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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Surveillance of Family Planning Services at Title X Clinics and Characteristics of Women Receiving These Services, 1991Abstract Problem/Condition: Public health surveillance data describing family planning services at Title X clinics and characteristics of women receiving these services during 1991 are contained in this report. These data update previously published information concerning characteristics of women and services at such clinics during 1981. Reporting Period Covered: 1991. Description of System: Data characterizing patients and services were reported by family planning clinics to Title X grantees. These data for 1991 were provided by all 75 grantees to CDC's Family Planning Services Surveillance (FPSS) project. Results: In 1991, 4.2 million women received services at Title X clinics. Overall, 69.5% of family planning patients had chosen oral contraceptives as their method of contraception, and 64.7% of patients were at or below the federal poverty level. In addition to information characterizing patients and services at Title X clinics, this report also evaluated current data-collection methods used by Title X grantees. Complexities in the analysis reflected variations in the quality and availability of data, including differences in definitions, data-collection instruments at the clinic level, and data categories. Interpretation: The number and characteristics of family planning patients receiving services at Title X clinics during 1991 were similar to the number and characteristics during 1981. Furthermore, these results underscore the need to improve the quality and timeliness of family planning data and to facilitate program planning and operations at the grantee level. Actions Taken: These surveillance findings have been communicated to state family planning administrators and to national Title X program administrators. This information will be used to assess how publicly funded family planning clinics currently contribute to health-care delivery and how these clinics might contribute to a national system of reproductive health-care services in the future. INTRODUCTION In 1970, federal legislation created a national family planning program funded by Title X of the Public Health Services Act. * Since then, Title X has been the primary source of funding for subsidized family planning services in the United States (1). From 1970 through 1981, agencies receiving Title X funds were required to report program activities and information characterizing women who received family planning services. This information was compiled into reports for program planning and policy development. Since 1981, however, neither data collection nor reporting methods have been standardized; therefore, no recent compilation of information is comparable to that of previous years. In 1991, the organization representing state family planning administrators, who manage family planning program activities funded by Title X, requested assistance from CDC's National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, in developing a comprehensive statistical report of family planning services based on state and local data. The goals of the Family Planning Services Surveillance (FPSS) project were a) to evaluate existing data-collection methods and objectively describe these methods and b) to characterize women who received family planning services at Title X clinics during 1991. Information from this report will be used to assess the role of publicly funded family planning services and to guide in improving data collection. METHODS The Title X family planning funds are administered through 75 grantees in the 50 states and the District of Columbia. Because these grantees have used different patient record forms, the number of data items available and the methods used to collect and categorize the information varied. The FPSS project relied on an initial effort by U.S. Department of Health and Human Services (DHHS) Region X family planning officials to determine which data were available nationally. Before contacting the grantees, CDC sought input from several groups and organizations about the scope of the project, preferred definitions for data items that were collected, sources of data, and availability and categorization of data items. CDC staff communicated directly with all 10 DHHS Regional Program Consultants for family planning, the National Family Planning and Reproductive Health Association, the Planned Parenthood Federation of America, the Public Health Foundation, the DHHS Office of Population Affairs, and The Alan Guttmacher Institute (AGI). In 1983, AGI had produced the most recent report concerning national family planning services; this report contained information for 1981 and included data from organized family planning providers other than Title X clinics (2). CDC staff also consulted with the two private contractors that process family planning clinic information for Title X grantees in several states. The FPSS project was limited to information provided by Title X grantees regarding female patients who had received family planning services during 1991 from clinics funded entirely or partially with Title X funds. A mailing list was developed that contained the names of the 75 grantees that provided contraceptive services. Grantees that provided only counseling or informational services were excluded, as were grantees not located in the 50 states or the District of Columbia. Clinics that had multiple sources of funding were not asked to identify patients by source of payment. Grantees were asked for information at the highest level of aggregation possible, which was usually at the state level. Definitions Grantees were given the following preferred definitions to use for data-collection purposes. These definitions enabled us to compare 1991 data with that from AGI's national report for 1981.
Maximizing the Data We used as much of the data reported by grantees as possible. Many grantees could report data for a given variable, but not for the specific categories requested. Thus, distributions of data in requested categories were used to estimate data for nonstandard categories. For example, the age distribution of family planning patients less than or equal to 19 years of age was requested by single year of age. Thirty-two grantees reported data this way, and these data were used to estimate single-year data for grantees reporting combinations of age groupings for patients less than or equal to 19 years of age. RESULTS Evaluation of Data-Collection Methods Availability and Sources of Data We identified seventy-five Title X grantees that had funded contraceptive services during 1991. All 75 grantees had collected and compiled data regarding family planning services, and they provided all the data they had available for the specific categories of characteristics. Thirty-five states (including the District of Columbia) had only one Title X grantee; in 27 of these states, the state health department was the grantee. In eight states, the grantee was a statewide family planning council or association that served as an umbrella organization for administering family planning funds. Three of the umbrella organizations were Planned Parenthood agencies. Sixteen states had more than one Title X grantee; however, in 12 of these states, one of the grantees was the state health department. Thus, in 39 states the state health department was either the sole grantee or one of the grantees. Although no uniform data-collection system exists nationally for family planning clinics funded by Title X, two data-processing contractors were used by 24 grantees in 16 states to process data and produce reports. These data represent approximately 28% of all family planning patients who received services at Title X clinics during 1991. In DHHS Region I, all 10 grantees used Contractor A, whereas all seven grantees in DHHS Region X used Contractor B. Thus, states in Regions I and X provided one consolidated data set per state, regardless of the number of grantees in the state. One grantee outside of Region I used the data-processing services of Contractor A. Six grantees in five states other than those in Region X used the data-processing services of Contractor B. All grantees who used Contractor A had used a clinic reporting form that was essentially uniform in content and definitions. Likewise, all grantees who used Contractor B had used an essentially uniform clinic reporting form. However, the forms used by the two contractors were not the same and had several major content and definitional differences. In cooperation with the regional offices and grantees in Regions I and X and with the grantees directly in other states, arrangements were made with the contractors of the two consolidated data systems to provide, as uniformly as possible, the requested tabulations at the state level. Quality of the Data The data that were collected by grantees and available for this report varied in quality because of the lack of uniform definitions, dissimilar data-collection instruments at the clinic level, different categorizations of data, and infrequent use and scrutiny of existing data by grantees. In addition, the accuracy of the reported data was not assessed. Poverty status was the most completely reported variable. All grantees could provide data in the categories requested, primarily because information concerning poverty status was requested exactly as it is reported routinely via BCRR. We did not determine the validity of poverty status, but relied entirely on the definitions, data, and categories operative for BCRR reporting. All grantees provided some data concerning patients' ages; however, less than half could provide data in the exact categories requested. Thirty-two (42.7%) grantees reported data as requested by single year of age for patients less than or equal to 19 years of age, and 37 (49.3%) reported as requested by 5-year age groups for patients greater than or equal to 20 years of age. The variables "type of visit," "patient type," and "family planning services," although fundamental to record keeping by grantees, were defined differently by them. Six grantees could not separate data for male and female patients, but these data did not substantially affect national statistics because male patients represented less than 1% of the total number of family planning patients. The two grantees that could not provide data for calendar year 1991 submitted data for fiscal year 1991 instead (i.e., October 1, 1990, through September 30, 1991). Many data collection and data compilation methods used in 1991 had been developed and implemented before 1981, when more specific program data were required of family planning providers. Thus, data-collection forms and computer-generated reports reflected past data needs and reporting requirements. Several grantees mentioned periodic data reports that had been developed previously but were of uncertain value to family planning needs during 1991; these statistical reports were rarely used but were still being generated by computerized data systems. Characteristics of Family Planning Patients Family Planning Patients The total number of family planning patients reported by the 75 grantees was 4,218,412 Table_1. All grantees reported the total number of patients who received services, but only 40 grantees (representing 57.5% of the total number of patients reported) could report these patients by type of patient. The total number included at least 3,469 men (i.e., less than 1% of family planning patients). The term "family planning patient" was defined inconsistently by grantees (e.g., for all patient records processed by Contractor B, the definition of "patient" included persons who had received counseling only). In addition, some grantees could not separate data for male and female patients in the statistics they reported. A precise definition of a "family planning patient" was not provided by most grantees. For some of these grantees, we assumed that the definitions of a family planning "patient" and a family planning "user," as required for BCRR reporting, were the same because the number of patients they reported was identical to the total number of users they reported in the BCRR reporting system. Type of patient was estimated based on reporting from 57.5% of total patients. The original data-collection request asked that patients be categorized into four patient types: a) initial medical, b) annual medical, c) other medical, and d) other family planning. After reviewing the data, we decided that grouping the visits into two groups, initial/annual and continuing/revisit, maximized the data received. An estimated 2.6 million patients had either an initial or annual medical examination, and an estimated 1.6 million patients returned (continuing/revisit) for medical services other than an initial or annual medical examination. Family Planning Visits Approximately 6.4 million family planning visits by women were reported for 1991 Table_1. Almost half the visits were for either an initial medical examination (19.3%) or a repeat annual medical examination (28.4%). Among Title X grantees, the definition of a family planning "visit" was complex and varied; thus, the data for 6,449,902 visits -- reported by 73 of the 75 grantees -- contain both inclusions and exclusions from the intended definition. The operational definition of a family planning visit excluded visits made for procurement of counseling only, pregnancy testing, STD treatment, and routine supplies without medical contact; however, visit counts for some grantees contained some or all of the above types of visits. Furthermore, the ability of grantees to identify from the patient records the types of visits made (e.g., an initial medical visit for a new patient or a repeat annual medical visit for a returning patient) was difficult, and categorization by types of visits varied. The intended definition included women only, but some grantees could not separate family planning visits on the basis of patients' sex. We estimated, however, that less than 1% of visits were made by male patients. Ages of Family Planning Patients Overall, 34.5% of family planning patients were 20-24 years of age, and 27.3% were 15-19 years of age Table_2. The number of patients by age was reported by all grantees. Race and Ethnicity of Family Planning Patients Race and ethnicity are two separate variables, and the ability of grantees to report data for both variables differed. Some grantees that were able to report race were not able to report ethnicity. Thus, this report presents data by race and Hispanic ethnicity from 59 grantees (representing 71.7% of the total number of patients) and by race only from 71 grantees (representing 97.5% of the total number of patients). Data by race and ethnicity indicate that most (61.9%) family planning patients were non-Hispanic whites Table_3. The percentage of Hispanic and black women receiving family planning services was 14.9% and 17.3%, respectively, and other minorities represented less than 5% of all patients. Twelve grantees that provided data by race did not provide data by ethnicity; seven of these 12 grantees were state health departments from southern states. These states have a proportionately larger black patient population than do the states represented by grantees that reported both race and ethnicity. The distribution of data by race alone indicates a larger percentage of black patients (23.0%) Table_4 compared with 17.3% for the distribution of data by race and ethnicity Table_3. Number of Previous Live Births The number of previous live births is often used by clinicians as a surrogate for pregnancy history in advising female patients about choices of contraceptive methods and other gynecologic services. Most (58.5%) family planning patients had had no live births, and few (7.5%) had had more than two live births Table_5. The number of live births was reported by 35 grantees, and the number of living children by 10 grantees, together representing 53.8% of all patients. The distributions of the data for live births and for living children were similar enough to warrant combining the two categories. Methods of Contraception Method of contraception was reported by 66 grantees, representing 91.9% of all patients. However, the categories that grantees used to describe methods of contraception differed. For example, only 26 grantees reported data for all of the following three categories: foam/jelly/cream, foam and condom, and condom. Other grantees used combinations of these categories. Oral contraceptives were the most frequently chosen method of contraception (i.e., 69.5% of patients had chosen this method) Table_6. The next most frequently chosen methods were condoms only (6.2%) and foam and condoms (5.1%). The category "none" (which comprised women who were a} receiving infertility services, b} pregnant, c} receiving counseling only, or d} abstaining from sexual intercourse) was reported for 11.3% of patients. The category "other," reported for 1.2% of patients, represented unlisted methods of contraception, including contraceptive implants. Nineteen grantees indicated specifically that the "other" category included use of Norplant(R). Services Provided to Family Planning Patients The variable most difficult for grantees to report and for us to interpret pertained to services provided. Definitions of what constituted a service, classification and cate-gorization of services, and manner of counting patients who received services differed among grantees. For example, many grantees overcounted services for women because data for male and female patients had been combined. Some grantees counted patients, not services; thus, multiple services for the same patient during the same year were not reported, resulting in undercounting of total services provided. For all grantees that reported services, 20,582,565 total services were provided to 2,832,153 patients during 4,801,353 visits. Thus, patients received an average of 7.27 services per year and an average of 4.29 services per visit. Total services provided included all services specified plus "other" services (18.7% of all services) and "unknown" services (0.04%). The category "other" included a broad range of services (e.g., measuring patients' height or weight, infertility screening, and unspecified services that may or may not have been classifiable in one or more of the specified service categories listed). The service ratio is the number of times a specific service is provided by grantees that report the service divided by the total number of patients receiving services from those grantees. This ratio indicates the frequency with which specific services are performed in relation to the total number of patients who received services. Papanicolaou (Pap) smear testing was the most frequently reported type of service provided to family planning patients (56 grantees) Table_7. The ratio of the total number of Pap smears to the total number of patients was 0.79. The highest service ratios (i.e., greater than 1.00) were for blood pressure testing and treatment or testing for STDs; the lowest service ratio (0.29) was for pregnancy testing. Grantees were asked not to provide data for patients who had had only pregnancy tests. Ratios of specific services provided per total patients receiving services varied. For example, greater than 90% of grantees had a ratio for breast examinations within the range 0.60-0.99. The ratios for STD treatment or testing, however, did not cluster around any central range of values. Male Patients Receiving Family Planning Services The number of male patients receiving family planning services (89,643) was reported from 73 of the 75 grantees. The counting and reporting of male patients differed greatly, but the ratio of male-to-female patients reported was uniformly low (overall ratio of 1:47). All but four grantees reporting data on the number of male patients had had less than 5% male patients. Poverty-Level Status of Family Planning Users Data concerning poverty-level status of family planning users were collected by grantees as part of required reporting by BCRR. ** All but one grantee provided data. The one grantee that did not provide poverty-status information did provide total number of family planning users, and that grantee's data were distributed on the basis of data from the other 74 grantees. Thus, information on poverty level is presented for all users from all grantees. Almost two thirds (64.7%) of family planning users were at or below the federal poverty level Table_8. Another 18.9% of family planning users were within 101%-150% of the poverty level; only 13.9% were above the poverty level by greater than 150%. In aggregate, 4.2 million family planning patients received services Table_1, compared with 4.4 million family planning users who received services Table_8. The difference likely reflects the broader definition of family planning users. Age Group, Race, and Ethnicity of Family Planning Patients Grantees were asked to provide cross-tabulations of age by race and ethnicity. Usable cross-tabulations were available for 1,652,637 family planning patients from 35 grantees Table_9. These patients represented 39.2% of all family planning patients and 54.6% of the patients reported by race and ethnicity Table_3. In the percentage distribution of patients Table_10, the total percentage distributions from the cross-tabulations by age group and race/ethnicity are similar to those of the respective univariate distributions (Table_2 and Table_3, respectively). Among the racial and ethnic groups, the distributions of patients by age differed notably. The largest number of patients less than or equal to 19 years of age were non-Hispanic whites (Table_9 and Table_10). Almost one third (31.1%) of non-Hispanic white patients were in this age group, and more than two thirds (68.6%) were less than 25 years of age. Similarly, 31.5% of black patients were less than or equal to 19 years of age; however, 17.9% of black patients were greater than or equal to 30 years of age, compared with 12.8% for non-Hispanic white patients. For Hispanics, Native Americans, and Asians/Pacific Islanders, more than one fourth of patients were greater than or equal to 30 years of age. By aggregating the racial and ethnic categories into white, black, and "other," data were usable from 42 grantees Table_11, representing 57.9% of the total number of family planning patients and 59.4% of the patients reported by race only. Again, the total percentage distributions Table_12 closely match the univariate distributions (Table_2 and Table_4). When we combined Hispanics and non-Hispanic whites into one racial group, the distributions for whites and blacks were similar. The percentage of patients ages 15-19 years was 27.6% for whites and 28.8% for blacks; the percentage of patients ages greater than or equal to 25 years was 35.3% for whites and 37.6% for blacks. For the "other" racial category, almost half (45.6%) the patients were greater than or equal to 25 years of age. Age Group and Number of Previous Live Births of Family Planning Patients Data cross-tabulated by age group and number of previous live births were usable from 36 grantees, representing 45.7% of the total number of family planning patients (Table_13 and Table_14). Most (54.0%) women reported having had no previous live births, and 2.9% had had four or more live births. Almost 20% of patients ages 15-19 years had had one or more live births. Age Group and Method of Contraception of Family Planning Patients Data cross-tabulated by age groups and method of contraception were usable from 43 grantees, representing 61.3% of the total number of family planning patients reported (Table_15 and Table_16. To maximize usable data, we combined foam, jelly, cream, and condoms into one category. For some grantees, the category "other" might contain some of the methods specified categorically. For every age group, oral contraceptives were the most preferred method of contraception; the next preferred category of contraceptives for every age group included foam/jelly/cream or condoms. Most (72.6%) teenagers used oral contraceptives, and 11.7% used foam/jelly/cream or condoms. For women greater than or equal to 30 years of age, 48.5% used oral contraceptives, and 17.7% used foam/jelly/cream or condoms. The age distribution of patients differed by method of contraception. Most (62.9%) women who chose sterilization were greater than or equal to 30 years of age, and most users of intrauterine devices (IUDs) (54.0%) and the cervical cap (51.0%) were in this same age group. Two thirds (67.5%) of women who used oral contraceptives and 56.2% of users of foam/jelly/cream or condoms were less than 25 years of age. The age distribution of women who received no method of contraception at their last visit parallels the age distribution of the patient population as a whole. DISCUSSION From the beginning of the national family planning program in 1970 until 1982, a data-collection system was in place to characterize patients receiving services from the program. In 1982, federal involvement in collecting and compiling national family planning statistics through a unified reporting system was discontinued. Currently, DHHS's Office of Population Affairs periodically monitors services to and characteristics of Title X patients at the national level by using information from CDC's National Survey of Family Growth (NSFG). Additional information related specifically to staffing and costs is available to the Office of Population Affairs because Title X grantees are required to report data annually to the BCRR system of the Bureau of Community Health Services. In 1983, AGI compiled data concerning family planning patients who had received services during 1981 from "organized family planning providers"; these providers included Title X clinics (2). The report, which AGI published in December 1983, includes data for 1981 and selected earlier years. *** Although the definition of a family planning patient used by AGI for the 1981 data was almost identical to that used for the FPSS data collection for 1991, the scope of the 1981 AGI report was somewhat broader. AGI's population of interest included women receiving family planning services from "organized family planning providers," whereas our population of interest was restricted to women receiving such services from clinics funded partially or entirely by Title X. A comparison of our data for 1991 with data compiled by AGI for selected years indicates that 1.4 million patients received family planning services at Title X clinics during 1970, compared with 4.6 million patients during both 1980 and 1981 and 4.2 million patients during 1991 Table_A-1. The percentage of family planning patients below the 150% poverty threshold increased from approximately 80% in 1981 to 86% in 1991 Table_A-2. In 1973, 28% of patients were at or above the 150% poverty threshold; in 1991, only 14% of patients were at that threshold. The age distribution of patients did not change over time; approximately 70% of patients in 1991 and for selected years since 1975 have been greater than or equal to 20 years of age Table_A-3. In both 1981 and 1991, the pregnancy histories of women using family planning services were similar Table_A-4. Approximately 60% of women had had no previous live births or living children, and less than 10% had had three or more live births or living children. Characteristics of all U.S. women who practice contraception, regardless of the source of contraceptive supplies, are collected periodically using NSFG. Data from the most recent NSFG indicate that oral contraceptives were the most frequently used birth control method during 1988 (6). In 1991, oral contraceptives were also the most frequently used method among women receiving services at Title X clinics. Nationally, however, approximately 31% of women used oral contraceptives, compared with 69% of women included in FPSS data. The age distribution of women who used oral contraceptives nationally was different from patients who received services at Title X clinics. In the NSFG, 59% of women 15-19 years of age who practiced contraception were using oral contraceptives; in comparison, at Title X clinics, 84% of women 15-19 years of age who practiced contraception were using oral contraceptives. Differences by racial or ethnic group in the percentage of family planning patients receiving services might be influenced by sociocultural phenomena and might be important variables to consider when assessing service-delivery practices. For example, black women are disproportionately represented among family planning patients at Title X clinics. Although black women constitute 13.4% of all women of reproductive age in the United States, they represent 23.0% of patients at Title X clinics (7). Recently, interest has been generated in assessing how funding patterns for public family planning services have changed during the 1980s and how those changes might have affected the characteristics of women who receive family planning services at Title X clinics. Reports published during the period 1981-1991 indicated that revenues for Title X clinics decreased both absolutely (43% in constant dollars) and as a proportion of total federal spending for family planning, and that the total number of Title X clinics decreased by 19% (1,4). However, the effects of decreases in Title X funding on the number and characteristics of family planning patients at Title X clinics are difficult to assess because of varying definitions and different study methodologies and time frames. Title X administrative data from BCRR and NSFG indicate that the number of patients has remained steady or has increased (1). In 1991, AGI initiated a new effort to monitor the current status of family planning needs and services; this activity included gathering information about the scope of the Title X family planning program. A report issued in 1992 indicated that in 1990 an estimated 5.3 million family planning patients received services in all clinics administered by Title X grantees (5). Thus, the data compiled by AGI indicate that approximately 1.1 million (26%) more family planning patients received services in 1990 than our data indicate for 1991. However, data for 1990 from AGI are not comparable with data from our report or with previous AGI data cited in the appendices of this report. The definition of "family planning patients" used in the most recent AGI study was broader than our definition and than that used in previous AGI studies. CONCLUSION The FPSS project characterizes women in the United States who receive family planning services at Title X clinics. Such clinics provided services to greater than 4 million women during 1991. Although the agencies funded by Title X monies collect and compile information about their patients, the usefulness of these data is limited because definitions, data items, data management, and statistical reporting are not standardized. Furthermore, because of inadequate staff resources, use of data by grantees for program planning and operations is given low priority. The need for national- and program-level data on family planning services, however, was expressed by all grantees. Despite important data limitations, the results from the FPSS project and related efforts by other organizations (5,8) will assist in characterizing the role of publicly funded family planning clinics in relation to current and future health-care delivery systems. In addition, improvements in the quality and timeliness of information about family planning services are needed to assist in formulating and evaluating national strategies and, at the state and local level, program planning and operation by grantees. References
* Family Planning Services and Population Research Act of 1970 (P.L. 91-572). Public Health Service Act, Title X. ** BCRR mandates that Title X grantees report poverty status of family planning users (3). Poverty statistics are based on a definition originated by the Social Security Administration in 1964 and subsequently modified by federal interagency committees in 1969 and 1980 and prescribed by the Office of Management and Budget as the standard that federal agencies use for statistical purposes. *** Appendix A presents data from that AGI report for comparison with the 1991 data compiled for this report. APPENDIX A Table_A-1. Number of family planning patients * -- United States, selected years Table_A-2. Percentage of family planning patients, * by poverty status of patients -- United States, selected years Table_A-3. Percentage of family planning patients, * by selected age groups -- United States, selected years Table_A-4. Percentage of family planning patients, * by
pregnancy
history of patient -- United States, selected years TABLE 1. Number and percentage of family planning patients * and visits + at Title X family planning clinics, by type -- United States, 1991 =============================================================== Category No. (%) --------------------------------------------------------------- Type of patient & Initial/Annual 2,631,544 ( 62.4) Continuing/Revisit 1,586,868 ( 37.6) Total 4,218,412 (100.0) Type of visit @ Initial medical 1,244,186 ( 19.3) Annual medical 1,832,417 ( 28.4) Other ** 3,373,299 ( 52.3) Total 6,449,902 (100.0) --------------------------------------------------------------- * Includes data for >=3,469 (0.1%) male patients. + Includes data for >=29,298 (0.5%) visits made by male patients. & Number of patients was reported by all grantees, but not all reported type of patients as requested; thus, percentages are based on data from 40 grantees that provided data as requested (representing 57.5% of the total 4,218,412 patients). @ Number of visits was reported by all but two grantees, but not all reported type of visit as requested; thus, percentages are based on data from 33 grantees that provided data as requested (representing 43.8% of the total 6,449,902 visits). ** Data for visits by four visit types were requested: a) initial medical, b) annual medical, c) other medical, and d) other family planning; however, because different definitions were used to categorize visits by type, other medical and other family planning visits were combined into one "other" visit category. =============================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Number and percentage of family planning patients * at Title X family planning clinics, by age group + -- United States, 1991 ============================================================== Age (yrs) & No. (%) -------------------------------------------------------------- <15 64,618 ( 1.5) 15-19 1,150,203 ( 27.3) (15) (101,572) ( 2.4) (16) (173,264) ( 4.1) (17) (246,075) ( 5.8) (18) (298,133) ( 7.1) (19) (331,159) ( 7.9) 20-24 1,451,277 ( 34.5) 25-29 845,129 ( 20.1) 30-34 437,422 ( 10.4) 35-39 162,445 ( 3.9) 40-44 57,719 ( 1.4) <=45 34,746 ( 0.8) Unknown 3,548 ( 0.1) Total 4,207,107 (100.0) -------------------------------------------------------------- * Includes data for >=5,339 (0.1%) male patients. + Number of patients by age group was reported by all grantees (representing 99.7% of the total 4,218,412 patients). & Many grantees provided age data in groupings other than those requested: 37 grantees provided age data as requested for women >=20 years of age (representing 39.9% of all patients); 32 grantees provided age data as requested for women <=19 years of age (representing 37.3% of all patients). ============================================================== Return to top. Table_3 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 3. Number and percentage of family planning patients * at Title X family planning clinics, by race/ethnicity + -- United States, 1991 =================================================================== Race/Ethnicity No. (%) ------------------------------------------------------------------- Hispanic 451,323 ( 14.9) White (non-Hispanic) 1,870,463 ( 61.9) Black (non-Hispanic) 524,095 ( 17.3) Native American 15,784 ( 0.5) Asian/Pacific Islander 37,615 ( 1.2) Other 71,022 ( 2.4) Unknown 53,823 ( 1.8) Total 3,024,125 (100.0) ------------------------------------------------------------------- * Includes >=9,328 (0.3%) male patients. + Both race and Hispanic ethnicity were reported by 59 grantees (representing 73.6% of the 4,111,769 patients for whom race was reported and 71.7% of the total 4,218,412 patients). =================================================================== Return to top. Table_4 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 4. Number and percentage of family planning patients * at Title X family planning clinics, by race + -- United States, 1991 ============================================================= Race No. (%) ------------------------------------------------------------- White & 2,952,381 ( 71.8) Black 947,112 ( 23.0) Other @ 142,973 ( 3.5) Unknown 69,303 ( 1.7) Total 4,111,769 (100.0) ------------------------------------------------------------- * Includes >=10,543 (0.3%) male patients. + By aggregating race and ethnicity into the above racial categories, data were available from 71 grantees (representing 97.5% of the total 4,218,412 patients). & Includes Hispanics and non-Hispanic whites. @ Includes Native Americans and Asians/Pacific Islanders. ============================================================= Return to top. Table_5 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 5. Number and percentage of family planning patients at Title X
family planning clinics, by number of previous live births * -- United
States, 1991
==========================================================================
Family planning patients
No. of -----------------------------------------
previous live births No. (%)
--------------------------------------------------------------------------
0 1,267,364 ( 58.5)
1 466,322 ( 21.5)
2 270,849 ( 12.5)
3 105,164 ( 4.8)
>=4 59,129 ( 2.7)
Total 2,168,828 (100.0)
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* Number of previous live births (or living children) was reported by 45
grantees (representing 2,270,162 {53.8%} of the total 4,218,412
patients); excluded were 101,334 patients reported as having an unknown
number of previous live births (or living children). Ten grantees
reported number of living children rather than number of live births
(representing 629,119 {27.7%} of the total 2,270,162 patients for whom
number of live births {or living children} were reported).
===========================================================================
Return to top. Table_6 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 6. Number and percentage of family planning patients * at Title X family planning clinics, by method of contraception + -- United States, 1991 ======================================================================== Method of contraception No. (%) ------------------------------------------------------------------------ Oral contraceptive 2,692,993 ( 69.5) Condom 242,057 ( 6.2) Foam and condom 196,180 ( 5.1) Sterilization 103,427 ( 2.7) Diaphragm 52,963 ( 1.4) Intrauterine device 29,948 ( 0.8) Foam/Jelly/Cream 28,221 ( 0.7) Sponge 14,640 ( 0.4) Natural 10,010 ( 0.3) Cervical cap 2,923 ( 0.1) Other & 48,321 ( 1.2) None @ 439,538 ( 11.3) Unknown 14,194 ( 0.4) Total 3,875,415 (100.0) ------------------------------------------------------------------------ * Includes >=23,064 (0.6%) male patients. + Method of contraception was reported by 66 grantees (representing 91.9% of the total 4,218,412 patients). & Includes patients using unlisted methods of contraception (e.g., Norplant (R)). @ Includes women who were a) receiving infertility services, b) pregnant, c) receiving counseling only, or d) abstaining from sexual intercourse. ======================================================================== Return to top. Table_7 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 7. Selected information regarding services provided to family planning patients * at Title X
family planning clinics -- United States, 1991
======================================================================================================
No. of Grantees
grantees Range of in range of
Service reporting Service ratio + ratios & ratios (%)
------------------------------------------------------------------------------------------------------
Blood pressure test 52 1.24 0.90-1.69 86.5
Breast examination 52 0.73 0.60-0.99 94.2
Hemoglobin/Hematocrit 52 0.61 0.20-0.99 96.2
Papanicolaou (PAP) smear test 56 0.79 0.60-1.09 92.9
Pelvic examination 52 0.87 0.70-1.19 86.5
Pregnancy test 55 0.29 0.10-0.49 90.9
Test or treatment for STD(s) @ 54 1.07 ** --
Urinalysis 50 0.56 0.20-0.99 88.0
------------------------------------------------------------------------------------------------------
* Some grantees included male patients in services reported.
+ The number of times specific services were provided by grantees that reported the service divided
by the total number of patients served by those grantees. This ratio indicates the frequency with
which specific services are performed in relation to the total number of patients served.
& Includes approximately 90% of grantees.
@ Sexually transmitted disease(s).
** Broad range of ratios (0.10-2.19), with no central grouping of ratios.
======================================================================================================
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TABLE 8. Number and percentage of family planning users * at Title X family
planning clinics, by poverty level + -- United States, 1991
============================================================================
Poverty level No. (%)
----------------------------------------------------------------------------
<=100% 2,831,254 ( 64.7)
101%-150% 826,093 ( 18.9)
>150% 606,497 ( 13.9)
Unknown 111,776 ( 2.6)
Total 4,375,620 (100.0)
----------------------------------------------------------------------------
* Family planning "user" (as defined by the Bureau of Common Reporting
Requirements {BCRR}, Section III.C.2 {3}) and family planning "patient"
are similar, but not identical, terms (e.g., "user" includes persons
receiving only family planning counseling).
+ Poverty level as defined by BCRR. Poverty level was reported by all but
one grantee; however, that grantee reported the total number of family
planning users, which was distributed into poverty-level categories based
on data from the other grantees.
============================================================================
Return to top. Table_9 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 9. Number of family planning patients at Title X family planning clinics, by age group and race/ethnicity * -- United States, 1991
===========================================================================================================================================
Race/Ethnicity
---------------------------------------------------------------------------------------------------------
Age group Non-Hispanic Non-Hispanic Native Asian/Pacific
(yrs) Hispanic white black American Islander Other Unknown Total
-------------------------------------------------------------------------------------------------------------------------------------------
<15 2,901 12,973 8,289 210 172 932 109 25,586
15-19 42,892 307,425 84,897 2,045 4,196 11,531 3,899 456,885
(15-17) (16,669) (137,024) (41,720) (1,019) (1,675) (5,649) (1,409) (205,165)
(18-19) (26,223) (170,401) (43,177) (1,026) (2,521) (5,882) (2,490) (251,720)
20-24 68,590 386,827 91,839 2,191 6,290 14,115 8,420 578,272
25-29 51,849 192,340 57,231 1,998 4,200 10,330 5,529 323,477
30-34 30,257 89,282 31,568 1,101 2,887 5,965 3,147 164,207
>=35 26,478 42,587 21,266 1,114 2,542 4,200 2,320 100,507
Unknown 53 261 148 0 1 6 3,234 3,703
Total 223,020 1,031,695 295,238 8,659 20,288 47,079 26,658 1,652,637
-------------------------------------------------------------------------------------------------------------------------------------------
* Thirty-five grantees provided data both in the age groups requested and by race and Hispanic ethnicity (representing 39.2% of the total
4,218,412 patients and 54.6% of the 3,024,125 patients for whom race and ethnicity were available).
===========================================================================================================================================
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TABLE 10. Percentage of family planning patients at Title X family planning clinics, by age group and race/ethnicity * -- United States, 1991
=========================================================================================================================================================
Race/Ethnicity
----------------------------------------------------------------------------------------------------------------
Age group Non-Hispanic Non-Hispanic Native Asian/Pacific
(yrs) Hispanic white black American Islander Other Unknown Total
---------------------------------------------------------------------------------------------------------------------------------------------------------
<15 1.3 1.3 2.8 2.4 0.8 2.0 0.4 1.5
15-19 19.3 29.8 28.7 23.6 20.7 24.5 14.6 27.6
(15-17) ( 7.5) (13.3) (14.1) (11.8) ( 8.3) (12.0) (5.3) (12.4)
(18-19) (11.8) (16.5) (14.6) (11.8) (12.4) (12.5) (9.3) (15.2)
20-24 30.7 37.5 31.1 25.3 31.1 30.0 31.7 35.1
25-29 23.2 18.6 19.4 23.1 20.7 21.9 20.7 19.6
30-34 13.6 8.7 10.7 12.7 14.2 12.7 11.8 9.9
>=35 11.9 4.1 7.2 12.9 12.5 8.9 8.7 6.1
Unknown 0.0 0.0 0.1 0.0 0.0 0.0 12.1 0.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% of total 13.5 62.5 17.9 0.5 1.2 2.8 1.6 100.0
---------------------------------------------------------------------------------------------------------------------------------------------------------
* Thirty-five grantees provided data both in the age groups requested and by race and Hispanic ethnicity (representing 39.2% of the
total
4,218,412 family planning patients and 54.6% of the 3,024,125 patients for whom race and ethnicity were available).
=========================================================================================================================================================
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TABLE 11. Number of family planning patients at Title X family planning clinics, by age
group and race * -- United States, 1991
===========================================================================================
Race
Age group -------------------------------------------------------
(yrs) White + Black Other & Unknown Total
-------------------------------------------------------------------------------------------
<15 21,504 15,390 1,584 223 38,701
15-19 473,974 164,913 22,337 8,121 669,345
(15-17) (208,386) (82,628) (10,417) (3,183) (304,615)
(18-19) (265,588) (82,285) (11,920) (4,938) (364,730)
20-24 613,686 175,780 29,592 14,623 833,681
25-29 344,479 116,432 21,848 13,947 496,706
30-34 168,474 62,628 12,927 8,800 252,829
>=35 93,739 36,084 10,175 6,255 146,253
Unknown 572 555 19 4,484 5,630
Total 1,716,428 571,782 98,482 56,453 2,443,145
-------------------------------------------------------------------------------------------
* Forty-two grantees provided data both in the age groups requested and by race
(representing 57.9% of the total 4,218,412 family planning patients and 59.4% of the
4,111,769 patients for whom race was reported).
+ Includes Hispanics and non-Hispanic whites.
& Includes Native Americans and Asians/Pacific Islanders.
===========================================================================================
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TABLE 12. Percentage of family planning patients at Title X family planning clinics, by
age group and race * -- United States, 1991
===============================================================================================
Race
Age group -------------------------------------------------------
(yrs) White + Black Other & Unknown Total
-----------------------------------------------------------------------------------------------
<15 1.3 2.7 1.6 0.4 1.6
15-19 27.6 28.8 22.7 14.4 27.4
(15-17) (12.1) (14.4) (10.6) (5.6) (12.5)
(18-19) (15.5) (14.4) (12.1) (8.8) (14.9)
2024 35.7 30.7 30.1 25.9 34.2
25-29 20.1 20.4 22.2 24.7 20.3
30-34 9.8 11.0 13.1 15.6 10.3
>=35 5.5 6.3 10.3 11.1 6.0
Unknown 0.0 0.1 0.0 7.9 0.2
Total 100.0 100.0 100.0 100.0 100.0
% of total 70.3 23.4 4.0 2.3 100.0
-----------------------------------------------------------------------------------------------
* Forty-two grantees provided data both in the age groups requested and by race (representing
57.9% of the total 4,218,412 family planning patients and 59.4% of the 4,111,769 patients for
whom race was reported).
+ Includes Hispanics and non-Hispanic whites.
& Includes Native Americans and Asians/Pacific Islanders.
===============================================================================================
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TABLE 13. Number of family planning patients at Title X family planning clinics, by age group and number of previous live
births * -- United States, 1991
===========================================================================================================================
No. of previous live births +
--------------------------------------------------------------------------------------
Age group (yrs) 0 1 2 3 >=4 Unknown Total
---------------------------------------------------------------------------------------------------------------------------
<15 22,564 1,709 134 24 16 2,619 27,066
15-19 383,498 78,046 14,145 2,099 424 36,421 514,633
(15-17) (184,845) (26,591) ( 2,971) ( 316) (84) (16,736) (231,543)
(18-19) (198,653) (51,455) (11,174) (1,783) (340) (19,685) (283,090)
20-24 358,481 156,549 70,737 19,708 4,991 47,051 657,517
25-29 131,649 101,218 84,271 35,983 12,416 29,471 395,008
30-34 46,418 46,295 51,966 32,722 16,779 15,541 209,721
>=35 21,432 19,297 28,996 25,278 17,542 8,797 121,342
Unknown 224 108 101 63 117 43 656
Total 964,266 403,222 250,350 115,877 52,285 139,943 1,925,943
---------------------------------------------------------------------------------------------------------------------------
* Thirty-six grantees provided data both in the requested age groups and by number of previous live births (or number of
living children). Patients served by these grantees represented 45.7% of the total 4,218,412 patients.
+ Number of living children reported by five grantees.
===========================================================================================================================
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TABLE 14. Percentage * of family planning patients at Title X family planning clinics, by age group and
number of previous live births + -- United States, 1991
==========================================================================================================
No. of previous live births &
Age group ----------------------------------------------------------------------
(yrs) 0 1 2 3 >=4 Total
<15 92.3 7.0 0.5 0.1 0.1 100.0
15-19 80.2 16.3 3.0 0.4 0.1 100.0
(15-17) (86.1) (12.4) (1.4) (0.1) (0.0) (100.0)
(18-19) (75.5) (19.5) (4.2) (0.7) (0.1) (100.0)
20-24 58.8 25.6 11.6 3.2 0.8 100.0
25-29 36.0 27.7 23.1 9.8 3.4 100.0
30-34 23.9 23.8 26.8 16.9 8.6 100.0
>=35 19.0 17.1 25.8 22.5 15.6 100.0
Total 54.0 22.6 14.0 6.5 2.9 100.0
----------------------------------------------------------------------------------------------------------
* Excluding unknown.
+ Thirty-six grantees provided data both in the requested age groups and by number of previous live births
(or number of living children). Patients served by these grantees represented 45.7% of the total
4,218,412 patients.
& Number of living children reported by five grantees.
==========================================================================================================
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TABLE 15. Number of family planning patients at Title X family planning clinics, by patient * age group and method of contraception + -- United States, 1991
============================================================================================================================================================
Method of contraception
---------------------------------------------------------------------------------------------------------------------------
Foam @
Age group Oral and/or Cervical
(yrs) contraception IUD & Diaphragm condom Natural Sponge cap Sterilization Other ** None Unknown Total
------------------------------------------------------------------------------------------------------------------------------------------------------------
<15 24,559 25 91 6,547 75 59 1 107 1,001 5,994 205 38,664
15-19 508,985 1,031 3,871 79,199 669 1,038 36 1,480 12,140 84,684 2,961 696,094
(15-17) (226,372) (351) (1,376) (38,872) (280) (434) (12) (670) (5,611) (38,656) (1,388) (314,022)
(18-19) (282,613) (680) (2,495) (40,327) (389) (604) (24) (810) (6,529) (46,028) (1,573) (382,072)
20-24 660,535 3,975 10,163 89,375 1,444 2,097 152 6,233 15,134 96,939 3,532 889,579
25-29 361,125 5,552 9,680 59,657 1,616 1,843 185 12,049 10,233 58,797 1,975 522,712
>=30 209,448 12,464 16,513 76,563 2,906 2,785 390 33,673 14,713 60,269 1,882 431,606
Unknown 3,654 26 90 548 7 13 1 59 471 415 65 5,349
Total 1,768,306 23,073 40,408 311,889 6,717 7,835 765 53,601 53,692 307,098 10,620 2,584,004
------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes >=19,856 (0.8%) male patients.
+ Forty-three grantees provided data both in the requested age groups and by method of contraception (representing 61.3% of the
total 4,218,412 patients).
& Intrauterine device.
@ Includes foam/jelly/cream.
** May contain some of the specified methods.
============================================================================================================================================================
Return to top. Table_16 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE 16. Percentage of family planning patients at Title X family planning clinics, by patient * age group and method of contraception + -- United States, 1991
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Method of contraception
-----------------------------------------------------------------------------------------------------------------------------
Foam @
Age group Oral and/or Cervical
(yrs) contraception IUD & Diaphragm condom Natural Sponge cap Sterilization Other ** None Unknown Total
----------------------------------------------------------------------------------------------------------------------------------------------------------------
<15 1.4 0.1 0.2 2.1 1.1 0.8 0.1 0.2 1.9 2.0 1.9 1.5
15-19 28.8 4.5 9.6 25.4 10.0 13.2 4.7 2.7 22.6 27.6 27.9 27.0
(15-17) (12.8) (1.5) (3.4) (12.5) (4.2) (5.5) (1.6) (1.2) (10.4) (12.6) (13.1) (12.2)
(18-19) (16.0) (3.0) (6.2) (12.9) (5.8) (7.7) (3.1) (1.5) (12.2) (15.0) (14.8) (14.8)
20-24 37.4 17.2 25.2 28.7 21.5 26.8 19.9 11.6 28.1 31.6 33.3 34.4
25-29 20.4 24.1 24.0 19.1 24.1 23.5 24.2 22.5 19.1 19.1 18.6 20.2
>=30 11.8 54.0 40.8 24.5 43.2 35.5 51.0 62.9 27.4 19.6 17.7 16.7
Unknown 0.2 0.1 0.2 0.2 0.1 0.2 0.1 0.1 0.9 0.1 0.6 0.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
% of total 68.3 0.9 1.6 12.1 0.3 0.3 0.0 2.1 2.1 11.9 0.4 100.0
----------------------------------------------------------------------------------------------------------------------------------------------------------------
* Includes >=19,856 (0.8%) male patients.
+ Forty-three grantees provided data both in the requested age groups and by method of contraception (representing 61.3% of the total 4,218,412 patients).
& Intrauterine device.
@ Includes foam/jelly/cream.
** May contain some of the specified methods.
================================================================================================================================================================
Return to top. Table_A-1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE A-1. Number of family planning patients * -- United States, selected years ================================================= Source Year + No. served ------------------------------------------------- AGI & 1970 1,410,000 AGI 1975 3,924,000 AGI 1980 4,644,000 AGI 1981 4,609,000 FPSS @ 1991 4,215,000 ------------------------------------------------- * Female patients only. + For 1970, the number of patients served during the fiscal year October 1, 1969, through September 30, 1970. For all other selected years, totals reflect the number served during the calendar year. & The Alan Guttmacher Institute. During 1970, 1975, 1980, and 1981, patients were served by organized family planning providers (4). @ Family Planning Services Surveillance project. During 1991, patients were served by clinics receiving Title X funds. ================================================= Return to top. Table_A-2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.
TABLE A-2. Percentage of family planning patients, * by poverty status of patients --
United States, selected years
======================================================================================
Poverty level
-------------------------------------
Source Year + <150% 150%-200%>200% Total (%)
--------------------------------------------------------------------------------------
AGI & 1973 72 13 15 100
AGI 1975 78 11 11 100
AGI 1980 81 10 9 100
AGI 1981 80 NA @ NA --
FPSS ** 1991 86 -- 14 -- 100
--------------------------------------------------------------------------------------
* Female patients only.
+ For 1973, the number of patients served during the fiscal year October 1, 1972,
through September 30, 1973. For all other selected years, totals reflect the number
served during the calendar year.
& The Alan Guttmacher Institute. During 1973, 1975, 1980, and 1981, patients were
served by organized family planning providers (4).
@ Not available.
** Family Planning Services Surveillance project. During 1991, patients were served by
clinics receiving Title X funds.
======================================================================================
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TABLE A-3. Percentage of family planning patients, * by selected age
groups -- United States, selected years
======================================================================
Age group (yrs)
-----------------------------------
Source Year + <18 <20>=20
----------------------------------------------------------------------
AGI & 1970 NA @ 21 NA
AGI 1975 12 30 70
AGI 1980 15 33 67
AGI 1981 15 33 67
FPSS ** 1991 14 29 71
----------------------------------------------------------------------
* Female patients only.
+ For 1970, the number of patients served during the fiscal year
October 1, 1969, through September 30, 1970. For all other selected
years, totals reflect the number served during the calendar year.
& The Alan Guttmacher Institute. During 1970, 1975, 1980, and 1981,
patients were served by organized family planning providers (4).
@ Not available.
** Family Planning Services Surveillance project. During 1991,
patients were served by clinics receiving Title X funds.
======================================================================
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TABLE A-4. Percentage of family planning patients, * by pregnancy history of patient
-- United States, selected years
======================================================================================
Percentage of patients
------------------------------------------------------
No. of live births or living children *
---------------------------------------
Source Year + 0 1-2 >=3 Total
--------------------------------------------------------------------------------------
AGI + 1975 49 36 15 100
AGI 1980 54 36 10 100
AGI 1981 60 32 8 100
FPSS & 1991 58 34 8 100
--------------------------------------------------------------------------------------
* For 1991, the number of previous live births, which is often used as a surrogate for
pregnancy history, was reported by 35 grantees. Ten grantees provided number of
living children instead of number of live births. Altogether, these grantees
represented 54% of the total 4,218,412 patients.
+ The Alan Guttmacher Institute. During 1975, 1980, and 1981, patients were served by
organized family planning providers (4).
& Family Planning Services Surveillance project. During 1991, patients were served by
clinics receiving Title X funds.
======================================================================================
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