Title X
Family Planning Annual Report
2019 National Summary
CELEBRATING TITLE X 1970–2020
September 2020
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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
ii Family Planning Annual Report: 2019 National Summary
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-planning-
annual-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.
Family Planning Annual Report: 2019 National Summary iii
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
iv Family Planning Annual Report: 2019 National Summary
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
Family Planning Annual Report: 2019 National Summary v
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
vi Family Planning Annual Report: 2019 National Summary
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
Family Planning Annual Report: 2019 National Summary vii
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
viii Family Planning Annual Report: 2019 National Summary
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
Family Planning Annual Report: 2019 National Summary ES-1
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.
ES-2 Family Planning Annual Report: 2019 National Summary
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 Rule
7,8
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
subsequently decreased to about 4 million per
year between 2012 and 2014 and remained at
about this level from 2014 to 2018
(see Exhibit A–2a). In comments
accompanying their FPAR data, grantees
attribute the annual changes in user counts to
economic factors affecting service demand or
the capacity and financial sustainability of the
network (e.g., recession, level or reduced
A family planning user is an individual who
has at least one family planning encounter at a
Title X service site during the reporting period.
A family planning encounter is a
documented, face-to-face interaction between
an individual and a family planning provider
that includes the delivery of family planning
services (alone or in conjunction with related
preventive health services) to avoid
unintended pregnancies or achieve intended
pregnancies.
Family Planning Annual Report: 2019 National Summary ES-3
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).
ES-4 Family Planning Annual Report: 2019 National Summary
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.
Family Planning Annual Report: 2019 National Summary 1
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
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.
On March 3, 2019, HHS issued a Final Rule
7,8
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.” The Final Rule affected regulations related to the range of contraceptive method
9
2 Family Planning Annual Report: 2019 National Summary
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.
FAMILY PLANNING ANNUAL REPORT
The FPAR
5
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
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: 2019 National Summary 3
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
4 Family Planning Annual Report: 2019 National Summary
▪ 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.
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.
5
Family Planning Annual Report: 2019 National Summary
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
requirements
2
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
Region
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
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% −17% 0% 0% 9% −8% 13% 20% 0% 6% 0%
Subrecipients
2019
1,060 61 68 173 271 134 46 92 62 86 67
2018
1,128 75 72 218 267 131 48 93 68 89 67
Difference
−68 −14 −4 −45 4 3 −2 −1 −6 −3 0
% Change
−6% −19% −6% −21% 1% 2% −4% −1% −9% −3% 0%
Service Sites
2019
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
% Change
−3% −12% −2% −2% 1% 2% 0%† −2% −8% −18% 3%
7
Family Planning Annual Report: 2019 National Summary
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 Ethnicity
12
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).
Com
pared 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)
Users
All
Regions
Region
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
Number
2019
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 6,375 −107,972 −12,712 −6,565 −26,334 −377,909 −36,242
% 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%
2018
100% 5% 11% 12% 16% 10% 8% 3% 3% 27% 4%
Note: Due to rounding, percentages may not sum to 100%.
9
Family Planning Annual Report: 2019 National Summary
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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11
Family Planning Annual Report: 2019 National Summary
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
Female Users
Under 15
34,021 2,067 2,425 7,659 8,503 2,434 3,268 1,208 1,227 4,063 1,167
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 44 168,118 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
Total All Users 3,095,666 145,737 308,031 374,499 648,599 295,108 321,395 110,363 104,814 666,147 120,973
12
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
1% 2% 1% 2% 2% 1% 1% 1% 1% 1% 1%
15 to 17
7% 8% 6% 8% 6% 7% 7% 8% 9% 5% 9%
18 to 19
9% 9% 9% 9% 9% 11% 9% 10% 12% 9% 11%
20 to 24
24% 22% 24% 21% 22% 27% 22% 24% 28% 26% 27%
25 to 29
21% 20% 21% 19% 20% 21% 20% 19% 18% 22% 21%
30 to 34
15% 15% 16% 15% 16% 14% 16% 14% 13% 15% 14%
35 to 39
10% 11% 11% 11% 11% 9% 12% 11% 9% 10% 9%
40 to 44
7% 7% 7% 7% 7% 5% 7% 7% 5% 7% 5%
Over 44
6% 6% 6% 8% 7% 4% 6% 6% 4% 6% 4%
Subtotal
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Male Users
Under 15
3% 5% 3% 8% 5% 1% 2% 1% 2% 2% 0%†
15 to 17
6% 10% 7% 11% 6% 3% 6% 5% 6% 5% 5%
18 to 19
7% 7% 9% 7% 5% 7% 8% 9% 7% 6% 7%
20 to 24
20% 18% 23% 17% 14% 27% 19% 28% 23% 22% 22%
25 to 29
19% 18% 20% 15% 14% 24% 18% 21% 23% 22% 21%
30 to 34
14% 13% 15% 11% 12% 15% 14% 14% 15% 15% 16%
35 to 39
9% 9% 9% 8% 10% 9% 11% 9% 9% 10% 12%
40 to 44
7% 6% 6% 6% 8% 6% 9% 5% 6% 6% 7%
Over 44
15% 13% 9% 17% 26% 9% 14% 8% 9% 11% 11%
Subtotal
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
All Users
Under 15
2% 2% 1% 3% 2% 1% 1% 1% 2% 1% 1%
15 to 17
7% 8% 6% 9% 6% 7% 6% 8% 9% 5% 9%
18 to 19
9% 9% 9% 9% 8% 10% 9% 10% 11% 8% 10%
20 to 24
23% 21% 24% 20% 21% 27% 22% 24% 27% 25% 26%
25 to 29
20% 20% 21% 18% 19% 22% 20% 19% 19% 22% 21%
30 to 34
15% 15% 16% 14% 15% 14% 15% 14% 13% 15% 14%
35 to 39
10% 11% 11% 10% 11% 9% 12% 10% 9% 10% 9%
40 to 44
7% 7% 7% 7% 7% 5% 7% 6% 5% 7% 5%
Over 44
7% 7% 7% 10% 9% 5% 7% 7% 5% 7% 4%
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Female Users
87% 84% 88% 85% 87% 87% 89% 88% 82% 87% 92%
Male Users
13% 16% 12% 15% 13% 13% 11% 12% 18% 13% 8%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
13
Family Planning Annual Report: 2019 National Summary
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)
Race
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 11,713 16,476 1,184 29,373 0%† 1% 0%† 1%
Asian 3,538 80,588 4,919 89,045 0%† 3% 0%† 3%
Black/African American 32,189 679,361 21,275 732,825 1% 22% 1% 24%
Nat Hawaiian/Pac Island 4,780 16,778 769 22,327 0%† 1% 0%† 1%
White 618,498 1,004,060 55,066 1,677,624 20% 32% 2% 54%
More than one race 61,815 42,730 5,827 110,372 2% 1% 0%† 4%
Unknown/not reported 304,268 80,235 49,597 434,100 10% 3% 2% 14%
Total All Users 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)
Race
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 10,430 14,495 922 25,847 0%† 1% 0%† 1%
Asian 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%
White 558,401 876,498 45,806 1,480,705 21% 33% 2% 55%
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
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 1,283 1,981 262 3,526 0%† 0%† 0%† 1%
Asian 415 8,357 711 9,483 0%† 2% 0%† 2%
Black/African American 5,195 115,514 4,339 125,048 1% 29% 1% 31%
Nat Hawaiian/Pac Island 663 1,709 102 2,474 0%† 0%† 0%† 1%
White 60,097 127,562 9,260 196,919 15% 31% 2% 49%
More than one race 8,761 5,228 1,127 15,116 2% 1% 0%† 4%
Unknown/not reported 33,716 11,408 7,424 52,548 8% 3% 2% 13%
Total Male Users 110,130 271,759 23,225 405,114 27% 67% 6% 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%.
15
Family Planning Annual Report: 2019 National Summary
Exhibit 9. Number of all family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Tables 2 and 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
11,713 204 1,706 1,213 2,930 863 541 351 774 2,578 553
Not Hispanic or Latino 16,476 432 777 3,596 1,424 1,329 2,645 614 1,254 2,938 1,467
Unknown/not reported 1,184 80 3 250 27 65 197 36 48 473 5
Subtotal 29,373 716 2,486 5,059 4,381 2,257 3,383 1,001 2,076 5,989 2,025
Asian
Hispanic or Latino
3,538 97 479 259 294 155 151 98 59 1,780 166
Not Hispanic or Latino 80,588 7,262 8,990 6,585 6,329 6,202 2,799 1,921 2,043 32,935 5,522
Unknown/not reported 4,919 157 49 708 105 240 41 125 84 3,401 9
Subtotal 89,045 7,516 9,518 7,552 6,728 6,597 2,991 2,144 2,186 38,116 5,697
Black or African American
Hispanic or Latino
32,189 3,617 13,245 4,088 3,354 1,484 1,671 1,078 357 2,850 445
Not Hispanic or Latino 679,361 23,267 69,710 113,297 249,330 73,131 69,557 18,757 7,152 49,854 5,306
Unknown/not reported 21,275 572 554 8,311 4,038 2,046 431 854 267 4,195 7
Subtotal 732,825 27,456 83,509 125,696 256,722 76,661 71,659 20,689 7,776 56,899 5,758
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
4,780 590 663 401 973 373 390 120 69 971 230
Not Hispanic or Latino 16,778 181 343 407 679 412 551 213 360 12,499 1,133
Unknown/not reported 769 16 3 76 74 26 6 11 25 529 3
Subtotal 22,327 787 1,009 884 1,726 811 947 344 454 13,999 1,366
White
Hispanic or Latino
618,498 19,821 55,374 34,704 108,677 28,852 139,935 22,443 24,445 169,483 14,764
Not Hispanic or Latino 1,004,060 58,361 75,943 114,356 226,554 142,231 83,238 55,116 52,775 127,168 68,318
Unknown/not reported 55,066 4,252 472 21,503 4,091 2,842 404 1,636 1,693 18,121 52
Subtotal 1,677,624 82,434 131,789 170,563 339,322 173,925 223,577 79,195 78,913 314,772 83,134
More Than One Race
Hispanic or Latino
61,815 7,177 16,445 5,863 6,577 3,574 3,913 1,325 598 15,590 753
Not Hispanic or Latino 42,730 4,272 3,405 2,295 5,237 7,931 4,344 1,680 1,155 9,198 3,213
Unknown/not reported 5,827 293 107 430 1,545 349 60 223 80 2,735 5
Subtotal 110,372 11,742 19,957 8,588 13,359 11,854 8,317 3,228 1,833 27,523 3,971
Race Unknown or Not Reported
Hispanic or Latino
304,268 9,618 48,347 34,116 14,981 15,726 2,868 2,292 8,356 155,811 12,153
Not Hispanic or Latino 80,235 3,064 10,466 14,088 6,740 4,737 888 937 2,152 30,336 6,827
Unknown/not reported 49,597 2,404 950 7,953 4,640 2,540 6,765 533 1,068 22,702 42
Subtotal 434,100 15,086 59,763 56,157 26,361 23,003 10,521 3,762 11,576 208,849 19,022
All Races
Hispanic or Latino
1,036,801 41,124 136,259 80,644 137,786 51,027 149,469 27,707 34,658 349,063 29,064
Not Hispanic or Latino 1,920,228 96,839 169,634 254,624 496,293 235,973 164,022 79,238 66,891 264,928 91,786
Unknown/not reported 138,637 7,774 2,138 39,231 14,520 8,108 7,904 3,418 3,265 52,156 123
Total All Users 3,095,666 145,737 308,031 374,499 648,599 295,108 321,395 110,363 104,814 666,147 120,973
16
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
0%† 0%† 1% 0%† 0%† 0%† 0%† 0%† 1% 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 1% 0%† 0%† 1% 1% 1% 0%† 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
1% 0%† 1% 1% 1% 1% 1% 1% 2% 1% 2%
Asian
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
3% 5% 3% 2% 1% 2% 1% 2% 2% 5% 5%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 0%†
Subtotal
3% 5% 3% 2% 1% 2% 1% 2% 2% 6% 5%
Black or African American
Hispanic or Latino
1% 2% 4% 1% 1% 1% 1% 1% 0%† 0%† 0%†
Not Hispanic or Latino 22% 16% 23% 30% 38% 25% 22% 17% 7% 7% 4%
Unknown/not reported
1% 0%† 0%† 2% 1% 1% 0%† 1% 0%† 1% 0%†
Subtotal
24% 19% 27% 34% 40% 26% 22% 19% 7% 9% 5%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 2% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
1% 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 2% 1%
White
Hispanic or Latino
20% 14% 18% 9% 17% 10% 44% 20% 23% 25% 12%
Not Hispanic or Latino
32% 40% 25% 31% 35% 48% 26% 50% 50% 19% 56%
Unknown/not reported
2% 3% 0%† 6% 1% 1% 0%† 1% 2% 3% 0%†
Subtotal
54% 57% 43% 46% 52% 59% 70% 72% 75% 47% 69%
More Than One Race
Hispanic or Latino
2% 5% 5% 2% 1% 1% 1% 1% 1% 2% 1%
Not Hispanic or Latino 1% 3% 1% 1% 1% 3% 1% 2% 1% 1% 3%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
4% 8% 6% 2% 2% 4% 3% 3% 2% 4% 3%
Race Unknown or Not Reported
Hispanic or Latino
10% 7% 16% 9% 2% 5% 1% 2% 8% 23% 10%
Not Hispanic or Latino
3% 2% 3% 4% 1% 2% 0%† 1% 2% 5% 6%
Unknown/not reported
2% 2% 0%† 2% 1% 1% 2% 0%† 1% 3% 0%†
Subtotal
14% 10% 19% 15% 4% 8% 3% 3% 11% 31% 16%
All Races
Hispanic or Latino
33% 28% 44% 22% 21% 17% 47% 25% 33% 52% 24%
Not Hispanic or Latino
62% 66% 55% 68% 77% 80% 51% 72% 64% 40% 76%
Unknown/not reported
4% 5% 1% 10% 2% 3% 2% 3% 3% 8% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
17
Family Planning Annual Report: 2019 National Summary
Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 2)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
10,430 173 1,537 1,129 2,713 771 473 292 657 2,184 501
Not Hispanic or Latino 14,495 353 672 3,094 1,276 1,102 2,517 512 1,078 2,545 1,346
Unknown/not reported 922 59 0 188 24 42 181 25 36 364 3
Subtotal 25,847 585 2,209 4,411 4,013 1,915 3,171 829 1,771 5,093 1,850
Asian
Hispanic or Latino
3,123 89 416 233 272 144 129 65 52 1,564 159
Not Hispanic or Latino 72,231 6,687 7,967 5,882 5,385 5,451 2,485 1,788 1,789 29,527 5,270
Unknown/not reported 4,208 123 44 637 69 204 35 115 70 2,905 6
Subtotal 79,562 6,899 8,427 6,752 5,726 5,799 2,649 1,968 1,911 33,996 5,435
Black or African American
Hispanic or Latino
26,994 2,897 11,644 3,159 2,979 1,272 1,429 606 279 2,336 393
Not Hispanic or Latino 563,847 19,046 59,933 91,034 210,390 61,367 56,922 15,029 4,972 40,492 4,662
Unknown/not reported 16,936 409 387 6,834 3,347 1,633 303 695 130 3,191 7
Subtotal 607,777 22,352 71,964 101,027 216,716 64,272 58,654 16,330 5,381 46,019 5,062
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
4,117 441 565 326 889 351 338 74 47 865 221
Not Hispanic or Latino 15,069 149 292 349 601 363 521 189 303 11,263 1,039
Unknown/not reported 667 13 2 70 73 21 4 8 18 455 3
Subtotal 19,853 603 859 745 1,563 735 863 271 368 12,583 1,263
White
Hispanic or Latino
558,401 17,147 50,471 30,369 99,503 26,210 127,790 21,064 21,165 150,625 14,057
Not Hispanic or Latino 876,498 48,534 66,634 101,772 200,051 123,749 74,301 49,144 42,913 106,931 62,469
Unknown/not reported 45,806 3,276 378 19,053 3,531 2,318 339 1,315 1,221 14,336 39
Subtotal 1,480,705 68,957 117,483 151,194 303,085 152,277 202,430 71,523 65,299 271,892 76,565
More Than One Race
Hispanic or Latino
53,054 6,298 13,880 4,673 5,600 3,174 3,423 1,190 496 13,673 647
Not Hispanic or Latino 37,502 3,819 2,986 1,940 4,475 6,982 3,970 1,483 957 7,893 2,997
Unknown/not reported 4,700 220 92 357 1,243 294 56 183 67 2,183 5
Subtotal 95,256 10,337 16,958 6,970 11,318 10,450 7,449 2,856 1,520 23,749 3,649
Race Unknown or Not Reported
Hispanic or Latino
270,552 8,196 42,007 29,480 13,628 14,342 2,546 2,009 7,302 139,815 11,227
Not Hispanic or Latino 68,827 2,495 8,917 11,889 6,175 4,080 753 837 1,750 25,903 6,028
Unknown/not reported 42,173 1,916 818 6,732 4,020 1,903 6,590 452 854 18,849 39
Subtotal 381,552 12,607 51,742 48,101 23,823 20,325 9,889 3,298 9,906 184,567 17,294
All Races
Hispanic or Latino
926,671 35,241 120,520 69,369 125,584 46,264 136,128 25,300 29,998 311,062 27,205
Not Hispanic or Latino 1,648,469 81,083 147,401 215,960 428,353 203,094 141,469 68,982 53,762 224,554 83,811
Unknown/not reported 115,412 6,016 1,721 33,871 12,307 6,415 7,508 2,793 2,396 42,283 102
Total All Users 2,690,552 122,340 269,642 319,200 566,244 255,773 285,105 97,075 86,156 577,899 111,118
18
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
0%† 0%† 1% 0%† 0%† 0%† 0%† 0%† 1% 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 1% 0%† 0%† 1% 1% 1% 0%† 1%
Unknown/not reported
0%† 0%† 0% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
1% 0%† 1% 1% 1% 1% 1% 1% 2% 1% 2%
Asian
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
3% 5% 3% 2% 1% 2% 1% 2% 2% 5% 5%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 0%†
Subtotal
3% 6% 3% 2% 1% 2% 1% 2% 2% 6% 5%
Black or African American
Hispanic or Latino
1% 2% 4% 1% 1% 0%† 1% 1% 0%† 0%† 0%†
Not Hispanic or Latino
21% 16% 22% 29% 37% 24% 20% 15% 6% 7% 4%
Unknown/not reported
1% 0%† 0%† 2% 1% 1% 0%† 1% 0%† 1% 0%†
Subtotal
23% 18% 27% 32% 38% 25% 21% 17% 6% 8% 5%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 2% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 2% 1%
White
Hispanic or Latino
21% 14% 19% 10% 18% 10% 45% 22% 25% 26% 13%
Not Hispanic or Latino
33% 40% 25% 32% 35% 48% 26% 51% 50% 19% 56%
Unknown/not reported
2% 3% 0%† 6% 1% 1% 0%† 1% 1% 2% 0%†
Subtotal
55% 56% 44% 47% 54% 60% 71% 74% 76% 47% 69%
More Than One Race
Hispanic or Latino
2% 5% 5% 1% 1% 1% 1% 1% 1% 2% 1%
Not Hispanic or Latino
1% 3% 1% 1% 1% 3% 1% 2% 1% 1% 3%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
4% 8% 6% 2% 2% 4% 3% 3% 2% 4% 3%
Race Unknown or Not Reported
Hispanic or Latino
10% 7% 16% 9% 2% 6% 1% 2% 8% 24% 10%
Not Hispanic or Latino
3% 2% 3% 4% 1% 2% 0%† 1% 2% 4% 5%
Unknown/not reported
2% 2% 0%† 2% 1% 1% 2% 0%† 1% 3% 0%†
Subtotal
14% 10% 19% 15% 4% 8% 3% 3% 11% 32% 16%
All Races
Hispanic or Latino
34% 29% 45% 22% 22% 18% 48% 26% 35% 54% 24%
Not Hispanic or Latino
61% 66% 55% 68% 76% 79% 50% 71% 62% 39% 75%
Unknown/not reported
4% 5% 1% 11% 2% 3% 3% 3% 3% 7% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
19
Family Planning Annual Report: 2019 National Summary
Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2019 (Source: FPAR Table 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
1,283 31 169 84 217 92 68 59 117 394 52
Not Hispanic or Latino 1,981 79 105 502 148 227 128 102 176 393 121
Unknown/not reported 262 21 3 62 3 23 16 11 12 109 2
Subtotal 3,526 131 277 648 368 342 212 172 305 896 175
Asian
Hispanic or Latino
415 8 63 26 22 11 22 33 7 216 7
Not Hispanic or Latino 8,357 575 1,023 703 944 751 314 133 254 3,408 252
Unknown/not reported 711 34 5 71 36 36 6 10 14 496 3
Subtotal 9,483 617 1,091 800 1,002 798 342 176 275 4,120 262
Black or African American
Hispanic or Latino
5,195 720 1,601 929 375 212 242 472 78 514 52
Not Hispanic or Latino 115,514 4,221 9,777 22,263 38,940 11,764 12,635 3,728 2,180 9,362 644
Unknown/not reported 4,339 163 167 1,477 691 413 128 159 137 1,004 0
Subtotal 125,048 5,104 11,545 24,669 40,006 12,389 13,005 4,359 2,395 10,880 696
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
663 149 98 75 84 22 52 46 22 106 9
Not Hispanic or Latino 1,709 32 51 58 78 49 30 24 57 1,236 94
Unknown/not reported 102 3 1 6 1 5 2 3 7 74 0
Subtotal 2,474 184 150 139 163 76 84 73 86 1,416 103
White
Hispanic or Latino
60,097 2,674 4,903 4,335 9,174 2,642 12,145 1,379 3,280 18,858 707
Not Hispanic or Latino 127,562 9,827 9,309 12,584 26,503 18,482 8,937 5,972 9,862 20,237 5,849
Unknown/not reported 9,260 976 94 2,450 560 524 65 321 472 3,785 13
Subtotal 196,919 13,477 14,306 19,369 36,237 21,648 21,147 7,672 13,614 42,880 6,569
More Than One Race
Hispanic or Latino
8,761 879 2,565 1,190 977 400 490 135 102 1,917 106
Not Hispanic or Latino 5,228 453 419 355 762 949 374 197 198 1,305 216
Unknown/not reported 1,127 73 15 73 302 55 4 40 13 552 0
Subtotal 15,116 1,405 2,999 1,618 2,041 1,404 868 372 313 3,774 322
Race Unknown or Not Reported
Hispanic or Latino
33,716 1,422 6,340 4,636 1,353 1,384 322 283 1,054 15,996 926
Not Hispanic or Latino 11,408 569 1,549 2,199 565 657 135 100 402 4,433 799
Unknown/not reported 7,424 488 132 1,221 620 637 175 81 214 3,853 3
Subtotal 52,548 2,479 8,021 8,056 2,538 2,678 632 464 1,670 24,282 1,728
All Races
Hispanic or Latino
110,130 5,883 15,739 11,275 12,202 4,763 13,341 2,407 4,660 38,001 1,859
Not Hispanic or Latino 271,759 15,756 22,233 38,664 67,940 32,879 22,553 10,256 13,129 40,374 7,975
Unknown/not reported 23,225 1,758 417 5,360 2,213 1,693 396 625 869 9,873 21
Total All Users 405,114 23,397 38,389 55,299 82,355 39,335 36,290 13,288 18,658 88,248 9,855
20
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 0%† 1%
Not Hispanic or Latino
0%† 0%† 0%† 1% 0%† 1% 0%† 1% 1% 0%† 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Subtotal
1% 1% 1% 1% 0%† 1% 1% 1% 2% 1% 2%
Asian
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
2% 2% 3% 1% 1% 2% 1% 1% 1% 4% 3%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 0%†
Subtotal
2% 3% 3% 1% 1% 2% 1% 1% 1% 5% 3%
Black or African American
Hispanic or Latino
1% 3% 4% 2% 0%† 1% 1% 4% 0%† 1% 1%
Not Hispanic or Latino
29% 18% 25% 40% 47% 30% 35% 28% 12% 11% 7%
Unknown/not reported
1% 1% 0%† 3% 1% 1% 0%† 1% 1% 1% 0%
Subtotal
31% 22% 30% 45% 49% 31% 36% 33% 13% 12% 7%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 1% 0%† 0%† 0%† 0%† 0%† 1% 0%† 2% 1%
White
Hispanic or Latino
15% 11% 13% 8% 11% 7% 33% 10% 18% 21% 7%
Not Hispanic or Latino
31% 42% 24% 23% 32% 47% 25% 45% 53% 23% 59%
Unknown/not reported
2% 4% 0%† 4% 1% 1% 0%† 2% 3% 4% 0%†
Subtotal
49% 58% 37% 35% 44% 55% 58% 58% 73% 49% 67%
More Than One Race
Hispanic or Latino
2% 4% 7% 2% 1% 1% 1% 1% 1% 2% 1%
Not Hispanic or Latino
1% 2% 1% 1% 1% 2% 1% 1% 1% 1% 2%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 0%
Subtotal
4% 6% 8% 3% 2% 4% 2% 3% 2% 4% 3%
Race Unknown or Not Reported
Hispanic or Latino
8% 6% 17% 8% 2% 4% 1% 2% 6% 18% 9%
Not Hispanic or Latino
3% 2% 4% 4% 1% 2% 0%† 1% 2% 5% 8%
Unknown/not reported
2% 2% 0%† 2% 1% 2% 0%† 1% 1% 4% 0%†
Subtotal
13% 11% 21% 15% 3% 7% 2% 3% 9% 28% 18%
All Races
Hispanic or Latino
27% 25% 41% 20% 15% 12% 37% 18% 25% 43% 19%
Not Hispanic or Latino
67% 67% 58% 70% 82% 84% 62% 77% 70% 46% 81%
Unknown/not reported
6% 8% 1% 10% 3% 4% 1% 5% 5% 11% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
21
Family Planning Annual Report: 2019 National Summary
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 regulations
2,3
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 regulations
2,3
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%
23
Family Planning Annual Report: 2019 National Summary
(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 Exhib
it 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
Exhibit 15. Number and distribution of all family planning users, by income level and region: 2019 (Source: FPAR Table 4)
Income Level
a
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
Total All Users 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%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
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
Family Planning Annual Report: 2019 National Summary
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
Private health insurance 607,961 49,257 64,317 85,217 146,655 72,375 45,329 29,603 27,131 53,997 34,080
Uninsured 1,255,337 26,019 90,193 106,599 269,043 109,497 187,823 57,522 52,366 314,364 41,911
Unknown/not reported 45,684 1,053 2,859 18,433 4,673 4,246 1,652 800 1,110 9,300 1,558
Total All Users 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%
Unknown/not reported 1% 1% 1% 5% 1% 1% 1% 1% 1% 1% 1%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
26
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 All Regions Region I Region II
a
Region III Region IV Region V Region VI Region VII Region VIII Region IX
b
Region X
LEP 461,829 22,197 71,575 52,691 73,525 19,395 68,260 12,646 14,032 117,149 10,359
Not LEP 2,583,016 123,515 236,384 304,856 545,553 272,386 253,020 97,118 90,734 548,849 110,601
Unknown/not reported 50,821 25 72 16,952 29,521 3,327 115 599 48 149 13
Total All Users 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%
Unknown/not reported 2% 0%† 0%† 5% 5% 1% 0%† 1% 0%† 0%† 0%†
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
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
Family Planning Annual Report: 2019 National Summary
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).
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.
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
■
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
■
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
■
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 delivery
14
■
Abstinence—Refers to refraining from oral, vaginal, and
anal intercourse
15
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)
Reasons for not using a method in both tables are:
■
[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.
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 regulations
2,3
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) Recommendations
16
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).
▪ By level of effectiveness in preventing
pregnancy, 19% of all female users relied
on a most effective method, 40% used a
moderately effective method, and 18%
used a less effective method
(Exhibits 18 and 19). The grouping of
methods by level of effectiveness aligns
with the OPA-developed and National
Quality Forum-endorsed performance
measures for contraceptive care.
17
See
Table 7 comments in the Field and
Methodological Notes (Appendix C) for
more information about the performance measures
17
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
Contraceptive Methods by Level of
Effectiveness in Preventing Pregnancy
18
■ Most effective: vasectomy, female
sterilization, implant, or intrauterine
device (IUD)
■ Moderately effective: injectable
contraception, vaginal ring, contraceptive
patch, pills, diaphragm, or cervical cap
■ Least effective: male condom, female
condom, sponge, withdrawal, a FAM or
lactational amenorrhea method (LAM), or
spermicide used alone
29
Family Planning Annual Report: 2019 National Summary
(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.
31
Family Planning Annual Report: 2019 National Summary
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
Female sterilization 82,472 0 0 0 815 6,061 12,996 17,776 17,024 27,800
Intrauterine device 237,073 261 6,032 14,090 52,600 55,578 44,914 32,221 19,634 11,743
Hormonal implant 190,615 2,507 19,608 24,364 54,768 40,752 25,107 14,360 6,395 2,754
Hormonal injection
398,894
a
5,416
a
42,416
a
47,043
a
94,061
a
74,387
a
56,185
a
40,642
a
23,916
a
14,828
a
Oral contraceptive 598,304 5,613 50,361 71,585 171,203 123,173 80,191 49,638 28,169 18,371
Contraceptive patch 32,714 379 3,034 3,933 9,270 7,125 4,754 2,596 1,192 431
Vaginal ring 46,021 134 1,837 3,626 12,264 12,940 8,912 4,065 1,609 634
Cervical cap or diaphragm 877 2 27 42 124 194 187 151 86 64
Contraceptive sponge 377 10 27 22 50 70 75 56 40 27
Female condom 3,159 17 151 200 600 555 489 419 348 380
Spermicide (used alone) 995 2 40 74 228 196 171 122 92 70
FAM or LAM
b
17,370 102 461 864 3,236 3,789 3,234 2,394 1,604 1,686
Abstinence
c
90,729 10,911 14,701 7,312 12,849 11,075 9,049 7,548 6,061 11,223
Withdrawal or other method
d
75,253 485 2,857 4,793 15,667 15,233 12,103 8,994 6,223 8,898
Rely on Male Method
Vasectomy
7,668 0 3 44 289 724 1,393 1,891 1,643 1,681
Male condom 385,950 2,089 19,188 34,052 96,917 83,476 58,203 40,087 27,069 24,869
No Method
Pregnant/seeking pregnancy 207,880 364 5,525 15,642 56,578 57,495 40,312 22,497 7,615 1,852
Other reason 167,834 1,517 6,306 10,723 32,711 32,688 26,193 20,192 15,378 22,126
Method Unknown 146,367 4,212 8,036 10,093 28,925 27,473 20,936 16,136 11,875 18,681
Total Female Users 2,690,552 34,021 180,610 248,502 643,155 552,984 405,404 281,785 175,973 168,118
Using Most, Moderately, or
Less Effective Method
e
2,077,742 17,017 146,042 204,732 512,092 424,253 308,914 215,412 135,044 114,236
Most effective
e
517,828 2,768 25,643 38,498 108,472 103,115 84,410 66,248 44,696 43,978
Moderately effective
e
1,076,810 11,544 97,675 126,229 286,922 217,819 150,229 97,092 54,972 34,328
Less effective
e
483,104 2,705 22,724 40,005 116,698 103,319 74,275 52,072 35,376 35,930
Abstinence 90,729 10,911 14,701 7,312 12,849 11,075 9,049 7,548 6,061 11,223
Not Using a Method 375,714 1,881 11,831 26,365 89,289 90,183 66,505 42,689 22,993 23,978
Method Unknown 146,367 4,212 8,036 10,093 28,925 27,473 20,936 16,136 11,875 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).
32
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
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
Female sterilization 3% 0% 0% 0% 0%† 1% 3% 6% 10% 17%
Intrauterine device 9% 1% 3% 6% 8% 10% 11% 11% 11% 7%
Hormonal implant 7% 7% 11% 10% 9% 7% 6% 5% 4% 2%
Hormonal injection
15%
a
16%
a
23%
a
19%
a
15%
a
13%
a
14%
a
14%
a
14%
a
9%
a
Oral contraceptive 22% 16% 28% 29% 27% 22% 20% 18% 16% 11%
Contraceptive patch 1% 1% 2% 2% 1% 1% 1% 1% 1% 0%†
Vaginal ring 2% 0%† 1% 1% 2% 2% 2% 1% 1% 0%†
Cervical cap or diaphragm 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Contraceptive sponge 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Female condom 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Spermicide (used alone) 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
FAM or LAM
b
1% 0%† 0%† 0%† 1% 1% 1% 1% 1% 1%
Abstinence
c
3% 32% 8% 3% 2% 2% 2% 3% 3% 7%
Withdrawal or other method
d
3% 1% 2% 2% 2% 3% 3% 3% 4% 5%
Rely on Male Method
Vasectomy 0%† 0% 0%† 0%† 0%† 0%† 0%† 1% 1% 1%
Male condom 14% 6% 11% 14% 15% 15% 14% 14% 15% 15%
No Method
Pregnant/seeking pregnancy
8% 1% 3% 6% 9% 10% 10% 8% 4% 1%
Other reason 6% 4% 3% 4% 5% 6% 6% 7% 9% 13%
Method Unknown 5% 12% 4% 4% 4% 5% 5% 6% 7% 11%
Total Female Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or
Less Effective Method
e
77% 50% 81% 82% 80% 77% 76% 76% 77% 68%
Most effective
e
19% 8% 14% 15% 17% 19% 21% 24% 25% 26%
Moderately effective
e
40% 34% 54% 51% 45% 39% 37% 34% 31% 20%
Less effective
e
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%.
33
Family Planning Annual Report: 2019 National Summary
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
398,894
a
14,227
a
32,204 43,560
a
103,500
a
43,065 46,911
a
19,033
a
13,774
a
65,002
a
17,618
Oral contraceptive 598,304 26,105 64,633 63,635 123,952 64,027 55,737 21,714 22,730 125,063 30,708
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
Female condom 3,159 50 152 618 577 151 484 64 51 986 26
Spermicide (used alone) 995 22 36 95 206 33 475 15 11 77 25
FAM or LAM
b
17,370 450 920 940 7,379 420 2,292 304 236 4,096 333
Abstinence
c
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 method
d
75,253 2,296 6,510 4,963 25,244 4,366 14,307 1,678 1,756 9,161 4,972
Rely on Male Method
Vasectomy 7,668 561 586 1,175 1,250 530 990 349 379 1,288 560
Male condom 385,950 15,653 51,878 37,871 50,651 34,592 36,525 11,656 8,065 129,014 10,045
No Method
Pregnant/seeking pregnancy 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
Total Female Users 2,690,552 122,340 269,642 319,200 566,244 255,773 285,105 97,075 86,156 577,899 111,118
Using Most, Moderately, or
Less Effective Method
e
2,077,742 93,897 216,736 215,712 402,169 202,796 222,956 78,884 74,659 474,785 95,148
Most effective
e
517,828 31,340 49,905 56,502 80,375 46,929 59,821 22,368 24,613 120,635 25,340
Moderately effective
e
1,076,810 44,069 107,320 114,668 237,721 116,299 109,036 42,798 39,922 210,578 54,399
Less effective
e
483,104 18,488 59,511 44,542 84,073 39,568 54,099 13,718 10,124 143,572 15,409
Abstinence 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
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).
34
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Female sterilization 3% 4% 2% 3% 3% 3% 5% 5% 2% 2% 1%
Intrauterine device 9% 13% 11% 7% 5% 9% 7% 11% 16% 10% 13%
Hormonal implant 7% 8% 6% 7% 6% 6% 8% 7% 10% 8% 8%
Hormonal injection
15%
a
12%
a
12% 14%
a
18%
a
17% 16%
a
20%
a
16%
a
11%
a
16%
Oral contraceptive 22% 21% 24% 20% 22% 25% 20% 22% 26% 22% 28%
Contraceptive patch 1% 1% 2% 1% 1% 1% 1% 1% 1% 2% 2%
Vaginal ring 2% 2% 2% 2% 1% 2% 1% 1% 3% 2% 3%
Cervical cap or diaphragm 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Contraceptive sponge 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Female condom 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Spermicide (used alone) 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
FAM or LAM
b
1% 0%† 0%† 0%† 1% 0%† 1% 0%† 0%† 1% 0%†
Abstinence
c
3% 6% 3% 4% 4% 2% 4% 3% 2% 3% 3%
Withdrawal or other method
d
3% 2% 2% 2% 4% 2% 5% 2% 2% 2% 4%
Rely on Male Method
Vasectomy 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1%
Male condom 14% 13% 19% 12% 9% 14% 13% 12% 9% 22% 9%
No Method
Pregnant/seeking pregnancy
8% 7% 8% 6% 10% 7% 10% 9% 6% 6% 5%
Other reason 6% 6% 6% 7% 7% 7% 8% 4% 5% 5% 7%
Method Unknown 5% 4% 2% 16% 8% 5% 1% 2% 0%† 4% 0%†
Total Female Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or
Less Effective Method
e
77% 77% 80% 68% 71% 79% 78% 81% 87% 82% 86%
Most effective
e
19% 26% 19% 18% 14% 18% 21% 23% 29% 21% 23%
Moderately effective
e
40% 36% 40% 36% 42% 45% 38% 44% 46% 36% 49%
Less effective
e
18% 15% 22% 14% 15% 15% 19% 14% 12% 25% 14%
Abstinence 3% 6% 3% 4% 4% 2% 4% 3% 2% 3% 3%
Not Using a Method 14% 13% 14% 13% 17% 14% 17% 14% 11% 11% 12%
Method Unknown 5% 4% 2% 16% 8% 5% 1% 2% 0%† 4% 0%†
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%.
35
Family Planning Annual Report: 2019 National Summary
Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2019 (Source: FPAR Table 8)
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
Vasectomy 2,913 0 0 0 53 213 438 598 603 1,008
Male condom 225,977 1,615 12,003 18,419 56,462 50,283 33,337 20,805 12,583 20,470
FAM or LAM
a
3,747 5 52 131 550 702 576 527 426 778
Abstinence
b
35,183 8,193 8,347 2,842 2,853 2,217 1,892 1,602 1,408 5,829
Withdrawal or other method
c
12,912 175 681 744 2,107 2,134 1,815 1,578 1,123 2,555
Rely on female method
d
32,507 114 593 1,411 5,393 5,951 4,760 3,936 3,135 7,214
No Method
Partner pregnant/seeking pregnancy
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 method
e
278,056 1,909 13,329 20,705 64,565 59,283 40,926 27,444 17,870 32,025
Abstinence
b
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
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).
36
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)
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
Vasectomy 1% 0% 0% 0% 0%† 0%† 1% 2% 2% 2%
Male condom 56% 12% 47% 66% 69% 66% 61% 54% 48% 34%
FAM or LAM
a
1% 0%† 0%† 0%† 1% 1% 1% 1% 2% 1%
Abstinence
b
9% 59% 32% 10% 4% 3% 3% 4% 5% 10%
Withdrawal or other method
c
3% 1% 3% 3% 3% 3% 3% 4% 4% 4%
Rely on female method
d
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%
Using most, moderately, or less
effective method
e
69% 14% 52% 75% 79% 77% 75% 71% 68% 53%
Abstinence
b
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%
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
Family Planning Annual Report: 2019 National Summary
Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2019 (Source: FPAR Table 8)
Primary Method
All
Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Vasectomy 2,913 184 190 255 694 293 247 112 293 417 228
Male condom 225,977 11,107 27,966 22,746 30,374 25,938 19,921 8,836 10,922 62,591 5,576
FAM or LAM
a
3,747 27 43 59 1,636 19 1,595 14 14 332 8
Abstinence
b
35,183 3,820 1,647 5,382 11,832 1,597 4,580 523 877 4,026 899
Withdrawal or other method
c
12,912 537 1,345 1,247 3,726 641 1,204 608 778 1,614 1,212
Rely on female method
d
32,507 1,984 778 3,039 10,707 3,447 2,902 1,217 3,536 4,582 315
No Method
Partner pregnant/seeking pregnancy
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 method
e
278,056 13,839 30,322 27,346 47,137 30,338 25,869 10,787 15,543 69,536 7,339
Abstinence
b
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
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).
38
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)
Primary Method
All
Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Vasectomy 1% 1% 0%† 0%† 1% 1% 1% 1% 2% 0%† 2%
Male condom 56% 47% 73% 41% 37% 66% 55% 66% 59% 71% 57%
FAM or LAM
a
1% 0%† 0%† 0%† 2% 0%† 4% 0%† 0%† 0%† 0%†
Abstinence
b
9% 16% 4% 10% 14% 4% 13% 4% 5% 5% 9%
Withdrawal or other method
c
3% 2% 4% 2% 5% 2% 3% 5% 4% 2% 12%
Rely on female method
d
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% 0%† 7% 0%†
Total Male Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using most, moderately, or less
effective method
e
69% 59% 79% 49% 57% 77% 71% 81% 83% 79% 74%
Abstinence
b
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% 0%† 7% 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
Family Planning Annual Report: 2019 National Summary
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.
The 2014 Bethesda System
19
classifies squamous cell
abnormalities into the following categories:
■ 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
and cervical intraepithelial neoplasia (CIN) 1 are other
terms for referring to LSILs.
20
■ 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
■ Squamous cell carcinoma is a finding of cancer in the
squamous cells of the cervix.
20
The 2014 Bethesda System
19
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 System
19
subdivides AGCs into two categories:
– AGC (endocervical, endometrial, or glandular cells),
not otherwise specified
– 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 regulations
2,3
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).
41
Family Planning Annual Report: 2019 National Summary
Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2019 (Source: FPAR Tables 9 and 10)
Tests/Exams All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Pap Tests
Female users tested
Number
a
541,661 17,826 47,646 55,875 145,704 36,145 76,621 22,424 16,515 106,743 16,162
Percentage
b
20% 15% 18% 18% 26% 14% 27% 23% 19% 18% 15%
Tests performed
Number 561,534 17,967 48,921 59,891 149,064 36,880 81,391 22,772 18,016 110,398 16,234
Tests per female tested 1.0 1.0 1.0 1.1 1.0 1.0 1.1 1.0 1.1 1.0 1.0
Tests with ASC or higher result
Number 72,212 3,074 8,510 9,039 14,522 4,325 9,750 3,260 3,066 12,450 4,216
Percentage
c
13% 17% 17% 15% 10% 12% 12% 14% 17% 11% 26%
Tests with HSIL or higher result
Number
6,113 261 627 725 1,835 316 603 261 135 1,162 188
Percentage
c
1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
Clinical Breast Exams
Female users examined
Number
a
627,282 22,986 57,410 73,042 195,296 40,833 102,174 32,153 23,504 66,553 13,331
Percentage
b
23% 19% 21% 23% 34% 16% 36% 33% 27% 12% 12%
Female users referred based on
exam
Number 31,595 1,646 2,541 2,958 6,063 2,605 5,589 1,835 383 7,665 310
Percentage
d
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.
42
Family Planning Annual Report: 2019 National Summary
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
43
Family Planning Annual Report: 2019 National Summary
Exhibit 27. Number of family planning users 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
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
Subtotal 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
a
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
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
Over 24 837,220 35,641 82,871 98,165 178,081 80,923 88,179 28,837 23,851 195,790 24,882
Total All Users 1,577,243 66,484 153,038 181,512 319,968 159,750 163,202 58,840 51,967 365,675 56,807
a
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].)
44
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%
Subtotal 49% 43% 48% 47% 51% 50% 50% 50% 45% 52% 45%
Under 25
a
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%
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%
a
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
Family Planning Annual Report: 2019 National Summary
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.
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Gonorrhea Tests
Female
1,476,781 63,399 145,165 173,067 310,289 147,429 159,992 55,840 51,191 316,839 53,570
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
Tests per 10 Users
Female
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
Syphilis Tests
Female
516,439 13,743 27,844 64,203 171,479 27,090 78,740 14,878 4,598 109,114 4,750
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
Tests per 10 Users
Female
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
Confidential HIV Tests
Female
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
Tests per 10 Users
Female
2.8 1.9 3.0 2.7 3.3 2.3 3.8 2.1 1.5 2.6 1.2
Male 5.3 3.5 6.2 5.4 3.0 5.3 5.8 5.2 7.9 7.0 4.8
Total 3.1 2.2 3.4 3.1 3.3 2.7 4.1 2.5 2.7 3.2 1.5
Positive Test Results 3,685 97 645 409 1,345 120 471 45 144 360 49
Anonymous HIV Tests 613 30 0 14 0 95 0 166 0 230 78
48
Family Planning Annual Report: 2019 National Summary
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.
49
Family Planning Annual Report: 2019 National Summary
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
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)
FTEs and FP Encounters
All
Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Number of CSP FTEs
Physician
884.0 106.4 82.3 214.8 203.6 25.3 43.3 23.0 12.2 119.9 53.3
PA/NP/CNM 2,449.6 168.1 207.2 474.4 595.3 200.4 172.6 79.5 72.4 282.8 197.0
Other CSP
a
344.7 54.1 14.9 70.6 105.5 80.4 4.0 1.0 0.0 11.2 3.0
Total 3,678.3 328.5 304.3 759.9 904.3 306.1 219.9 103.5 84.6 413.9 253.3
Distribution of CSP FTEs
Physician
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 CSP
a
9% 16% 5% 9% 12% 26% 2% 1% 0% 3% 1%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Midlevel to Physician FTE
b
2.8 1.6 2.5 2.2 2.9 7.9 4.0 3.5 6.0 2.4 3.7
Number of FP Encounters
With CSP
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
Distribution of FP Encounters
With CSP
77% 95% 91% 88% 65% 73% 60% 67% 74% 88% 88%
With other 23% 5% 9% 12% 35% 27% 40% 33% 26% 12% 12%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
FP Encounters per User
With CSP
1.2 1.3 1.3 1.5 1.1 1.2 1.0 1.2 1.3 1.0 1.2
With other 0.3 0.1 0.1 0.2 0.6 0.4 0.7 0.6 0.5 0.1 0.2
Total 1.5 1.4 1.4 1.7 1.7 1.6 1.7 1.8 1.7 1.1 1.3
CSP Encounters per CSP FTE 979 591 1,337 739 801 1,112 1,456 1,281 1,570 1,560 566
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.
51
Family Planning Annual Report: 2019 National Summary
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:
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).
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).
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.
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.
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
53
Family Planning Annual Report: 2019 National Summary
revenue was the second or third most important revenue source in seven regions
(Exhibits 32 and 33).
Other Revenue
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).
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
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).
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).
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
Title X
$229,031,074 22%
Payment for Services
Client fees
$40,051,795
4%
Third-party payers
a
Medicaid
b
$369,512,175
36%
Medicare $8,023,568 1%
Children’s Health Insurance Program $1,389,873 0%†
Other public $12,299,248 1%
Private $107,498,387 10%
Subtotal $538,775,046 52%
Other Revenue
Maternal and Child Health block grant
$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%
Other
c
$83,828,526 8%
Subtotal $268,494,130 26%
Total Revenue
$1,036,300,250 100%
Total Revenue per User $335 —
Total Revenue per Encounter $222 —
— Not applicable.
Notes: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year. Due to rounding, percentages may
not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from federally approved Medicaid family planning eligibility expansions in 24 states in all 10 HHS regions.
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of states by region.
c
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as
“other.”
† Percentage is less than 0.5%.
55
Family Planning Annual Report: 2019 National Summary
Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2019 (Source: FPAR Table 14)
Revenue Source
All Regions
($)
Region I
($)
Region II
($)
Region III
($)
Region IV
($)
Region V
($)
Region VI
($)
Region VII
($)
Region VIII
($)
Region IX
($)
Region X
($)
Title 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
Payment for Services
Client fees
$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 payers
a
Medicaid
b
$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 $392,293 $51,650
CHIP
$1,389,873 $0 $424,602 $168,877 $482,536 $9,562 $104,464 $31,782 $168,050 $0 $0
Other public
c
$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
Private
$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
Subtotal
$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
$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
Other
d
$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
Subtotal
$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
Total Revenue $1,036,300,250 $32,996,453 $128,217,462 $101,282,212 $173,148,814 $124,499,083 $102,479,066 $36,437,342 $39,820,988 $245,446,083 $51,972,747
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
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” amounts 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.”
56
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 All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Title X
22% 29% 14% 24% 32% 25% 29% 36% 27% 13% 13%
Payment for Services
Client fees
4% 4% 4% 4% 5% 6% 1% 5% 9% 2% 4%
Third-party payers
a
Medicaid
b
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 public
c
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%
State government
11% 11% 27% 5% 11% 5% 27% 3% 8% 1% 14%
Local government
3% 0%† 1% 0%† 7% 3% 3% 1% 10% 1% 5%
BPHC
1% 1% 0%† 0%† 0%† 7% 0%† 7% 0% 2% 0%†
Other
d
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%
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
Family Planning Annual Report: 2019 National Summary
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-statute-
attachment-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-service-
grants/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-x-
service-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-instructions-
reissued-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.
59
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-2019-03-
04/pdf/2019-03461.pdf
Family Planning Annual Report: 2019 National Summary
60
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/grant-
programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-
mandates-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-1997-10-
30/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/
Family Planning Annual Report: 2019 National Summary
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/contraceptive-
care-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/STD-
Trends-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/screening-
recommendations.htm
23. U.S. Preventive Services Task Force. (2014). Gonorrhea and chlamydia:
Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/
Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-
screening
61
Family Planning Annual Report: 2019 National Summary
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-around-
expanding-medicaid-under-the-affordable-care-
act/?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/about-
kyleena/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 A-1
Appendix A
National Trend Exhibits
A-2 Family Planning Annual Report: 2019 National Summary
Exhibit A–1a. Number 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
10
10 11 11 11 12 11 11 11 12 10
II 7 7 7 7 6 6 6 6 6 8 8
III
9
9 9 9 10 10 10 10 10 12 12
IV 10 10 10 13 13 14 10 9 9 11 12
V 11 12 12 11 11 10 12 11 11 13 12
VI
8
6 6 6 7 6 6 7 6 8 9
VII 5 5 5 5 5 5 5 5 5 5 6
VIII 6 6 6 6 6 6 6 6 6 6 6
IX
16
16 17 17 18 17 17 18 17 18 19
X 7 8 8 8 8 8 8 8 8 6 6
Total 89 89 91 93 95 94 91 91 89 99 100
Subrecipients
I
69
71 72 67 66 67 71 69 68 75 61
II 89 82 80 75 71 70 70 68 68 72 68
III
222
218 230 265 271 258 316 223 225 218 173
IV 190 188 183 184 214 253 226 281 277 267 271
V 136 130 135 129 133 120 122 118 113 131 134
VI
94
90 79 78 90 45 47 41 39 48 46
VII 107 105 106 101 97 93 94 92 91 93 92
VIII 73 74 74 75 74 74 74 68 69 68 62
IX
116
104 121 113 105 95 102 99 85 89 86
X 61 60 62 61 60 59 59 58 56 67 67
Total 1,157 1,122 1,142 1,148 1,181 1,134 1,181 1,117 1,091 1,128 1,060
Service Sites
I
230
221 228 238 225 233 224 225 221 242 214
II 296 272 263 253 256 251 247 244 244 241 237
III
656
641 639 633 627 615 648 640 653 626 614
IV 1,104 1,091 1,076 1,044 1,019 1,183 936 914 912 900 910
V 373 371 392 364 362 340 383 374 365 388 394
VI
588
580 553 521 571 442 457 425 415 468 466
VII 296 289 267 251 242 223 218 221 210 202 197
VIII 185 184 179 185 182 182 177 180 162 170 157
IX
501
495 539 474 460 441 461 469 465 478 391
X 286 245 246 226 224 217 200 206 211 239 245
Total 4,515 4,389 4,382 4,189 4,168 4,127 3,951 3,898 3,858 3,954 3,825
Family Planning Annual Report: 2019 National Summary A-3
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
11% 11% 12% 12% 12% 13% 12% 12% 12% 12% 10%
II 8% 8% 8% 8% 6% 6% 7% 7% 7% 8% 8%
III 10% 10% 10% 10% 11% 11% 11% 11% 11% 12% 12%
IV 11% 11% 11% 14% 14% 15% 11% 10% 10% 11% 12%
V 12% 13% 13% 12% 12% 11% 13% 12% 12% 13% 12%
VI 9% 7% 7% 6% 7% 6% 7% 8% 7% 8% 9%
VII 6% 6% 5% 5% 5% 5% 5% 5% 6% 5% 6%
VIII 7% 7% 7% 6% 6% 6% 7% 7% 7% 6% 6%
IX 18% 18% 19% 18% 19% 18% 19% 20% 19% 18% 19%
X 8% 9% 9% 9% 8% 9% 9% 9% 9% 6% 6%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Subrecipients
I
6% 6% 6% 6% 6% 6% 6% 6% 6% 7% 6%
II 8% 7% 7% 7% 6% 6% 6% 6% 6% 6% 6%
III 19% 19% 20% 23% 23% 23% 27% 20% 21% 19% 16%
IV 16% 17% 16% 16% 18% 22% 19% 25% 25% 24% 26%
V 12% 12% 12% 11% 11% 11% 10% 11% 10% 12% 13%
VI 8% 8% 7% 7% 8% 4% 4% 4% 4% 4% 4%
VII 9% 9% 9% 9% 8% 8% 8% 8% 8% 8% 9%
VIII 6% 7% 6% 7% 6% 7% 6% 6% 6% 6% 6%
IX 10% 9% 11% 10% 9% 8% 9% 9% 8% 8% 8%
X 5% 5% 5% 5% 5% 5% 5% 5% 5% 6% 6%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Service Sites
I
5% 5% 5% 6% 5% 6% 6% 6% 6% 6% 6%
II 7% 6% 6% 6% 6% 6% 6% 6% 6% 6% 6%
III 15% 15% 15% 15% 15% 15% 16% 16% 17% 16% 16%
IV 24% 25% 25% 25% 24% 29% 24% 23% 24% 23% 24%
V 8% 8% 9% 9% 9% 8% 10% 10% 9% 10% 10%
VI 13% 13% 13% 12% 14% 11% 12% 11% 11% 12% 12%
VII 7% 7% 6% 6% 6% 5% 6% 6% 5% 5% 5%
VIII 4% 4% 4% 4% 4% 4% 4% 5% 4% 4% 4%
IX 11% 11% 12% 11% 11% 11% 12% 12% 12% 12% 10%
X 6% 6% 6% 5% 5% 5% 5% 5% 5% 6% 6%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
A-4 Family Planning Annual Report: 2019 National Summary
Exhibit A–1c. 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.
4,515
4,389
4,382
4,189
4,168
4,127
3,951
3,898
3,858
3,954
3,825
1,149
1,190
1,146
1,137
1,094
1,001
1,017
1,028
1,038
996
809
0
500
1,000
1,500
2,000
0
1,000
2,000
3,000
4,000
5,000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Number of users per site
Number of service sites
Number of service sites Number of users per site
Family Planning Annual Report: 2019 National Summary A-5
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A-6 Family Planning Annual Report: 2019 National Summary
Exhibit A–2a. Number and distribution of all family planning users, by region and year: 2009–2019
Region 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
Male 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%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Female 93% 92% 92% 92% 92% 91% 90% 89% 88% 87% 87%
Male 7% 8% 8% 8% 8% 9% 10% 11% 12% 13% 13%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary A-7
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.
Note: Due to rounding, percentages in each year may not sum to 100%.
4%
4%
4%
4%
4%
4%
5%
5%
5%
5%
5%
10%
10%
10%
10%
10%
10%
11%
11%
11%
11%
10%
11%
11%
11%
12%
11%
11%
11%
12%
12%
12%
12%
19%
19%
19%
19%
19%
19%
16%
17%
17%
16%
21%
10%
9%
9%
9%
9%
9%
10%
10%
10%
10%
10%
10%
10%
9%
7%
8%
7%
9%
8%
9%
8%
10%
4%
4%
4%
4%
4%
4%
3%
3%
3%
3%
4%
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
25%
26%
26%
27%
28%
28%
29%
28%
27%
27%
22%
4%
4%
4%
4%
4%
4%
4%
4%
4%
4%
4%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Region I Region II Region III Region IV Region V
Region VI Region VII Region VIII Region IX Region X
5.22 million
5.19 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-8 Family Planning Annual Report: 2019 National Summary
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
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
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%
Total
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary A-9
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.
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.
10%
9%
8%
8%
7%
7%
7%
7%
7%
7%
15–17,
7%
12%
12%
11%
11%
10%
10%
9%
9%
9%
9%
18–19, 9%
30%
31%
30%
30%
29%
28%
27%
26%
25%
25%
20–24, 23%
20%
21%
21%
21%
22%
22%
22%
22%
22%
21%
25–29, 20%
22%
23%
24%
25%
26%
27%
28%
29%
29%
30%
30–44, 32%
4%
4%
4%
5%
5%
5%
5%
6%
6%
7%
7%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
<15 15–17 18–19 20–24 25–29 30–44 >44
5.19 million
5.22 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-10 Family Planning Annual Report: 2019 National Summary
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
Asian 150,847 136,958 134,345 136,412 135,567 128,797 131,676 135,555 143,215 139,084 89,045
Black/African American 1,015,013 1,028,991 986,803 969,776 939,941 863,136 857,659 859,886 869,574 861,707 732,825
Native Hawaiian/Pacific Islander 73,559 65,662 70,929 70,519 52,263 39,266 40,941 35,479 31,019 29,545 22,327
White 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
Total All Users 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%
Black/African American 20% 20% 20% 20% 21% 21% 21% 21% 22% 22% 24%
Native Hawaiian/Pacific Islander 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
White 59% 58% 57% 56% 56% 54% 53% 54% 54% 53% 54%
More than one race 3% 5% 5% 5% 4% 4% 3% 4% 4% 4% 4%
Unknown/not reported 13% 13% 13% 13% 15% 16% 17% 16% 16% 16% 14%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary A-11
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.
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.
59%
58%
57%
56%
56%
54%
53%
54%
54%
53%
White, 54%
20%
20%
20%
20%
21%
21%
21%
21%
22%
22%
Black, 24%
8%
10%
10%
11%
9%
9%
8%
9%
9%
9%
Other, 8%
13%
13%
13%
13%
15%
16%
17%
16%
16%
16%
Unknown, 14%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
White Black Other Unknown
5.19 million
5.22 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-12 Family Planning Annual Report: 2019 National Summary
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
Total All Users 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%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary A-13
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.
Note: Due to rounding, percentages in each year may not sum to 100%.
70%
69%
68%
69%
68%
67%
65%
65%
64%
62%
Not Hispanic/Latino, 62%
28%
29%
29%
28%
30%
30%
32%
32%
33%
33%
Hispanic/Latino, 33%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Not Hispanic/Latino Hispanic/Latino Unknown
5.19 million
5.22 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-14 Family Planning Annual Report: 2019 National Summary
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 2019
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
Black or African American 969,690 986,409 939,143 917,539 890,133 816,061 811,244 806,815 806,970 796,450 679,361
White 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
Other/unknown 280,956 290,783 295,150 284,089 262,473 266,861 244,759 223,807 221,326 217,273 156,219
Hispanic or Latino
All races 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
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
Total All Users 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
Not Hispanic or Latino
Asian
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%
Unknown/Not Reported 2% 2% 3% 3% 3% 3% 3% 3% 3% 5% 4%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
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 A-15
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.
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.
43%
42%
41%
41%
40%
38%
36%
36%
35%
33%
NH White, 32%
19%
19%
19%
19%
20%
20%
20%
20%
20%
20%
NH Black, 22%
8%
8%
8%
9%
9%
9%
9%
9%
9%
9%
8%
28%
29%
29%
28%
30%
30%
32%
32%
33%
33%
Hispanic (all races), 33%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
NH White NH Black NH Other/Unknown Hispanic (all races) Unknown
5.22 million
5.19 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-16 Family Planning Annual Report: 2019 National Summary
Exhibit A–7a. Number and distribution of all family planning users, by income level and year: 2009–2019
Income Level
a
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Under 101% 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
Total All Users 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%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
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 A-17
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.
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.
70%
69%
69%
71%
70%
69%
66%
64%
67%
65%
≤100%, 64%
15%
15%
15%
14%
14%
14%
14%
14%
14%
14%
101%–150%, 14%
5%
5%
5%
5%
5%
6%
6%
6%
6%
7%
7%
4%
5%
5%
5%
5%
5%
6%
7%
7%
7%
7%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
≤100% 101%–150% 151%–200% 201%–250% >250% Unknown
5.19 million
5.22 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-18 Family Planning Annual Report: 2019 National Summary
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
Public insurance 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
Private insurance 426,308 438,042 429,919 447,341 453,535 559,845 621,066 715,090 760,051 794,535 607,961
Uninsured 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
Unknown/not reported 318,880 118,665 124,665 144,669 107,211 114,413 67,594 55,302 56,837 62,324 45,684
Total All Users 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%
Uninsured 66% 67% 64% 64% 63% 54% 48% 43% 42% 40% 41%
Unknown/not reported 6% 2% 2% 3% 2% 3% 2% 1% 1% 2% 1%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2019 National Summary A-19
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.
Note: Due to rounding, percentages in each year may not sum to 100%.
20%
23%
25%
24%
25%
29%
35%
37%
38%
38%
Public insurance, 38%
8%
8%
9%
9%
10%
14%
15%
18%
19%
20%
Private insurance, 20%
66%
67%
64%
64%
63%
54%
48%
43%
42%
40%
Uninsured, 41%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Public insurance Private insurance Uninsured Unknown/Not reported
5.19 million
5.22 million
5.02 million
4.76 million
4.56 million
4.13 million
4.02 million
4.01 million
4.00 million
3.94 million
3.10 million
A-20 Family Planning Annual Report: 2019 National Summary
Exhibit A–9a. Number of all female family planning users, by primary contraceptive method and year: 2009–2019
Primary Method 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Most Effective
a
Vasectomy 6,905 8,683 8,632 8,540 8,175 7,582 6,879 8,178 8,848 9,237 7,668
Sterilization
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 Effective
a
Hormonal injection
b
615,188 643,682 645,351 645,136 635,093 611,619 574,476 519,841 500,960 474,609 398,894
Vaginal ring
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
Oral contraceptive
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
Cervical cap/diaphragm
12,278 4,402 3,390 4,116 8,245 2,379 1,660 2,130 2,219 1,652 877
Less Effective
a
Male condom 737,991 787,329 838,131 745,265 692,678 578,139 572,607 559,356 547,129 533,079 385,950
Female condom
4,635 5,944 5,939 3,722 3,914 3,308 3,558 2,929 2,537 3,782 3,159
Contraceptive sponge
991 1,581 921 765 541 651 660 138 169 371 377
Withdrawal or other
c
105,705 116,635 115,002 113,016 95,798 70,982 61,504 75,191 73,047 81,486 75,253
FAM
d
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
Other
Abstinence 62,380 75,534 69,924 71,737 72,486 70,098 73,896 89,102 92,385 99,733 90,729
No Method
Pregnant/seeking pregnancy 395,633 400,194 361,056 377,547 356,750 330,279 321,229 321,706 313,802 279,025 207,880
Other reason
260,946 238,347 229,541 183,613 181,657 175,111 171,068 175,371 190,518 194,405 167,834
Method Unknown
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
Most effective
a
346,046 401,471 437,426 462,497 478,117 487,640 542,612 592,243 666,224 664,305 517,828
Moderately effective
a
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
Less effective
a
877,553 934,214 984,159 880,370 808,712 668,639 653,705 653,854 640,160 637,173 483,104
Abstinent 62,380 75,534 69,924 71,737 72,486 70,098 73,896 89,102 92,385 99,733 90,729
Not Using a Method 656,579 638,541 590,597 561,160 538,407 505,390 492,297 497,077 504,320 473,430 375,714
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 A-21
Exhibit A–9b. Distribution of all female family planning users, by primary contraceptive method and year: 2009–2019
Primary Method 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Most Effective
a
Vasectomy
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Sterilization
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 Effective
a
Hormonal injection
b
13% 13% 14% 15% 15% 16% 16% 15% 14% 14% 15%
Vaginal ring
3% 4% 4% 4% 3% 3% 3% 2% 2% 2% 2%
Contraceptive patch
2% 2% 2% 2% 2% 2% 1% 1% 1% 1% 1%
Oral contraceptive
35% 35% 33% 32% 31% 30% 28% 27% 25% 24% 22%
Cervical cap/diaphragm
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Less Effective
a
Male condom
15% 16% 18% 17% 17% 15% 16% 16% 15% 15% 14%
Female condom
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 other
c
2% 2% 2% 3% 2% 2% 2% 2% 2% 2% 3%
FAM
d
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%†
Other
Abstinence
1% 2% 2% 2% 2% 2% 2% 3% 3% 3% 3%
No Method
Pregnant/seeking pregnancy
8% 8% 8% 9% 9% 9% 9% 9% 9% 8% 8%
Other reason
5% 5% 5% 4% 4% 5% 5% 5% 5% 6% 6%
Method Unknown
6% 3% 2% 2% 3% 3% 3% 3% 3% 5% 5%
Total Female Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or Less
Effective Method
79% 82% 84% 83% 83% 82% 81% 80% 80% 79% 77%
Most effective
a
7% 8% 9% 11% 11% 13% 15% 17% 19% 19% 19%
Moderately effective
a
54% 54% 53% 53% 52% 51% 48% 45% 43% 41% 40%
Less effective
a
18% 19% 21% 20% 19% 18% 18% 18% 18% 18% 18%
Abstinent 1% 2% 2% 2% 2% 2% 2% 3% 3% 3% 3%
Not Using a Method 14% 13% 13% 13% 13% 13% 14% 14% 14% 14% 14%
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 Family Planning Annual Report: 2019 National Summary
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.
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).
7%
8%
9%
11%
11%
13%
15%
17%
19%
19%
Most effective, 19%
54%
54%
53%
53%
52%
51%
48%
45%
43%
41%
Moderately effective, 40%
18%
19%
21%
20%
19%
18%
18%
18%
18%
18%
Less effective, 18%
14%
13%
13%
13%
13%
13%
14%
14%
14%
14%
No method, 14%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Most effective Moderately effective Less effective
Abstinence No method Method unknown
4.81 million
4.82 million
4.64 million
4.38 million
4.18 million
3.76 million
3.61 million
3.55 million
3.54 million
2.70 million
3.45 million
Family Planning Annual Report: 2019 National Summary A-23
Exhibit 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
Screening Measures 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Female Users Screened
Number
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
Percentage 42% 36% 31% 28% 24% 21% 21% 19% 18% 18% 20%
Pap Tests Performed
Number
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
Percentage with an ASC or
higher result
12% 13% 15% 14% 14% 14% 14% 14% 14% 14% 13%
ASC=atypical squamous cells.
Exhibit A–10b. 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.
2.04
1.73
1.44
1.24
0.99
0.79
0.74
0.69
0.65
0.63
0.54
42%
36%
31%
28%
24%
21%
21%
19%
18%
18%
20%
0%
20%
40%
60%
80%
100%
0.0
1.0
2.0
3.0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Percentage of female users screened
Number of female users screened (in
millions)
Number of female users screened (in millions) Percentage of female users screened
A-24 Family Planning Annual Report: 2019 National Summary
Exhibit A–11a. Number and percentage of female users under 25 tested for chlamydia, by year: 2009–2019
Chlamydia Testing Measures 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Number tested 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
Percentage tested
55% 57% 58% 59% 60% 58% 59% 61% 61% 61% 58%
Exhibit A–11b. 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
1.27
1.18
1.01
0.96
0.95
0.94
0.90
0.64
55%
57%
58%
59%
60%
58%
59%
61%
61%
61%
58%
0%
20%
40%
60%
80%
100%
0.0
0.5
1.0
1.5
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Percentage of female users <25 years
tested
Number of female users <25 years tested
(in millions)
Number of female users <25 years tested (in millions) Percentage of female users <25 years tested
Family Planning Annual Report: 2019 National Summary A-25
Exhibit A–12a. 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 2019
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
Exhibit A–12b. 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.
1.00
1.10
1.28
1.25
1.19
1.03
1.11
1.16
1.19
1.24
0.96
1.8
1.9
2.3
2.4
2.4
2.2
2.4
2.5
2.6
2.7
2.8
4.1
4.3
5.2
5.5
5.3
5.7
5.9
5.7
5.9
5.9
5.3
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
0.0
0.5
1.0
1.5
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Tests per 10 users
Number of tests performed (in millions)
Number of tests performed (in millions) Tests per 10 female users Tests per 10 male users
A-26 Family Planning Annual Report: 2019 National Summary
Exhibit A–13a. Actual and adjusted (constant 2019$ and 2009$) total, Title X, and Medicaid revenue, by year: 2009–2019
Revenue
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
Change
2009–
2019
2018–
2019
Total
Actual
a
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
Actual
a
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%
Medicaid
c
Actual
a
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%
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.
Family Planning Annual Report: 2019 National Summary A-27
Exhibit A–13b. 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.
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
$1,634
$1,036
$597
$371
$353
$229
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Total revenue (in millions)
Total revenue Medicaid Title X
A-28 Family Planning Annual Report: 2019 National Summary
Exhibit A–13c. Total actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$1,634
$1,036
$1,231
$781
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Total revenue (in millions)
Actual (unadjusted) Adjusted (2019$) Total Revenue Adjusted (2009$)
Family Planning Annual Report: 2019 National Summary A-29
Exhibit A–13d. Title X actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
$353
$229
$266
$173
$0
$100
$200
$300
$400
$500
$600
$700
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Title X revenue (in millions)
Actual (unadjusted) Adjusted (2019$) Adjusted (2009$)
A-30 Family Planning Annual Report: 2019 National Summary
Exhibit A–13e. Medicaid actual (unadjusted) and adjusted (constant 2019$ and 2009$) revenue (in millions), by year: 2009–2019
Note: The data in this graph are presented in tabular form in Exhibit A-13a.
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
$597
$371
$450
$280
$0
$100
$200
$300
$400
$500
$600
$700
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Medicaid revenue (in millions)
Actual (unadjusted) Adjusted (2019$) Adjusted (2009$)
Family Planning Annual Report: 2019 National Summary A-31
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A-32 Family Planning Annual Report: 2019 National Summary
Exhibit A–14a. Amount of Title X project revenue, by revenue source and year: 2009–2019
Revenue Sources
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
Title X 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
Subtotal 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
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
Subtotal 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
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.
a
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).
Family Planning Annual Report: 2019 National Summary A-33
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%
Other Revenue
MCH block grant
2% 2% 2% 2% 2% 2% 1% 1% 1% 1% 2%
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-34 Family Planning Annual Report: 2019 National Summary
Exhibit A–14c. 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.
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.
22%
22%
21%
21%
20%
20%
19%
19%
19%
19%
Title X, 22%
37%
37%
39%
40%
40%
40%
40%
39%
38%
39%
Medicaid, 36%
4%
4%
4%
5%
5%
8%
8%
10%
11%
11%
10%
19%
18%
16%
16%
18%
16%
16%
15%
15%
13%
14%
19%
20%
19%
18%
18%
16%
16%
17%
18%
17%
Other, 18%
0% 100%
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Title X Medicaid Private third party State/local government Other
$1.23 billion
$1.29 billion
$1.29 billion
$1.26 billion
$1.28 billion
$1.24 billion
$1.24 billion
$1.31 billion
$1.30 billion
$1.32 billion
$1.04 billion
Family Planning Annual Report: 2019 National Summary B-1
Appendix B
State Exhibits
B-2 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)
State Female Male Total Female Male
State Users as %
of All Users
Alabama 71,324 91 71,415 100% 0%† 2%
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% 0%† 1%
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%†
New Hampshire 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%†
New York 182,235 25,431 207,666 88% 12% 7%
† Percentage is less than 0.5%. (continued)
Family Planning Annual Report: 2019 National Summary B-3
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%†
Tennessee 60,847 2,282 63,129 96% 4% 2%
Texas 154,740 21,957 176,697 88% 12% 6%
Utah 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%†
Guam
14 0 14 100% 0% 0%†
Puerto Rico
13,153 2,498 15,651 84% 16% 1%
Republic of the
Marshall Islands
1,849 20 1,869 99% 1% 0%†
Republic of Palau
874 97 971 90% 10% 0%†
U.S. Virgin Islands
1,843 141 1,984 93% 7% 0%†
Total All Users 2,690,552 405,114 3,095,666 87% 13% 100%
Range
70%–100% 0%–30% 0%†–20%
FAS=Freely Associated States.
† Percentage is less than 0.5%.
B-4 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)
State
Under
101%
101%
to 250%
Over
250% UK/NR Total
Under
101%
101%
to 250%
Over
250%
UK/NR
Alabama 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%
Maine 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%
New York 133,166 50,512 22,815 1,173 207,666 64% 24% 11% 1%
UK/NR=unknown or not reported. (continued)
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary B-5
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%
Tennessee 48,316 12,526 1,887 400 63,129 77% 20% 3% 1%
Texas 137,540 28,965 3,237 6,955 176,697 78% 16% 2% 4%
Utah 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%†
Guam 13 1 0 0 14 93% 7% 0% 0%
Puerto Rico 13,362 1,760 342 187 15,651 85% 11% 2% 1%
Republic of the
Marshall Islands
1,869 0 0 0 1,869 100% 0% 0% 0%
Republic of Palau 651 183 13 124 971 67% 19% 1% 13%
U.S. Virgin Islands 1,894 78 12 0 1,984 95% 4% 1% 0%
Total All Users 1,968,876 741,641 226,957 158,192 3,095,666 64% 24% 7% 5%
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%.
B-6 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)
State Public Private
Uninsured
UK/NR Total Public Private Uninsured UK/NR
Alabama 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%†
Delaware 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%†
Maine 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%†
New York 103,334 48,296 53,361 2,675 207,666 50% 23% 26% 1%
UK/NR=unknown or not reported. (continued)
† Percentage is less than 0.5%.
Family Planning Annual Report: 2019 National Summary B-7
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2019 (Source:
FPAR Table 5) (continued)
State Public Private Uninsured UK/NR Total Public Private Uninsured UK/NR
North Carolina 30,593 11,304 41,706 1,903 85,506 36% 13% 49% 2%
North Dakota 467 2,991 2,194 6 5,658 8% 53% 39% 0%†
Ohio 30,843 22,807 27,845 381 81,876 38% 28% 34% 0%†
Oklahoma 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%
South Dakota 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%
Utah 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%
Wyoming 392 2,064 4,159 88 6,703 6% 31% 62% 1%
Territories & FAS
American Samoa
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% 0%† 81% 5%
Guam 8 2 3 1 14 57% 14% 21% 7%
Puerto Rico 14,447 561 599 44 15,651 92% 4% 4% 0%†
Republic of the Marshall
Islands
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%
Total Users 1,186,684 607,961 1,255,337 45,684 3,095,666 38% 20% 41% 1%
Range 0%–95% 0%–53% 0%–100% 0%–22%
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%.
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)
State Public Private Uninsured UK/NR Total Public Private Uninsured UK/NR
Expansion States
Alaska
a
1,148 1,891 1,703 0 4,742 24% 40% 36% 0%
Arizona
b
3,841 5,353 17,221 0 26,415 15% 20% 65% 0%
Arkansas
b
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%†
Delaware 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%
Hawaii 2,568 1,452 979 12 5,011 51% 29% 20% 0%†
Illinois 29,498 20,397 28,525 1,018 79,438 37% 26% 36% 1%
Indiana
a,b
4,410 4,777 11,783 0 20,970 21% 23% 56% 0%
Iowa
b
9,989 9,887 7,112 389 27,377 36% 36% 26% 1%
Kentucky 18,529 6,838 15,829 1,661 42,857 43% 16% 37% 4%
Louisiana
a
29,425 7,280 14,915 54 51,674 57% 14% 29% 0%†
Maine
a
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
a,b
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%
Montana
a,b,c
3,322 6,400 4,117 278 14,117 24% 45% 29% 2%
Nevada 3,200 2,594 6,716 3 12,513 26% 21% 54% 0%†
New Hampshire
a,b
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
b
3,156 1,196 7,516 13 11,881 27% 10% 63% 0%†
New York 103,334 48,296 53,361 2,675 207,666 50% 23% 26% 1%
North Dakota 467 2,991 2,194 6 5,658 8% 53% 39% 0%†
Ohio
b
30,843 22,807 27,845 381 81,876 38% 28% 34% 0%†
Oregon 11,606 5,357 16,873 56 33,892 34% 16% 50% 0%†
Pennsylvania
a
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%†
Vermont 2,746 2,550 284 29 5,609 49% 45% 5% 1%
Virginia
a
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%
Expansion States
Subtotal
891,923 414,519 753,908 36,697 2,097,047 43% 20% 36% 2%
Range 8%–72% 7%–53% 5%–65% 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%.
Family Planning Annual Report: 2019 National Summary B-9
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%
Florida
d
57,025 21,701 30,954 845 110,525 52% 20% 28% 1%
Georgia
d
47,962 60,712 61,080 191 169,945 28% 36% 36% 0%†
Idaho
a,d
2,299 2,023 8,881 722 13,925 17% 15% 64% 5%
Kansas
d
2,410 3,863 14,111 77 20,461 12% 19% 69% 0%†
Mississippi
d
11,400 3,347 20,315 58 35,120 32% 10% 58% 0%†
Missouri
a,d
6,824 10,238 20,554 0 37,616 18% 27% 55% 0%
Nebraska
a,d
3,215 5,615 15,745 334 24,909 13% 23% 63% 1%
North Carolina
d
30,593 11,304 41,706 1,903 85,506 36% 13% 49% 2%
Oklahoma
a,d
6,684 5,789 25,735 0 38,208 17% 15% 67% 0%
South Carolina 22,949 23,098 24,055 0 70,102 33% 33% 34% 0%
South Dakota
d
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%
Utah
a,b,d
745 5,564 13,571 0 19,880 4% 28% 68% 0%
Wisconsin
d
12,380 2,370 4,857 2,779 22,386 55% 11% 22% 12%
Wyoming 392 2,064 4,159 88 6,703 6% 31% 62% 1%
Nonexpansion States
Subtotal
277,215 192,351 493,143 8,660 971,369 29% 20% 51% 1%
Range
4%–55% 7%–36% 22%–73% 0%–12%
All States
Total
1,169,138 606,870 1,247,051 45,357 3,068,416 38% 20% 41% 1%
Range
4%–72% 7%–53% 5%–73% 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%.
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 (Source: FPAR Table 7)
State
Most
Effective
Permanent
Methods
a
Most
Effective
Reversible
Methods
a
Moderately
Effective
Methods
b
Less
Effective
Methods
c
Total
At Risk
d
Most
Effective
Methods
a
Moderately
Effective
Methods
b
Less
Effective
Methods
c
Alabama
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%
Connecticut
1,431 5,230 11,131 4,892 25,714 26% 43% 19%
Delaware
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%
Massachusetts
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%
Nebraska
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%
New York
3,666 35,052 68,954 34,985 159,136 24% 43% 22%
(continued)
Family Planning Annual Report: 2019 National Summary B-11
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
Effective
Permanent
Methods
b
Most
Effective
Reversible
Methods
b
Moderately
Effective
Methods
c
Less
Effective
Methods
d
Total
At Risk
a
Most
Effective
Methods
b
Moderately
Effective
Methods
c
Less
Effective
Methods
d
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
88 578 3,009 316 4,163 16% 72% 8%
Tennessee
296 6,959 28,132 5,430 44,847 16% 63% 12%
Texas
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%
West Virginia
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%
Territories & FAS
American Samoa
40 125 626 406 1,401 12% 45% 29%
Comm. of the Northern
Mariana Islands
1 313 805 69 1,253 25% 64% 6%
Federated States of
Micronesia
78 553 1,022 1,105 3,041 21% 34% 36%
Guam
0 0 10 4 14 0% 71% 29%
Puerto Rico
203 524 7,157 5,070 13,092 6% 55% 39%
Republic of the
Marshall Islands
78 440 584 7 1,279 41% 46% 1%
Republic of Palau
1 27 539 181 871 3% 62% 21%
U.S. Virgin Islands
163 76 764 622 1,775 13% 43% 35%
Total Users 90,140 427,688 1,076,810 483,104 2,391,943 22% 45% 20%
Range 0%–42% 17%–72% 1%–44%
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.
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)
State
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
Alabama
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%
Hawaii
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%
Michigan
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%
New York
42,363 72,349 59%
(continued)
Family Planning Annual Report: 2019 National Summary B-13
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%
Oregon
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%
Washington
18,677 30,851 61%
West Virginia
5,265 18,865 28%
Wisconsin
4,605 9,371 49%
Wyoming
1,609 2,799 57%
Territories & FAS
American Samoa
44 392 11%
Comm. of the Northern Mariana
Islands
154 553 28%
Federated States of Micronesia
280 1,172 24%
Guam
8 8 100%
Puerto Rico
1,526 6,820 22%
Republic of the Marshall Islands
171 769 22%
Republic of Palau
56 271 21%
U.S. Virgin Islands
399 565 71%
Total Users 644,080 1,106,288 58%
Range
11%–100%
FAS=Freely Associated States.
B-14 Family Planning Annual Report: 2019 National Summary
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Family Planning Annual Report: 2019 National Summary C-1
Appendix C
Field and Methodological Notes
C-2 Family Planning Annual Report: 2019 National Summary
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
Family Planning Annual Report: 2019 National Summary C-3
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.
C-4 Family Planning Annual Report: 2019 National Summary
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.
Family Planning Annual Report: 2019 National Summary C-5
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%
C-6 Family Planning Annual Report: 2019 National Summary
▪ 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 (21
st
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
Family Planning Annual Report: 2019 National Summary C-7
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.
C-8 Family Planning Annual Report: 2019 National Summary
▪ 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
Family Planning Annual Report: 2019 National Summary C-9
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
C-10 Family Planning Annual Report: 2019 National Summary
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.
Family Planning Annual Report: 2019 National Summary C-11
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
C-12 Family Planning Annual Report: 2019 National Summary
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.
Family Planning Annual Report: 2019 National Summary
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