Title X: History, Theory, and Outcomes among African-American Women

University of Kansas Family planning has a long, controversial history in the United States. Amid a history characterized by overpopulation, politics, and eugenics allegations, President Nixon signed Title X, a law that funded birth control for low-income women, in 1970. In this analysis, history and theory provide an understanding of Title X’s origins. Furthermore, empirical evidence reveals the impact of today’s Title X programming on African-American (African-American and black are used interchangeably throughout) women when considering the following outcome measures: the number of black women accessing Title X services, the rate of unplanned pregnancies, and contraceptive failure rates.
History
Contraception in U.S. public policy dates back to the nineteenth century when male physicians began playing a more dominant role in pregnancy and birthing, a role that had previously been filled by midwives. For instance, the Comstock Law of 1873 prohibited contraception information and devices from being sent by U.S. mail. The Comstock Law was overturned in 1936, eighteen years after a judge granted medical exception for the cure and prevention of reproductive disease (May, 2010). This happened when women’s rights were moving to the forefront. Women were fighting for the right to vote, ability to divorce, equal rights in marriage, and the right to control their reproduction. The birth control pill was approved to treat gynecological disorders in 1957 and for the purpose of birth control in 1960 (May, 2010). The approval of birth control occurred during a time when the world was concerned about overpopulation. The growing population raised anxiety about meeting people’s basic needs as well as concerns about poverty, shrinking natural resources, and education. According to May (2010), “The pill promised to be a stealth weapon that would defuse the ‘population bomb’ by limiting the size of ‘nuclear’ families across the globe” (p. 37). Unfortunately, some viewed birth control legalization as a way to express their eugenicist, racist ideas. According to May (2010), Clarence J. Gamble, a eugenicist, encouraged inexpensive birth control for the poor. These racial overtones, a history of forced sterilizations, and an existing mistrust of the social service system resulting from slavery made women of color suspicious of the motivations of family planning clinics. In fact, leaders of the Black Power movement in the sixties were convinced that the pill was a method of genocide and denounced it at a Black Power conference in 1967 (May, 2010). Despite these accusations and apprehensions, many women of color were ready for birth control that gave them power over their reproduction. Ralph Z. Hallow (1969) writes about the clash between male leaders of the Black Power movement and the women of color who wished to access birth control, “caught in the middle is the indigent American woman who wishes to have the same freedom to choose sex without conception that her middle-class counterpart enjoys” (p. 537).
Title X Legislation
In light of the perceived overpopulation predicament in the United States and internationally, President Nixon called for the creation of a Commission on Population Growth and the American Future in his special message on population to Congress in July, 1969. The following year Nixon signed the Title X Population Research and Voluntary Family Planning Programs as a part of the Public Health Service Act. Title X gave priority to low-income women to access contraceptives and information. Thus, ten years after approval, the birth control pill was theoretically available to women of all economic backgrounds.
Today, Title X is administered through the Office of Family Planning within the Office of Population Affairs (OPA). In 2009, Title X supported a network of over 4,500 service