicated number of female users referred for further
evaluation based on CBE results
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 33–36.5
40
Family Planning Annual Report: 2019 National Summary
6 Related Preventive Health Services
To support effective contraceptive use and practices, federal regulations2,3 specify that
Title X-funded projects must provide for medical services related to family planning and
referral to other medical facilities when medically necessary. According to the QFP
Recommendations,16 providers should assess a client’s need for related preventive health
services (e.g., cervical and breast cancer screening, STD services) and provide these services
according to federal and professional recommendations regarding frequency, client eligibility,
and procedures. This assessment is especially important for clients whose only source of
health care is the Title X service site.
CERVICAL AND BREAST CANCER SCREENING
Cervical Cancer Screening (Exhibit 26)
In 2019, Title X service sites provided Papanicolaou (Pap) testing to 20% (541,661) of female
family planning users and performed 561,534 Pap tests (just over 1.0 test per female tested).
Of the Pap tests performed, 13% had an indeterminate or abnormal result (i.e., atypical
squamous cells [ASC] or higher result) requiring further evaluation and possible treatment,
and 1% had a result of high-grade squamous intraepithelial lesion (HSIL) or higher,
indicating the presence of a more severe condition (Exhibit 26).
By region, the percentage of total female users who received a Pap test ranged from 14% to
27%. In addition, from 10% to 26% of Pap tests had an ASC or higher result, and 1% of Pap
tests in all regions had an HSIL or higher result (Exhibit 26).
See Exhibits A–10a and A–10b for trends (2009 through 2019) in cervical cancer screening.
Breast Cancer Screening (Exhibit 26)
In 2019, Title X service sites provided clinical breast exams (CBEs) to 23% (627,282) of
female users and referred 5% (31,595) of those examined for further evaluation based on the
results of the CBE (Exhibit 26).
By region, from 12% to 36% of female users received a CBE, and from 2% to 12% of those
examined were referred for further evaluation (Exhibit 26).
Family Planning Annual Report: 2019 National Summary
41
42
Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2019 (Source: FPAR Tables 9 and 10)
Tests/Exams
Pap Tests
Female users tested
Numbera
Percentage
b
Tests performed
Number
Tests per female tested
Tests with ASC or higher result
Number
Percentagec
Tests with HSIL or higher result
Number
Percentage
c
Clinical Breast Exams
Female users examined
Numbera
Family Planning Annual Report: 2019 National Summary
Percentage
b
Female users referred based on
exam
Number
Percentage
d
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region IX
Region X
541,661
17,826
47,646
55,875
145,704
36,145
76,621
22,424
16,515
106,743
16,162
20%
15%
18%
18%
26%
14%
27%
23%
19%
18%
15%
561,534
17,967
48,921
59,891
149,064
36,880
81,391
22,772
18,016
110,398
16,234
1.0
1.0
1.0
1.1
1.0
1.0
1.1
1.0
1.1
1.0
1.0
72,212
3,074
8,510
9,039
13%
17%
17%
15%
14,522
4,325
9,750
3,260
3,066
12,450
4,216
10%
12%
12%
14%
17%
11%
26%
6,113
261
627
725
1,835
316
603
261
135
1,162
188
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
627,282
22,986
57,410
73,042
195,296
40,833
102,174
32,153
23,504
66,553
13,331
23%
19%
21%
23%
34%
16%
36%
33%
27%
12%
12%
31,595
1,646
2,541
2,958
6,063
2,605
5,589
1,835
383
7,665
310
5%
7%
4%
4%
3%
6%
5%
6%
2%
12%
2%
ASC=atypical squamous cells. HSIL=high-grade squamous epithelial lesion.
a
Unduplicated number of female users.
b
Denominator is the total unduplicated number of female users.
c
Denominator is the total number of Pap tests performed.
d
Denominator is the total unduplicated number of users examined.
Region VII Region VIII
SEXUALLY TRANSMITTED DISEASE TESTING
Through screening and testing, Title X service providers help to prevent and treat STDs. If
left untreated, STDs can be transmitted to others and lead to serious and lifelong health
consequences for women, men, infants, and unborn babies.21 According to the QFP
Recommendations,16 STD services are integral to family planning services because they
improve health and can affect a person’s ability to conceive and have a healthy birth outcome.
The QFP Recommendations advise providers to offer STD services to clients, both
symptomatic and asymptomatic, in accordance with the Centers for Disease Control and
Prevention’s (CDC’s) Sexually Transmitted Diseases Treatment Guidelines, 2015.22
Chlamydia Testing (Exhibits 27 and 28)
Chlamydia Testing of Female Users. CDC recommends routine annual chlamydia screening
for all sexually active women under 25 and for sexually active women 25 or older who may
be at increased risk of infection (e.g., new or multiple sex partners, a sex partner with
concurrent partners, or a sex partner with an STD). For sexually active women with HIV,
CDC recommends chlamydia screening at the first HIV evaluation and at least annually
thereafter unless risk behaviors and the local epidemiology warrant more frequent
screening.22
In 2019, Title X service sites tested 49% (1.3 million) of all female users for chlamydia and
58% (644,080) of females under 25 (Exhibits 27 and 28).
▪ By age group, chlamydia testing rates were higher among females 15 to 24 (57% to 60%)
than among those over 24 (43%) or under 15 (37%) (Exhibits 27 and 28).
▪ By region, the chlamydia testing rate for females under 25 ranged from 51% to 63%
(Exhibits 27 and 28).
▪ By state, the chlamydia testing rate for females under 25 ranged from 11% to 100%
(Exhibit B–5).
See Exhibits A–11a and A–11b for trends (2009 through 2019) in chlamydia testing.
Selected Guidance for Reporting STD Testing Activities in FPAR Tables 11 and 12
In FPAR Table 11, grantees report the unduplicated number
of family planning users tested for chlamydia, by age
(<15, 15–17, 18–19, 20–24, and 25 or over) and sex.
In FPAR Table 12, grantees report the number of STD and
HIV tests performed during the reporting period that are
provided within the scope of the grantee’s Title X project.
STD tests that are performed in STD clinics operated by
Title X-funded agencies should be excluded unless the
activities of the STD clinic are within the scope of the
agency’s Title X project.
STD testing information includes the following:
■
Number of gonorrhea tests performed, by sex
■
Number of syphilis tests performed, by sex
■
Number of confidential HIV tests performed, by sex
■
Number of confidential HIV tests with a positive result
■
Number of anonymous HIV tests performed
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 39–40.5
Family Planning Annual Report: 2019 National Summary
43
44
Exhibit 27. Number of family planning users tested for chlamydia, by sex, age, and region: 2019 (Source: FPAR Table 11)
Age Group (Years)
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
12,574
631
874
2,560
2,954
1,026
1,634
460
393
1,546
496
15 to 17
103,542
4,463
8,457
13,956
21,665
10,238
11,525
4,546
4,228
18,941
5,523
18 to 19
149,612
5,762
13,841
16,334
30,662
15,811
15,738
6,325
5,855
32,374
6,910
20 to 24
378,352
14,188
36,736
37,149
75,994
39,726
38,456
14,049
12,818
92,709
16,527
Over 24
687,551
27,967
69,335
79,504
158,536
61,965
75,477
23,257
15,444
155,045
21,021
1,331,631
53,011
129,243
149,503
289,811
128,766
142,830
48,637
38,738
300,615
50,477
Under 25
644,080
25,044
59,908
69,999
131,275
66,801
67,353
25,380
23,294
145,570
29,456
Male Users
Under 15
2,300
271
187
959
252
56
197
58
27
285
8
15 to 17
12,120
1,074
1,150
2,788
1,387
923
1,012
454
508
2,560
264
18 to 19
19,198
1,194
2,241
2,718
2,094
2,195
1,618
1,014
977
4,631
516
20 to 24
62,325
3,260
6,681
6,883
6,879
8,852
4,843
3,097
3,310
16,839
1,681
Over 24
149,669
7,674
13,536
18,661
19,545
18,958
12,702
5,580
8,407
40,745
3,861
Subtotal
245,612
13,473
23,795
32,009
30,157
30,984
20,372
10,203
13,229
65,060
6,330
Subtotal
a
Family Planning Annual Report: 2019 National Summary
All Users
Under 15
14,874
902
1,061
3,519
3,206
1,082
1,831
518
420
1,831
504
15 to 17
115,662
5,537
9,607
16,744
23,052
11,161
12,537
5,000
4,736
21,501
5,787
18 to 19
168,810
6,956
16,082
19,052
32,756
18,006
17,356
7,339
6,832
37,005
7,426
20 to 24
440,677
17,448
43,417
44,032
82,873
48,578
43,299
17,146
16,128
109,548
18,208
837,220
35,641
82,871
98,165
178,081
80,923
88,179
28,837
23,851
195,790
24,882
1,577,243
66,484
153,038
181,512
319,968
159,750
163,202
58,840
51,967
365,675
56,807
Over 24
Total All Users
a
All Regions
The U.S. Centers for Disease Control and Prevention (CDC) recommends routine annual chlamydia screening for all sexually active women 24 years or younger and for older (25
years or older) women at increased risk of infection (e.g., with a new or multiple sex partners, a sex partner with concurrent partners, or sexual partner with an STD). The U.S.
Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection in sexually active women 24 years or younger and in older women who are at increased
risk for infection. In the absence of studies on screening intervals, the USPSTF recommends rescreening women whose sexual history reveals new or persistent risk factors since
the last negative test result. (Sources: CDC [2015]. Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64[No. RR–3], 1–137 [see reference 22] and USPSTF [2014,
September]. Gonorrhea and chlamydia: Screening [see reference 23].)
Family Planning Annual Report: 2019 National Summary
Exhibit 28. Percentage of family planning users in each age group tested for chlamydia, by sex, age, and region: 2019 (Source: FPAR Table 11)
Age Group (Years)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
37%
31%
36%
33%
35%
42%
50%
38%
32%
38%
43%
15 to 17
57%
46%
56%
53%
59%
56%
61%
58%
54%
62%
56%
18 to 19
60%
53%
59%
57%
61%
58%
61%
62%
56%
65%
59%
20 to 24
59%
53%
57%
56%
60%
57%
60%
61%
53%
63%
56%
Over 24
43%
38%
42%
42%
46%
45%
43%
42%
36%
45%
36%
49%
43%
48%
47%
51%
50%
50%
50%
45%
52%
45%
Under 25
58%
51%
57%
54%
59%
57%
60%
60%
53%
63%
56%
Male Users
Under 15
17%
24%
18%
23%
6%
14%
27%
33%
6%
19%
22%
15 to 17
47%
46%
42%
45%
29%
70%
51%
69%
47%
62%
55%
18 to 19
69%
70%
66%
66%
49%
84%
58%
82%
75%
82%
77%
Subtotal
a
a
20 to 24
77%
78%
76%
73%
58%
84%
70%
83%
76%
86%
79%
Over 24
58%
55%
60%
60%
34%
77%
53%
74%
73%
71%
59%
Subtotal
61%
58%
62%
58%
37%
79%
56%
77%
71%
74%
64%
All Users
Under 15
31%
28%
31%
30%
25%
38%
46%
37%
25%
33%
42%
15 to 17
56%
46%
54%
51%
56%
57%
60%
59%
53%
62%
56%
18 to 19
61%
56%
59%
58%
60%
60%
61%
64%
58%
67%
60%
20 to 24
61%
56%
59%
58%
60%
60%
61%
64%
57%
65%
58%
Over 24
45%
41%
45%
44%
44%
50%
45%
46%
44%
49%
38%
Total All Users
51%
46%
50%
48%
49%
54%
51%
53%
50%
55%
47%
The U.S. Centers for Disease Control and Prevention (CDC) recommends routine annual chlamydia screening for all sexually active women 24 years or younger and for older (25
years or older) women at increased risk of infection (e.g., with a new or multiple sex partners, a sex partner with concurrent partners, or sexual partner with an STD). The U.S.
Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection in sexually active women 24 years or younger and in older women who are at increased
risk for infection. In the absence of studies on screening intervals, the USPSTF recommends rescreening women whose sexual history reveals new or persistent risk factors since
the last negative test result. (Sources: CDC [2015]. Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64[No. RR–3], 1–137 [see reference 22] and USPSTF [2014,
September]. Gonorrhea and chlamydia: Screening [see reference 23].)
45
Chlamydia Testing of Male Users. CDC recommends that providers consider screening young men for
chlamydia in high-prevalence clinical settings (e.g., adolescent clinics, correctional facilities, and STD clinics)
and in populations with a high burden of infection (e.g., men who have sex with men [MSM]). In addition,
CDC recommends screening sexually active MSM at anatomic sites of contact (urethra and rectum), regardless
of condom use, at least annually or more frequently (every 3 to 6 months) if at increased risk. For sexually
active men with HIV, CDC recommends chlamydia screening at the first HIV evaluation and at least annually
thereafter unless risk behaviors and the local epidemiology warrant more frequent screening.22
In 2019, Title X service sites tested 61% (245,612) of all male users for chlamydia
(Exhibits 27 and 28).
▪ By age group, rates of chlamydia testing were higher for males 18 to 19 (69%) and 20 to 24 (77%) and
lower for males over 24 (58%), 15 to 17 (47%), and under 15 (17%).
▪ By region, Title X service sites tested between 37% and 79% of all male users for chlamydia.
Gonorrhea Testing (Exhibit 29)
CDC recommends annual gonorrhea screening for all sexually active women under 25 and for sexually active
older women (25 or older) at increased risk of infection (e.g., new or multiple sex partners, a sex partner with
concurrent partners, a sex partner who has an STD, inconsistent condom use among persons who are not in
mutually monogamous relationships, previous or coexisting STDs, or exchanging sex for drugs or money).
CDC also recommends screening sexually active MSM at least annually or more frequently (every 3 to
6 months) if at increased risk at anatomic sites of contact (urethra, rectum, and pharynx), regardless of condom
use. Finally, CDC recommends screening sexually active persons with HIV for gonorrhea at the first HIV
evaluation and at least annually thereafter unless individual risk behaviors and the local epidemiology warrant
more frequent screening.22
In 2019, Title X service sites performed nearly 1.8 million gonorrhea tests, or an average of 5.5 gonorrhea tests
for every 10 female users and 6.8 tests for every 10 male users. By region, the rate of gonorrhea testing ranged
from 4.8 to 5.9 tests for every 10 female users and from 4.0 to 9.0 tests for every 10 male users (Exhibit 29).
Syphilis Testing (Exhibit 29)
CDC recommends syphilis screening for sexually active MSM at least annually or more frequently based on
subsequent behavior. CDC also recommends screening sexually active persons with HIV at the first HIV
evaluation and at least annually thereafter unless individual risk behaviors and the local epidemiology warrant
more frequent screening.22
In 2019, Title X service sites performed 674,764 syphilis tests, or an average of 1.9 syphilis tests for every
10 female users and 3.9 tests for every 10 male users. By region, the rate of syphilis testing ranged from 0.4
tests to 3.0 tests for every 10 female users and from 2.7 tests to 5.5 tests for every 10 male users (Exhibit 29).
HIV Testing (Exhibit 29)
CDC recommends HIV screening (opt-out approach) for men and women 13 to 64 in all health care settings,
including family planning, and for all persons who seek evaluation and treatment for STDs. CDC also
recommends HIV screening at least annually for sexually active MSM if their HIV status is unknown or
46
Family Planning Annual Report: 2019 National Summary
negative and the client or their sex partner(s) have had more than one sex partner since their most recent HIV
test.22
In 2019, Title X service sites performed 961,859 confidential HIV tests, or an average of 2.8 confidential HIV
tests for every 10 female users and 5.3 tests for every 10 male users. Of the confidential HIV tests performed,
3,685, or 3.8 tests per 1,000 tests performed, were positive for HIV. In addition, Title X sites performed
613 anonymous HIV tests. By region, the rate of HIV testing ranged from 1.2 test to 3.8 tests for every
10 female users and from 3.0 tests to 7.9 tests for every 10 male users (Exhibit 29).
See Exhibits A–12a and A–12b for trends (2009 through 2019) in confidential HIV testing among female and
male users.
Family Planning Annual Report: 2019 National Summary
47
Family Planning Annual Report: 2019 National Summary
Exhibit 29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region, and number of positive HIV tests, by region: 2019
(Source: FPAR Table 12)
STD Tests
Region I
Region II
Region III
Region IV
Region V
Region VI
1,476,781
63,399
145,165
173,067
310,289
147,429
159,992
55,840
51,191
Male
274,410
16,224
26,501
36,299
32,723
35,276
22,919
10,910
16,212
70,378
6,968
Total
1,751,191
79,623
171,666
209,366
343,012
182,705
182,911
66,750
67,403
387,217
60,538
5.5
5.2
5.4
5.4
5.5
5.8
5.6
5.8
5.9
5.5
4.8
Male
6.8
6.9
6.9
6.6
4.0
9.0
6.3
8.2
8.7
8.0
7.1
Total
5.7
5.5
5.6
5.6
5.3
6.2
5.7
6.0
6.4
5.8
5.0
516,439
13,743
27,844
64,203
171,479
27,090
78,740
14,878
4,598
109,114
4,750
Gonorrhea Tests
Female
Tests per 10 Users
Female
Syphilis Tests
Female
All Regions
Region VII
Region VIII
Region IX
Region X
316,839
53,570
Male
158,325
6,209
11,899
23,764
23,048
13,383
18,184
4,722
5,453
48,498
3,165
Total
674,764
19,952
39,743
87,967
194,527
40,473
96,924
19,600
10,051
157,612
7,915
1.9
1.1
1.0
2.0
3.0
1.1
2.8
1.5
0.5
1.9
0.4
Male
3.9
2.7
3.1
4.3
2.8
3.4
5.0
3.6
2.9
5.5
3.2
Total
2.2
1.4
1.3
2.3
3.0
1.4
3.0
1.8
1.0
2.4
0.7
745,213
23,540
81,644
85,165
188,468
57,684
109,658
20,517
13,161
152,314
13,062
Male
216,646
8,164
23,675
29,706
25,061
20,976
21,136
6,941
14,825
61,444
4,718
Total
961,859
31,704
105,319
114,871
213,529
78,660
130,794
27,458
27,986
213,758
17,780
2.8
1.9
3.0
2.7
3.3
2.3
3.8
2.1
1.5
2.6
1.2
5.3
3.5
6.2
5.4
3.0
5.3
5.8
5.2
7.9
7.0
4.8
Tests per 10 Users
Female
Confidential HIV Tests
Female
Tests per 10 Users
Female
Male
Total
Positive Test Results
Anonymous HIV Tests
3.1
2.2
3.4
3.1
3.3
2.7
4.1
2.5
2.7
3.2
1.5
3,685
97
645
409
1,345
120
471
45
144
360
49
613
30
0
14
0
95
0
166
0
230
78
48
7 Staffing and Service Utilization
STAFFING AND FAMILY PLANNING ENCOUNTERS
Clinical Services Provider Staffing (Exhibit 30)
Highly trained clinical services providers (CSPs) participate in the delivery of Title X-funded
services. CSPs include physicians, physician assistants (PAs), nurse practitioners (NPs),
certified nurse midwives (CNMs), and registered nurses with an expanded scope of practice
(“other” CSPs) who are trained and permitted by state-specific regulations to perform all
aspects of the user (male and female) physical assessments recommended for contraceptive,
related preventive health, and basic infertility care, as described in the Title X program
requirements.2
In 2019, 3,678 full-time equivalent (FTE) CSPs delivered medical family planning and
related preventive health services in Title X service sites (Exhibit 30).
▪ By type of CSP, midlevel clinicians (i.e., PAs, NPs, and CNMs) accounted for 67% of
total FTEs, followed by physicians (24%) and other CSPs (9%). On average, there were
2.8 midlevel clinician FTEs for every 1.0 physician FTE.
▪ By region, from 8% to 32% of total FTEs were physician FTEs, 51% to 86% were
midlevel clinician FTEs, and 0% to 26% were other CSP FTEs. There were from 1.6 to
7.9 midlevel clinician FTEs for every 1.0 physician FTE.
Family Planning Encounters (Exhibit 30)
In 2019, Title X service sites reported a total of almost 4.7 million family planning
encounters, or an average of 1.5 encounters per user (Exhibit 30).
▪ By type, most family planning encounters (77%, or 3.6 million) were attended by a CSP,
resulting in an average of 1.2 CSP encounters per user and 979 CSP encounters per CSP
FTE.
▪ By region, the number and types of family planning encounters varied as follows:
– Number of encounters per user: The average number of encounters per user ranged
from 1.1 to 1.8.
– CSP encounters: The percentage of encounters that were attended by a CSP ranged
from 60% to 95%, and the number of CSP encounters per CSP FTE ranged from 566 to
1,570.
– Non-CSP encounters: The percentage of encounters that were attended by non-CSP
staff ranged from 5% to 40%. The number of non-CSP encounters per user ranged from
0.1 to 0.7.
Family Planning Annual Report: 2019 National Summary
49
Selected Guidance for Reporting Staffing and Encounter Data in FPAR Table 13
In FPAR Table 13, grantees report the following information
on the level of clinical provider staffing and the number of
family planning encounters:
■
Number of full-time equivalent (FTE) family planning
Clinical Services Providers by type of provider,
■
Number of family planning encounters with Clinical
Services Providers, and
■
Number of family planning encounters with Other
Services Providers.
Family Planning Provider—The individual who assumes
primary responsibility for assessing a client and documenting
services in the client record. Providers exercise independent
judgment as to the services rendered to the client during an
encounter. There are two types of family planning providers:
■
Clinical Services Providers (CSPs) include physicians,
physician assistants, nurse practitioners, certified nurse
midwives, and registered nurses with an expanded scope
of practice who are trained and permitted by state-specific
regulations to perform all aspects of the user (male and
female) physical assessments recommended for
contraceptive, related preventive health, and basic
infertility care. CSPs offer a range of clinical, counseling,
and educational services relating to a client’s proposed or
adopted method of contraception, general reproductive
health, or infertility treatment, in accordance with the
Title X program requirements.2
■
Other Services Providers include other agency staff
(e.g., registered nurses, public health nurses, licensed
vocational or licensed practical nurses, certified nurse
assistants, health educators, social workers, or clinic
aides) that offer client education, counseling, referral, or
follow-up services relating to the client’s proposed or
adopted method of contraception, general reproductive
health, or infertility treatment, as described in the Title X
program requirements.2
Family Planning Encounter—A documented, face-to-face
contact between an individual and a family planning provider
that takes place in a Title X service site. The purpose of a
family planning encounter is to provide family planning and
related preventive health services to female and male clients
who want to avoid unintended pregnancies or achieve
intended pregnancies. Laboratory tests and related
counseling and education do not constitute a family planning
encounter unless the encounter is face-to-face, documented,
and includes family planning counseling or education.
The two types of family planning encounters are
classified based on the type of family planning provider who
renders the care: an encounter with a CSP or an encounter
with an Other Services Provider.
Full-Time Equivalent (FTE)—For each type of CSP,
grantees report the time in FTEs that CSP providers are
involved in the direct provision of Title X-funded services
(i.e., engaged in a family planning encounter). An FTE of 1.0
describes staff who, individually or as a group, work the
equivalent of full time for 1 year. Each agency defines the
number of hours for “full-time” work and may define it
differently for different positions.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 43–45.5
50
Family Planning Annual Report: 2019 National Summary
Family Planning Annual Report: 2019 National Summary
Exhibit 30. Number and distribution of FTE CSP staff, by type of CSP and region, and number and distribution of FP encounters, by type of encounter
and region: 2019 (Source: FPAR Table 13)
All
Regions
Region I
884.0
106.4
82.3
214.8
203.6
25.3
43.3
23.0
12.2
119.9
53.3
2,449.6
168.1
207.2
474.4
595.3
200.4
172.6
79.5
72.4
282.8
197.0
344.7
54.1
14.9
70.6
105.5
80.4
4.0
1.0
0.0
11.2
3.0
3,678.3
328.5
304.3
759.9
904.3
306.1
219.9
103.5
84.6
413.9
253.3
24%
32%
27%
28%
23%
8%
20%
22%
14%
29%
21%
PA/NP/CNM
67%
51%
68%
62%
66%
65%
78%
77%
86%
68%
78%
Other CSPa
9%
16%
5%
9%
12%
26%
2%
1%
0%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
2.8
1.6
2.5
2.2
2.9
7.9
4.0
3.5
6.0
2.4
3.7
FTEs and FP Encounters
Number of CSP FTEs
Physician
PA/NP/CNM
Other CSPa
Total
Distribution of CSP FTEs
Physician
Total
Midlevel to Physician FTEb
Number of FP Encounters
With CSP
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
3%
1%
3,602,064
194,041
406,873
561,497
724,718
340,333
320,095
132,608
132,798
645,785
143,316
With other
1,071,605
10,548
39,100
75,234
390,455
128,010
211,145
65,298
47,308
85,120
19,387
Total
4,673,669
204,589
445,973
636,731
1,115,173
468,343
531,240
197,906
180,106
730,905
162,703
77%
95%
91%
88%
65%
73%
60%
67%
74%
88%
88%
Distribution of FP Encounters
With CSP
With other
Total
FP Encounters per User
With CSP
With other
Total
CSP Encounters per CSP FTE
23%
5%
9%
12%
35%
27%
40%
33%
26%
12%
12%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
1.2
1.3
1.3
1.5
1.1
1.2
1.0
1.2
1.3
1.0
1.2
0.3
0.1
0.1
0.2
0.6
0.4
0.7
0.6
0.5
0.1
0.2
1.5
1.4
1.4
1.7
1.7
1.6
1.7
1.8
1.7
1.1
1.3
979
591
1,337
739
801
1,112
1,456
1,281
1,570
1,560
566
51
CNM=certified nurse midwife. CSP=clinical services provider. FP=family planning. FTE=full-time equivalent. NP=nurse practitioner. PA=physician assistant.
Note: Due to rounding, percentages may not sum to 100%.
a
Other CSPs are registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user (male and
female) physical assessments recommended for contraceptive, related preventive health, and basic infertility care.
b
Midlevel providers include physician assistants, nurse practitioners, and certified nurse midwives.
Selected Guidance for Reporting Project Revenue in FPAR Table 14
In FPAR Table 14, grantees report the revenue received
(i.e., actual cash receipts or drawdown amounts) during the
reporting period from various funding sources that support
activities within the scope of the grantee’s Title X services
grant, even if the funds were not expended during the
reporting period. Table 14 excludes the monetary value of
in-kind contributions. Sources of revenue include the
following:
Medicare/Title XVIII—Grantees report the amount
received from Medicare, regardless of whether the
reimbursement was paid directly by Medicare or through a
fiscal intermediary or an HMO. For clients enrolled in a
capitated Medicare program (i.e., where the grantee has a
contract with a private plan like Blue Cross), the payer is
Medicare, even though the actual payment may come
from Blue Cross.
Title X Grant—Refers to the amount received from the
Title X Section 1001 family planning services grant, including
revenue received from other Title X special initiatives (e.g.,
HIV integration).
Children’s Health Insurance Program (CHIP)—
Grantees report the amount received from CHIP.
Other Public Health Insurance—Grantees report the
amount received from other federal, state, or local
government health insurance programs. Other public
health insurance programs include state or local
government programs that provide a broad set of benefits
and public-paid or public-subsidized private insurance
programs.
Payment for Services—Refers to funds collected directly
from clients and revenues received (i.e., reimbursed) from
public and private third-party payers for services provided
within the scope of the grantee’s Title X project.
■
■
Total Client Collections/Self-Pay (“Client Fees”)—
Grantees report the amount in fees collected directly from
clients.
Third-Party Payers—Grantees report revenue received
from public and private third-party payers. Third-party
payer revenue reported as “prepaid” (capitated) is from
managed care arrangements (e.g., capitated Medicare,
Medicaid, and private managed care contracts).
Third-party payer revenue reported as “not prepaid” is
received after the date of service, even under managed
care arrangements. Third-party payer sources include:
Medicaid/Title XIX—Grantees report the amount
received from Medicaid (federal and state shares),
regardless of whether the reimbursement was paid
directly by Medicaid or through a fiscal intermediary or a
health maintenance organization (HMO). The Medicaid
amount includes revenue (federal and state shares) from
Medicaid family planning eligibility expansions (waivers or
State Plan Amendments).
Private Health Insurance—Grantees report the amount
received from private third-party health insurance plans,
which include plans obtained through an employer, union,
or direct purchase that provide a broad set of primary
medical care benefits for the enrolled individual
(beneficiary or dependent). Private health insurance
includes coverage purchased for public employees or
retirees or military personnel and their dependents (e.g.,
TRICARE or CHAMPVA).
Other Revenue—Grantees report the amounts received
from various other sources, including
■
Maternal and Child Health Block Grants (Title V)
■
Social Services Block Grants (Title XX)
■
Temporary Assistance for Needy Families (TANF)
■
Local government sources (includes county and city
grants or contracts)
■
State government sources (includes grants or contracts)
■
Bureau of Primary Health Care grants (e.g., Section 330)
■
Private and client donations
■
Other public or private revenues.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
October 2016), pp. 47–49.5
52
Family Planning Annual Report: 2019 National Summary
8 Project Revenue
REVENUE
In 2019, Title X grantees reported total program revenue of over $1.0 billion to support the
delivery of Title X-funded family planning and related preventive health care. The two largest
sources of revenue—Medicaid and the Children’s Health Insurance Program (CHIP)
combined ($370.9 million) and Title X ($229.0 million)—accounted for 36% and 22%,
respectively, of total revenue. Revenue from state governments ($110.0 million), private
third-party payers ($107.5 million), client service fees ($40.1 million), and local governments
($30.1 million) each accounted for 3% to 11% of total revenue, while all other sources each
contributed 2% or less (Exhibit 31).
Title X Services Grant
Revenue from Title X accounted for 22% ($229.0 million) of total national revenue and
between 13% and 36% of total regional revenue. Title X was the largest source of revenue in
four regions and the second largest source after Medicaid in four others (Exhibits 32 and 33).
Payment for Services: Client Fees
Revenue from client service fees accounted for 4% ($40.1 million) of total revenue and
between 1% and 9% of total regional revenue (Exhibits 32 and 33).
Payment for Services: Third-Party Payers
In 2019, revenue from third-party payers was 48% ($498.7 million) of total revenue, with
Medicaid/CHIP accounting for most (74%) of this amount.
Medicaid and CHIP. Medicaid revenue (federal and state shares) accounted for 36%
($369.5 million) of total revenue, and separately reported CHIP revenue accounted for less
than 0.5% ($1.4 million) of total revenue. Together, these two sources totaled $370.9 million,
or 36% of total 2019 revenue.
By region, Medicaid and CHIP revenue combined accounted for 13% to 61% of total regional
revenue, and Medicaid was the largest revenue source (27% to 61%) in six regions
(Exhibits 32 and 33). In 24 states, grantees included revenue from federally approved
Medicaid family planning eligibility expansions in the amount they reported for Medicaid.
See the Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of
these states.
Medicare and Other Public. Revenue from Medicare ($8.0 million) and other public
third-party payers ($12.3 million) together accounted for 2% of total national revenue. By
region, the share of revenue from Medicare and other public third-party payers ranged from
less than 0.5% to 9% (Exhibits 32 and 33).
Private. Revenue from private third-party payers ($107.5 million) accounted for 10% of total
national revenue and between 6% and 24% of total regional revenue. Private third-party payer
Family Planning Annual Report: 2019 National Summary
53
revenue was the second or third most important revenue source in seven regions
(Exhibits 32 and 33).
Other Revenue
Block Grants and Temporary Assistance for Needy Families (TANF). Revenue from the
Title V Maternal and Child Health (MCH) block grant ($17.0 million), the Title XX Social
Services block grant ($6.1 million), and TANF ($6.1 million) each accounted for 1% to 2% of
total national revenue. By region, the share of total regional revenue from block grants (MCH
or Social Services) or TANF ranged from 0% to 4%, with several regions reporting no
revenue from either block grants or TANF (Exhibits 32 and 33).
State Governments. State government revenue accounted for 11% ($110.0 million) of total
national revenue and from 1% to 27% of total regional revenue. State government revenue
was the second largest source of regional revenue in two regions (Exhibits 32 and 33).
Local Governments. Local government revenue accounted for 3% ($30.1 million) of total
national revenue and from less than 0.5% to 10% of total regional revenue
(Exhibits 32 and 33).
Bureau of Primary Health Care (BPHC). Revenue from the Health Resources Services
Administration, BPHC accounted for 1% ($15.5 million) of total national revenue. Across
regions, BPHC revenue ranged from 0% to 7% of total regional revenue, with one region
reporting no BPHC revenue (Exhibits 32 and 33).
All Other Revenue. Finally, 8% ($83.8 million) of total revenue came from a combination of
all other public and private sources not listed separately in Table 14. Revenue from other
sources ranged from 2% to 17% of total regional revenue (Exhibits 32 and 33). See the
Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of other
revenue sources.
Revenue per User and Encounter
On average, in 2019, grantees reported $335 in program revenue per family planning user
served and $222 per family planning encounter. By region, revenue per user ranged from
$226 to $464, and revenue per encounter ranged from $155 to $336 (Exhibit 32).
54
Family Planning Annual Report: 2019 National Summary
Exhibit 31. Amount and distribution of Title X project revenues, by revenue source: 2019 (Source: FPAR
Table 14)
Revenue Source
Amount
Distribution
$229,031,074
22%
Payment for Services
Client fees
$40,051,795
4%
Third-party payers
Medicaidb
$369,512,175
36%
Medicare
$8,023,568
1%
Children’s Health Insurance Program
$1,389,873
0%†
$12,299,248
1%
Private
$107,498,387
10%
Subtotal
$538,775,046
52%
$16,956,909
2%
Social Services block grant
$6,105,713
1%
Temporary Assistance for Needy Families
$6,077,922
1%
State government
$109,977,858
11%
Local government
$30,059,604
3%
Bureau of Primary Health Care
$15,487,598
1%
Otherc
$83,828,526
8%
$268,494,130
26%
$1,036,300,250
100%
Title X
a
Other public
Other Revenue
Maternal and Child Health block grant
Subtotal
Total Revenue
Total Revenue per User
$335
—
Total Revenue per Encounter
$222
—
— Not applicable.
Notes: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year. Due to rounding, percentages may
not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from federally approved Medicaid family planning eligibility expansions in 24 states in all 10 HHS regions.
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of states by region.
c
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as
“other.”
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
55
56
Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2019 (Source: FPAR Table 14)
Region I
($)
Region II
($)
Region III
($)
Region IV
($)
Region V
($)
Region VI
($)
Region VII
($)
Region VIII
($)
Region IX
($)
Region X
($)
$229,031,074
$9,615,110
$17,462,293
$23,978,812
$54,930,215
$31,211,536
$30,113,470
$13,042,095
$10,669,156
$31,252,005
$6,756,382
$40,051,795
$1,389,725
$4,926,376
$4,308,780
$7,860,329
$6,897,798
$1,340,479
$2,000,576
$3,769,108
$5,407,479
$2,151,145
Third-party
Medicaidb
$369,512,175
$7,067,549
$36,618,826
$41,227,333
$55,980,366
$33,952,158
$16,378,925
$4,654,255
$6,419,173 $150,229,250
$16,984,340
Medicare
$8,023,568
$274,009
$451,176
$1,031,163
$1,707,429
$3,270,625
$394,753
$349,376
$101,094
Revenue Source
Title X
Payment for Services
Client fees
All Regions
($)
payersa
CHIP
Other publicc
Private
Subtotal
$392,293
$51,650
$1,389,873
$0
$424,602
$168,877
$482,536
$9,562
$104,464
$31,782
$168,050
$0
$0
$12,299,248
$1,145,153
$60,053
$1,646,461
$79,329
$166,447
$8,679,561
$193,862
$34,062
$158,014
$136,306
$107,498,387
$7,803,353
$16,490,638
$15,286,152
$10,680,679
$13,700,203
$6,871,327
$5,906,038
$6,964,459
$16,271,654
$7,523,884
$538,775,046 $17,679,789
$58,971,671
$63,668,766
$76,790,668
$57,996,793
$33,769,509
$13,135,889
$17,455,946 $172,458,690
$26,847,325
Other Revenue
MCH block grant
$16,956,909
$0
$5,332,852
$2,260,462
$3,205,984
$2,539,192
$1,524,513
$152,570
$173,311
$1,287,319
$480,706
SS block grant
$6,105,713
$1,074,608
$1,365,007
$2,608,761
$0
$995,897
$0
$0
$42,637
$18,803
$0
TANF
Family Planning Annual Report: 2019 National Summary
$6,077,922
$81,520
$0
$0
$3,145,329
$2,425,924
$418,715
$0
$6,434
$0
$0
State government
$109,977,858
$3,586,794
$34,398,542
$5,127,286
$18,218,899
$6,174,925
$28,015,434
$1,068,000
$3,276,544
$2,923,901
$7,187,533
Local government
$30,059,604
$6,200
$776,407
$226,613
$12,677,418
$3,888,041
$3,423,985
$301,824
$3,928,640
$2,030,915
$2,799,561
BPHC
$15,487,598
$167,873
$341,558
$53,796
$130,870
$8,189,911
$265,703
$2,590,436
$0
$3,725,174
$22,277
Otherd
Subtotal
Total Revenue
$83,828,526
$784,559
$9,569,132
$3,357,716
$4,049,431
$11,076,864
$4,947,737
$6,146,528
$4,268,320
$31,749,276
$7,878,963
$268,494,130
$5,701,554
$51,783,498
$13,634,634
$41,427,931
$35,290,754
$38,596,087
$10,259,358
$11,695,886
$41,735,388
$18,369,040
$173,148,814 $124,499,083 $102,479,066
$36,437,342
$39,820,988 $245,446,083
$51,972,747
$1,036,300,250 $32,996,453 $128,217,462 $101,282,212
Total Revenue per User
$335
$226
$416
$270
$267
$422
$319
$330
$380
$368
$430
Total Revenue per
Encounter
$222
$161
$288
$159
$155
$266
$193
$184
$221
$336
$319
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy Families.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
b
c
d
Prepaid and not prepaid.
Includes revenue from federally approved Medicaid family planning eligibility expansions in 24 states in all 10 HHS regions. See Table 14 comments in the Field and Methodological Notes
(Appendix C) for a list of states by region.
“All Regions” and “Region VI” amounts for “Other Public” third-party payment for services include revenue from the Texas Women’s Health Program.
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as “other.”
Family Planning Annual Report: 2019 National Summary
Exhibit 33. Distribution of Title X project revenues, by revenue source and region: 2019 (Source: FPAR Table 14)
Revenue Source
Title X
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
22%
29%
14%
24%
32%
25%
29%
36%
27%
13%
13%
4%
4%
4%
4%
5%
6%
1%
5%
9%
2%
4%
36%
21%
29%
41%
32%
27%
16%
13%
16%
61%
33%
Medicare
1%
1%
0%†
1%
1%
3%
0%†
1%
0%†
0%†
0%†
CHIP
0%†
0%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%
0%
Other publicc
1%
3%
0%†
2%
0%†
0%†
8%
1%
0%†
0%†
0%†
Private
10%
24%
13%
15%
6%
11%
7%
16%
17%
7%
14%
Subtotal
52%
54%
46%
63%
44%
47%
33%
36%
44%
70%
52%
Other Revenue
MCH block grant
2%
0%
4%
2%
2%
2%
1%
0%†
0%†
1%
1%
SS block grant
1%
3%
1%
3%
0%
1%
0%
0%
0%†
0%†
0%
TANF
1%
0%†
0%
0%
2%
2%
0%†
0%
0%†
0%
0%
27%
5%
11%
5%
27%
3%
8%
1%
14%
1%
0%†
7%
3%
3%
1%
10%
1%
5%
Payment for Services
Client fees
Third-party payersa
Medicaidb
State government
11%
Local government
3%
11%
0%†
BPHC
1%
1%
0%†
0%†
0%†
7%
0%†
7%
0%
2%
Otherd
8%
2%
7%
3%
2%
9%
5%
17%
11%
13%
15%
Subtotal
26%
17%
40%
13%
24%
28%
38%
28%
29%
17%
35%
Total Revenue
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
0%†
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy
Families.
Note: Due to rounding, percentages may not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from federally approved Medicaid family planning eligibility expansions in 24 states in all 10 HHS regions. See Table 14 comments in the Field and
Methodological Notes (Appendix C) for a list of states by region.
c
“All Regions” and “Region VI” percentages for “Other Public” third-party payment for services include revenue from the Texas Women’s Health Program.
d
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as “other.”
† Percentage is less than 0.5%.
57
Trends in Project Revenue 2009 vs. 2019
2019 vs. 2018. Comparing 2019 revenue data with those from 2018 shows that
inflation-adjusted (constant 2019 dollars)24 total revenue decreased 24% (by $322.3 million),
from $1.4 billion in 2018 to just over $1.0 billion in 2019. Revenue from all but two smaller
sources—other public third parties and TANF—decreased.
2019 vs. 2009. Comparing 2019 revenue data with those from 2009 shows that
inflation-adjusted (constant 2019 dollars)24 total revenue decreased 37% (by $597.6 million),
from $1.6 billion in 2009 to $1.0 billion in 2019. Decreases totaling $654.9 million from
several major sources were too large to offset modest increases ($57.3 million) in others
(Exhibits A–13a, A–13b, and A–13c).
Compared with 2009, revenue from each of the following sources in 2019 was lower
(Exhibits A–13a, A–13b, and A–13e):
▪ Combined Medicaid and CHIP revenue decreased 38%, or by $226.3 million, between
2009 ($597.2 million) and 2019 ($370.9 million).
▪ Title X revenue decreased 35%, or by $124.5 million, between 2009 ($353.5 million) and
2019 ($229.0 million).
▪ State government revenue decreased 46%, or by $94.1 million, between 2009
($204.1 million) and 2019 ($110.0 million) (not shown).
▪ Local government revenue decreased 73%, or by $82.3 million, between 2009
($112.3 million) and 2019 ($30.1 million) (not shown).
▪ Client service fees revenue decreased 63%, or by $67.4 million, between 2009
($107.4 million) and 2019 ($40.1 million) (not shown).
▪ Block grant revenue decreased 67%, or by $45.8 million, between 2009 ($68.8 million)
and 2019 ($23.1 million) (not shown).
▪ TANF revenue decreased 71%, or by $14.6 million, between 2009 ($20.7 million) and
2019 ($6.1 million) (not shown).
Compared with 2009, revenue from each of the following sources in 2019 was higher:
▪ Private third-party payer revenue increased 67%, or by $43.2 million, between 2009
($64.3 million) and 2019 ($107.5 million) (not shown).
▪ Medicare and other public third-party payer revenue increased 167%, or by
$12.7 million, between 2009 ($7.6 million) and 2019 ($20.3 million) (not shown).
▪ Revenue from multiple “other” sources increased 1%, or by $1.4 million, between 2009
($97.9 million) and 2019 ($99.3 million) (not shown).
Compared with 2009, the distribution of total revenue across most major sources in 2019 was
about the same. Noteworthy changes included a 6-point increase in the percentage of total
revenue from private third-party payers and a 3-point decrease in the percentage from client
service fees (see Exhibits A–14a, A–14b, and A–14c).
58
Family Planning Annual Report: 2019 National Summary
9 References
1. Title X of the Public Health Service Act, 42 U.S. Code 300 et seq. (1970).
Retrieved from https://opa.hhs.gov/sites/default/files/2020-07/title-x-statuteattachment-a_0.pdf
2. The Title X program requirements consist of the following two documents:
Compliance with statutory program integrity requirements (“Title X Final
Rule”) retrieved from https://opa.hhs.gov/grant-programs/title-x-servicegrants/title-x-statutes-regulations-and-legislative-mandates-0
Providing quality family planning services: Recommendations of CDC and the
U.S. Office of Population Affairs (“QFP”) and updates (2015 and 2017) to the
Recommendations retrieved from https://opa.hhs.gov/grant-programs/title-xservice-grants/about-title-x-service-grants/quality-family-planning
3. 42 Code of Federal Regulations (CFR) Part 59 Subpart A. (2020, March 4)
Project grants for family planning services. Retrieved from
https://www.ecfr.gov/cgi-bin/text-idx?SID=c1cbd72e13f7230f1e8328fa
52b57899&mc=true&node=sp42.1.59.a&rgn=div6
4. Office of Population Affairs. (2020). Title X funding history. Retrieved from
https://opa.hhs.gov/grant-programs/archive/title-x-program-funding-history
5. Office of Population Affairs. (2016). Title X Family Planning Annual Report:
Forms and instructions (reissued October 2016). Rockville, MD: U.S.
Department of Health and Human Services, Office of the Assistant Secretary
for Health/Office, Office of Population Affairs. Retrieved from
https://opa.hhs.gov/sites/default/files/2020-07/fpar-forms-instructionsreissued-oct-2016.pdf
6. 45 Code of Federal Regulations (CFR) Part 75. (2016, October 1). Uniform
administrative requirements, cost principles, and audit requirements for HHS
awards. Retrieved from https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=
1&SID=df3c54728d090168d3b2e780a6f6ca7c&ty=HTML&h=L&mc=true&n
=pt45.1.75&r=PART
7. Office of the Assistant Secretary for Health, Office of the Secretary,
Department of Health and Human Services. (2019). Compliance with Statutory
Program Integrity Requirements. Federal Register, 84(42): 7714-7791.
Accessed from https://www.govinfo.gov/content/pkg/FR-2019-0304/pdf/2019-03461.pdf
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59
8. Napili, A and Elliot, V.L. (2020). Title X Family Planning Program: 2019
Final Rule. Congressional Research Service No. IF 11142. Accessed from
https://crsreports.congress.gov/product/pdf/IF/IF11142
9. Office of Population Affairs. (2019). Fact Sheet: Final Title X Rule Detailing
Family Planning Grant Program. Accessed from https://opa.hhs.gov/grantprograms/title-x-service-grants/title-x-statutes-regulations-and-legislativemandates-4
10. U.S. Department of Health and Human Services. (2019). 2019 poverty
guidelines, U.S. federal poverty guidelines used to determine financial
eligibility for certain federal programs. Retrieved from
https://aspe.hhs.gov/2019-poverty-guidelines
11. Cohen, R. A., Terlizzi, E. P., Martinez, M. E., & Cha, A.E. (2020). Health
insurance coverage: Early release of estimates from the National Health
Interview Survey, January-June 2019. Retrieved from
https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202005-508.pdf
12. Office of Management and Budget. (1997). Revisions to the standards for the
classification of federal data on race and ethnicity, October 30, 1997. Federal
Register Notice. Retrieved from https://www.gpo.gov/fdsys/pkg/FR-1997-1030/pdf/97-28653.pdf
13. U.S. Department of Health and Human Services. (2003). Guidance to federal
financial assistance recipients regarding Title VI prohibition against national
origin discrimination affecting limited English proficient persons (“Revised
HHS LEP guidance”). Federal Register, 68(153), 47311–47323. Retrieved
from https://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/
policyguidancedocument.html
14. Kennedy, K. I., & Goldsmith, C. (2018). Contraception after pregnancy. In R.
A. Hatcher, A. L. Nelson, J. Trussell, C. Cwiak, P. Cason, M. S. Policar, A. R.
A. Aiken, J. Marrazzo, & D. Kowal (Eds.), Contraceptive technology (21st ed.,
pp. 511–542). New York, NY: Ardent Media.
15. Centers for Disease Control and Prevention. (2020). Sexual risk behaviors can
lead to HIV, STDs & teen pregnancy. Retrieved from
https://www.cdc.gov/healthyyouth/sexualbehaviors/
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16. Centers for Disease Control and Prevention and the U.S. Office of Population
Affairs. (2014). Providing quality family planning services: Recommendations
of CDC and the U.S. Office of Population Affairs. MMWR, 63(4), 1–54.
Retrieved from https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf. For the 2015
update to the Recommendations, see Gavin, L., & Pazol, K. (2016). Update:
Providing quality family planning services–Recommendations from CDC and
the U.S. Office of Population Affairs, 2015. MMWR, 65(9), 231–234.
Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/
mm6509a3.pdf. For the 2017 update to the Recommendations, see Gavin, L.,
Pazol, K., & Ahrens, K. (2017). Update: Providing quality family planning
services–Recommendations from CDC and the U.S. Office of Population
Affairs, 2017. MMWR, 66(50), 1383–1385. Retrieved from
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6650a4-H.pdf
17. Office of Population Affairs. (2019). Performance measures. Retrieved from
https://opa.hhs.gov/evaluation-research/title-x-services-research/contraceptivecare-measures
18. Trussell, J. (2011). Chapter 26: Contraceptive: Efficacy. In R. A. Hatcher,
J. Trussell, A. L. Nelson, W. Cates, D. Kowal, & M. S. Policar (Eds.),
Contraceptive technology (20th ed.). New York, NY: Ardent Media, Inc.
19. Nayar, R., & Wilbur, D. C. (2015). The Pap test and Bethesda 2014. Acta
Cytologica 29, 121–132. Retrieved from https://www.karger.com/Article/
Pdf/381842
20. National Cancer Institute. (2020). NCI dictionary of cancer terms. Retrieved
from https://www.cancer.gov/publications/dictionaries/cancer-terms
21. Centers for Disease Control and Prevention. (2019). Reported STDs in the
United States, 2018, GA: U.S. Department of Health and Human Services.
Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/STDTrends-508.pdf
22. Centers for Disease Control and Prevention. (2015). Sexually transmitted
diseases treatment guidelines, 2015. MMWR, 64(RR-3), 1–137. Retrieved from
https://www.cdc.gov/std/tg2015/tg-2015-print.pdf and Centers for Disease
Control and Prevention. (2016). Screening recommendations and
considerations referenced in treatment guidelines and original sources.
Retrieved from https://www.cdc.gov/std/tg2015/screeningrecommendations.htm
23. U.S. Preventive Services Task Force. (2014). Gonorrhea and chlamydia:
Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/
Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrheascreening
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61
24. U.S. Department of Labor, Bureau of Labor Statistics (BLS). (n.d.). Consumer
price index: Series ID. CUUR0000SAM. Retrieved from
https://data.bls.gov/cgi-bin/srgate
25. Henry J. Kaiser Family Foundation. (2020, August 17). Status of state action
on the Medicaid expansion decision. Retrieved from
https://www.kff.org/health-reform/state-indicator/state-activity-aroundexpanding-medicaid-under-the-affordable-careact/?currentTimeframe=0&sortModel=%7B%22colId%
22:%22Location%22,%22sort%22:%22asc%22%7D
26. Bayer HealthCare Pharmaceuticals, Inc. (2018). Skyla: Highlights of
prescribing information. Retrieved from http://labeling.bayerhealthcare.com/
html/products/pi/Skyla_PI.pdf#IUDEfficacy
27. Bayer HealthCare Pharmaceuticals, Inc. (2020). Important safety information
about Kyleena. Retrieved from https://hcp.kyleena-us.com/aboutkyleena/efficacy/
28. Allergan USA, Inc. (2019). Liletta: Highlights of prescribing information.
Retrieved from https://www.allergan.com/assets/pdf/lilettashi_pi
29. Hatcher, R. A. (2018). Contraceptive technology (21st edition) (D. Kowal, R.
A. Hatcher, A. L. Nelson, J. Trussell, C. Cwiak, P. Cason, M. S. Policar, A. B.
Edelman, A. R. A. Aiken, & J. M. Marrazzo, Eds.). Managing Contraception,
LLC. Retrieved from https://books.google.com/books/about/Contraceptive_
Technology_21st_Edition.html?id=qsz8twEACAAJ
62
Family Planning Annual Report: 2019 National Summary
Appendix A
National Trend Exhibits
Family Planning Annual Report: 2019 National Summary
A-1
A-2
Exhibit A–1a.
Region
Number of Title X-funded grantees, subrecipients, and service sites, by region and year: 2009–2019
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
10
7
9
10
11
8
5
6
16
7
89
10
7
9
10
12
6
5
6
16
8
89
11
7
9
10
12
6
5
6
17
8
91
11
7
9
13
11
6
5
6
17
8
93
11
6
10
13
11
7
5
6
18
8
95
12
6
10
14
10
6
5
6
17
8
94
11
6
10
10
12
6
5
6
17
8
91
11
6
10
9
11
7
5
6
18
8
91
11
6
10
9
11
6
5
6
17
8
89
12
8
12
11
13
8
5
6
18
6
99
10
8
12
12
12
9
6
6
19
6
100
Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
69
89
222
190
136
94
107
73
116
61
1,157
71
82
218
188
130
90
105
74
104
60
1,122
72
80
230
183
135
79
106
74
121
62
1,142
67
75
265
184
129
78
101
75
113
61
1,148
66
71
271
214
133
90
97
74
105
60
1,181
67
70
258
253
120
45
93
74
95
59
1,134
71
70
316
226
122
47
94
74
102
59
1,181
69
68
223
281
118
41
92
68
99
58
1,117
68
68
225
277
113
39
91
69
85
56
1,091
75
72
218
267
131
48
93
68
89
67
1,128
61
68
173
271
134
46
92
62
86
67
1,060
Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
230
296
656
1,104
373
588
296
185
501
286
4,515
221
272
641
1,091
371
580
289
184
495
245
4,389
228
263
639
1,076
392
553
267
179
539
246
4,382
238
253
633
1,044
364
521
251
185
474
226
4,189
225
256
627
1,019
362
571
242
182
460
224
4,168
233
251
615
1,183
340
442
223
182
441
217
4,127
224
247
648
936
383
457
218
177
461
200
3,951
225
244
640
914
374
425
221
180
469
206
3,898
221
244
653
912
365
415
210
162
465
211
3,858
242
241
626
900
388
468
202
170
478
239
3,954
214
237
614
910
394
466
197
157
391
245
3,825
Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
Family Planning Annual Report: 2019 National Summary
Family Planning Annual Report: 2019 National Summary
Exhibit A–1b.
Distribution of Title X-funded grantees, subrecipients, and service sites, by region and year: 2009–2019
Region
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
11%
8%
10%
11%
12%
9%
6%
7%
18%
8%
100%
11%
8%
10%
11%
13%
7%
6%
7%
18%
9%
100%
12%
8%
10%
11%
13%
7%
5%
7%
19%
9%
100%
12%
8%
10%
14%
12%
6%
5%
6%
18%
9%
100%
12%
6%
11%
14%
12%
7%
5%
6%
19%
8%
100%
13%
6%
11%
15%
11%
6%
5%
6%
18%
9%
100%
12%
7%
11%
11%
13%
7%
5%
7%
19%
9%
100%
12%
7%
11%
10%
12%
8%
5%
7%
20%
9%
100%
12%
7%
11%
10%
12%
7%
6%
7%
19%
9%
100%
12%
8%
12%
11%
13%
8%
5%
6%
18%
6%
100%
10%
8%
12%
12%
12%
9%
6%
6%
19%
6%
100%
Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
6%
8%
19%
16%
12%
8%
9%
6%
10%
5%
100%
6%
7%
19%
17%
12%
8%
9%
7%
9%
5%
100%
6%
7%
20%
16%
12%
7%
9%
6%
11%
5%
100%
6%
7%
23%
16%
11%
7%
9%
7%
10%
5%
100%
6%
6%
23%
18%
11%
8%
8%
6%
9%
5%
100%
6%
6%
23%
22%
11%
4%
8%
7%
8%
5%
100%
6%
6%
27%
19%
10%
4%
8%
6%
9%
5%
100%
6%
6%
20%
25%
11%
4%
8%
6%
9%
5%
100%
6%
6%
21%
25%
10%
4%
8%
6%
8%
5%
100%
7%
6%
19%
24%
12%
4%
8%
6%
8%
6%
100%
6%
6%
16%
26%
13%
4%
9%
6%
8%
6%
100%
Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
5%
7%
15%
24%
8%
13%
7%
4%
11%
6%
100%
5%
6%
15%
25%
8%
13%
7%
4%
11%
6%
100%
5%
6%
15%
25%
9%
13%
6%
4%
12%
6%
100%
6%
6%
15%
25%
9%
12%
6%
4%
11%
5%
100%
5%
6%
15%
24%
9%
14%
6%
4%
11%
5%
100%
6%
6%
15%
29%
8%
11%
5%
4%
11%
5%
100%
6%
6%
16%
24%
10%
12%
6%
4%
12%
5%
100%
6%
6%
16%
23%
10%
11%
6%
5%
12%
5%
100%
6%
6%
17%
24%
9%
11%
5%
4%
12%
5%
100%
6%
6%
16%
23%
10%
12%
5%
4%
12%
6%
100%
6%
6%
16%
24%
10%
12%
5%
4%
10%
6%
100%
Note: Due to rounding, percentages in each year may not sum to 100%.
A-3
Number of Title X-funded service sites and users per service site, by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibits A-1a and A-1b.
2,000
5,000
4,515
4,389
4,382
4,189
4,168
4,127
Number of service sites
4,000
3,000
3,951
3,898
3,858
3,954
3,825
1,500
1,149
1,190
1,146
1,137
1,094
1,001
1,017
1,028
1,038
996
809
1,000
2,000
Family Planning Annual Report: 2019 National Summary
500
1,000
0
2009
2010
2011
2012
2013
Number of service sites
2014
2015
2016
2017
Number of users per site
2018
2019
0
Number of users per site
A-4
Exhibit A–1c.
This page intentionally left blank.
Family Planning Annual Report: 2019 National Summary
A-5
A-6
Exhibit A–2a.
Region
Number and distribution of all family planning users, by region and year: 2009–2019
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
I
199,779
198,962
192,252
195,264
182,684
184,005
184,389
183,383
194,952
201,188
145,737
II
497,614
499,231
493,369
488,872
470,836
429,409
431,060
428,146
429,091
436,971
308,031
III
592,475
584,167
564,163
550,051
520,403
468,157
432,418
477,585
464,216
472,832
374,499
IV
1,010,012
989,770
940,931
907,020
852,400
770,501
660,156
669,743
677,146
642,224
648,599
V
492,741
492,359
472,062
434,587
401,935
377,552
390,446
390,541
391,901
403,080
295,108
VI
512,019
512,868
475,863
350,164
372,296
298,294
346,670
334,933
350,646
334,107
321,395
VII
209,350
214,032
205,167
186,716
167,286
148,405
140,055
135,907
120,759
116,928
110,363
VIII
160,919
176,892
169,311
163,068
152,248
137,509
131,031
124,021
126,922
131,148
104,814
IX
1,294,974
1,352,569
1,314,270
1,309,439
1,269,252
1,149,781
1,146,183
1,102,836
1,093,827
1,044,056
666,147
X
216,384
204,012
194,323
178,616
168,484
165,670
155,607
160,457
154,786
157,215
120,973
Total
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
Female
4,811,691
4,822,570
4,635,195
4,378,744
4,184,587
3,764,622
3,607,353
3,553,018
3,541,235
3,446,504
2,690,552
374,576
402,292
386,516
385,053
373,237
364,661
410,662
454,534
463,011
493,245
405,114
I
4%
4%
4%
4%
4%
4%
5%
5%
5%
5%
5%
II
10%
10%
10%
10%
10%
10%
11%
11%
11%
11%
10%
III
11%
11%
11%
12%
11%
11%
11%
12%
12%
12%
12%
IV
19%
19%
19%
19%
19%
19%
16%
17%
17%
16%
21%
V
10%
9%
9%
9%
9%
9%
10%
10%
10%
10%
10%
VI
10%
10%
9%
7%
8%
7%
9%
8%
9%
8%
10%
VII
4%
4%
4%
4%
4%
4%
3%
3%
3%
3%
4%
VIII
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
IX
25%
26%
26%
27%
28%
28%
29%
28%
27%
27%
22%
X
4%
4%
4%
4%
4%
4%
4%
4%
4%
4%
4%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
93%
92%
92%
92%
92%
91%
90%
89%
88%
87%
87%
7%
8%
8%
8%
8%
9%
10%
11%
12%
13%
13%
Male
Family Planning Annual Report: 2019 National Summary
Total
Female
Male
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Exhibit A–2b.
Number and distribution of all family planning users, by region and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-2a.
2019
5%
2018
5%
11%
2017
5%
11%
12%
17%
10%
2016
5%
11%
12%
17%
10%
2015
5%
11%
11%
2014
4%
10%
11%
19%
9%
2013
4%
10%
11%
19%
9%
2012
4%
10%
12%
19%
2011
4%
10%
11%
19%
9%
9%
2010
4%
10%
11%
19%
9%
10%
2009
4%
10%
11%
0%
12%
10%
12%
16%
16%
19%
27%
4% 3.94 million
9%
3% 3%
27%
4% 4.00 million
8%
3% 3%
28%
4% 4.01 million
3% 3%
29%
4% 4.02 million
7%
4% 3%
28%
4% 4.13 million
8%
4% 3%
28%
4% 4.56 million
7%
4% 3%
27%
4% 4.76 million
4% 3%
26%
4% 5.02 million
4% 3%
26%
4% 5.22 million
4% 3%
25%
4% 5.19 million
9%
9%
10%
10%
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Note: Due to rounding, percentages in each year may not sum to 100%.
4% 3.10 million
3% 3%
8%
10%
10%
22%
4% 3%
10%
10%
21%
100%
A-7
A-8
Exhibit A–3a.
Number and distribution of all family planning users, by age and year: 2009–2019
Age Group (Years)
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Under 15
74,287
73,383
59,351
53,012
45,633
45,863
46,045
58,649
49,060
53,998
47,836
15 to 17
502,226
466,284
423,702
368,965
327,152
298,839
280,785
275,499
271,429
264,389
206,305
18 to 19
647,432
616,709
560,848
505,356
454,044
404,197
379,710
373,253
373,235
363,399
276,270
20 to 24
1,577,051
1,600,833
1,508,215
1,405,487
1,320,188
1,169,948
1,091,549
1,043,071
1,013,943
970,356
724,585
25 to 29
1,037,776
1,071,999
1,058,256
1,023,503
999,476
912,130
887,225
876,921
877,588
841,832
629,510
30 to 34
578,031
607,257
621,119
616,259
622,258
573,010
570,708
572,573
580,833
573,004
460,181
35 to 39
353,712
359,749
358,400
351,820
355,877
331,439
344,385
359,108
374,756
380,153
320,185
40 to 44
209,292
215,914
222,429
222,621
220,836
200,955
204,360
211,324
220,748
225,997
202,397
Over 44
206,460
212,734
209,391
216,774
212,360
192,902
213,248
237,154
242,654
266,621
228,397
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
Under 15
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
2%
15 to 17
10%
9%
8%
8%
7%
7%
7%
7%
7%
7%
7%
18 to 19
12%
12%
11%
11%
10%
10%
9%
9%
9%
9%
9%
20 to 24
30%
31%
30%
30%
29%
28%
27%
26%
25%
25%
23%
25 to 29
20%
21%
21%
21%
22%
22%
22%
22%
22%
21%
20%
30 to 34
11%
12%
12%
13%
14%
14%
14%
14%
15%
15%
15%
35 to 39
7%
7%
7%
7%
8%
8%
9%
9%
9%
10%
10%
40 to 44
4%
4%
4%
5%
5%
5%
5%
5%
6%
6%
7%
Over 44
4%
4%
4%
5%
5%
5%
5%
6%
6%
7%
7%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Total
Family Planning Annual Report: 2019 National Summary
Total
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Exhibit A–3b.
Number and distribution of all family planning users, by age and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-3a.
2019
15–17,
7%
18–19, 9%
2018
7%
9%
25%
2017
7%
9%
25%
2016
7%
9%
26%
2015
7%
9%
27%
2014
7%
10%
28%
22%
2013
7%
10%
29%
22%
2012
8%
2011
8%
2010
9%
2009
10%
0%
20–24, 23%
11%
25–29, 20%
21%
22%
22%
30%
<15
29%
6%
4.00 million
29%
6%
4.01 million
5%
4.02 million
27%
5%
4.13 million
26%
5%
4.56 million
5%
4.76 million
4%
5.02 million
23%
4%
5.22 million
22%
4%
5.19 million
28%
25%
24%
21%
30%
15–17
3.94 million
21%
31%
12%
7%
21%
30%
12%
3.10 million
30%
22%
11%
7%
30–44, 32%
18–19
20%
20–24
25–29
30–44
>44
100%
Notes: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of the individual percentages
that are included in the aggregated categories. The percentage of users under 15 is 1% each year from 2009 through 2019.
A-9
A-10
Exhibit A–4a.
Number and distribution of all family planning users, by race and year: 2009–2019
Race
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
American Indian/Alaska Native
39,220
44,899
43,204
45,785
34,051
29,327
30,526
33,467
35,587
38,097
29,373
150,847
136,958
134,345
136,412
135,567
128,797
131,676
135,555
143,215
139,084
89,045
1,015,013
1,028,991
986,803
969,776
939,941
863,136
857,659
859,886
869,574
861,707
732,825
73,559
65,662
70,929
70,519
52,263
39,266
40,941
35,479
31,019
29,545
22,327
3,054,226
3,015,861
2,864,253
2,664,736
2,530,204
2,238,847
2,142,835
2,174,833
2,150,480
2,076,854
1,677,624
More than one race
169,044
261,397
250,825
248,590
191,871
153,907
136,043
142,564
144,397
151,281
110,372
Unknown/not reported
684,358
671,094
671,352
627,979
673,927
676,003
678,335
625,768
629,974
643,181
434,100
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
American Indian/Alaska Native
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
Asian
3%
3%
3%
3%
3%
3%
3%
3%
4%
4%
3%
20%
20%
20%
20%
21%
21%
21%
21%
22%
22%
24%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
59%
58%
57%
56%
56%
54%
53%
54%
54%
53%
54%
3%
5%
5%
5%
4%
4%
3%
4%
4%
4%
4%
13%
13%
13%
13%
15%
16%
17%
16%
16%
16%
14%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Total All Users
Black/African American
Family Planning Annual Report: 2019 National Summary
Native Hawaiian/Pacific Islander
White
More than one race
Unknown/not reported
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Exhibit A–4b.
Number and distribution of all family planning users, by race and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-4a.
White, 54%
2019
Black, 24%
Other, 8% Unknown, 14%
3.10 million
22%
9%
16%
3.94 million
2018
53%
2017
54%
22%
9%
16%
4.00 million
2016
54%
21%
9%
16%
4.01 million
2015
53%
2014
54%
21%
21%
8%
17%
4.02 million
9%
16%
4.13 million
2013
56%
21%
9%
2012
56%
20%
11%
13%
4.76 million
2011
57%
10%
13%
5.02 million
2010
58%
10%
13%
5.22 million
8%
13%
5.19 million
20%
20%
59%
2009
0%
White
20%
Black
Other
Unknown
15%
4.56 million
100%
Notes: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of the individual percentages
that are included in the aggregated categories. The Other race category includes users who self-identified as American Indian or Alaska Native, Asian, Native Hawaiian or Other
Pacific Islander, and more than one race.
A-11
A-12
Exhibit A–5a.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2009–2019
Ethnicity
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Hispanic or Latino
1,447,422
1,493,007
1,451,215
1,349,528
1,344,601
1,237,652
1,276,765
1,269,988
1,324,817
1,306,370
1,036,801
Not Hispanic or Latino
3,618,344
3,618,285
3,416,314
3,277,828
3,093,545
2,786,005
2,617,597
2,600,742
2,553,416
2,453,448
1,920,228
Unknown/not reported
120,501
113,570
154,182
136,441
119,678
105,626
123,653
136,822
126,013
179,931
138,637
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
Hispanic or Latino
28%
29%
29%
28%
30%
30%
32%
32%
33%
33%
33%
Not Hispanic or Latino
70%
69%
68%
69%
68%
67%
65%
65%
64%
62%
62%
Unknown/not reported
2%
2%
3%
3%
3%
3%
3%
3%
3%
5%
4%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Total All Users
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Family Planning Annual Report: 2019 National Summary
Exhibit A–5b.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-5a.
2019
Not Hispanic/Latino, 62%
Hispanic/Latino, 33%
3.10 million
2018
62%
33%
3.94 million
2017
64%
33%
4.00 million
2016
65%
32%
4.01 million
2015
65%
32%
4.02 million
2014
67%
30%
4.13 million
2013
68%
30%
4.56 million
2012
69%
28%
4.76 million
2011
68%
29%
5.02 million
2010
69%
29%
5.22 million
2009
70%
28%
5.19 million
0%
100%
Not Hispanic/Latino
Note: Due to rounding, percentages in each year may not sum to 100%.
Hispanic/Latino
Unknown
A-13
A-14
Exhibit A–6a.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2009–2019
Ethnicity and Race
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Not Hispanic or Latino
Asian
139,831
126,413
121,777
124,790
128,015
119,454
122,310
124,233
130,688
128,678
80,588
969,690
986,409
939,143
917,539
890,133
816,061
811,244
806,815
806,970
796,450
679,361
2,227,867
2,214,680
2,060,244
1,951,410
1,812,924
1,583,629
1,439,284
1,445,887
1,394,432
1,311,047
1,004,060
280,956
290,783
295,150
284,089
262,473
266,861
244,759
223,807
221,326
217,273
156,219
1,447,422
1,493,007
1,451,215
1,349,528
1,344,601
1,237,652
1,276,765
1,269,988
1,324,817
1,306,370
1,036,801
120,501
113,570
154,182
136,441
119,678
105,626
123,653
136,822
126,013
179,931
138,637
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
3%
2%
2%
3%
3%
3%
3%
3%
3%
3%
3%
Black or African American
19%
19%
19%
19%
20%
20%
20%
20%
20%
20%
22%
White
43%
42%
41%
41%
40%
38%
36%
36%
35%
33%
32%
Other/unknown
5%
6%
6%
6%
6%
6%
6%
6%
6%
6%
5%
Hispanic or Latino
All races
28%
29%
29%
28%
30%
30%
32%
32%
33%
33%
33%
2%
2%
3%
3%
3%
3%
3%
3%
3%
5%
4%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Black or African American
White
Other/unknown
Hispanic or Latino
All races
Unknown/Not Reported
Total All Users
Not Hispanic or Latino
Asian
Family Planning Annual Report: 2019 National Summary
Unknown/Not Reported
Total All Users
2019
Notes: The Not Hispanic or Latino “Other/Unknown” category includes users who self-identified as not Hispanic or Latino and for whom either race was unknown/not reported or the
user self-identified as one of the following: Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or more than one race. Due to rounding,
percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Exhibit A–6b.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-6a.
2019
NH White, 32%
NH Black, 22%
8%
Hispanic (all races), 33%
3.10 million
2018
33%
20%
9%
33%
3.94 million
2017
9%
20%
35%
33%
4.00 million
2016
36%
20%
9%
32%
4.01 million
2015
36%
20%
9%
32%
4.02 million
2014
38%
2013
40%
9%
20%
20%
2012
41%
19%
2011
41%
19%
9%
9%
8%
30%
4.13 million
30%
4.56 million
28%
4.76 million
29%
5.02 million
2010
42%
19%
8%
29%
5.22 million
2009
43%
19%
8%
28%
5.19 million
0%
100%
NH White
NH Black
NH Other/Unknown
Hispanic (all races)
Unknown
NH=Not Hispanic or Latino.
Notes: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of the individual percentages
that are included in the aggregated categories. The “NH Other/Unknown” category includes users who self-identified as not Hispanic or Latino and for whom either race was
unknown/not reported or the user self-identified as one of the following: Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or more than one race.
The “Unknown” category includes users with unknown or not reported Hispanic or Latino ethnicity.
A-15
A-16
Exhibit A–7a.
Income Level
Number and distribution of all family planning users, by income level and year: 2009–2019
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
3,632,506
3,618,813
3,466,912
3,382,089
3,211,380
2,840,650
2,653,841
2,564,992
2,665,911
2,542,526
1,968,876
101% to 150%
785,090
795,065
731,410
649,462
636,484
572,948
556,141
575,420
551,163
566,040
426,239
151% to 200%
277,103
281,294
269,478
247,490
245,805
234,425
238,420
252,273
257,155
277,321
211,586
201% to 250%
119,768
125,298
116,188
103,061
103,246
100,402
105,975
128,874
123,477
134,010
103,816
Over 250%
207,484
250,440
250,829
230,947
222,718
226,918
255,093
297,988
277,975
289,208
226,957
Unknown/not reported
164,316
153,952
186,894
150,748
138,191
153,940
208,545
188,005
128,565
130,644
158,192
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
Under 101%
70%
69%
69%
71%
70%
69%
66%
64%
67%
65%
64%
101% to 150%
15%
15%
15%
14%
14%
14%
14%
14%
14%
14%
14%
151% to 200%
5%
5%
5%
5%
5%
6%
6%
6%
6%
7%
7%
201% to 250%
2%
2%
2%
2%
2%
2%
3%
3%
3%
3%
3%
Over 250%
4%
5%
5%
5%
5%
5%
6%
7%
7%
7%
7%
Unknown/not reported
3%
3%
4%
3%
3%
4%
5%
5%
3%
3%
5%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
a
Under 101%
Total All Users
Family Planning Annual Report: 2019 National Summary
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of individual percentages
included in the aggregated categories.
a
Title X-funded grantees and subrecipients report users’ family income as a percentage of poverty based on guidelines issued by the U.S. Department of Health and Human
Services (HHS). Each year, HHS announces updates to its poverty guidelines in the Federal Register and on the HHS Website at http://aspe.hhs.gov/poverty/.
Family Planning Annual Report: 2019 National Summary
Exhibit A–7b.
Number and distribution of all family planning users, by income level and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-7a.
2019
≤100%, 64%
2018
65%
2017
101%–150%, 14%
2016
6%
14%
6%
14%
66%
2014
6%
14%
64%
2015
7%
14%
67%
14%
69%
7%
7%
3.10 million
7%
3.94 million
7%
4.00 million
7%
4.01 million
6%
4.02 million
5%
6%
4.13 million
2013
70%
14%
5%
5%
4.56 million
2012
71%
14%
5%
5%
4.76 million
2011
69%
15%
2010
69%
15%
2009
70%
15%
5%
5%
5%
5%
5.02 million
5%
5.22 million
4%
5.19 million
0%
100%
≤100%
101%–150%
151%–200%
201%–250%
>250%
Unknown
Notes: Title X-funded grantees and subrecipients report users’ family income as a percentage of poverty based on guidelines issued by the U.S. Department of Health and Human
Services (HHS). Each year, HHS announces updates to its poverty guidelines in the Federal Register and on the HHS Website at http://aspe.hhs.gov/poverty/. Due to rounding,
percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of the individual percentages that are included in
the aggregated categories.
A-17
A-18
Exhibit A–8a.
Number and distribution of all family planning users, by primary health insurance status and year: 2009–2019
Primary Insurance
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
1,021,164
1,184,795
1,236,343
1,121,372
1,131,406
1,215,648
1,395,201
1,499,672
1,511,533
1,502,777
1,186,684
426,308
438,042
429,919
447,341
453,535
559,845
621,066
715,090
760,051
794,535
607,961
3,419,915
3,483,360
3,230,784
3,050,415
2,865,672
2,239,377
1,934,154
1,737,488
1,675,825
1,580,113
1,255,337
318,880
118,665
124,665
144,669
107,211
114,413
67,594
55,302
56,837
62,324
45,684
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3,939,749
3,095,666
Public insurance
20%
23%
25%
24%
25%
29%
35%
37%
38%
38%
38%
Private insurance
8%
8%
9%
9%
10%
14%
15%
18%
19%
20%
20%
66%
67%
64%
64%
63%
54%
48%
43%
42%
40%
41%
6%
2%
2%
3%
2%
3%
2%
1%
1%
2%
1%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Public insurance
Private insurance
Uninsured
Unknown/not reported
Total All Users
Uninsured
Unknown/not reported
Total All Users
Family Planning Annual Report: 2019 National Summary
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary
Exhibit A–8b.
Number and distribution of all family planning users, by primary health insurance status and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-8a.
2019
Public insurance, 38%
Private insurance, 20%
Uninsured, 41%
3.10 million
2018
38%
20%
40%
3.94 million
2017
38%
2016
37%
2012
24%
2011
25%
10%
9%
9%
23%
2010
20%
2009
4.02 million
54%
14%
25%
2013
4.01 million
48%
15%
29%
2014
4.00 million
43%
18%
35%
2015
42%
19%
4.13 million
63%
4.56 million
64%
4.76 million
64%
5.02 million
8%
67%
8%
5.22 million
66%
0%
5.19 million
100%
Public insurance
Private insurance
Note: Due to rounding, percentages in each year may not sum to 100%.
Uninsured
Unknown/Not reported
A-19
A-20
Exhibit A–9a.
Number of all female family planning users, by primary contraceptive method and year: 2009–2019
Primary Method
2009
Most Effectivea
Vasectomy
Sterilization
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
6,905
8,683
8,632
8,540
8,175
7,582
6,879
8,178
8,848
9,237
7,668
92,616
92,652
90,438
86,854
82,067
74,748
84,108
86,112
94,173
91,569
82,472
Hormonal implant
30,135
48,015
65,673
82,642
108,586
139,799
177,975
209,014
239,029
240,418
190,615
Intrauterine device
216,390
252,121
272,683
284,461
279,289
265,511
273,650
288,939
324,174
323,081
237,073
Moderately Effectivea
Hormonal injectionb
Vaginal ring
615,188
643,682
645,351
645,136
635,093
611,619
574,476
519,841
500,960
474,609
398,894
165,121
186,238
183,182
164,693
142,292
115,230
95,186
83,473
76,252
66,968
46,021
Contraceptive patch
106,266
93,499
89,795
83,145
78,547
69,469
49,010
47,030
48,256
46,384
32,714
1,696,319
1,684,201
1,534,684
1,409,300
1,316,671
1,135,950
1,000,062
946,383
894,128
823,992
598,304
12,278
4,402
3,390
4,116
8,245
2,379
1,660
2,130
2,219
1,652
877
737,991
787,329
838,131
745,265
692,678
578,139
572,607
559,356
547,129
533,079
385,950
4,635
5,944
5,939
3,722
3,914
3,308
3,558
2,929
2,537
3,782
3,159
991
1,581
921
765
541
651
660
138
169
371
377
105,705
116,635
115,002
113,016
95,798
70,982
61,504
75,191
73,047
81,486
75,253
FAMd or LAM
12,633
14,379
17,105
12,676
11,753
12,648
13,503
14,392
15,287
17,320
17,370
Spermicide
15,598
8,346
7,061
4,926
4,028
2,911
1,873
1,848
1,991
1,135
995
62,380
75,534
69,924
71,737
72,486
70,098
73,896
89,102
92,385
99,733
90,729
395,633
400,194
361,056
377,547
356,750
330,279
321,229
321,706
313,802
279,025
207,880
167,834
Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom
Contraceptive sponge
Withdrawal or otherc
Family Planning Annual Report: 2019 National Summary
Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
260,946
238,347
229,541
183,613
181,657
175,111
171,068
175,371
190,518
194,405
273,961
160,788
96,687
96,590
106,017
98,208
124,449
121,885
116,331
158,258
146,367
Total Female Users
4,811,691
4,822,570
4,635,195
4,378,744
4,184,587
3,764,622
3,607,353
3,553,018
3,541,235
3,446,504
2,690,552
Using Most, Moderately, or Less
Effective Method
3,818,771
3,947,707
3,877,987
3,649,257
3,467,677
3,090,926
2,916,711
2,844,954
2,828,199
2,715,083
2,077,742
346,046
401,471
437,426
462,497
478,117
487,640
542,612
592,243
666,224
664,305
517,828
2,595,172
2,612,022
2,456,402
2,306,390
2,180,848
1,934,647
1,720,394
1,598,857
1,521,815
1,413,605
1,076,810
877,553
934,214
984,159
880,370
808,712
668,639
653,705
653,854
640,160
637,173
483,104
62,380
75,534
69,924
71,737
72,486
70,098
73,896
89,102
92,385
99,733
90,729
656,579
638,541
590,597
561,160
538,407
505,390
492,297
497,077
504,320
473,430
375,714
Method Unknown
Most effectivea
Moderately effective
a
Less effectivea
Abstinent
Not Using a Method
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
See Table 7 comments in the Field and Methodological Notes (Appendix C).
b
Hormonal injection figures include both 1- and 3-month hormonal injection users.
c
Withdrawal/Other category includes other methods not listed separately in FPAR Table 7.
d
For 2009 through 2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2019,
the FAM category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
Family Planning Annual Report: 2019 National Summary
Exhibit A–9b.
Distribution of all female family planning users, by primary contraceptive method and year: 2009–2019
Primary Method
2009
Most Effectivea
Vasectomy
Sterilization
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
2%
2%
2%
2%
2%
2%
2%
2%
3%
3%
3%
Hormonal implant
1%
1%
1%
2%
3%
4%
5%
6%
7%
7%
7%
Intrauterine device
4%
5%
6%
6%
7%
7%
8%
8%
9%
9%
9%
Moderately Effectivea
Hormonal injectionb
Vaginal ring
13%
13%
14%
15%
15%
16%
16%
15%
14%
14%
15%
3%
4%
4%
4%
3%
3%
3%
2%
2%
2%
2%
Contraceptive patch
2%
2%
2%
2%
2%
2%
1%
1%
1%
1%
1%
35%
35%
33%
32%
31%
30%
28%
27%
25%
24%
22%
Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom
0%†
15%
2010
0%†
16%
2011
0%†
18%
2012
0%†
17%
2013
0%†
17%
2014
0%†
15%
2015
0%†
16%
2016
0%†
16%
2017
0%†
15%
2018
0%†
15%
2019
0%†
14%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Contraceptive sponge
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Withdrawal or otherc
2%
2%
2%
3%
2%
2%
2%
2%
2%
2%
3%
FAMd or LAM
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
1%
1%
Spermicide
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
1%
2%
2%
2%
2%
2%
2%
3%
3%
3%
3%
8%
8%
8%
9%
9%
9%
9%
9%
9%
8%
8%
5%
5%
5%
4%
4%
5%
5%
5%
5%
6%
6%
6%
3%
2%
2%
3%
3%
3%
3%
3%
5%
5%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Using Most, Moderately, or Less
Effective Method
Most effectivea
Moderately effectivea
Less effectivea
Abstinent
79%
7%
54%
18%
1%
82%
8%
54%
19%
2%
84%
9%
53%
21%
2%
83%
11%
53%
20%
2%
83%
11%
52%
19%
2%
82%
13%
51%
18%
2%
81%
15%
48%
18%
2%
80%
17%
45%
18%
3%
80%
19%
43%
18%
3%
79%
19%
41%
18%
3%
77%
19%
40%
18%
3%
Not Using a Method
14%
13%
13%
13%
13%
13%
14%
14%
14%
14%
14%
Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
A-21
FAM=fertility awareness-based method. LAM=lactational amenorrhea method. Note: Due to rounding, the percentages in each year may not sum to 100%.
a
See Table 7 comments in the Field and Methodological Notes (Appendix C).
b
Hormonal injection figures include both 1- and 3-month hormonal injection users.
c
Withdrawal/Other category includes other methods not listed separately in FPAR Table 7.
d
For 2009 through 2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2019,
the FAM category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
† Percentage is less than 0.5%.
A-22
Exhibit A–9c.
Number and distribution of all female family planning users, by type of primary contraceptive method and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibits A-9a and A-9b.
2019
Most effective, 19%
Moderately effective, 40%
2018
19%
41%
2017
19%
43%
2016
2014
51%
13%
Family Planning Annual Report: 2019 National Summary
2013
11%
2012
11%
2011
9%
53%
2010
8%
54%
2009
7%
0%
52%
53%
3.45 million
14%
3.54 million
18%
14%
3.55 million
14%
3.61 million
18%
13%
3.76 million
19%
13%
4.18 million
20%
13%
4.38 million
21%
13%
4.64 million
19%
18%
54%
2.70 million
18%
18%
48%
15%
No method, 14%
14%
18%
45%
17%
2015
Less effective, 18%
13%
14%
Most effective
Moderately effective
Less effective
Abstinence
No method
Method unknown
4.82 million
4.81 million
100%
Notes: Due to rounding, the percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of individual percentages
included in the aggregated categories. Most effective permanent methods include vasectomy (male sterilization) and female sterilization. Most effective reversible methods
include implants and intrauterine devices/systems. Moderately effective methods include injectable contraception, vaginal ring, contraceptive patch, pills, diaphragm with
spermicidal cream/jelly, and the cervical cap. Less effective methods include male condoms, female condoms, the sponge, withdrawal, fertility awareness-based (FAM) and
lactational amenorrhea (LAM) methods, spermicides, and other methods not listed in Table 7. Because of combined FPAR reporting categories (e.g., FAM and LAM, diaphragm
and cervical cap, or withdrawal and other), the FPAR data may vary slightly from the moderately and less effective method categories described in the Table 7 comments in the
Field and Methodological Notes (Appendix C).
Number and percentage of female users who received a Pap test, number of Pap tests performed, and percentage of Pap tests
performed with an ASC or higher result, by year: 2009–2019
Screening Measures
2009
Female Users Screened
Number
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2,035,017
1,727,251
1,444,418
1,237,328
988,114
785,540
743,683
687,373
649,266
625,808
541,661
42%
36%
31%
28%
24%
21%
21%
19%
18%
18%
20%
2,190,127
1,810,620
1,522,777
1,308,667
1,043,671
813,858
769,807
720,215
683,247
651,920
561,534
12%
13%
15%
14%
14%
14%
14%
14%
14%
14%
13%
Percentage
Pap Tests Performed
Number
Percentage with an ASC or
higher result
ASC=atypical squamous cells.
Number and percentage of female users who received a Pap test, by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-10a.
3.0
2.0
100%
80%
2.04
1.73
1.44
1.0
0.0
60%
1.24
0.99
42%
36%
2009
2010
31%
2011
28%
2012
24%
2013
40%
0.79
0.74
21%
21%
2014
2015
Number of female users screened (in millions)
0.69
0.65
0.63
0.54
19%
18%
18%
20%
2016
2017
2018
2019
Percentage of female users screened
20%
0%
Percentage of female users screened
Exhibit A–10b.
Number of female users screened (in
millions)
Family Planning Annual Report: 2019 National Summary
Exhibit A–10a.
A-23
Number and percentage of female users under 25 tested for chlamydia, by year: 2009–2019
Chlamydia Testing Measures
Number tested
Percentage tested
Family Planning Annual Report: 2019 National Summary
Number of female users <25 years tested
(in millions)
Exhibit A–11b.
1.5
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
1,433,829
1,442,176
1,357,231
1,268,269
1,181,534
1,011,474
955,775
953,273
939,250
900,603
644,080
55%
57%
58%
59%
60%
58%
59%
61%
61%
61%
58%
Number and percentage of female users under 25 tested for chlamydia, by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-11a.
1.43
1.44
1.36
100%
1.27
1.18
1.01
1.0
55%
57%
58%
59%
60%
58%
80%
0.96
59%
0.95
61%
0.94
0.90
61%
61%
58%
0.64
0.5
60%
40%
20%
0.0
2009
2010
2011
2012
2013
2014
Number of female users <25 years tested (in millions)
2015
2016
2017
2018
2019
0%
Percentage of female users <25 years tested
Percentage of female users <25 years
tested
A-24
Exhibit A–11a.
Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2009–2019
HIV Testing Measures
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Tests performed
997,765
1,101,665
1,283,375
1,249,867
1,187,631
1,031,624
1,113,635
1,163,883
1,192,119
1,237,968
961,859
Tests per 10 users
1.9
2.1
2.6
2.6
2.6
2.5
2.8
2.9
3.0
3.1
3.1
Tests per 10 female users
1.8
1.9
2.3
2.4
2.4
2.2
2.4
2.5
2.6
2.7
2.8
Tests per 10 male users
4.1
4.3
5.2
5.5
5.3
5.7
5.9
5.7
5.9
5.9
5.3
Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-12a.
10.0
1.5
1.28
1.0
1.00
0.0
1.25
1.10
1.19
1.03
1.11
1.16
1.19
9.0
1.24
8.0
0.96
7.0
6.0
5.2
0.5
2019
4.1
5.5
5.3
5.7
5.9
5.7
5.9
5.9
5.3
4.3
1.8
1.9
2009
2010
5.0
4.0
3.0
2.3
2.4
2.4
2.2
2.4
2.5
2011
2012
2013
2014
2015
2016
Number of tests performed (in millions)
2.6
2.7
2.8
2.0
1.0
Tests per 10 female users
2017
2018
2019
0.0
Tests per 10 male users
Tests per 10 users
Exhibit A–12b.
Number of tests performed (in millions)
Family Planning Annual Report: 2019 National Summary
Exhibit A–12a.
A-25
A-26
Exhibit A–13a.
Actual and adjusted (constant 2019$ and 2009$) total, Title X, and Medicaid revenue, by year: 2009–2019
Change
Revenue
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
2009–
2019
2018–
2019
Total
Actuala
1,231,311,085 1,293,835,909 1,286,574,610 1,260,206,935 1,284,715,163 1,243,901,947 1,244,040,899 1,305,139,649 1,297,618,121 1,321,225,497 1,036,300,250
–16%
–22%
2019$b
1,633,866,378 1,660,156,723 1,602,080,436 1,513,779,678 1,506,157,443 1,424,278,188 1,387,897,887 1,402,919,217 1,360,656,020 1,358,585,627 1,036,300,250
–37%
–24%
2009$b
1,231,311,085 1,251,123,962 1,207,356,627 1,140,811,588 1,135,067,335 1,073,361,656 1,045,944,807 1,057,265,151 1,025,414,846 1,023,854,561
780,974,505
–37%
–24%
Title X
Actuala
266,393,881
279,295,186
276,002,719
267,095,215
253,655,493
249,517,445
242,576,878
245,066,054
244,563,111
255,902,324
229,031,074
–14%
–11%
2019$b
353,486,630
358,371,396
343,686,680
320,838,822
297,377,286
285,699,573
270,627,707
263,426,122
256,443,913
263,138,442
229,031,074
–35%
–13%
2009$b
266,393,881
270,075,129
259,008,463
241,789,906
224,108,871
215,308,336
203,949,907
198,522,663
193,260,745
198,305,862
172,601,936
–35%
–13%
Actuala
450,028,613
482,175,678
506,887,574
499,181,475
508,494,458
493,061,463
503,186,368
505,508,702
496,501,892
521,679,227
370,902,048
–18%
–29%
2019$b
597,157,476
618,692,980
631,191,273
599,624,357
596,142,036
564,559,521
561,373,261
543,380,835
520,621,805
536,430,686
370,902,048
–38%
–31%
2009$b
450,028,613
466,258,156
475,677,094
451,887,698
449,263,359
425,462,208
423,060,985
409,501,569
392,349,955
404,263,812
279,518,453
–38%
–31%
Medicaidc
Family Planning Annual Report: 2019 National Summary
a
Revenue is shown in actual dollars (unadjusted) for each year.
b
Revenue is shown in constant 2019 dollars (2019$) and 2009 dollars (2009$), based on the consumer price index for medical care, which includes medical care commodities and medical care
services (Source: U.S. Department of Labor, Bureau of Labor Statistics, http://data.bls.gov/cgi-bin/srgate).
c
Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
Total, Title X, and Medicaid adjusted (constant 2019$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$1,800
$1,600
Total revenue (in millions)
Family Planning Annual Report: 2019 National Summary
Exhibit A–13b.
$1,634
$1,400
$1,200
$1,000
$1,036
$800
$600
$597
$371
$400
$200
$0
$353
$229
2009
2010
2011
2012
2013
Total revenue
2014
Medicaid
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
2015
2016
Title X
2017
2018
2019
A-27
A-28
Exhibit A–13c.
Total actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$1,800
Total revenue (in millions)
$1,600
$1,634
$1,400
$1,200
$1,231
$1,000
$1,036
$800
$781
$600
Family Planning Annual Report: 2019 National Summary
$400
$200
$0
2009
2010
2011
Actual (unadjusted)
2012
2013
2014
2015
2016
Adjusted (2019$) Total Revenue
2017
2018
2019
Adjusted (2009$)
Title X actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$700
$600
Title X revenue (in millions)
Family Planning Annual Report: 2019 National Summary
Exhibit A–13d.
$500
$400
$353
$300
$200
$229
$266
$173
$100
$0
2009
2010
2011
2012
Actual (unadjusted)
2013
2014
2015
Adjusted (2019$)
2016
2017
2018
Adjusted (2009$)
2019
A-29
A-30
Exhibit A–13e.
Medicaid actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$700
Family Planning Annual Report: 2019 National Summary
Medicaid revenue (in millions)
$600
$597
$500
$400
$450
$371
$300
$280
$200
$100
$0
2009
2010
2011
2012
Actual (unadjusted)
2013
2014
2015
Adjusted (2019$)
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
2016
2017
2018
Adjusted (2009$)
2019
This page intentionally left blank.
Family Planning Annual Report: 2019 National Summary
A-31
A-32
Exhibit A–14a.
Amount of Title X project revenue, by revenue source and year: 2009–2019
Revenue Sources
Title X
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
266,393,881
279,295,186
276,002,719
267,095,215
253,655,493
249,517,445
242,576,878
245,066,054
244,563,111
255,902,324
229,031,074
Payment for Services
Client fees
80,940,857
84,540,815
72,156,363
70,400,120
69,425,823
53,170,034
47,872,483
52,876,599
52,367,880
54,674,193
40,051,795
Third-party payers
Medicaid
449,834,131
481,262,633
506,608,330
498,739,261
505,709,855
490,470,842
501,418,354
504,313,859
495,245,884
519,967,258
369,512,175
Medicare
843,164
1,913,519
2,002,181
1,173,110
1,864,987
3,083,719
4,731,999
3,945,295
7,169,121
7,168,217
8,023,568
CHIP
194,482
913,045
279,244
442,214
2,784,603
2,590,621
1,768,014
1,194,843
1,256,008
1,711,969
1,389,873
Other
4,903,482
2,466,949
4,088,072
3,743,183
10,848,382
10,202,966
14,230,460
10,540,646
11,445,695
12,052,800
12,299,248
Private
48,445,935
50,409,637
51,655,083
63,955,467
69,210,207
95,138,355
104,000,648
132,617,104
140,145,229
147,295,805
107,498,387
585,162,051
621,506,598
636,789,273
638,453,355
659,843,857
654,656,537
674,021,958
705,488,346
707,629,817
742,870,242
538,775,046
Other Revenue
MCH block grant
21,044,962
21,205,336
25,512,030
24,439,148
19,852,391
23,095,828
18,485,003
16,526,644
12,960,533
17,488,306
16,956,909
SS block grant
30,841,136
34,001,848
23,736,983
11,229,640
8,805,626
5,601,590
4,711,602
4,285,521
4,547,979
5,972,937
6,105,713
TANF
15,580,002
14,475,023
14,517,155
13,548,818
13,268,175
10,570,729
5,347,682
7,797,115
6,385,879
5,136,717
6,077,922
State government
153,830,395
135,464,470
125,392,165
117,468,476
131,054,838
120,974,720
119,983,576
133,484,660
119,036,286
134,279,658
109,977,858
Local government
84,666,243
91,289,586
84,214,372
87,010,991
93,770,370
80,388,864
73,018,511
66,637,455
69,199,630
43,605,003
30,059,604
Subtotal
Family Planning Annual Report: 2019 National Summary
BPHC
4,965,372
4,090,546
5,289,075
4,625,737
11,461,645
10,080,722
12,468,766
14,319,221
21,389,246
19,194,743
15,487,598
Other
68,827,043
92,507,316
95,120,838
96,335,555
93,002,768
89,015,512
93,426,923
111,534,633
111,905,640
96,775,567
83,828,526
379,755,153
393,034,125
373,782,618
354,658,365
371,215,813
339,727,965
327,442,063
354,585,249
345,425,193
322,452,931
268,494,130
Subtotal
Total Revenue
Actual
1,231,311,085 1,293,835,909 1,286,574,610 1,260,206,935 1,284,715,163 1,243,901,947 1,244,040,899 1,305,139,649 1,297,618,121 1,321,225,497 1,036,300,250
2019$a
1,633,866,378 1,660,156,723 1,602,080,436 1,513,779,678 1,506,157,443 1,424,278,188 1,387,897,887 1,402,919,217 1,360,656,020 1,358,585,627 1,036,300,250
2009$a
1,231,311,085 1,251,123,962 1,207,356,627 1,140,811,588 1,135,067,335 1,073,361,656 1,045,944,807 1,057,265,151 1,025,414,846 1,023,854,561
780,974,505
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy Families.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
Total revenue is shown in constant 2019 dollars (2019$) and 2009 dollars (2009$), based on the consumer price index for medical care, which includes medical care commodities and medical
care services (Source: U.S. Department of Labor, Bureau of Labor Statistics, http://data.bls.gov/cgi-bin/srgate).
a
Family Planning Annual Report: 2019 National Summary
Exhibit A–14b.
Distribution of Title X project revenue, by revenue source and year: 2009–2019
Revenue Sources
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Title X
22%
22%
21%
21%
20%
20%
19%
19%
19%
19%
22%
Payment for Services
Client fees
7%
7%
6%
6%
5%
4%
4%
4%
4%
4%
4%
Third-party payers
Medicaid
37%
37%
39%
40%
39%
39%
40%
39%
38%
39%
36%
Medicare
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
1%
1%
1%
CHIP
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Other
0%†
0%†
0%†
0%†
1%
1%
1%
1%
1%
1%
1%
Private
4%
4%
4%
5%
5%
8%
8%
10%
11%
11%
10%
Subtotal
48%
48%
49%
51%
51%
53%
54%
54%
55%
56%
52%
2%
2%
2%
2%
2%
2%
1%
1%
1%
1%
2%
Other Revenue
MCH block grant
SS block grant
3%
3%
2%
1%
1%
0%†
0%†
0%†
0%†
0%†
1%
TANF
1%
1%
1%
1%
1%
1%
0%†
1%
0%†
0%†
1%
State government
12%
10%
10%
9%
10%
10%
10%
10%
9%
10%
11%
Local government
7%
7%
7%
7%
7%
6%
6%
5%
5%
3%
3%
BPHC
0%†
0%†
0%†
0%†
1%
1%
1%
1%
2%
1%
1%
Other
6%
7%
7%
8%
7%
7%
8%
9%
9%
7%
8%
Subtotal
31%
30%
29%
28%
29%
27%
26%
27%
27%
24%
26%
Total Revenue
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy
Families.
Note: Due to rounding, percentages in each year may not sum to 100%.
† Percentage is less than 0.5%.
A-33
A-34
Exhibit A–14c.
2019
Amount (unadjusted) and distribution of Title X project revenue, by revenue source and year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibits A-14a and 14b.
Title X, 22%
10%
Medicaid, 36%
2018
19%
2017
19%
38%
11%
2016
19%
39%
10%
2015
19%
40%
8%
2014
20%
40%
8%
2013
20%
40%
14%
5%
Family Planning Annual Report: 2019 National Summary
2012
21%
40%
5%
2011
21%
39%
4%
2010
22%
37%
2009
22%
37%
4%
4%
$1.04 billion
17%
$1.32 billion
15%
18%
$1.30 billion
15%
17%
$1.31 billion
16%
$1.24 billion
16%
$1.24 billion
13%
11%
39%
Other, 18%
16%
16%
18%
18%
$1.28 billion
16%
18%
$1.26 billion
19%
$1.29 billion
18%
20%
$1.29 billion
19%
19%
$1.23 billion
16%
0%
100%
Title X
Medicaid
Private third party
State/local government
Other
Notes: Medicaid revenue includes separately reported Children’s Health Insurance Program (CHIP) revenue. The Other revenue category includes revenue from the Bureau of Primary
Health Care and other federal grants; other public and private third parties; block grants; Temporary Assistance for Needy Families revenue; and revenue reported as Other in the
FPAR revenue table. Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories (e.g., Medicaid plus CHIP) may not
match the sum of the individual percentages that are included in the aggregated categories.
Appendix B
State Exhibits
Family Planning Annual Report: 2019 National Summary
B-1
Exhibit B–1.
Number and distribution of all family planning users, by sex and state, and distribution of all
users, by state: 2019 (Source: FPAR Table 1)
State
Alabama
Female
Male
Total
Female
Male
71,324
91
71,415
100%
Alaska
3,793
949
4,742
80%
20%
0%†
Arizona
20,859
5,556
26,415
79%
21%
1%
Arkansas
42,843
92
42,935
100%
California
532,416
80,177
612,593
87%
13%
20%
Colorado
43,774
9,840
53,614
82%
18%
2%
Connecticut
27,552
4,545
32,097
86%
14%
1%
Delaware
16,672
3,243
19,915
84%
16%
1%
District of Columbia
43,050
17,987
61,037
71%
29%
2%
Florida
104,309
6,216
110,525
94%
6%
4%
Georgia
119,711
50,234
169,945
70%
30%
5%
Hawaii
4,767
244
5,011
95%
5%
0%†
Idaho
12,455
1,470
13,925
89%
11%
0%†
Illinois
71,340
8,098
79,438
90%
10%
3%
Indiana
18,889
2,081
20,970
90%
10%
1%
Iowa
25,106
2,271
27,377
92%
8%
1%
Kansas
18,044
2,417
20,461
88%
12%
1%
Kentucky
35,518
7,339
42,857
83%
17%
1%
Louisiana
38,691
12,983
51,674
75%
25%
2%
Maine
12,780
2,314
15,094
85%
15%
0%†
Maryland
34,558
4,298
38,856
89%
11%
1%
Massachusetts
46,154
8,056
54,210
85%
15%
2%
Michigan
47,485
6,527
54,012
88%
12%
2%
Minnesota
30,302
6,124
36,426
83%
17%
1%
Mississippi
33,784
1,336
35,120
96%
4%
1%
Missouri
33,352
4,264
37,616
89%
11%
1%
Montana
11,971
2,146
14,117
85%
15%
0%†
Nebraska
20,573
4,336
24,909
83%
17%
1%
Nevada
11,156
1,357
12,513
89%
11%
0%†
8,663
1,158
9,821
88%
12%
0%†
New Jersey
72,411
10,319
82,730
88%
12%
3%
New Mexico
11,186
695
11,881
94%
6%
0%†
182,235
25,431
207,666
88%
12%
7%
New Hampshire
New York
† Percentage is less than 0.5%.
B-2
0%†
State Users as %
of All Users
0%†
2%
1%
(continued)
Family Planning Annual Report: 2019 National Summary
Exhibit B–1.
Number and distribution of all family planning users, by sex and state, and distribution of all
users, by state: 2019 (Source: FPAR Table 1) (continued)
State
Female
Male
Total
Female
Male
State Users as
% of All Users
North Carolina
84,843
663
85,506
99%
1%
3%
North Dakota
4,475
1,183
5,658
79%
21%
0%†
Ohio
68,669
13,207
81,876
84%
16%
3%
Oklahoma
37,645
563
38,208
99%
1%
1%
Oregon
33,004
888
33,892
97%
3%
1%
Pennsylvania
147,022
22,732
169,754
87%
13%
5%
Rhode Island
22,308
6,598
28,906
77%
23%
1%
South Carolina
55,908
14,194
70,102
80%
20%
2%
South Dakota
4,411
431
4,842
91%
9%
0%†
60,847
2,282
63,129
96%
4%
2%
154,740
21,957
176,697
88%
12%
6%
15,984
3,896
19,880
80%
20%
1%
Vermont
4,883
726
5,609
87%
13%
0%†
Virginia
33,480
1,385
34,865
96%
4%
1%
Washington
61,866
6,548
68,414
90%
10%
2%
West Virginia
44,418
5,654
50,072
89%
11%
2%
Wisconsin
19,088
3,298
22,386
85%
15%
1%
Wyoming
5,541
1,162
6,703
83%
17%
0%†
Territories & FAS
American Samoa
1,461
117
1,578
93%
7%
0%†
Comm. of the Northern
Mariana Islands
1,344
1
1,345
100%
0%†
0%†
Federated States of
Micronesia
3,159
679
3,838
82%
18%
0%†
14
0
14
100%
0%
0%†
13,153
2,498
15,651
84%
16%
1%
1,849
20
1,869
99%
1%
0%†
874
97
971
90%
10%
0%†
1,843
141
1,984
93%
7%
0%†
2,690,552
405,114
3,095,666
87%
13%
70%–100%
0%–30%
Tennessee
Texas
Utah
Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range
100%
0%†–20%
FAS=Freely Associated States.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
B-3
Exhibit B–2.
Number and distribution of all family planning users, by user income level and state: 2019
(Source: FPAR Table 4)
State
Alabama
Under
101%
101%
to 250%
Over
250%
UK/NR
Total
Under
101%
101%
to 250%
Over
250%
UK/NR
38,725
13,794
1,317
17,579
71,415
54%
19%
2%
25%
Alaska
2,114
1,831
764
33
4,742
45%
39%
16%
1%
Arizona
16,294
6,904
1,934
1,283
26,415
62%
26%
7%
5%
Arkansas
32,077
9,925
932
1
42,935
75%
23%
2%
0%†
California
422,928
133,654
20,354
35,657
612,593
69%
22%
3%
6%
Colorado
38,387
12,062
3,165
0
53,614
72%
22%
6%
0%
Connecticut
15,353
14,438
2,020
286
32,097
48%
45%
6%
1%
Delaware
11,874
4,900
587
2,554
19,915
60%
25%
3%
13%
District of Columbia
38,729
15,052
3,086
4,170
61,037
63%
25%
5%
7%
Florida
64,341
28,724
14,408
3,052
110,525
58%
26%
13%
3%
Georgia
108,289
28,868
26,455
6,333
169,945
64%
17%
16%
4%
Hawaii
3,504
895
270
342
5,011
70%
18%
5%
7%
Idaho
8,247
4,949
725
4
13,925
59%
36%
5%
0%†
Illinois
64,823
12,241
2,285
89
79,438
82%
15%
3%
0%†
Indiana
14,228
5,665
1,068
9
20,970
68%
27%
5%
0%†
Iowa
15,891
6,060
2,042
3,384
27,377
58%
22%
7%
12%
Kansas
11,847
6,408
1,542
664
20,461
58%
31%
8%
3%
Kentucky
30,732
8,178
1,956
1,991
42,857
72%
19%
5%
5%
Louisiana
34,714
11,328
1,865
3,767
51,674
67%
22%
4%
7%
5,051
6,534
3,404
105
15,094
33%
43%
23%
1%
Maryland
26,821
6,014
1,061
4,960
38,856
69%
15%
3%
13%
Massachusetts
34,131
15,220
3,879
980
54,210
63%
28%
7%
2%
Michigan
28,335
19,241
6,331
105
54,012
52%
36%
12%
0%†
Minnesota
18,759
11,177
6,203
287
36,426
51%
31%
17%
1%
Mississippi
19,833
3,528
260
11,499
35,120
56%
10%
1%
33%
Missouri
20,697
10,286
6,633
0
37,616
55%
27%
18%
0%
Montana
6,098
5,026
2,620
373
14,117
43%
36%
19%
3%
Nebraska
15,247
6,047
2,911
704
24,909
61%
24%
12%
3%
Nevada
6,420
4,986
980
127
12,513
51%
40%
8%
1%
New Hampshire
4,151
3,714
1,921
35
9,821
42%
38%
20%
0%†
New Jersey
44,189
33,605
3,156
1,780
82,730
53%
41%
4%
2%
New Mexico
10,609
1,117
56
99
11,881
89%
9%
0%†
1%
133,166
50,512
22,815
1,173
207,666
64%
24%
Maine
New York
UK/NR=unknown or not reported.
† Percentage is less than 0.5%.
B-4
11%
1%
(continued)
Family Planning Annual Report: 2019 National Summary
Exhibit B–2.
Number and distribution of all family planning users, by user income level and state: 2019
(Source: FPAR Table 4) (continued)
State
Under
101%
101%
to 250%
Over
250%
UK/NR
Total
Under
101%
101%
to 250%
Over
250%
UK/NR
North Carolina
59,490
19,234
3,248
3,534
85,506
70%
22%
4%
4%
North Dakota
2,320
1,868
1,283
187
5,658
41%
33%
23%
3%
Ohio
36,061
29,150
11,880
4,785
81,876
44%
36%
15%
6%
Oklahoma
26,018
11,135
969
86
38,208
68%
29%
3%
0%†
Oregon
19,706
11,627
2,551
8
33,892
58%
34%
8%
0%†
Pennsylvania
99,905
43,984
18,813
7,052
169,754
59%
26%
11%
4%
Rhode Island
12,963
4,157
5,128
6,658
28,906
45%
14%
18%
23%
South Carolina
42,691
17,046
10,365
0
70,102
61%
24%
15%
0%
South Dakota
3,132
1,184
526
0
4,842
65%
24%
11%
0%
48,316
12,526
1,887
400
63,129
77%
20%
3%
1%
137,540
28,965
3,237
6,955
176,697
78%
16%
2%
4%
14,265
4,405
1,210
0
19,880
72%
22%
6%
0%
Vermont
2,077
2,161
1,363
8
5,609
37%
39%
24%
0%†
Virginia
20,501
9,380
1,205
3,779
34,865
59%
27%
3%
11%
Washington
36,070
21,531
9,164
1,649
68,414
53%
31%
13%
2%
West Virginia
23,238
9,864
1,187
15,783
50,072
46%
20%
2%
32%
Wisconsin
10,304
6,482
2,197
3,403
22,386
46%
29%
10%
15%
Wyoming
3,394
1,955
1,354
0
6,703
51%
29%
20%
0%
Territories & FAS
American Samoa
1,567
0
0
11
1,578
99%
0%
0%
1%
Comm. of the Northern
Mariana Islands
1,091
82
18
154
1,345
81%
6%
1%
11%
Federated States of
Micronesia
3,834
0
0
4
3,838
100%
0%
0%
0%†
13
1
0
0
14
93%
7%
0%
0%
13,362
1,760
342
187
15,651
85%
11%
2%
1%
1,869
0
0
0
1,869
100%
0%
0%
0%
651
183
13
124
971
67%
19%
1%
13%
1,894
78
12
0
1,984
95%
4%
1%
0%
1,968,876
741,641
226,957
158,192
3,095,666
64%
24%
7%
5%
Tennessee
Texas
Utah
Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range
33%–100% 0%–45% 0%–24% 0%–33%
UK/NR=unknown or not reported. FAS=Freely Associated States.
Notes: Due to rounding, the percentages may not sum to 100%. Title X-funded agencies report user income as a percentage of
poverty based on guidelines issued by the U.S. Department of Health and Human Services (HHS). Each year, HHS
announces updates to its poverty guidelines in the Federal Register and on the HHS Website at http://aspe.hhs.gov/poverty/.
†
Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
B-5
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2019 (Source:
FPAR Table 5)
State
Alabama
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
19,133
12,309
39,973
0
71,415
27%
17%
56%
0%
Alaska
1,148
1,891
1,703
0
4,742
24%
40%
36%
0%
Arizona
3,841
5,353
17,221
0
26,415
15%
20%
65%
0%
Arkansas
15,114
17,821
10,000
0
42,935
35%
42%
23%
0%
California
276,757
44,302
282,476
9,058
612,593
45%
7%
46%
1%
Colorado
18,926
8,347
25,666
675
53,614
35%
16%
48%
1%
Connecticut
15,290
10,596
6,207
4
32,097
48%
33%
19%
0%†
6,837
5,139
6,987
952
19,915
34%
26%
35%
5%
District of Columbia
43,839
5,978
11,220
0
61,037
72%
10%
18%
0%
Florida
57,025
21,701
30,954
845
110,525
52%
20%
28%
1%
Georgia
47,962
60,712
61,080
191
169,945
28%
36%
36%
0%†
Hawaii
2,568
1,452
979
12
5,011
51%
29%
20%
0%†
Idaho
2,299
2,023
8,881
722
13,925
17%
15%
64%
5%
Illinois
29,498
20,397
28,525
1,018
79,438
37%
26%
36%
1%
Indiana
4,410
4,777
11,783
0
20,970
21%
23%
56%
0%
Iowa
9,989
9,887
7,112
389
27,377
36%
36%
26%
1%
Kansas
2,410
3,863
14,111
77
20,461
12%
19%
69%
0%†
Kentucky
18,529
6,838
15,829
1,661
42,857
43%
16%
37%
4%
Louisiana
29,425
7,280
14,915
54
51,674
57%
14%
29%
0%†
3,921
6,944
3,442
787
15,094
26%
46%
23%
5%
Maryland
11,956
8,480
17,179
1,241
38,856
31%
22%
44%
3%
Massachusetts
26,871
16,958
10,300
81
54,210
50%
31%
19%
0%†
Michigan
16,897
14,920
22,127
68
54,012
31%
28%
41%
0%†
Minnesota
14,962
7,104
14,360
0
36,426
41%
20%
39%
0%
Mississippi
11,400
3,347
20,315
58
35,120
32%
10%
58%
0%†
Missouri
6,824
10,238
20,554
0
37,616
18%
27%
55%
0%
Montana
3,322
6,400
4,117
278
14,117
24%
45%
29%
2%
Nebraska
3,215
5,615
15,745
334
24,909
13%
23%
63%
1%
Nevada
3,200
2,594
6,716
3
12,513
26%
21%
54%
0%†
New Hampshire
3,438
4,176
2,118
89
9,821
35%
43%
22%
1%
New Jersey
31,902
15,226
35,518
84
82,730
39%
18%
43%
0%†
New Mexico
3,156
1,196
7,516
13
11,881
27%
10%
63%
0%†
103,334
48,296
53,361
2,675
207,666
50%
23%
26%
1%
Delaware
Maine
New York
UK/NR=unknown or not reported.
† Percentage is less than 0.5%.
B-6
(continued)
Family Planning Annual Report: 2019 National Summary
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2019 (Source:
FPAR Table 5) (continued)
State
North Carolina
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
30,593
11,304
41,706
1,903
85,506
36%
13%
49%
2%
467
2,991
2,194
6
5,658
8%
53%
39%
0%†
30,843
22,807
27,845
381
81,876
38%
28%
34%
0%†
6,684
5,789
25,735
0
38,208
17%
15%
67%
0%
Oregon
11,606
5,357
16,873
56
33,892
34%
16%
50%
0%†
Pennsylvania
76,435
50,121
38,122
5,076
169,754
45%
30%
22%
3%
Rhode Island
17,142
8,033
3,668
63
28,906
59%
28%
13%
0%†
South Carolina
22,949
23,098
24,055
0
70,102
33%
33%
34%
0%
355
1,765
2,659
63
4,842
7%
36%
55%
1%
Tennessee
20,637
7,346
35,131
15
63,129
33%
12%
56%
0%†
Texas
32,212
13,243
129,657
1,585
176,697
18%
7%
73%
1%
745
5,564
13,571
0
19,880
4%
28%
68%
0%
Vermont
2,746
2,550
284
29
5,609
49%
45%
5%
1%
Virginia
9,522
5,157
20,003
183
34,865
27%
15%
57%
1%
Washington
28,371
24,809
14,454
780
68,414
41%
36%
21%
1%
West Virginia
15,661
10,342
13,088
10,981
50,072
31%
21%
26%
22%
Wisconsin
12,380
2,370
4,857
2,779
22,386
55%
11%
22%
12%
392
2,064
4,159
88
6,703
6%
31%
62%
1%
0
0
1,575
3
1,578
0%
0%
100%
0%†
Comm. of the Northern
Mariana Islands
646
278
398
23
1,345
48%
21%
30%
2%
Federated States of
Micronesia
542
1
3,105
190
3,838
14%
81%
5%
8
2
3
1
14
57%
14%
21%
7%
14,447
561
599
44
15,651
92%
4%
4%
0%†
0
0
1,869
0
1,869
0%
0%
100%
0%
Republic of Palau
924
15
22
10
971
95%
2%
2%
1%
U.S. Virgin Islands
979
234
715
56
1,984
49%
12%
36%
3%
1,186,684
607,961
1,255,337
45,684
3,095,666
38%
20%
41%
1%
0%–53%
0%–100%
0%–22%
North Dakota
Ohio
Oklahoma
South Dakota
Utah
Wyoming
Territories & FAS
American Samoa
Guam
Puerto Rico
Republic of the Marshall
Islands
Total Users
Range
0%–95%
0%†
UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: Due to rounding, the percentages may not sum to 100%.
†
Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
B-7
Exhibit B–3b. Number and distribution of all family planning users in the 50 states and District of Columbia, by
insurance status and state according to the status of the states’ 2019 Medicaid expansion under the
Affordable Care Act (ACA): 2019 (Source: FPAR Table 5)
State
Expansion States
Alaskaa
Public
Private
Uninsured UK/NR
Total
Arizonab
Arkansasb
California
Colorado
Connecticut
Delaware
District of Columbia
Hawaii
Illinois
Indianaa,b
Iowab
Kentucky
Louisianaa
Mainea
Maryland
Massachusetts
Michigana,b
Minnesota
Montanaa,b,c
Nevada
New Hampshirea,b
New Jersey
New Mexicob
New York
North Dakota
Ohiob
Oregon
Pennsylvaniaa
Rhode Island
Vermont
Virginiaa
Washington
West Virginia
1,148
3,841
15,114
276,757
18,926
15,290
6,837
43,839
2,568
29,498
4,410
9,989
18,529
29,425
3,921
11,956
26,871
16,897
14,962
3,322
3,200
3,438
31,902
3,156
103,334
467
30,843
11,606
76,435
17,142
2,746
9,522
28,371
15,661
1,891
5,353
17,821
44,302
8,347
10,596
5,139
5,978
1,452
20,397
4,777
9,887
6,838
7,280
6,944
8,480
16,958
14,920
7,104
6,400
2,594
4,176
15,226
1,196
48,296
2,991
22,807
5,357
50,121
8,033
2,550
5,157
24,809
10,342
1,703
17,221
10,000
282,476
25,666
6,207
6,987
11,220
979
28,525
11,783
7,112
15,829
14,915
3,442
17,179
10,300
22,127
14,360
4,117
6,716
2,118
35,518
7,516
53,361
2,194
27,845
16,873
38,122
3,668
284
20,003
14,454
13,088
0
0
0
9,058
675
4
952
0
12
1,018
0
389
1,661
54
787
1,241
81
68
0
278
3
89
84
13
2,675
6
381
56
5,076
63
29
183
780
10,981
4,742
26,415
42,935
612,593
53,614
32,097
19,915
61,037
5,011
79,438
20,970
27,377
42,857
51,674
15,094
38,856
54,210
54,012
36,426
14,117
12,513
9,821
82,730
11,881
207,666
5,658
81,876
33,892
169,754
28,906
5,609
34,865
68,414
50,072
Expansion States
Subtotal
891,923
414,519
753,908
36,697
2,097,047
Range
Public
24%
15%
35%
45%
35%
48%
34%
72%
51%
37%
21%
36%
43%
57%
26%
31%
50%
31%
41%
24%
26%
35%
39%
27%
50%
8%
38%
34%
45%
59%
49%
27%
41%
31%
Private
40%
20%
42%
7%
16%
33%
26%
10%
29%
26%
23%
36%
16%
14%
46%
22%
31%
28%
20%
45%
21%
43%
18%
10%
23%
53%
28%
16%
30%
28%
45%
15%
36%
21%
43%
20%
8%–72%
7%–53%
Uninsured
UK/NR
36%
65%
23%
46%
48%
19%
35%
18%
20%
36%
56%
26%
37%
29%
23%
44%
19%
41%
39%
29%
54%
22%
43%
63%
26%
39%
34%
50%
22%
13%
5%
57%
21%
26%
0%
0%
0%
1%
1%
0%†
5%
0%
0%†
1%
0%
1%
4%
0%†
5%
3%
0%†
0%†
0%
2%
0%†
1%
0%†
0%†
1%
0%†
0%†
0%†
3%
0%†
1%
1%
1%
22%
36%
5%–65%
2%
0%–22%
UK/NR=unknown or not reported.
(continued)
a
Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted the Medicaid expansion
except for the following: Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska
(9/1/2015), Montana (1/1/2016), Louisiana (7/1/2016), Virginia (1/1/2019), and Maine (1/10/2019 with coverage retroactive to
7/2/2018). The following states adopted the Medicaid expansion after the 2019 reporting period: Idaho (1/1/2020), Utah (1/1/2020),
Nebraska (planned for 10/1/2020), Oklahoma (planned for 7/1/2021 or earlier), Missouri (planned for 7/1/2020) [see reference 25].
b
Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah have approved Section
1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law [see reference 25].
c
On April 18, 2019, the Montana Legislature passed a bill (signed by the governor on May 9, 2019) to continue the state’s expansion
program with significant changes until 2025. The approved bill directs the state to seek federal waiver authority to make several
changes to the existing expansion program, including adding a work requirement as a condition of eligibility and increasing the
premiums required of many beneficiaries. The state submitted a Section 1115 waiver proposal with these changes to CMS on
August 30, 2019 and the request is pending [see reference 25].
† Percentage is less than 0.5%.
B-8
Family Planning Annual Report: 2019 National Summary
Exhibit B–3b. Number and distribution of all family planning users in the 50 states and District of Columbia, by
insurance status and state according to the status of the states’ 2019 Medicaid expansion under
the Affordable Care Act (ACA): 2019 (Source: FPAR Table 5) (continued)
State
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
Nonexpansion States
Alabama
19,133
12,309
39,973
0
71,415
27%
17%
56%
0%
Floridad
57,025
21,701
30,954
845
110,525
52%
20%
28%
1%
Georgia
47,962
60,712
61,080
191
169,945
28%
36%
36%
0%†
Idahoa,d
2,299
2,023
8,881
722
13,925
17%
15%
64%
5%
Kansasd
2,410
3,863
14,111
77
20,461
12%
19%
69%
0%†
d
Mississippid
11,400
3,347
20,315
58
35,120
32%
10%
58%
0%†
Missouria,d
6,824
10,238
20,554
0
37,616
18%
27%
55%
0%
Nebraskaa,d
North Carolinad
Oklahomaa,d
South Carolina
South Dakotad
3,215
5,615
15,745
334
24,909
13%
23%
63%
1%
30,593
11,304
41,706
1,903
85,506
36%
13%
49%
2%
6,684
5,789
25,735
0
38,208
17%
15%
67%
0%
22,949
23,098
24,055
0
70,102
33%
33%
34%
0%
355
1,765
2,659
63
4,842
7%
36%
55%
1%
Tennessee
20,637
7,346
35,131
15
63,129
33%
12%
56%
0%†
Texas
32,212
13,243
129,657
1,585
176,697
18%
7%
73%
1%
745
5,564
13,571
0
19,880
4%
28%
68%
0%
12,380
2,370
4,857
2,779
22,386
55%
11%
22%
12%
392
2,064
4,159
88
6,703
6%
31%
62%
1%
277,215
192,351
493,143
8,660
971,369
Utaha,b,d
Wisconsind
Wyoming
Nonexpansion States
Subtotal
29%
20%
51%
7%–36%
22%–73%
38%
20%
41%
4%–72%
7%–53%
4%–55%
Range
1%
0%–12%
All States
Total
1,169,138
606,870
1,247,051
45,357
3,068,416
Range
5%–73%
1%
0%–22%
UK/NR=unknown or not reported.
Notes: Due to rounding, the percentages may not sum to 100%.
d
See reference 25 for updates on the status of Medicaid expansion in this state.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary
B-9
Exhibit B–4.
Number and distribution of female family planning users at risk of unintended pregnancy,a by
level of effectiveness of the primary method used or adopted at exit from the encounter and state:
2019 (Source: FPAR Table 7)
State
Most
Effective
Permanent
Methodsa
Most
Effective Moderately
Reversible
Effective
Methodsa
Methodsb
Less
Effective
Methodsc
Total
At Riskd
Most
Moderately
Effective
Effective
Methodsa Methodsb
Less
Effective
Methodsc
328
3,636
41,088
6,999
66,571
6%
62%
11%
Alaska
94
1,164
1,460
517
3,400
37%
43%
15%
Arizona
159
3,713
9,739
3,196
18,666
21%
52%
17%
Arkansas
2,519
7,143
20,344
3,807
36,746
26%
55%
10%
California
13,724
97,947
190,411
136,813
484,613
23%
39%
28%
Colorado
634
14,102
16,643
4,696
39,256
38%
42%
12%
1,431
5,230
11,131
4,892
25,714
26%
43%
19%
613
3,081
6,466
2,772
15,064
25%
43%
18%
District of Columbia
1,026
5,539
8,721
2,243
36,598
18%
24%
6%
Florida
1,457
13,022
52,360
11,098
84,216
17%
62%
13%
Georgia
13,266
9,974
16,906
25,145
98,920
23%
17%
25%
Hawaii
158
780
1,889
648
4,068
23%
46%
16%
Idaho
622
2,488
4,735
1,371
10,274
30%
46%
13%
Illinois
1,708
11,749
27,641
10,600
63,006
21%
44%
17%
Indiana
579
3,222
10,410
2,244
16,991
22%
61%
13%
Iowa
981
5,413
11,084
2,995
22,383
29%
50%
13%
Kansas
617
1,666
10,317
1,664
16,158
14%
64%
10%
Kentucky
992
2,482
13,085
14,304
32,217
11%
41%
44%
Louisiana
3,720
4,319
15,677
5,744
31,501
26%
50%
18%
Maine
438
3,096
5,272
1,248
11,628
30%
45%
11%
Maryland
813
5,735
13,628
6,275
31,758
21%
43%
20%
1,247
9,829
15,495
7,571
40,170
28%
39%
19%
Michigan
651
6,706
26,058
7,731
43,721
17%
60%
18%
Minnesota
284
6,308
16,337
4,832
28,256
23%
58%
17%
Mississippi
4
351
16,313
362
33,706
1%
48%
1%
Missouri
1,660
4,454
16,978
4,529
28,867
21%
59%
16%
Montana
444
3,008
5,733
1,879
11,170
31%
51%
17%
1,713
5,864
4,419
4,530
17,958
42%
25%
25%
Nevada
224
2,274
4,953
1,143
10,266
24%
48%
11%
New Hampshire
225
2,223
4,042
768
7,636
32%
53%
10%
New Jersey
1,838
8,383
30,445
18,834
65,027
16%
47%
29%
New Mexico
124
3,558
4,803
807
10,244
36%
47%
8%
3,666
35,052
68,954
34,985
159,136
24%
43%
22%
Alabama
Connecticut
Delaware
Massachusetts
Nebraska
New York
(continued)
B-10
Family Planning Annual Report: 2019 National Summary
Exhibit B–4.
Number and distribution of female family planning users at risk of unintended pregnancy,a by
level of effectiveness of the primary method used or adopted at exit from the encounter and state:
2019 (continued)
State
Most
Most
Effective
Effective Moderately
Permanent Reversible
Effective
Methodsb
Methodsb
Methodsc
Less
Effective
Methodsd
Total
At Riska
Most
Effective
Methodsb
Moderately
Effective
Methodsc
Less
Effective
Methodsd
North Carolina
730
17,180
42,366
9,402
77,683
23%
55%
12%
North Dakota
180
813
2,546
479
4,176
24%
61%
11%
Ohio
3,854
9,752
28,815
10,806
62,269
22%
46%
17%
Oklahoma
184
5,416
19,255
3,626
30,398
18%
63%
12%
Oregon
491
8,747
16,911
2,959
30,055
31%
56%
10%
Pennsylvania
6,754
17,601
51,492
26,336
130,440
19%
39%
20%
Rhode Island
2,352
3,785
5,836
3,526
17,175
36%
34%
21%
South Carolina
2,656
7,042
27,471
11,333
48,502
20%
57%
23%
South Dakota
Tennessee
Texas
88
578
3,009
316
4,163
16%
72%
8%
296
6,959
28,132
5,430
44,847
16%
63%
12%
9,705
23,133
48,957
40,115
137,816
24%
36%
29%
Utah
72
3,534
9,071
1,904
14,679
25%
62%
13%
Vermont
51
1,433
2,293
483
4,501
33%
51%
11%
Virginia
842
8,492
17,450
3,526
32,054
29%
54%
11%
Washington
746
10,988
31,293
10,562
58,910
20%
53%
18%
2,081
3,925
16,911
3,390
42,182
14%
40%
8%
Wisconsin
270
1,846
7,038
3,355
18,233
12%
39%
18%
Wyoming
265
895
2,920
850
5,229
22%
56%
16%
40
125
626
406
1,401
12%
45%
29%
1
313
805
69
1,253
25%
64%
6%
78
553
1,022
1,105
3,041
21%
34%
36%
0
0
10
4
14
0%
71%
29%
203
524
7,157
5,070
13,092
6%
55%
39%
78
440
584
7
1,279
41%
46%
1%
West Virginia
Territories & FAS
American Samoa
Comm. of the Northern
Mariana Islands
Federated States of
Micronesia
Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total Users
1
27
539
181
871
3%
62%
21%
163
76
764
622
1,775
13%
43%
35%
90,140
427,688
1,076,810
483,104
2,391,943
22%
45%
20%
0%–42%
17%–72%
1%–44%
Range
FAS=Freely Associated States.
Notes: Percentages (row) do not sum to 100% because the table does not show the percentages for female users whose method is
unknown/not reported. Because of combined FPAR reporting categories (e.g., FAM and LAM, diaphragm and cervical cap, or
withdrawal and other), the FPAR data may vary slightly from the method-effectiveness categories described in the Table 7
comments in the Field and Methodological Notes (Appendix C).
a
Female users at risk of unintended pregnancy exclude users who are pregnant, seeking pregnancy, or abstinent.
b
Most effective permanent methods include female sterilization and vasectomy (male sterilization). Most effective reversible
methods include implants and intrauterine devices/systems.
c
Moderately effective methods include injectable contraception, vaginal ring, contraceptive patch, pills, and diaphragm or cervical
cap.
d
Less effective methods include male condoms, female condoms, the sponge, withdrawal, fertility-based awareness or lactational
amenorrhea methods, and spermicides.
— Not applicable.
Family Planning Annual Report: 2019 National Summary
B-11
Exhibit B–5.
Number and percentage of female family planning users under 25 years who were tested for
chlamydia, by state: 2019 (Source: FPAR Table 11)
State
Alabama
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
24,130
31,903
76%
Alaska
1,183
1,592
74%
Arizona
8,361
9,984
84%
Arkansas
13,243
19,111
69%
California
132,918
213,359
62%
Colorado
13,180
20,400
65%
Connecticut
5,479
10,584
52%
Delaware
6,073
8,102
75%
District of Columbia
6,911
14,173
49%
Florida
16,912
41,061
41%
Georgia
17,456
36,325
48%
845
2,029
42%
Idaho
1,441
4,836
30%
Illinois
14,087
29,484
48%
Indiana
6,223
8,027
78%
Iowa
6,331
10,872
58%
Kansas
3,647
7,108
51%
Kentucky
7,072
14,903
47%
Louisiana
12,013
15,309
78%
Maine
2,940
5,757
51%
Maryland
7,159
12,721
56%
Massachusetts
9,758
18,645
52%
14,210
23,480
61%
Minnesota
9,752
16,063
61%
Mississippi
8,331
15,829
53%
Missouri
9,458
16,061
59%
Montana
4,180
6,392
65%
Nebraska
5,944
8,134
73%
Nevada
2,733
3,871
71%
New Hampshire
2,097
3,881
54%
New Jersey
15,620
26,220
60%
New Mexico
3,831
5,231
73%
42,363
72,349
59%
Hawaii
Michigan
New York
(continued)
B-12
Family Planning Annual Report: 2019 National Summary
Exhibit B–5.
Number and percentage of female family planning users under 25 years who were tested for
chlamydia, by state: 2019 (Source: FPAR Table 11) (continued)
State
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
North Carolina
16,780
29,623
57%
North Dakota
1,316
2,095
63%
Ohio
17,924
31,276
57%
Oklahoma
11,465
19,354
59%
8,155
15,015
54%
Pennsylvania
35,895
63,148
57%
Rhode Island
3,310
8,222
40%
South Carolina
17,622
23,272
76%
South Dakota
1,251
2,225
56%
Tennessee
22,972
28,987
79%
Texas
26,801
52,476
51%
Utah
1,758
9,666
18%
Vermont
1,460
2,337
62%
Virginia
8,696
12,360
70%
18,677
30,851
61%
West Virginia
5,265
18,865
28%
Wisconsin
4,605
9,371
49%
Wyoming
1,609
2,799
57%
Oregon
Washington
Territories & FAS
American Samoa
44
392
11%
Comm. of the Northern Mariana
Islands
154
553
28%
Federated States of Micronesia
280
1,172
24%
8
8
100%
1,526
6,820
22%
171
769
22%
Republic of Palau
56
271
21%
U.S. Virgin Islands
399
565
71%
644,080
1,106,288
58%
Guam
Puerto Rico
Republic of the Marshall Islands
Total Users
Range
11%–100%
FAS=Freely Associated States.
Family Planning Annual Report: 2019 National Summary
B-13
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B-14
Family Planning Annual Report: 2019 National Summary
Appendix C
Field and Methodological Notes
Family Planning Annual Report: 2019 National Summary
C-1
INTRODUCTION
This appendix presents additional information about the 2019 Family Planning Annual Report
(FPAR), including issues identified during data validation and relevant table-specific notes
from grantees and Health and Human Services (HHS) Project Officers. The notes are
organized according to the FPAR reporting table to which they apply.
FPAR COVER SHEET: GRANTEE PROFILE
Grantees—In this report, the terms “grantee” and “grant” are synonymous. If an agency has
more than one Title X service grant, and OPA requires that agency to submit a separate FPAR
for each of those grants, then that agency will appear more than once in the Title X grantee
count. In 2019, 91 agencies submitted one FPAR, three agencies submitted two FPARs, and
one agency submitted three FPARs. In general, if an agency receives multiple grants to
support Title X services in different geographic areas (e.g., different states), OPA will require
the agency to submit separate FPARs.
During 2019, 28 of the 100 grants were discontinued during the calendar year.
•
9 grants administered by 8 agencies were discontinued because the project period for
the grants had ended
•
19 grants administered by 18 agencies were discontinued because the agencies
withdrew from the program as a result of the implementation of the Final Rule. The
discontinuation of these 19 grants resulted in the withdrawal of 195 subrecipients
(700 service sites) from Title X participation.
•
Among the 72 grantees that continued their participation, 36 additional subrecipients
(245 service sites) withdrew from Title X because of the Final Rule.
For purposes of describing grantee-level changes across FPAR performance metrics, we
compare data for grantees (N=92) that were active and reported family planning users in both
2018 and 2019. Note that four grantees were active in both years but, in 2018, reported no
family planning users; therefore, we have excluded these four grantees from the 2018 vs.
2019 comparisons presented in Appendix C.
Subrecipients—Of the 92 grantees that were active in both 2018 and 2019, 62 reported no
change in the number of subrecipients, 20 reported a decrease, and 10 reported an increase.
Fourteen of the grantees that reported a decrease in subrecipients mentioned the March 2019
revisions to the Title X regulations as a reason for their withdrawal from the Title X program.
During 2019, a total of 231 subrecipients withdrew from Title X participation because of
implementation of the Final Rule.
Service Sites—Of the 92 grantees that were active in both 2018 and 2019, 46 reported no
change in the number of service sites, 27 reported a decrease, and 19 reported an increase.
Reasons given by several grantees for the change in the number of services sites included the
addition or withdrawal of subrecipients and site closures. During 2019, the number of
C-2
Family Planning Annual Report: 2019 National Summary
Title X-funded service sites was reduced by 945 sites because of implementation of the Final
Rule.
Reporting Period—Thirty-three grantees reported data for a reporting period that was less
than 12 months, 1 grantee reported data for a different 12-month period, and all others (N=66)
reported data for the 12-month period from January 1, 2019, through December 31, 2019.
FPAR TABLE 1: USERS BY AGE AND SEX
Of the 92 grantees that were active in both 2018 and 2019, 70 reported a decrease, and 22
reported an increase in the number of family planning users.
▪ Reasons given by grantees for the decrease in the number of users included site closures,
site or subrecipient withdrawal from Title X participation as a result of the change in
Title X regulations, staffing issues (e.g., difficulty filling vacancies, furlough, and difficulty
recruiting or retaining clinical services providers [CSPs]), issues related to electronic health
record (EHR) systems (e.g., implementation, programming, and data extraction), reduction
in funding, change in scope of clinical activities, decline in the number of encounters
because of increased use of long-acting reversible contraception (LARC) or increased
screening interval for cervical cancer, increased choices for care among newly insured
clients, errors (e.g., overreporting) in reporting the previous years’ data, and
weather-related disruptions in care delivery (e.g., blizzards).
▪ Reasons given by grantees for the increase in the number of users included the addition
of new subrecipients and service sites, improvements (e.g., standardization) in data
collection and reporting, increased or improved marketing (e.g., social media), increased
outreach in hard-to-reach areas or to hard-to-reach groups (e.g., males), integration of
family planning in sexually transmitted disease (STD) clinics, and increased use of mobile
clinics.
FPAR TABLE 2: FEMALE USERS BY ETHNICITY AND RACE
Female Hispanic or Latino users accounted for a disproportionate share of female users with
an unknown race. Of the 14% of total female users for whom race was unknown or not
reported in 2019, 71% self-identified as Hispanic or Latino.
▪ Reasons given by grantees for an increase in or continued high percentage of female
users with unknown race or ethnicity included client confusion about race categories,
reporting more than one race, or refusal to report race data; EHR offering an “Other” race
option; and staff failure to collect race or ethnicity data.
▪ Reasons given by grantees for a decrease in the percentage of female users with
unknown race or ethnicity included general improvements in the collection, storage, and
retrieval of race and ethnicity data and implementation of a quality improvement project
focused on improving data collection.
Family Planning Annual Report: 2019 National Summary
C-3
FPAR TABLE 3: MALE USERS BY ETHNICITY AND RACE
Male Hispanic or Latino users accounted for a disproportionate share of male users with an
unknown race. Of the 13% of total male users for whom race was unknown or not reported in
2019, 64% identified as Hispanic or Latino.
▪ Reasons given by grantees for an increase in or continued high percentage of male users
with unknown race or ethnicity included client confusion about or refusal to report race
information, the inclusion of an “Other” race option in the EHR, difficulty with a new or
changing EHR system, EHR coding errors, and staff failure to collect data.
▪ Reasons given for a decrease in the percentage of male users with unknown race or
ethnicity included improved capture of ethnicity and race data, staff training, and
improved data collection.
FPAR TABLE 4: USERS BY INCOME LEVEL
Unknown/not reported income status—Several grantees attributed the high or increased
number of family planning users with unknown or not reported income to problems with data
collection, including client (e.g., full-fee or insured clients) refusal to report income data,
failure of clinic staff to collect income data overall or in specific settings (e.g., community
settings), staff turnover, and EHR-related issues.
Several other grantees attributed the decrease in number of family planning users with
unknown or not reported income to improvements to data collection, data quality monitoring,
and staff training.
FPAR TABLE 5: USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE STATUS
Of the 92 grantees operating in both 2018 and 2019, 50 reported a decrease in the percentage
of users with health insurance, 40 reported an increase, and 2 reported no change.
▪ Reasons grantees gave for an increase in the percentage of users with health insurance
included an increase in clients newly insured through the Affordable Care Act and state
Medicaid expansion, improved collection of insurance status data (e.g., a template in the
EHR, staff training, and data quality monitoring), and on-site health insurance enrollment
assistance.
▪ Reasons grantees gave for a decrease in the percentage of users with health insurance
included targeted outreach to uninsured populations and an increase in the number of
uninsured clients seeking care.
Unknown/not reported health insurance status—Several grantees attributed the high or
increased number of family planning users with unknown or not reported health insurance
coverage status to EHR-related issues affecting insurance classification and client refusal to
report their insurance status for fear of denial of care or loss of confidentiality.
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Family Planning Annual Report: 2019 National Summary
FPAR TABLE 6: USERS WITH LIMITED ENGLISH PROFICIENCY (LEP)
Of the 92 grantees operating in both 2018 and 2019, 57 reported a decrease in the percentage
of users who are LEP, 34 reported an increase, and 1 grantee reported no change.
▪ Reasons given by grantees for the decrease in percentage of users who are LEP included
an increase in the total number of users (denominator), reluctance to seek services at
government facilities, and improved data collection.
▪ Reasons given by grantees for the increase in percentage of users who are LEP included
errors in reporting 2018 LEP data and changing client demographic characteristics.
Unknown/not reported LEP status—Several grantees attributed the high or increased
number of family planning users with unknown or not reported LEP status to errors in
documenting LEP status.
FPAR TABLE 7: FEMALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Primary method category definitions—Contraceptive methods are grouped into three
categories—most, moderately, and less effective—based on the effectiveness of each method
in preventing pregnancy under typical use conditions. These method effectiveness categories
align with the Office of Population Affairs (OPA)-developed and National Quality Forum
(NQF)-endorsed contraceptive care performance measures.17 The contraceptive care measures
are based on the following method groups or tiers defined by Trussell (2018):18
Most effective contraceptives (Tier 1) refer to methods that result in less than 1% of women
experiencing an unintended pregnancy during the first year of typical use. They include:
▪ Male sterilization/vasectomy, 0.15%
▪ Female sterilization, 0.5%
▪ Implant (Nexplanon®), 0.05%
▪ Intrauterine device (Mirena®), 0.2%
▪ Intrauterine device (Skyla®), 0.4%26
▪ Intrauterine device (Kyleena®), 0.2%27
▪ Intrauterine device (Liletta®), 0.2%28
▪ Intrauterine device (ParaGard®), 0.8%
Moderately effective contraceptives (Tier 2) refer to methods that result in between 6% and
12% of women experiencing an unintended pregnancy during the first year of typical use.
They include:
▪ Injectable (Depo-Provera®), 6%
▪ Vaginal ring (NuvaRing®), 9%
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▪ Contraceptive patch (Xulane®), 9%
▪ Combined and progestin-only pills, 9%
▪ Diaphragm (with spermicidal cream/jelly), 12%
Less effective contraceptives (Tier 3) refer to methods that result in between 18% and 28% of
women experiencing an unintended pregnancy during the first year of typical use. They
include:
▪ Sponge, nulliparous women, 12%
▪ Male condom, 18%
▪ Female condom, 21%
▪ Withdrawal, 22%
▪ Sponge, parous women, 24%
▪ Fertility awareness-based method (FAM), 24%
▪ Spermicides, 28%
Because the FPAR combines some methods into a single reporting category (e.g., FAM or
lactational amenorrhea method [LAM], diaphragm or cervical cap), the methods in two of the
three effectiveness categories may differ slightly from those listed above. We do not expect
these differences to have an impact on the findings because a limited number of Title X
clients report using the methods in these combined categories.
Please note that the methods listed under each tier and their corresponding failure rate were
updated in the 2018 publication of Contraceptive Technology (21st edition).29 In this update,
the diaphragm was the only method that changed tiers, moving from Tier 2 to Tier 3. The
diaphragm’s failure rate increased from 12% to 17%. Failure rates for other methods changed
as well. For purposes of maintaining alignment with the OPA contraceptive care performance
measures, the diaphragm was retained as a Tier 2 method based on the 2011 classification.18
Hormonal injection users—Nineteen grantees in seven regions (I, III, IV, VI, VII, VIII, and
IX) reported a total of 133 female users who relied on 1-month hormonal injections as their
primary method. One-month hormonal injection users accounted for 0.03% of the 398,894
hormonal injection users reported in 2019.
Sterilization among users under 20—No grantees reported female users under 20 relying on
female sterilization as a primary contraceptive method.
Vasectomy among users under 18—Three grantees reported three female users under 18
relying on vasectomy as their primary contraceptive method. The grantees confirmed that
these users received noncoercion counseling.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of female users with an unknown primary method to one or both of
these reasons: (1) staff capacity (e.g., inadequate training or turnover) or (2) data collection or
system problems, including inconsistent or incomplete documentation of primary method
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Family Planning Annual Report: 2019 National Summary
overall or for a specific subgroup (e.g., users relying on a third-party payer source, teens,
women over 45), data entry or extraction problems, issues related to EHR implementation or
transition, or lack of FPAR-specific data fields in the EHR.
Grantees attributed the decrease in female users with an unknown primary method to
improved data collection, a change in subrecipients’ reporting methodology, and staff
training.
FPAR TABLE 8: MALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Primary method category definitions—See note for FPAR Table 7 in above section.
Sterilization among users under 20—No grantees reported male users under 20 relying on
vasectomy as their primary contraceptive method.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of male users with an unknown primary method to one or more of
the following reasons: inconsistent or incomplete documentation of primary method overall
or for a specific subgroup (e.g., users relying on third-party payer source or clients seeking
STD testing); EHR-related issues (e.g., transition to new EHR, unstructured data field for
recording primary method, and problems retrieving data); failure to collect data for
“no method, other reason” category; and staff turnover.
Several other grantees attributed a decrease in the number of male users with an unknown
primary method to improved data collection, staff training, and technical assistance.
FPAR TABLE 9: CERVICAL CANCER SCREENING ACTIVITIES
Of the 92 grantees that submitted an FPAR in both 2018 and 2019, 48 reported a decrease in
the percentage of female users who received a Pap test, and 44 reported an increase
▪ Reasons given by grantees for the decrease in the percentage of females screened for
cervical cancer included adherence to cervical cancer screening guidelines, decreased
opportunities to screen because of a decline in annual visits by some users (e.g., LARC
users), EHR-related issues (e.g., loss of data or difficulty extracting data), clients declining
screening, better documentation of tests done elsewhere, and withdrawal of subrecipients
that performed screening.
▪ Reasons given by grantees for an increase in the percentage of females screened for
cervical cancer included improved data collection, an increase in the number of females in
need of screening, and underreporting of screening in 2018.
FPAR TABLE 10: CLINICAL BREAST EXAMS (CBES) AND REFERRALS
CBEs—Of the 92 grantees that were active in both 2018 and 2019, 66 reported a decrease in
the percentage of female users who received a CBE, and 26 reported an increase.
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▪ Reasons given by grantees for a decrease in the percentage of females who received a
CBE included adherence to breast cancer screening guidelines, a decrease in the frequency
of clients receiving other physical exams or tests during which a CBE might be performed
(e.g., physical exam), and EHR-related issues (e.g., extraction, adjustment to new system,
mapping and location of the CBE reporting field).
▪ Reasons given by grantees for an increase in the percentage of females who received a
CBE included adherence to guidelines, improved ability to identify clients needing exam,
an increase in older clients, underreporting of 2018 CBE data, and improved data
collection.
CBE-related referrals—Of the 92 grantees that submitted an FPAR in both 2018 and 2019,
52 reported an increase in the percentage of female users referred for further evaluation
following a CBE, 35 reported a decrease, and 2 reported no change.
▪ Reasons given by grantees for a decrease in the percentage of CBE-related referrals
were related to improved data collection (e.g., mapping and location of CBE reporting
fields in the EHR).
▪ Reasons given by grantees for an increase in the percentage of CBE-related referrals
included better documentation of referrals in the EHR.
FPAR TABLE 11: USERS TESTED FOR CHLAMYDIA BY AGE AND SEX
Of the 92 grantees that submitted an FPAR in both 2018 and 2019, 47 reported an increase in
the percentage of female users under 25 tested for chlamydia, and 45 reported a decrease. In
addition, 39 grantees reported an increase in the percentage of male users tested, 48 reported a
decrease, and 3 reported no change. Two of the 92 grantees that were active in both years
reported no male users in 2018.
▪ Reasons given for an increase in the chlamydia testing rate included adherence to
screening guidelines, high chlamydia prevalence in the state or service area, improved data
collection, increased staff training and awareness, and an increased number of male users at
risk for chlamydia.
▪ Reasons given for a decrease in the chlamydia testing rate included a decrease in the
number of service sites, quality issues with testing data (e.g., difficulty with data extraction
and challenges transitioning to a new EHR, limitations of paper data collection, and
inability of the subrecipient to report testing data), improved data collection resulting in
more accurate data, an increase in clients tested at non-Title X sites, and staff turnover.
FPAR TABLE 12: GONORRHEA, SYPHILIS, AND HIV TESTING BY SEX
General STD testing—Several grantees commented on reasons for the increase or decrease
in STD testing activities without specifying the type of STD test.
▪ Reasons given for the increase in STD testing included errors (underreporting) in
reporting 2018 data, improved data collection and reporting, implementation of initiatives
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Family Planning Annual Report: 2019 National Summary
to increase staff awareness and encourage STD/HIV testing, high prevalence of STDs in
the state or service area, an increase in users at high risk, an increase in male clients, and
marketing and outreach to high-risk populations to encourage STD/HIV testing.
▪ Reasons given for the decrease in STD testing included a decrease in clients, clients
declining testing, difficulty with mapping lab data to EHR data, and reporting errors.
Gonorrhea testing rate—Of the 92 grantees that submitted an FPAR in both 2018 and 2019,
47 reported a decrease in the number of gonorrhea tests per female user, and 45 reported an
increase. In addition, 49 grantees reported a decrease in the number of gonorrhea tests per
male user, 39 reported an increase, and 2 reported no change. Two grantees are excluded from
this comparison because they served no male users in 2018.
▪ Reasons given by grantees for the increase in gonorrhea testing included improved data
collection/reporting, increased gonorrhea prevalence in the service area, and an increase in
the availability of testing supplies.
▪ Reasons given by grantees for the decrease in gonorrhea testing included the withdrawal
of subrecipient agencies and service sites.
Syphilis testing rate—Of the 92 grantees that submitted an FPAR in both 2018 and 2019, 54
reported an increase in the number of syphilis tests per female user, and 38 reported a
decrease. In addition, 49 grantees reported an increase in the number of syphilis tests per male
user, 38 reported a decrease, and 3 reported no change. Two grantees are excluded from this
comparison because they served no male users in 2018.
▪ Reasons given for the increase in syphilis testing included high prevalence or an outbreak
in the service area, increased ability to test on-site, combining HIV and syphilis testing, and
underreporting of syphilis testing data in the previous year’s FPAR.
▪ A reason given for the decrease in syphilis testing was narrowing the scope of STD
testing in service sites.
Confidential HIV testing rate—Of the 92 grantees that submitted an FPAR in both 2018
and 2019, 46 grantees reported an increase in the number of confidential HIV tests per female
user, and 46 reported a decrease. In addition, 45 grantees reported an increase in the number
of confidential HIV tests per male user, 42 reported a decrease, and 3 reported no change.
Two grantees are excluded from this comparison because they served no male users in 2018.
▪ Reasons given by grantees for the increase in confidential HIV testing included increased
use of pre-exposure prophylaxis (PrEP) services, an increase in clients with risk factors
associated with misuse of opioids and other substances, and improved data
collection/reporting.
▪ Reasons given by grantees for the decrease in confidential HIV testing included clients
obtaining testing elsewhere and withdrawal of a subrecipient that had a special focus on
HIV testing.
Positive confidential HIV tests—Of the 92 grantees that submitted an FPAR in both 2018
and 2019, 34 reported a decrease in the number of positive confidential HIV tests per 1,000
tests performed, 32 reported an increase, and 24 reported no change (ratio was zero in both
Family Planning Annual Report: 2019 National Summary
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years). Two grantees are excluded from the comparison because they reported zero
confidential HIV tests in 2018.
Reasons cited by grantees for the increase in positive confidential HIV tests included an
increase in clients with risk factors associated with misuse of opioids and other substances
and improved reporting.
FPAR TABLE 13: FAMILY PLANNING ENCOUNTERS AND STAFFING
CSP full-time equivalent (FTE)—Of the 92 grantees that submitted an FPAR in both 2018
and 2019, 48 reported a decrease in the total number of CSP FTEs delivering Title X-funded
services, 39 reported an increase, and 5 reported no change.
▪ Reasons given for an increase in CSP FTEs included the addition of new subrecipients
and service sites, success in filling vacant CSP positions, and more accurate reporting of
CSP FTEs.
▪ Reasons given for a decrease in CSP FTEs included difficulty retaining or recruiting staff,
a reduction in time dedicated to service delivery because of EHR-related training, site
closures, and the withdrawal of subrecipient agencies and their sites from the Title X
program.
Physician FTEs—Of the 92 grantees that submitted an FPAR in both 2018 and 2019, 39
reported an increase in physician FTEs, 33 reported a decrease, and 9 reported no change. A
reason cited for the increase in physician FTEs was the addition of subrecipients
(e.g., federally qualified health centers) that rely more heavily on physician providers. A
reason for the decrease in physician FTEs was improved reporting of FTE data.
Midlevel clinician FTEs—Of the 92 grantees that submitted an FPAR in both 2018 and
2019, 46 reported a decrease in midlevel clinician FTEs, 37 grantees reported an increase, and
9 reported no change. In addition to the general reasons cited above for the increase in CSP
FTEs, there was a shift in staffing composition from physician to midlevel clinician FTEs.
Other CSP FTEs—Of the 92 grantees that submitted an FPAR in both 2018 and 2019, 64
reported zero other CSP FTEs in both years, 14 reported an increase, 10 reported a decrease,
and 4 reported no change.
Family planning encounters—Of the 92 grantees that submitted an FPAR in both 2018 and
2019, 67 reported a decrease in the number of total encounters, and 25 reported an increase.
▪ Reasons given for the decrease in encounters included withdrawal of subrecipients and
their service sites from the Title X program because of the change in Title X regulations, a
decline in the number of clients, lack of adequate clinic staffing, and loss of productivity
due to EHR implementation.
▪ Reasons given for the increase in encounters included the addition of new subrecipients
and service sites, an increase in clients, improved data capture, and improved workflow.
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Family Planning Annual Report: 2019 National Summary
FPAR TABLE 14: REVENUE REPORT
Total revenue (row 18)—All Regions—Of the 92 grantees that submitted an FPAR in both
2018 and 2019, 57 reported a decrease in total revenue, and 35 reported an increase.
Title X revenue (row 1)—All Regions—Title X revenue includes 2019 cash receipts or
drawdown amounts from all family planning service grants.
Medicaid revenue (row 3a)—All Regions—Medicaid revenue includes revenue from
federally approved Medicaid family planning eligibility expansions in the following 24 states:
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Region I—Connecticut, Maine, New Hampshire, and Rhode Island
Region II—New York
Region III—Maryland, Pennsylvania, and Virginia
Region IV—Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina
Region V—Indiana, Minnesota, and Wisconsin
Region VI—New Mexico and Oklahoma
Region VII—None
Region VIII—Montana and Wyoming
Region IX—California
Region X—Oregon and Washington
Note that four states (Iowa, Missouri, Texas, and Vermont) operate entirely state-funded
programs to provide family planning services.
Other revenue (rows 12 through 16)—All Regions—An illustrative list of “other” revenue
sources reported in rows 12 through 16 includes the following: Advocates for Youth; agency
contributions; applicant funds; Arizona Department of Health Services STD Control; Breast
and Cervical Cancer Early Detection Program; Breast and Cervical Cancer Project; Breast
and Cervical Cancer Services; cash; Centers for Disease Control and Prevention (CDC);
unspecified); CDC Infertility Prevention Project; Community Services Block Grant;
conference fees; DC Campaign to Prevent Teen Pregnancy; donations (private donor, clients,
corporate, individuals, restricted, and unspecified source); Early Detection Works Program;
earned and special funds; education income; EHR incentive funds; endowment; federal grant
(STD services); federal grant (Teen Pregnancy Prevention); federal grants (unspecified);
fees;; fundraising; general fund (private); Gilead; Grant in Aid; grantee subsidy; grants
(foundation, state and local government, private, general use, restricted, and unspecified
source); Health Systems Transformation Incentive; HealthyWoman Project (Breast and
Cervical Cancer Early Detection Program [BCCEDP]); HIV and STD funding; Health
Resources and Services Administration (HRSA) (Ryan White); Illinois Breast and Cervical
Cancer Program; insurance exchange; interest income; Justice Fund; Kansas Set-Off and
One-Time revenues; Kentucky Office of Refugees; LARC funding (Medicaid); local health
department carry-over funds; meaningful use funds; medical records fees; Metrocard
reimbursement; miscellaneous; Montana Cancer Screening Program; Montana STD/HIV
Program; net assets released from restrictions; One City Health; Pennsylvania Department of
Family Planning Annual Report: 2019 National Summary
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Health STD Project; Personal Responsibility Education Program grant; Planned Parenthood
Federation of America; Population Grant; Pregnancy Prevention Grant; Preventive Health and
Health Services Block Grant; program income; refunds; rental income; Revenue Recovery
and Interest Earned; Sanilac County Health Department; Sexual Risk Avoidance Education
Program grant; Sisters of St. Joseph Grant; State Farmworker Voucher Program; State
Migrant Worker Voucher Program; State of Georgia Catapult; STD and HIV prevention
testing and counseling; subcontract funding; subrecipient funding (unspecified); Teen
Pregnancy Prevention Initiative; The Right Time initiative; Tobacco Settlement; Turning
Point North Shore University Health Fund; United Nations Population Fund (UNFPA);
United Way (various); university funding (University of Kentucky Adolescent Medicine
Program); University of Wisconsin; and Workers Compensation Refund.
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Family Planning Annual Report: 2019 National Summary
Office of Population Affairs
Office of the Assistant Secretary for Health
U.S. Department of Health and Human Services
1101 Wootton Parkway, Suite 200
Rockville, MD 20852
opa.hhs.gov
| File Type | application/pdf |
| File Title | Family Planning Annual Report: 2019 National Summary |
| Subject | Title X, Office of Population Affairs, FPAR, Family Planning Annual Report, family planning, family planning services, contracep |
| Author | HHS/OPA |
| File Modified | 2020-09-18 |
| File Created | 2020-09-01 |