New Title X Regulations: Assessing the Impact on Reproductive Health

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Project Summary/Abstract The Title X Family Planning Program is a critical component of our health care safety net, providing federally- funded, low-cost contraceptive and reproductive health services for women since 1970. In August 2019, Health and Human Services (HHS) implemented significant new regulations for the program—including those that prohibit Title X-funded health centers from referring for abortion services even when requested by the patient— resulting in 1 in 5 grantees withdrawing from the program. Because Title X clients are disproportionately racial/ethnic minorities, and Title X health centers are often the only source of reproductive health care in rural areas, there is concern that this policy change will exacerbate existing racial- and geographic-related health disparities. For instance, about 45% of all pregnancies in the U.S. are unintended, but they are more common among low-income and minority women, who are also at higher risk for adverse pregnancy outcomes, including maternal morbidity and mortality. We propose to characterize the impact of this policy change on racial and geographic disparities in access to health services and health outcomes. To answer critical knowledge gaps, we propose to leverage the natural experiment occurring in Michigan, where more than half of Title X funding will need to be reallocated to different organizations or go unused. We will be guided by the following aims: (1) Characterize changes in Title X grantee profiles, spending, and geographic location in Michigan communities between 2017 and 2022. In this aim, we will specifically examine if changes differentially impact rural or minority communities. (2) Characterize changes in Title X client characteristics and health service delivery rates in Michigan counties between 2017 and 2022. In this aim, we will also adopt and examine a novel measure of reproductive health service availability and determine if rural communities or racial minorities are differentially impacted by changes. (3) Determine if the Title X policy change is associated with changes in women’s reproductive health outcomes in Michigan communities. In this final aim, we will examine health outcomes within and across geographic, income, and racial groups. We will use publicly available data collected by the Michigan Department of Health and Human Services, HHS, and the Michigan Inpatient Sample to observe changes in rates of sexually transmitted infection/HIV, low birth weight, and severe maternal morbidity in Michigan communities two years before and two years after the policy change (2017-2022).