Family Planning Annual Report: Forms and Instructions

Attachment F - 1

ATTACHMENT F
Family Planning Annual Report:
20 National Summary

Attachment F - 2

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Attachment F - 3

November 2012

Title X
Family Planning
Annual Report
2011 National Summary

Attachment F - 4

November 2012

Family Planning Annual Report:
2011 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 700
Rockville, MD 20852

Prepared by
RTI International
3040 Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709

RTI International is a trade name of Research Triangle Institute.

Attachment F - 5

SUGGESTED CITATION
Fowler, CI, Lloyd, S, Gable, J, Wang, J, and McClure, E. (November 2012). Family Planning
Annual Report: 2011 National Summary. Research Triangle Park, NC: RTI International.

ADDITIONAL COPIES
This report can be viewed, downloaded, and printed from the Office of Population Affairs
Website at http://www.hhs.gov/opa/title-x-family-planning/research-and-data/fp-annualreports/#fpar.

ACKNOWLEDGMENTS
This report was prepared at RTI International by Christina Fowler (Senior Health Services
Analyst), Stacey Lloyd (Analyst), Julia Gable (Statistician), Jiantong Wang (Statistician), and
Emily McClure (Analyst). Nathan Sikes, Allan Downs, and Michael Mouzakitis provided
support for web-based data collection, and Richard Hair (Editor), Roxanne Snaauw
(Document Preparation Specialist), and Cheryl Velez, Kimberly Cone, Teresa Bass, and
Danny Occoquan (Web Conversion Team) provided publications assistance.
For their help resolving data validation issues and reviewing the final report, the authors
thank U.S. Department of Health and Human Services (HHS) staff Susan Moskosky (Deputy
Director, Office of Population Affairs [OPA]), CDR Nancy Mautone-Smith (Public Health
Advisor, OPA), Evelyn Glass (FPAR Consultant), Christina Lachance (Public Health
Advisor, OPA), and HHS staff in regional offices.
RTI prepared this report under OPA contract number HHSP23320095651WC/
HHSP23337008T (Task Order 10). The conclusions expressed in this report are those of the
authors and do not necessarily represent the views of HHS or OPA.

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CONTENTS
1

Introduction ........................................................................................ 1

Title X National Family Planning Program ........................................................................... 1
Family Planning Annual Report............................................................................................. 1
Report Structure ..................................................................................................................... 3
2

FPAR Methodology .............................................................................. 5

Data Collection ...................................................................................................................... 5
Data Reporting ....................................................................................................................... 5
Data Validation ...................................................................................................................... 5
3

Findings .............................................................................................. 7

Grantee Profile ....................................................................................................................... 7
Family Planning User Demographic Profile .......................................................................... 8
Total Users (Exhibit 3) .................................................................................................... 8
Users by Sex (Exhibits 4 and 5) ...................................................................................... 8
Users by Age (Exhibits 4 and 5) ..................................................................................... 9
Users by Race (Exhibits 6 to 14) ..................................................................................... 9
Users by Ethnicity (Exhibits 6 to 14) ............................................................................ 12
Family Planning User Social and Economic Profile ............................................................ 21
Users by Income Level (Exhibit 15) ............................................................................. 21
Users by Insurance Coverage Status (Exhibit 16) ......................................................... 21
Limited English Proficient Users (Exhibit 17) .............................................................. 24
Family Planning Method Use............................................................................................... 27
Female Users by Primary Contraceptive Method (Exhibits 18 to 21) .......................... 27
Male Users by Primary Contraceptive Method (Exhibits 22 to 25) .............................. 29
Cervical and Breast Cancer Screening ................................................................................. 39
Cervical Cancer Screening (Exhibit 26) ........................................................................ 39
Breast Cancer Screening (Exhibit 26) ........................................................................... 39
Sexually Transmitted Disease Testing ................................................................................. 41
Chlamydia Testing (Exhibits 27 and 28) ....................................................................... 41
Gonorrhea Testing (Exhibit 29) .................................................................................... 41
Syphilis Testing (Exhibit 29) ........................................................................................ 45
Human Immunodeficiency Virus Testing (Exhibit 29) ................................................. 45
Staffing and Family Planning Encounters ............................................................................ 47
Staffing (Exhibit 30) ..................................................................................................... 47

Attachment F - 7

Family Planning Encounters (Exhibit 30) ..................................................................... 47
Revenue ................................................................................................................................ 49
Title X Services Grant ................................................................................................... 49
Payment for Services: Client Collections ...................................................................... 49
Payment for Services: Third-Party Payers .................................................................... 49
Other Revenue ............................................................................................................... 50
Revenue per User .......................................................................................................... 50
Trends............................................................................................................................ 52
4

References ........................................................................................ 57

Appendixes

A.

National and Regional 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 ............................................ 2

2.

Number of and percentage change in grantees, delegates, and service sites,
by year and region: 2010–2011 (Source: FPAR Grantee Profile Cover Sheet) ........... 7

3.

Number, distribution, and percentage change in number of family planning
users, by year and region: 2010–2011 (Source: FPAR Table 1) .................................. 8

4.

Number of family planning users, by sex, age, and region: 2011
(Source: FPAR Table 1)............................................................................................. 10

5.

Distribution of family planning users, by sex, age, and region: 2011
(Source: FPAR Table 1)............................................................................................. 11

6.

Number and distribution of all family planning users, by race and ethnicity:
2011 (Source: FPAR Tables 2 and 3) ........................................................................ 13

7.

Number and distribution of female family planning users, by race and
ethnicity: 2011 (Source: FPAR Table 2).................................................................... 13

8.

Number and distribution of male family planning users, by race and
ethnicity: 2011 (Source: FPAR Table 3).................................................................... 13

9.

Number of all family planning users, by race, ethnicity, and region: 2011
(Source: FPAR Tables 2 and 3) ................................................................................. 14

10.

Distribution of all family planning users, by race, ethnicity, and region: 2011
(Source: FPAR Tables 2 and 3) ................................................................................. 15

11.

Number of female family planning users, by race, ethnicity, and region:
2011 (Source: FPAR Table 2).................................................................................... 16

Attachment F - 8

12.

Distribution of female family planning users, by race, ethnicity, and region:
2011 (Source: FPAR Table 2).................................................................................... 17

13.

Number of male family planning users, by race, ethnicity, and region: 2011
(Source: FPAR Table 3)............................................................................................. 18

14.

Distribution of male family planning users, by race, ethnicity, and region:
2011 (Source: FPAR Table 3).................................................................................... 19

15.

Number and distribution of all family planning users, by income level and
region: 2011 (Source: FPAR Table 4) ....................................................................... 22

16.

Number and distribution of all family planning users, by principal health
insurance coverage status and region: 2011 (Source: FPAR Table 5) ....................... 23

17.

Number and percentage of limited English proficiency family planning users
who are served by all grantees and grantees in the 50 states and DC, by
region: 2011 (Source: FPAR Table 6) ....................................................................... 25

18.

Number of female family planning users, by primary contraceptive method
and age: 2011 (Source: FPAR Table 7) ..................................................................... 30

19.

Distribution of female family planning users, by primary contraceptive
method and age: 2011 (Source: FPAR Table 7) ........................................................ 31

20.

Number of female family planning users, by primary contraceptive method
and region: 2011 (Source: FPAR Table 7)................................................................. 32

21.

Distribution of female family planning users, by primary contraceptive
method and region: 2011 (Source: FPAR Table 7) .................................................... 33

22.

Number of male family planning users, by primary contraceptive method
and age: 2011 (Source: FPAR Table 8) ..................................................................... 34

23.

Distribution of male family planning users, by primary contraceptive method
and age: 2011 (Source: FPAR Table 8) ..................................................................... 35

24.

Number of male family planning users, by primary contraceptive method
and region: 2011 (Source: FPAR Table 8)................................................................. 36

25.

Distribution of male family planning users, by primary contraceptive method
and region: 2011 (Source: FPAR Table 8)................................................................. 37

26.

Cervical and breast cancer screening activities, by screening test or exam
and region: 2011 (Source: FPAR Tables 9 and 10) ................................................... 40

27.

Number of family planning users tested for chlamydia, by sex, age, and
region: 2011 (Source: FPAR Table 11) ..................................................................... 42

28.

Percentage of family planning users in each age group tested for chlamydia,
by sex, age, and region: 2011 (Source: FPAR Table 11) ........................................... 43

29.

Number of gonorrhea, syphilis, and HIV tests performed, by test type and
region: 2011 (Source: FPAR Table 12) ..................................................................... 44

30.

Number and distribution of clinical services provider (CSP) full-time
equivalent (FTE) staff by type of CSP and region, and number and
distribution of family planning encounters, by type of encounter and region:
2011 (Source: FPAR Table 13).................................................................................. 48

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31.

Amount and distribution of Title X project revenues, by revenue source:
2011 (Source: FPAR Table 14).................................................................................. 53

32.

Amount of Title X project revenues, by revenue source and region: 2011
(Source: FPAR Table 14)........................................................................................... 54

33.

Distribution of Title X project revenues, by revenue source and region: 2011
(Source: FPAR Table 14)........................................................................................... 55

A–1a.

Number and distribution of all family planning users, by region and year:
1999–2011 ............................................................................................................... A-2

A–1b. Distribution of all family planning users, by region and year: 1999–2011 .............. A-3
A–2a.

Number and distribution of all family planning users, by age and year:
1999–2011 ............................................................................................................... A-4

A–2b. Distribution of all family planning users, by age and year: 1999–2011 .................. A-5
A–3a.

Number and distribution of all family planning users, by race and year:
1999–2011 ............................................................................................................... A-6

A–3b. Distribution of all family planning users, by race and year: 1999–2011 ................. A-7
A–4a.

Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 1999–2011 ................................................................ A-8

A–4b. Distribution of all family planning users, by Hispanic or Latino ethnicity (all
races) and year: 1999–2011 ..................................................................................... A-9
A–5a.

Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 1999–2011 ..................................................................... A-10

A–5b. Distribution of all family planning users, by Hispanic or Latino ethnicity,
race, and year: 1999–2011 ..................................................................................... A-11
A–6a.

Number and distribution of all family planning users, by income level and
year: 1999–2011 .................................................................................................... A-12

A–6b. Distribution of all family planning users, by income level and year:
1999–2011 ............................................................................................................. A-13
A–7a.

Number of female family planning users, by primary contraceptive method
and year: 1999–2011 .............................................................................................. A-14

A–7b. Distribution of female family planning users who reported a primary
contraceptive method at exit from the encounter, by method and year:
1999–2011 ............................................................................................................. A-15
A–7c.

Distribution of female family planning users who reported a primary
contraceptive method at exit from the encounter, by level of method
effectiveness and year: 1999–2011 ........................................................................ A-16

A–8a.

Number and percentage of female users who received a Pap test, number of
Pap tests performed, and percentage of Pap tests performed with an atypical
squamous cells or higher result, by year: 2005–2011 ............................................ A-17

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A–8b. Number and percentage of female users who received a Pap test, by year:
2005–2011 ......................................................................................................... A-17
A–9a.

Number and percentage of female users under 25 tested for chlamydia, by
year: 2005–2011 ................................................................................................. A-18

A–9b. Number and percentage of female users under 25 tested for chlamydia, by
year: 2005–2011 ................................................................................................. A-18
A-10a. Number of confidential HIV tests performed and number of tests per 10
users: 1999–2011 ................................................................................................ A-19
A-10b. Number of confidential HIV tests performed and number of tests per 10
users: 1999–2011 ................................................................................................ A-19
A–11a. Actual and adjusted (constant 1999$ and 1981$) total, Title X, and
Medicaid revenue, by year: 1999–2011.............................................................. A-20
A–11b. Total, Title X, and Medicaid adjusted (constant 1999$) revenue, by year:
1999–2011 ......................................................................................................... A-21
A–11c. Total actual (unadjusted) and adjusted (constant 1999$ and 1981$)
revenue, by year: 1999–2011.............................................................................. A-22
A–11d. Title X actual (unadjusted) and adjusted (constant 1999$ and 1981$)
revenue, by year: 1999–2011.............................................................................. A-23
A–11e. Medicaid actual (unadjusted) and adjusted (constant 1999$ and 1981$)
revenue, by year: 1999–2011.............................................................................. A-24
A–12a. Amount of Title X project revenue, by revenue source and year: 1999–
2011 ................................................................................................................... A-25
A–12b. Distribution of Title X project revenue, by revenue source and year: 1999–
2011 ................................................................................................................... A-26
A–12c. Distribution of Title X project revenue, by revenue source and year: 1999–
2011 ................................................................................................................... A-27
B–1.

State-level number and distribution of family planning users, by user sex,
and distribution of all users by state: 2011 (Source: FPAR Table 1) ................... B-2

B–2.

State-level number and distribution of family planning users, by user
income level: 2011 (Source: FPAR Table 4) ........................................................ B-4

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1

Introduction

TITLE X NATIONAL FAMILY PLANNING PROGRAM
The 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). The
Title X program is the only federal program dedicated solely to the provision of family
planning and related preventive health care. The program is designed to provide contraceptive
supplies and information to all who want and need them, with priority given to persons from
low-income families. Title X-funded agencies offer a broad range of effective and acceptable
contraceptive methods on a voluntary and confidential basis. In addition, Title X funds
support the delivery of related preventive health services, including patient education and
counseling; cervical and breast cancer screening; sexually transmitted disease (STD) and HIV
prevention education, testing, and referral; and pregnancy diagnosis and counseling. By law,
Title X funds may not be used in programs where abortion is a method of family planning.2
For many clients, Title X service sites provide the only continuing source of health care and
health education. In fiscal year 2011, the program received approximately $299.4 million in
funding.3
OPA allocates Title X service funds to U.S. Department of Health and Human Services
(HHS) offices in 10 regions, shown in Exhibit 1. Each regional office manages the
competitive review of Title X grant applications, makes grant awards, and monitors program
performance for its respective region.

FAMILY PLANNING ANNUAL REPORT
The Family Planning Annual Report (FPAR) is the only source of uniform reporting by all
Title X service 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 service
grantees for purposes of monitoring program performance and reporting.4,5 The FPAR data
are reported and presented in summary form to protect the confidentiality of the persons who
receive Title X-funded services.6
Title X administrators and grantees use FPAR data to
• monitor compliance with statutory requirements;

•

comply with accountability and federal performance requirements for Title X family
planning funds, as required by the 1993 Government Performance and Results Act and
the Office of Management and Budget;

•

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.

Attachment F - 13

Exhibit 1.

U.S. Department of Health and Human Services regions

Not shown on map: American Samoa,
Commonwealth of the Northern Mariana
Islands, Federated States of Micronesia,
Guam, Republic of the Marshall Islands,
and Republic of Palau.

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, Washington, DC, Maryland, Pennsylvania,
Virginia, and West Virginia

•

Region IV (Atlanta, GA)—Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, and Tennessee

•

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

Attachment F - 14

REPORT STRUCTURE
The Family Planning Annual Report: 2011 National Summary presents data for the
91 Title X service grantees that submitted an FPAR report for the 2011 reporting period
(January 1, 2011 to December 31, 2011). The Summary has five 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.
Section 3—Findings—presents the results for each FPAR table and includes a discussion of
national and regional patterns and trends for selected indicators. Section 3 also presents
definitions for table-specific FPAR terms and reporting instructions.
Section 4—References—is a list of key FPAR and report references.
Section 5—Appendixes—consists of three appendixes. Appendix A presents trend data for
1999 to 2011 or 2005 to 2011 for selected indicators. Appendix B presents information on the
number and distribution of users served in 2011 by sex and income level for each state, the
District of Columbia, and the eight U.S. territories and jurisdictions (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 C presents general and table-specific notes about the data presented in this
report.

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Key Terms and Definitions for FPAR Reporting
Family Planning User—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. The same individual may be counted as a family planning user only
once during a reporting period.
Family Planning Encounter—A family planning encounter is 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—whether clinical or nonclinical—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. To be counted
for purposes of the FPAR, a written record of the service(s) provided during the family planning encounter must be
documented in the client record.
There are two types of family planning encounters at Title X service sites: (1) family planning encounters with a
clinical services provider and (2) family planning encounters with other services providers. The type of family
planning provider who renders the care, regardless of the services rendered, determines the type of family planning
encounter.
Laboratory tests and related counseling and education, in and of themselves, do not constitute a family planning
encounter unless there is face-to-face contact between the client and provider, the provider documents the encounter
in the client’s record, and the test(s) is/are accompanied by family planning counseling or education.
Family Planning Provider—A family planning provider is the individual who assumes primary responsibility for
assessing a client and documenting services in the client record. Providers include those agency staff who exercise
independent judgment as to the services rendered to the client during an encounter. Two general types of providers
deliver Title X family planning services: clinical services providers and other services providers.
Family Planning Service Site—A family planning service site refers to an established unit where grantee or
delegate agency staff provide Title X services (clinical, counseling, educational, and/or referral) that comply with the
Title X Program Guidelines7 and where at least some of the encounters between the family planning provider(s) and
the individual(s) 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 Record—Title X projects must establish a medical record for every client who obtains 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.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 5–7.

Attachment F - 16

2

FPAR Methodology

DATA COLLECTION
The FPAR (Title X Family Planning Annual Report: Forms and Instructions [Reissued
January 2011]) consists of a Grantee Profile and 14 reporting tables.8 OPA instructs grantees
to report on the scope of services or activities that are proposed in their approved grant
applications and supported with Title X grant and related sources of funding. 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.
Throughout this report, we present the instructions for preparing each FPAR table alongside
the table-specific findings. In addition, we use the term “table” when referring to an FPAR
reporting table and “exhibit” when referring to the tabular presentation of the 2011 findings.
Each exhibit identifies the FPAR table that is the source for the data presented.

DATA REPORTING
Title X service grantees are required to submit an FPAR by February 15 for the recently
completed reporting period (January 1 to December 31). In February 2012, 91 grantees
submitted FPARs for the 2011 reporting period. Grantees submitted 90% (82 reports) of
FPARs by the February 15 due date, and 99% (90 reports) 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 (e.g., =, < , > , ≤ , ≥ ).
After a grantee submits an FPAR, it goes through two levels of review by HHS staff. First,
regional HHS staff review the FPAR and either accept it or return it to the grantee for
correction or clarification. Once the regional HHS staff accept the FPAR, the FPAR Data
Coordinator performs a second and final review, either accepting the FPAR or returning it to
the HHS regional staff and the grantee for correction or clarification. When the FPAR Data
Coordinator has accepted all FPARs, RTI extracts the FPAR data from the FPAR Data
System database and performs further electronic validations to identify potential reporting
errors and problems, including missing (e.g., ≥ 10% unknown/not reported) and out-of-range

Attachment F - 17

values for selected measures (e.g., STD test-to-user ratios). RTI also performs a manual
review of all comments entered into the FPAR “Notes” 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 HHS staff address all outstanding validation issues in the FPAR Data
System, RTI extracts the final data file for tabulation and analysis.

Guidance for Reporting User Demographic Profile Data in FPAR Tables 1 to 3
In FPAR Tables 1, 2, and 3, grantees report information on the demographic profile of family planning users,
including age and sex (Table 1) and race and ethnicity (Tables 2 and 3).
In FPAR Table 1, grantees report the unduplicated number of family planning users by age group and sex,
categorizing the users based on their age as of June 30th of the reporting period. The FPAR instructions provide the
following guidance for reporting this information:
Age Group—Categorize family planning users based on their age as of June 30th of the reporting period.
In FPAR Tables 2 and 3, grantees report the unduplicated number of female (Table 2) and male (Table 3) family
planning users by race and ethnicity. The FPAR instructions provide the following guidance for reporting this
information:
Race and Ethnicity—The categories for reporting ethnicity and race in the FPAR conform to the Office of
Management and Budget (OMB) 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity9 and are used by other HHS programs and compilers of such national data sets as the National
Survey of Family Growth. If an agency wants to collect data for ethnicity or race subcategories, the agency must be
able to aggregate the data reported into the OMB minimum standard set of ethnicity and race categories. OMB
encourages self-identification of race. When respondents are allowed to self-identify or self-report their race,
agencies should adopt a method that allows respondents to mark or select more than one of the five minimum race
categories.
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 are
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.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 13–14, A1–A2.

Attachment F - 18

3

Findings

GRANTEE PROFILE
In 2011, OPA regional offices awarded Title X service grants to 91 public and private
grantees, including 49 (54% of grantees) state and local health departments and 42 (46% of
grantees) nonprofit family planning agencies, independent service sites, and community
health agencies. In turn, grantees distributed these funds to 1,142 subrecipients (“delegates”)
and their own service sites, ultimately supporting a family planning service network of 4,382
service sites in the 50 United States, the District of Columbia, and the eight U.S. territories
and jurisdictions (Exhibit 2).
From 2010 to 2011, there were small changes in the size and distribution of the Title X
service network. The number of grantees increased 2%, from 89 to 91, with new grantees in
Regions I and IX. There was a net increase of 20 delegate agencies, from 1,122 to 1,142. Six
regions (I, III, V, VII, IX, and X) reported an increase in delegates, three (II, IV, and VI)
reported a decrease, and one (VIII) reported no change. There was a net decrease of seven
service sites, from 4,389 to 4,382, with four regions (I, V, IX, and X) reporting increases of
between 1 and 44 sites and the remaining six regions (II, III, IV, VI, VII, and VII) reporting
declines of between 2 and 27 sites (Exhibit 2).
Exhibit 2.
Network
Features

Number of and percentage change in grantees, delegates, and service sites, by year and
region: 2010–2011 (Source: FPAR Grantee Profile Cover Sheet)
All
Regions

Region
I

Region
II

Region
III

Region
IV

Region
V

Region
VI

Region
VII

Region
VIII

Region
IX

Region
X

Grantees
2011

91

11

7

9

10

12

6

5

6

17

8

2010

89

10

7

9

10

12

6

5

6

16

8

Difference

2

1

0

0

0

0

0

0

0

1

0

% Change

2%

10%

0%

0%

0%

0%

0%

0%

0%

6%

0%

Delegates
2011

1,142

72

80

230

183

135

79

106

74

121

62

2010

1,122

71

82

218

188

130

90

105

74

104

60

Difference

20

1

−2

12

−5

5

−11

1

0

17

2

% Change

2%

1%

−2%

−3%

4%

−12%

1%

0%

16%

3%

Service Sites
2011

4,382

228

263

639

1,076

392

553

267

179

539

246

4,389

221

272

641

1,091

371

580

289

184

495

245

Difference

−7

7

−9

−2

−15

21

−27

−22

−5

44

1

% Change

0%†

3%

−3%

0%†

−1%

6%

−5%

−8%

2010

†

6%

Percentage is greater than –0.5% and less than 0.5%.

−3%

9%

0%†

Attachment F - 19

FAMILY PLANNING USER DEMOGRAPHIC PROFILE
Total Users (Exhibit 3)

In 2011, Title X-funded sites served 5,021,711 family planning users. Regions IV and IX
accounted for 19% and 26%, respectively, of the total users served in 2011. Regions II, III, V,
and VI each served between 9% and 11% of total users, and Regions I, VII, VIII, and X each
served between 3% and 4% (Exhibit 3).
Between 2010 and 2011, the total number of users served in Title X-funded service sites
decreased 4%, or by 203,151 users. All 10 regions reported declines ranging between 5,800
and 49,000 users (Exhibit 3). On average, the number of users per service site decreased by
44, from 1,190 in 2010 to 1,146 in 2011 (not shown).
Between 1999 and 2011, the total number of users increased 13%, from 4,442,138 in 1999 to
5,021,711 in 2011. During this period, four regions (II, III, VIII, and IX) increased their total
number of users served by 13% or more, with Region IX nearly doubling (85% increase) their
number of users. Five regions experienced a decrease in total users served (IV, V, VI, VII,
and X), with Region VII experiencing the highest percentage decrease in number of users
(17%) (Exhibit A–1a in Appendix A).
Exhibit 3.

Number, distribution, and percentage change in number of family planning users, by year
and region: 2010–2011 (Source: FPAR Table 1)
All
Regions

Region
II

Region
III

Region
IV

Region
V

Region
VI

Region
VII

Region
VIII

Number
2011

5,021,711 192,252 493,369

564,163

940,931

472,062

475,863

205,167

169,311

1,314,270 194,323

5,224,862 198,962 499,231

584,167

989,770

492,359

512,868

214,032

176,892

1,352,569 204,012

Difference

−203,151

−6,710

−5,862

−20,004

−48,839

−20,297

−37,005

−8,865

−7,581

−38,299

−9,689

% Change

−4%

−3%

−1%

−3%

−5%

−4%

−7%

−4%

−4%

−3%

−5%

100%

4%

10%

11%

19%

9%

10%

4%

3%

26%

4%

100%

4%

10%

11%

19%

9%

9%

4%

3%

26%

4%

2010

Distribution
2010
2011

Region
I

Region
IX

Region
X

Users

Note: Due to rounding, percentages may not sum to 100%.

Users by Sex (Exhibits 4 and 5)

Of the total number of users in 2011, 92% (4,635,195) were female and 8% (386,516) were
male. Across regions, the percentage of total users who were female ranged from 87% (VIII)
to 97% (IV) (Exhibits 4 and 5). Exhibit B–1 (Appendix B) presents the number and
distribution of female and male family planning users for 2011 for each state, the District of
Columbia, and the eight U.S. territories and jurisdictions.
Between 1999 and 2011, the percentage of users who were female decreased from 97% of
total users in 1999 to 92% in 2011. Numerically, however, the number of female users
increased 7%, from 4,315,040 in 1999 to 4,635,195 in 2011. During this same time, the
number of male users more than tripled, increasing from 127,098 in 1999 to 386,516 in 2011
(Exhibit A–1a).

Attachment F - 20

Users by Age (Exhibits 4 and 5)

In 2011, 51% (2,566,471) of family planning users were in their 20s, 28% (1,411,339) were
30 or over, and 21% (1,043,901) were 19 or under. By age group, the highest percentages of
users were 20 to 24 (30%), 25 to 29 (21%), and 15 to 19 (20%). By region, the percentage of
users in their early 20s ranged from 28% (I and VI) to 33% (V), while the percentage 15 to 19
ranged from 18% (II and IX) to 22% (I, V, VIII, and X). Users under 15 accounted for only
1% (59,351) of total users nationally and between 1% and 2% of total users across the regions
(Exhibits 4 and 5).
Nationally, the same percentages of male and female users were in their teens (21%), and a
slightly higher percentage of female (30%) than male (29%) users were in their early 20s.
Compared to female users, there was more variation across regions in the age distribution of
male users. For example, the percentage of male users who were teenagers ranged from 15%
(X) to 39% (IV), compared with 19% (II and IX) to 25% (VIII) for female users. Similarly,
the percentage of male users in their early 20s ranged from 20% (IV) to 34% (II and V) of
male users, compared with 27% (I) to 33% (V) for female users. Females under 15 accounted
for 1% of female users in all regions, while males in this age group accounted for 1% to 4%
of male users in all regions except Region IV, where they comprised 18% of male users
(Exhibits 4 and 5).
Between 1999 and 2011, there were small shifts in the percentage distribution of family
planning users by age group. There was an increase in the number of users in all age groups,
except in the group 17 or under, which decreased 23% (or by 144,443 users), and the age
group 18 to 19, which decreased 13% (or by 87,376 users). Numerically, the age group 25 to
29 had the largest increase in users (245,933 or a 30% increase). In addition, the age group
over 44 increased by 101%, or by 105,089 users (Exhibits A–2a and A–2b).
Users by Race (Exhibits 6 to 14)

In 2011, 57% (2,864,253) of all family planning users identified themselves as white, 20%
(986,803) as black, 3% (134,345) as Asian, 1% (70,929) as Native Hawaiian or Other Pacific
Islander, and 1% (43,204) as American Indian or Alaska Native. Five percent (250,825) of all
users self-identified with two or more of the five minimum race categories specified in the
Office of Management and Budget’s Revisions to the Standards for the Classification of
Federal Data on Race and Ethnicity.9 Race was either unknown or not reported for 13%
(671,352) of all users (Exhibits 6, 9, and 10).
The racial composition of female users (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 or black. Among female users, 58% self-identified as white and 19% as black, while
among male users, 50% self-identified as white and 23% as black. Additionally, race was
unknown or not reported for a slightly higher percentage of male (15%) than female (13%)
users.

Attachment F - 21

Exhibit 4.

Number of family planning users, by sex, age, and region: 2011 (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

10,755

4,661

5,455

2,434

1,840

Region IX

Region X

7,651

2,181

Female Users
Under 15

49,297

2,509

4,240

7,571

15 to 17

391,124

17,851

35,229

49,767

72,281

41,723

37,980

17,893

14,355

84,876

19,169

18 to 19

520,921

19,259

46,792

56,579

100,467

56,937

49,386

23,123

19,910

126,846

21,622

20 to 24

1,395,493

46,810

132,808

148,535

280,091

145,945

127,706

57,751

46,491

355,468

53,888

25 to 29

981,737

32,988

101,639

104,308

197,998

92,610

95,346

38,191

29,083

250,363

39,211

30 to 34

578,197

19,458

60,798

61,349

121,570

49,093

64,365

22,405

16,393

140,209

22,557

35 to 39

334,025

12,118

35,140

34,114

66,590

25,825

38,771

12,789

8,895

87,191

12,592

40 to 44

204,591

9,109

20,989

21,506

36,776

15,061

20,550

8,320

5,491

59,617

7,172

Over 44

179,810

10,851

18,288

24,360

27,390

11,139

13,536

8,936

4,608

55,599

5,103

Subtotal

4,635,195

170,953

455,923

508,089

913,918

442,994

453,095

191,842

147,066

1,167,820

183,495

Male Users
Under 15

10,054

767

686

1,324

4,748

334

216

248

377

1,299

55

15 to 17

32,578

2,383

3,073

7,037

3,724

2,302

1,691

939

1,142

9,650

637

18 to 19

39,927

2,047

4,248

6,839

2,116

3,365

3,027

1,418

2,028

13,948

891

20 to 24

112,722

6,110

12,575

14,969

5,271

9,777

7,539

4,365

6,809

42,559

2,748

25 to 29

76,519

4,152

7,853

9,098

3,661

5,942

4,206

2,872

5,010

31,474

2,251

30 to 34

42,922

2,043

4,005

5,235

2,486

3,182

2,497

1,460

2,845

17,680

1,489

35 to 39

24,375

1,182

1,867

3,193

1,664

1,570

1,424

791

1,512

10,229

943

40 to 44

17,838

1,000

1,256

2,703

1,241

1,049

879

457

978

7,591

684

Over 44

29,581

1,615

1,883

5,676

2,102

1,547

1,289

775

1,544

12,020

1,130

Subtotal

386,516

21,299

37,446

56,074

27,013

29,068

22,768

13,325

22,245

146,450

10,828

All Users
Under 15

59,351

3,276

4,926

8,895

15,503

4,995

5,671

2,682

2,217

8,950

2,236

15 to 17

423,702

20,234

38,302

56,804

76,005

44,025

39,671

18,832

15,497

94,526

19,806

18 to 19

560,848

21,306

51,040

63,418

102,583

60,302

52,413

24,541

21,938

140,794

22,513

20 to 24

1,508,215

52,920

145,383

163,504

285,362

155,722

135,245

62,116

53,300

398,027

56,636

25 to 29

1,058,256

37,140

109,492

113,406

201,659

98,552

99,552

41,063

34,093

281,837

41,462

30 to 34

621,119

21,501

64,803

66,584

124,056

52,275

66,862

23,865

19,238

157,889

24,046

35 to 39

358,400

13,300

37,007

37,307

68,254

27,395

40,195

13,580

10,407

97,420

13,535

40 to 44

222,429

10,109

22,245

24,209

38,017

16,110

21,429

8,777

6,469

67,208

7,856

Over 44

209,391

12,466

20,171

30,036

29,492

12,686

14,825

9,711

6,152

67,619

6,233

5,021,711

192,252

493,369

564,163

940,931

472,062

475,863

205,167

169,311

1,314,270

194,323

Total All Users

Attachment F - 22

Exhibit 5.

Distribution of family planning users, by sex, age, and region: 2011 (Source: FPAR Table 1)

Age Group (Years)
Female Users
Under 15

All Regions

Region I

1%

1%

15 to 17

8%

18 to 19

11%

20 to 24

Region II

Region III

Region IV
1%

Region V

1%

1%

1%

10%

8%

10%

8%

9%

11%

10%

11%

11%

13%

30%

27%

29%

29%

31%

33%

25 to 29

21%

19%

22%

21%

22%

30 to 34

12%

11%

13%

12%

35 to 39

7%

7%

8%

7%

40 to 44

4%

5%

5%

Over 44

4%

6%

Subtotal

100%

Male Users
Under 15

Region VI
1%

Region VII

Region VIII

1%

1%

8%

9%

11%

12%

28%

21%

13%
7%

4%

4%

100%

100%

Region IX

Region X

1%

1%

10%

7%

10%

14%

11%

12%

30%

32%

30%

29%

21%

20%

20%

21%

21%

11%

14%

12%

11%

12%

12%

6%

9%

7%

6%

7%

7%

4%

3%

5%

4%

4%

5%

4%

5%

3%

3%

3%

5%

3%

5%

3%

100%

100%

100%

100%

100%

100%

100%

100%

3%

4%

2%

2%

18%

1%

1%

2%

2%

1%

1%

15 to 17

8%

11%

8%

13%

14%

8%

7%

7%

5%

7%

6%

18 to 19

10%

10%

11%

12%

8%

12%

13%

11%

9%

10%

8%

20 to 24

29%

29%

34%

27%

20%

34%

33%

33%

31%

29%

25%

25 to 29

20%

19%

21%

16%

14%

20%

18%

22%

23%

21%

21%

30 to 34

11%

10%

11%

9%

9%

11%

11%

11%

13%

12%

14%

35 to 39

6%

6%

5%

6%

6%

5%

6%

6%

7%

7%

9%

40 to 44

5%

5%

3%

5%

5%

4%

4%

3%

4%

5%

6%

Over 44

8%

8%

5%

10%

8%

5%

6%

6%

7%

8%

10%

Subtotal

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

All Users
Under 15

1%

2%

1%

2%

2%

1%

1%

1%

1%

1%

1%

15 to 17

8%

11%

8%

10%

8%

9%

8%

9%

9%

7%

10%

18 to 19

11%

11%

10%

11%

11%

13%

11%

12%

13%

11%

12%

20 to 24

30%

28%

29%

29%

30%

33%

28%

30%

31%

30%

29%

25 to 29

21%

19%

22%

20%

21%

21%

21%

20%

20%

21%

21%

30 to 34

12%

11%

13%

12%

13%

11%

14%

12%

11%

12%

12%

35 to 39

7%

7%

8%

7%

7%

6%

8%

7%

6%

7%

7%

40 to 44

4%

5%

5%

4%

4%

3%

5%

4%

4%

5%

4%

Over 44

4%

6%

4%

5%

3%

3%

3%

5%

4%

5%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Total All Users

Attachment F - 23

In all regions, between 44% (II) and 80% (VIII) self-identified as white, and between 3% (X)
and 35% (IV) self-identified as black. Region IX, which includes the Pacific territories, had
the highest percentages of users identifying themselves as Asian (6%), Native Hawaiian or
Other Pacific Islander (5%), and more than one race (10%). The percentage of users for
whom race was unknown or not reported met or exceeded the national average of 13% in
three regions (II, IX, and X) (Exhibits 9 and 10).
Between 1999 and 2011, there were small changes (two to eight percentage points) in the
percentage distribution of family planning users by race. The percentage of total users who
self-identified as white decreased from 65% in 1999 to 57% in 2011, the percentage who selfidentified as black decreased from 22% to 20%, and the percentage of users for whom race
was unknown or not reported increased from 9% to 13%. In addition, between 2005 and
2011, the percentage of total users who self-identified with two or more OMB race categories
increased from 3% to 5%. The increased percentage of users with an unknown race is likely
due to the increase in Hispanic/Latino users, many of whom do not self-identify with any
OMB race category (Exhibits A–3a and A–3b).
Users by Ethnicity (Exhibits 6 to 14)

In 2011, 29% (1,451,215) of users identified themselves as Hispanic or Latino, including 29%
(1,344,769) of female users and 28% (106,446) of male users. Ethnicity was unknown or not
reported for 3% of female users and 4% of male users (Exhibits 6, 7, and 8). For female and
male users, the highest percentages of Hispanic or Latino users were in Regions II, VI, and IX
(Exhibits 11 to 14).
Between 1999 and 2011, the percentage of all family planning users who identified
themselves as Hispanic or Latino increased from 17% of users in 1999 to 29% in 2011, while
the percentage of users with unknown Hispanic or Latino ethnicity decreased from 4% to 3%.
Numerically, the number of Hispanic or Latino users increased 88%, from 772,129 in 1999 to
1,451,215 in 2011 (Exhibits A–4a and A–4b).
Since 2005, grantees have reported race and ethnicity data in a single, cross-tabulated table
for female (FPAR Table 2) and male (FPAR Table 3) users. The revised format provides
information on the ethnic composition of users reported in each race category, including those
for whom race is unknown or not reported. Among the 13% (611,704) of female users for
whom race was unknown or not reported in 2011, 71% (436,806) were Hispanic or Latino
(Exhibit 7). Similarly, among the 15% (59,648) of male users for whom race was unknown or
not reported, 69% (40,936) were Hispanic or Latino (Exhibit 8). Among both female and
male users, 1% did not self-identify with either a race or an ethnic group category.
Exhibits A–5a and A–5b present trends in the distribution of users by ethnicity and race for
1999 to 2011.

Attachment F - 24

Exhibit 6.

Number and distribution of all family planning users, by race and ethnicity: 2011
(Source: FPAR Tables 2 and 3)
Hispanic
or Latino

Race
Am Indian/Alaska Native

Not Hispanic
or Latino

Ethnicity
UK/NR

Total

%
Hispanic
or Latino

%
Not Hispanic
or Latino

%
Ethnicity
UK/NR

%
Total

12,530

29,629

1,045

43,204

0%†

1%

0%†

3,976

121,777

8,592

134,345

0%†

2%

0%†

3%

Black/African American

27,474

939,143

20,186

986,803

1%

19%

0%†

20%

Nat Hawaiian/Pac Island

11,218

58,687

1,024

70,929

0%†

1%

0%†

1%

White

742,062

2,060,244

61,947

2,864,253

15%

41%

1%

57%

More than one race

176,213

64,182

10,430

250,825

4%

1%

0%†

5%

UK/NR

477,742

142,652

50,958

671,352

10%

3%

1%

13%

1,451,215

3,416,314

154,182

5,021,711

29%

68%

3%

100%

Asian

Total All Users

1%

Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

Exhibit 7.

Number and distribution of female family planning users, by race and ethnicity: 2011
(Source: FPAR Table 2)
Hispanic
or Latino

Race
Am Indian/Alaska Native

Not Hispanic
or Latino

Ethnicity
UK/NR

Total

%
Hispanic
or Latino

%
Not Hispanic
or Latino

%
Ethnicity
UK/NR

%
Total

11,777

27,494

907

40,178

0%†

1%

0%†

3,709

113,805

8,011

125,525

0%†

2%

0%†

3%

Black/African American

25,453

852,955

17,582

895,990

1%

18%

0%†

19%

Nat Hawaiian/Pac Island

10,417

49,173

915

60,505

0%†

1%

0%†

1%

White

694,347

1,921,198

56,314

2,671,859

15%

41%

1%

58%

More than one race

162,260

58,058

9,116

229,434

4%

1%

0%†

5%

UK/NR

436,806

128,445

46,453

611,704

9%

3%

1%

13%

1,344,769

3,151,128

139,298

4,635,195

29%

68%

3%

100%

Asian

Total Female Users

1%

Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

Exhibit 8.

Number and distribution of male family planning users, by race and ethnicity: 2011
(Source: FPAR Table 3)

Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White

Hispanic
or Latino
753

Not Hispanic
or Latino
2,135

Ethnicity
UK/NR
138

Total
3,026

%
Hispanic
or Latino
0%†

%
Not Hispanic
or Latino

%
Ethnicity
UK/NR

1%

0%†

%
Total
1%

267

7,972

581

8,820

0%†

2%

0%†

2%

2,021

86,188

2,604

90,813

1%

22%

1%

23%

801

9,514

109

10,424

47,715

139,046

5,633

192,394

0%†
12%

2%

0%†

3%

36%

1%

50%

More than one race

13,953

6,124

1,314

21,391

4%

2%

0%†

6%

UK/NR

40,936

14,207

4,505

59,648

11%

4%

1%

15%

106,446

265,186

14,884

386,516

28%

69%

4%

100%

Total Male Users

Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

Attachment F - 25

Exhibit 9.

Number of all family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Tables 2 and 3)

Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII Region VIII

Region IX

Region X

12,530
29,629
1,045
43,204

111
441
49
601

402
1,303
20
1,725

250
898
23
1,171

940
2,033
3
2,976

1,208
1,486
142
2,836

642
5,357
34
6,033

256
1,208
39
1,503

339
2,250
79
2,668

7,614
12,093
656
20,363

768
2,560
0
3,328

Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

3,976
121,777
8,592
134,345

93
7,225
287
7,605

305
13,130
44
13,479

194
9,791
73
10,058

263
6,977
12
7,252

116
5,133
287
5,536

341
3,084
121
3,546

41
2,315
240
2,596

52
1,957
81
2,090

2,270
66,663
7,442
76,375

301
5,502
5
5,808

Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

27,474
939,143
20,186
986,803

2,228
22,856
302
25,386

9,208
115,374
814
125,396

2,024
181,271
1,856
185,151

7,457
319,729
537
327,723

1,100
101,268
5,913
108,281

1,404
81,967
529
83,900

269
28,166
1,933
30,368

295
6,229
297
6,821

3,111
76,200
7,999
87,310

378
6,083
6
6,467

11,218
58,687
1,024
70,929

418
614
17
1,049

394
995
94
1,483

388
583
20
991

919
832
6
1,757

147
450
30
627

398
604
31
1,033

165
457
13
635

48
506
8
562

7,748
52,263
803
60,814

593
1,383
2
1,978

White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

742,062
2,060,244
61,947
2,864,253

17,686
109,718
2,789
130,193

54,059
163,344
274
217,677

29,388
260,940
6,998
297,326

104,105
421,651
512
526,268

35,756
264,986
10,626
311,368

201,405
149,085
1,142
351,632

19,856
128,339
3,348
151,543

22,157
110,703
2,199
135,059

236,154
328,776
33,990
598,920

21,496
122,702
69
144,267

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

176,213
64,182
10,430
250,825

6,051
3,418
99
9,568

19,412
2,685
311
22,408

6,161
2,889
104
9,154

38,416
6,475
33
44,924

3,096
5,273
938
9,307

1,254
2,675
111
4,040

949
1,549
84
2,582

4,989
2,785
109
7,883

94,548
34,601
8,631
137,780

1,337
1,832
10
3,179

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

477,742
142,652
50,958
671,352

13,500
2,213
2,137
17,850

78,008
32,687
506
111,201

35,029
19,098
6,185
60,312

18,216
7,339
4,476
30,031

23,182
7,741
3,184
34,107

19,601
3,340
2,738
25,679

5,267
5,231
5,442
15,940

11,372
1,967
889
14,228

252,583
54,728
25,397
332,708

20,984
8,308
4
29,296

1,451,215
3,416,314
154,182
5,021,711

40,087
146,485
5,680
192,252

161,788
329,518
2,063
493,369

73,434
475,470
15,259
564,163

170,316
765,036
5,579
940,931

64,605
386,337
21,120
472,062

225,045
246,112
4,706
475,863

26,803
167,265
11,099
205,167

39,252
126,397
3,662
169,311

604,028
625,324
84,918
1,314,270

45,857
148,370
96
194,323

Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.

Attachment F - 26

Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Tables 2 and 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
2%

1%
1%
0%†
2%

0%†
1%
0%
2%

0%†
2%
0%†
3%

0%†
4%
0%†
4%

0%†
3%
0%†
3%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
5%
1%
6%

0%†
3%
0%†
3%

1%
19%
0%†
20%

1%
12%
0%†
13%

2%
23%
0%†
25%

0%†
32%
0%†
33%

1%
34%
0%†
35%

0%†
21%
1%
23%

0%†
17%
0%†
18%

0%†
14%
1%
15%

0%†
4%
0%†
4%

0%†
6%
1%
7%

0%†
3%
0%†
3%

0%†
1%
0%†
1%

0%†
0%†
0%†
1%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

1%
4%
0%†
5%

0%†
1%
0%†
1%

15%
41%
1%
57%
4%
1%
0%†
5%

9%
57%
1%
68%

11%
33%
0%†
44%

5%
46%
1%
53%

3%
2%
0%†
5%

4%
1%
0%†
5%

1%
1%
0%†
2%

10%
3%
1%
13%

7%
1%
1%
9%

16%
7%
0%†
23%

6%
3%
1%
11%

29%
68%
3%
100%

21%
76%
3%
100%

33%
67%
0%†
100%

13%
84%
3%
100%

11%
45%
0%†
56%

8%
56%
2%
66%

42%
31%
0%†
74%

10%
63%
2%
74%

13%
65%
1%
80%

18%
25%
3%
46%

11%
63%
0%†
74%

4%
1%
0%†
5%

1%
1%
0%†
2%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

3%
2%
0%†
5%

7%
3%
1%
10%

1%
1%
0%†
2%

2%
1%
0%†
3%

5%
2%
1%
7%

4%
1%
1%
5%

3%
3%
3%
8%

7%
1%
1%
8%

19%
4%
2%
25%

11%
4%
0%†
15%

14%
82%
4%
100%

47%
52%
1%
100%

13%
82%
5%
100%

23%
75%
2%
100%

46%
48%
6%
100%

24%
76%
0%†
100%

18%
81%
1%
100%

Attachment F - 27

Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Table 2)
Race and Ethnicity

Region I

Region II

11,777
27,494
907
40,178

101
392
45
538

386
1,223
18
1,627

237
818
21
1,076

938
2,016
3
2,957

1,180
1,386
132
2,698

624
5,071
28
5,723

243
1,088
36
1,367

282
2,046
69
2,397

7,048
11,152
555
18,755

738
2,302
0
3,040

Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

3,709
113,805
8,011
125,525

90
6,859
264
7,213

292
12,332
44
12,668

179
9,175
67
9,421

260
6,854
12
7,126

114
4,819
274
5,207

337
2,947
115
3,399

39
2,241
235
2,515

47
1,733
76
1,856

2,052
61,557
6,919
70,528

299
5,288
5
5,592

Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

25,453
852,955
17,582
895,990

1,977
19,516
252
21,745

8,763
105,182
743
114,688

1,696
154,969
1,297
157,962

7,225
308,769
526
316,520

999
91,099
5,391
97,489

1,334
77,346
500
79,180

240
24,716
1,828
26,784

228
4,057
185
4,470

2,631
62,289
6,854
71,774

360
5,012
6
5,378

10,417
49,173
915
60,505

387
564
16
967

368
668
87
1,123

348
531
14
893

900
806
6
1,712

140
427
27
594

389
584
27
1,000

161
440
12
613

34
424
8
466

7,101
43,458
716
51,275

589
1,271
2
1,862

White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

694,347
1,921,198
56,314
2,671,859

15,805
97,798
2,485
116,088

51,715
150,906
230
202,851

27,592
241,885
6,589
276,066

102,050
409,376
504
511,930

34,272
251,647
10,102
296,021

190,571
143,776
1,077
335,424

18,873
121,340
3,189
143,402

20,072
97,462
1,873
119,407

212,329
291,518
30,197
534,044

21,068
115,490
68
136,626

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

162,260
58,058
9,116
229,434

5,446
3,138
79
8,663

17,885
2,454
222
20,561

5,750
2,553
26
8,329

38,077
6,279
33
44,389

2,852
4,883
840
8,575

1,188
2,581
105
3,874

868
1,405
80
2,353

4,097
2,341
85
6,523

84,791
30,789
7,638
123,218

1,306
1,635
8
2,949

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

436,806
128,445
46,453
611,704

11,917
1,852
1,970
15,739

71,919
30,046
440
102,405

31,983
16,493
5,866
54,342

17,791
7,086
4,407
29,284

22,050
7,398
2,962
32,410

18,739
3,193
2,563
24,495

4,939
5,087
4,782
14,808

9,569
1,624
754
11,947

227,733
47,788
22,705
298,226

20,166
7,878
4
28,048

1,344,769
3,151,128
139,298
4,635,195

35,723
130,119
5,111
170,953

151,328
302,811
1,784
455,923

67,785
426,424
13,880
508,089

167,241
741,186
5,491
913,918

61,607
361,659
19,728
442,994

213,182
235,498
4,415
453,095

25,363
156,317
10,162
191,842

34,329
109,687
3,050
147,066

543,685
548,551
75,584
1,167,820

44,526
138,876
93
183,495

American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.

All Regions

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Attachment F - 28

Exhibit 12. Distribution of female family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Table 2)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
2%

1%
1%
0%†
2%

0%†
1%
0%
2%

0%†
2%
0%†
3%

0%†
4%
0%†
4%

0%†
3%
0%†
3%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
5%
1%
6%

0%†
3%
0%†
3%

1%
18%
0%†
19%

1%
11%
0%†
13%

2%
23%
0%†
25%

0%†
31%
0%†
31%

1%
34%
0%†
35%

0%†
21%
1%
22%

0%†
17%
0%†
17%

0%†
13%
1%
14%

0%†
3%
0%†
3%

0%†
5%
1%
6%

0%†
3%
0%†
3%

0%†
1%
0%†
1%

0%†
0%†
0%†
1%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

1%
4%
0%†
4%

0%†
1%
0%†
1%

15%
41%
1%
58%
4%
1%
0%†
5%

9%
57%
1%
68%

11%
33%
0%†
44%

5%
48%
1%
54%

3%
2%
0%†
5%

4%
1%
0%†
5%

1%
1%
0%†
2%

9%
3%
1%
13%

7%
1%
1%
9%

16%
7%
0%†
22%

6%
3%
1%
11%

29%
68%
3%
100%

21%
76%
3%
100%

33%
66%
0%†
100%

13%
84%
3%
100%

11%
45%
0%†
56%

8%
57%
2%
67%

42%
32%
0%†
74%

10%
63%
2%
75%

14%
66%
1%
81%

18%
25%
3%
46%

11%
63%
0%†
74%

4%
1%
0%†
5%

1%
1%
0%†
2%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

3%
2%
0%†
4%

7%
3%
1%
11%

1%
1%
0%†
2%

2%
1%
0%†
3%

5%
2%
1%
7%

4%
1%
1%
5%

3%
3%
2%
8%

7%
1%
1%
8%

20%
4%
2%
26%

11%
4%
0%†
15%

14%
82%
4%
100%

47%
52%
1%
100%

13%
81%
5%
100%

23%
75%
2%
100%

47%
47%
6%
100%

24%
76%
0%†
100%

18%
81%
1%
100%

Attachment F - 29

Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Table 3)
Race and Ethnicity

Region I

Region II

753
2,135
138
3,026

10
49
4
63

16
80
2
98

13
80
2
95

2
17
0
19

28
100
10
138

18
286
6
310

13
120
3
136

57
204
10
271

566
941
101
1,608

30
258
0
288

267
7,972
581
8,820

3
366
23
392

13
798
0
811

15
616
6
637

3
123
0
126

2
314
13
329

4
137
6
147

2
74
5
81

5
224
5
234

218
5,106
523
5,847

2
214
0
216

Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

2,021
86,188
2,604
90,813

251
3,340
50
3,641

445
10,192
71
10,708

328
26,302
559
27,189

232
10,960
11
11,203

101
10,169
522
10,792

70
4,621
29
4,720

29
3,450
105
3,584

67
2,172
112
2,351

480
13,911
1,145
15,536

18
1,071
0
1,089

Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

801
9,514
109
10,424

31
50
1
82

26
327
7
360

40
52
6
98

19
26
0
45

7
23
3
33

9
20
4
33

4
17
1
22

14
82
0
96

647
8,805
87
9,539

4
112
0
116

White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

47,715
139,046
5,633
192,394

1,881
11,920
304
14,105

2,344
12,438
44
14,826

1,796
19,055
409
21,260

2,055
12,275
8
14,338

1,484
13,339
524
15,347

10,834
5,309
65
16,208

983
6,999
159
8,141

2,085
13,241
326
15,652

23,825
37,258
3,793
64,876

428
7,212
1
7,641

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

13,953
6,124
1,314
21,391

605
280
20
905

1,527
231
89
1,847

411
336
78
825

339
196
0
535

244
390
98
732

66
94
6
166

81
144
4
229

892
444
24
1,360

9,757
3,812
993
14,562

31
197
2
230

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

40,936
14,207
4,505
59,648

1,583
361
167
2,111

6,089
2,641
66
8,796

3,046
2,605
319
5,970

425
253
69
747

1,132
343
222
1,697

862
147
175
1,184

328
144
660
1,132

1,803
343
135
2,281

24,850
6,940
2,692
34,482

818
430
0
1,248

106,446
265,186
14,884
386,516

4,364
16,366
569
21,299

10,460
26,707
279
37,446

5,649
49,046
1,379
56,074

3,075
23,850
88
27,013

2,998
24,678
1,392
29,068

11,863
10,614
291
22,768

1,440
10,948
937
13,325

4,923
16,710
612
22,245

60,343
76,773
9,334
146,450

1,331
9,494
3
10,828

American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.

All Regions

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Attachment F - 30

Exhibit 14. Distribution of male family planning users, by race, ethnicity, and region: 2011 (Source: FPAR Table 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
UK/NR
Total All Users
UK/NR=unknown or not reported.
†

Percentage is less than 0.5%.

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%
0%†

0%†
0%†
0%†
0%†

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
2%
0%
3%

0%†
2%
0%†
2%

0%†
2%
0%†
2%

0%†
2%
0%
2%

0%†
1%
0%†
1%

0%†
0%†
0%
0%†

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
3%
0%†
4%

0%†
2%
0%
2%

1%
16%
0%†
17%

1%
27%
0%†
29%

1%
41%
0%†
41%

0%†
35%
2%
37%

0%†
20%
0%†
21%

0%†
26%
1%
27%

0%†
10%
1%
11%

0%†
9%
1%
11%

0%†
10%
0%
10%

0%†
0%†
0%†
0%†

0%†
1%
0%†
1%

0%†
0%†
0%
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%
0%†

0%†
6%
0%†
7%

0%†
1%
0%
1%

1%
22%
1%
23%
0%†
2%
0%†
3%
12%
36%
1%
50%
4%
2%
0%†
6%

9%
56%
1%
66%
3%
1%
0%†
4%

11%
4%
1%
15%

7%
2%
1%
10%

28%
69%
4%
100%

20%
77%
3%
100%

6%
33%
0%†
40%
4%
1%
0%†
5%
16%
7%
0%†
23%
28%
71%
1%
100%

1%
47%
1%
48%
0%†
0%†
0%†
0%†
3%
34%
1%
38%
1%
1%
0%†
1%

8%
45%
0%†
53%

5%
46%
2%
53%

48%
23%
0%†
71%

7%
53%
1%
61%

9%
60%
1%
70%
4%
2%
0%†
6%

16%
25%
3%
44%

4%
67%
0%†
71%

7%
3%
1%
10%

0%†
2%
0%†
2%

1%
1%
0%
2%

1%
1%
0%†
3%

0%†
0%†
0%†
1%

1%
1%
0%†
2%

5%
5%
1%
11%

2%
1%
0%†
3%

4%
1%
1%
6%

4%
1%
1%
5%

2%
1%
5%
8%

8%
2%
1%
10%

17%
5%
2%
24%

8%
4%
0%
12%

10%
87%
2%
100%

11%
88%
0%†
100%

10%
85%
5%
100%

52%
47%
1%
100%

11%
82%
7%
100%

22%
75%
3%
100%

41%
52%
6%
100%

12%
88%
0%†
100%

Attachment F - 31

Guidance for Reporting User Social and Economic Profile Data in FPAR Tables 4 to 6
In FPAR Tables 4, 5, and 6, grantees report information on the social and economic profile of family planning users,
including income level (Table 4), health insurance coverage (Table 5), and English proficiency (Table 6).
In FPAR Table 4, grantees report the unduplicated number of family planning users by income level, using the
following instructions:
Income Level as a Percentage of the HHS Poverty Guidelines—Grantees are required to collect income data
on all users at least annually. 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). Report the
unduplicated number of users by income level, using the most current income information available. For additional
guidance, see OPA Program Instruction Series documents OPA 08-1: Verification of Income for Title X Clients10
and OPA 97-1: Fees and Charges to Title X Low-Income Clients and Teenagers (Revised),11 which are available
on the OPA website at http://www.hhs.gov/opa/title-x-family-planning/title-x-policies/program-instructions/.
In FPAR Table 5, grantees report the unduplicated number of users by their principal insurance coverage status,
using the following instructions:
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. 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 health insurance covering primary medical
care include public and private sources of coverage.
Public Health Insurance Covering Primary Medical Care—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, state Children’s Health Insurance
Programs (CHIPs), health plans for military personnel and their dependents (e.g., TRICARE or CHAMPVA), and
state-sponsored health insurance programs.
Private Health Insurance Covering Primary Medical Care—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).
Uninsured—Refers to clients 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
(LEP), using the following instructions:
Limited English Proficiency (LEP)—Refers to 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. In
Table 6, report the unduplicated number of family planning users who required language assistance services
(interpretation or translation) to optimize their use of Title X services. Include those users who received Title X
services from bilingual staff or who were assisted by a competent agency or contracted interpreter. Also, include
users who opted to use a family member or friend as an interpreter after refusing an offer for a qualified interpreter
at no cost. Service providers should consult the Revised HHS LEP Guidance12 for further information about
identifying LEP individuals and complying with language assistance requirements.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 19–21.

Attachment F - 32

FAMILY PLANNING USER SOCIAL AND ECONOMIC PROFILE
Users by Income Level (Exhibit 15)

Federal regulations specify that Title X-funded providers give priority in the provision of
services to persons from low-income families and that individuals with family incomes at or
below the poverty level 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 level, Title X-funded agencies are required to charge
for services using a sliding scale based on family size and family income.6,11 For
unemancipated minors seeking confidential services, the assessment of income level is based
on their own rather than their family’s income.6,11
Nationally, 69% (3,466,912) of users had family incomes at or below the poverty level, based
on HHS poverty guidelines13 for the 2011 calendar year ($18,530 for a family of three in 48
contiguous states and DC), and 89% (4,467,800) had family incomes at or below 200% of the
poverty level. Additionally, 2% (116,188) of users had incomes between 201% and 250% of
the poverty level and 5% (250,829) had incomes exceeding 250% of the poverty level. The
income level for 4% (186,894) of users was unknown or not reported (Exhibit 15).
Across regions, between 54% (I) and 75% (VI) of users had family incomes at or below the
poverty level, and between 83% (I) and 95% (VI) had incomes at or below 200% of poverty.
The percentage of users with incomes at or below the poverty level met or exceeded the
national average of 69% in five regions (IV, V, VI, IX, and X) (Exhibit 15). Exhibit B–2
(Appendix B) presents the distribution of family planning users by income level within each
state, the District of Columbia, and the eight U.S. territories and jurisdictions for 2011.
Between 1999 and 2011, the percentage of total users with family incomes at or below the
poverty level increased from 65% to 69%, and the percentage with incomes at or below 200%
decreased from 90% to 89%. Numerically, the number of users at or below poverty increased
20%, from 2,886,684 in 1999 to 3,466,912 in 2011, and the number with incomes at or below
two times the poverty level increased 11%, from 4,018,128 in 1999 to 4,467,800 in 2011
(Exhibit A–6a).
Users by Insurance Coverage Status (Exhibit 16)

Since 2005, grantees have reported the number of users by type of principal health insurance
coverage, including those insured by public or private plans covering broad primary medical
care benefits, those who were uninsured, or those for whom insurance status was unknown or
not reported. In 2011, 64% (3,230,784) of family planning users were uninsured, 25%
(1,236,343) had Medicaid or other public health insurance, 9% (429,919) had private
insurance, and coverage status was unknown or not reported for 2% (124,665). Users whose
family planning care was covered by a Medicaid family planning waiver, but who had no
private or public health insurance plan that covered broad primary medical care services, were
considered uninsured, as were 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 (Exhibit 16).

Attachment F - 33

Exhibit 15. Number and distribution of all family planning users, by income level and region: 2011 (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

3,466,912

103,978

304,235

374,322

677,553

334,170

354,626

122,854

114,206

946,870

134,098

101% to 150%

731,410

39,683

112,979

72,638

114,766

69,421

68,649

36,018

24,579

160,530

32,147

151% to 200%

269,478

15,183

33,175

37,041

34,593

29,977

28,896

12,907

11,686

53,110

12,910

201% to 250%
Over 250%

116,188

7,779

12,086

20,430

13,239

13,758

7,623

5,505

6,342

24,556

4,870

250,829

10,238

28,774

35,752

35,288

23,475

6,949

19,917

11,974

71,157

7,305

UK/NR

186,894

15,391

2,120

23,980

65,492

1,261

9,120

7,966

524

58,047

2,993

5,021,711

192,252

493,369

564,163

940,931

472,062

475,863

205,167

169,311

1,314,270

194,323

Under 101%

69%

54%

62%

66%

72%

71%

75%

60%

67%

72%

69%

101% to 150%

15%

21%

23%

13%

12%

15%

14%

18%

15%

12%

17%

151% to 200%

5%

8%

7%

7%

4%

6%

6%

6%

7%

4%

7%

201% to 250%

2%

4%

2%

4%

1%

3%

2%

3%

4%

2%

3%

Over 250%

5%

5%

6%

6%

4%

5%

1%

10%

7%

5%

4%

UK/NR

4%

8%

0%†

4%

7%

0%†

2%

4%

0%†

4%

2%

100%

100%

100%

100%

100%

100%

100%

100%

Under 101%

Total All Users

Total All Users

100%

100%

100%

UK/NR=unknown or not reported.
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 http://aspe.hhs.gov/poverty/.
† Percentage is less than 0.5%.

Attachment F - 34

Exhibit 16. Number and distribution of all family planning users, by principal health insurance coverage status and region: 2011
(Source: FPAR Table 5)
Insurance Status

Region I

Region II

Region III

Region IV

Region V

1,236,343

66,454

165,197

148,566

272,157

140,999

95,726

36,224

12,501

257,570

40,949

429,919

47,687

51,404

65,364

76,813

47,424

20,354

36,260

26,107

29,935

28,571

3,230,784

74,038

260,317

329,516

566,088

277,253

347,437

128,727

120,879

1,009,075

117,454

124,665

4,073

16,451

20,717

25,873

6,386

12,346

3,956

9,824

17,690

7,349

5,021,711

192,252

493,369

564,163

940,931

472,062

475,863

205,167

169,311

1,314,270

194,323

Public health insurance

25%

35%

33%

26%

29%

30%

20%

18%

7%

20%

21%

Private health insurance

9%

25%

10%

12%

8%

10%

4%

18%

15%

2%

15%

64%

39%

53%

58%

60%

59%

73%

63%

71%

77%

60%

2%

2%

3%

4%

3%

1%

3%

2%

6%

1%

4%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Public health insurance
Private health insurance
Uninsured
UK/NR
Total All Users

All Regions

Uninsured
UK/NR
Total All Users
UK/NR=unknown or not reported.

Region VI

Region VII

Region VIII

Region IX

Region X

Attachment F - 35

Across regions, there were large differences in the distribution of users by insurance coverage
status. The percentage of total users who were uninsured ranged from 39% (I) to 77% (IX),
with three regions (VI, VIII, and IX) reporting a percentage of uninsured users at or above the
national average of 64%. The percentage of users with any health insurance coverage
(Medicaid or other public or private insurance) ranged from 22% (IX) to 59% (I), with three
regions (VI, VIII, and IX) reporting levels of insurance coverage below the national average
of 33%. By type of insurance, the percentage of users with Medicaid or other public coverage
ranged from 7% (VIII) to 35% (I), and the percentage of privately insured users ranged from
2% (IX) to 25% (I). The percentage of users for whom insurance coverage was unknown or
not reported ranged from 1% (V and IX) to 6% (VIII). The percentage of users with Medicaid
or other public coverage exceeded the percentage covered by private sources in all regions
except Region VII, where the percentages of users with private and Medicaid or other public
insurance were the same (18%), and Region VIII where the percentage of users with private
coverage (15%) exceeded the percentage with Medicaid or other public coverage (7%)
(Exhibit 16). Since 2005, the number of family planning users who are uninsured has
increased 8%, from 2,998,508 in 2005 to 3,230,784 in 2011 (not shown).
Limited English Proficient Users (Exhibit 17)

In compliance with the HHS Guidance to Federal Financial Assistance Recipients Regarding
Title VI Prohibition Against National Origin Discrimination Affecting Limited English
Proficient Persons,12 any agency that receives federal financial assistance from HHS must
take steps to ensure that limited English proficient (LEP) individuals have meaningful access
to the health and social services that the agency provides. As recipients of HHS assistance,
Title X grantees and delegates, including those operating in U.S. territories and jurisdictions
where English is an official language, are required to provide language assistance services to
LEP individuals.
In 2011, 14% (681,630) of family planning users were LEP, a percentage that drops to just
13% (641,817) when LEP users in the eight U.S territories and jurisdictions are excluded.
Across regions, the percentage of users who were LEP ranged between 6% (V) and 22% (VI),
and in Regions II and IX the percentage of users who were LEP decreased between 1 and 3
percentage points when excluding users in the U.S. territories and jurisdictions (Exhibit 17).
Since 2005, the number of LEP users in the 50 states and District of Columbia has increased
22%, from 557,034 in 2005 to 681,630 in 2011 (not shown).

Attachment F - 36

Exhibit 17. Number and percentage of limited English proficiency family planning users who are served
by all grantees and grantees in the 50 states and DC, by region: 2011 (Source: FPAR Table
6)
Region

LEP Users

LEP Users
(50 states and DC)a

% LEP Users

% LEP Users
(50 states and DC)a

I

24,670

24,670

13%

13%

II

64,138

45,010b

13%

10%b

III

39,953

39,953

7%

7%

IV

127,744

127,744

14%

14%

V

28,472

28,472

6%

6%

VI

102,854

102,854

22%

22%

VII

18,163

18,163

9%

9%

VIII

15,973

15,973

9%

9%

18%

17%c

c

IX

239,291

218,606

X

20,372

20,372

10%

10%

Total

681,630

641,817

14%

13%

DC=District of Columbia. LEP=limited English proficient.
a
Excludes LEP users in U.S. territories and jurisdictions.
b
Excludes LEP users in Puerto Rico and the U.S. Virgin Islands.
c
Excludes LEP users in American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia,
Guam, Republic of the Marshall Islands, and Republic of Palau.

Guidance for Reporting Primary Contraceptive Use Data in FPAR Tables 7 and 8
In FPAR Table 7, grantees report the unduplicated number of female family planning users by primary method and
age, and in FPAR Table 8, grantees report the unduplicated number of male users by primary method and age. The
FPAR instructions provide the following guidance for reporting this information:
Age—Use the client’s age as of June 30th of the reporting period.
Primary Method of Family Planning—The primary method of family planning is the user’s method—adopted or
continued—at the time of exit from his or her last encounter in the reporting period. If the user reports that he or she
is using more than one family planning method, report the most effective one as the primary method. Family planning
methods include:
Female Sterilization— In Table 7, report the number of female users who rely on female sterilization as their
primary family planning method. Female sterilization refers to surgical (tubal ligation) or non-surgical (implant)
sterilization procedures performed on a female user in the current or any previous reporting period.
Intrauterine Device (IUD)—In Table 7, report the number of female users who use a long-term hormonal or other
type of intrauterine device (IUD) or system as their primary family planning method.
Hormonal Implant—In Table 7, report the number of female users who use a long-term, subdermal hormonal
implant as their primary family planning method.
1-Month Hormonal Injection—In Table 7, report the number of female users who use 1-month injectable
hormonal contraception as their primary family planning method.
3-Month Hormonal Injection—In Table 7, report the number of female users who use 3-month injectable
hormonal contraception as their primary family planning method.
Oral Contraceptive—In Table 7, report the number of female users who use any oral contraceptive, including
combination and progestin-only (“mini-pills”) formulations, as their primary family planning method.
(continued)

Attachment F - 37

Guidance for Reporting Primary Contraceptive Use Data in FPAR Tables 7 and 8 (continued)
Hormonal/Contraceptive Patch—In Table 7, report the number of female users who use a transdermal hormonal
contraceptive patch as their primary family planning method.
Vaginal Ring—In Table 7, report the number of female users who use a hormonal vaginal ring as their primary
family planning method.
Cervical Cap/Diaphragm—In Table 7, report the number of female users who use a cervical cap or diaphragm
(with or without spermicidal jelly or cream) as their primary family planning method.
Contraceptive Sponge—In Table 7, report the number of female users who use a contraceptive sponge as their
primary family planning method.
Female Condom—In Table 7, report the number of female users who use female condoms (with or without
spermicidal foam or film) as their primary family planning method.
Spermicide (used alone)—In Table 7, report the number of female users who use only spermicidal jelly, cream,
foam, or film (i.e., not in conjunction with another method of contraception) as their primary family planning method.
Fertility Awareness Method (FAM) or Lactational Amenorrhea Method (LAM)—Fertility awareness methods
(FAMs) refer to family planning methods that rely on identifying potentially fertile days in each menstrual cycle
when intercourse is most likely to result in a pregnancy. FAMs include Calendar Rhythm, Standard Days, TwoDay,
Billings Ovulation, and SymptoThermal methods. In Table 7, report the number of female users who use one or a
combination of the FAMs listed above or who rely on LAM as their primary family planning method. In Table 8,
row 3 report male users who rely on a FAM as their primary method. Report male users who rely on LAM as their
primary method in Table 8, Row 6, “Rely on female method(s).”
Abstinence—For purposes of FPAR reporting, abstinence is defined as refraining from oral, vaginal, and anal
intercourse. In Table 7, report the number of female users who rely on abstinence as their primary family planning
method or who are not currently sexually active and therefore not using contraception. In Table 8, report the
number of male users who rely on abstinence as their primary family planning method or who are not currently
sexually active.
Withdrawal or Other Methods—In Tables 7 and 8, report the number of female and male users, respectively,
who use withdrawal or other methods not listed in the tables as their primary family planning method.
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. In Table 7, report the number of female
users who rely on vasectomy as their (partner’s) primary family planning method. In Table 8, report the number of
male users on whom a vasectomy was performed in the current or any previous reporting period.
Male condom—In Table 7, report the number of female users who rely on their sexual partner to use male
condoms (with or without spermicidal foam or film) as their primary family planning method. In Table 8, report the
number of male users who use male condoms (with or without spermicidal foam or film) as their primary family
planning method.
No Method–[Partner] Pregnant or Seeking Pregnancy—In Tables 7 and 8, report the number of users who are
not using any family planning method because they (Table 7) or their partners (Table 8) are pregnant or seeking
pregnancy.
No Method–Other Reason—In Tables 7 and 8, report the number of users who are not using any family planning
method to avoid pregnancy due to reasons other than pregnancy or seeking pregnancy, including if either partner is
sterile without having been sterilized surgically or if either partner has had a non-contraceptive surgical procedure
that has rendered him or her unable to conceive or impregnate.
Method Unknown or Not Reported—In Tables 7 and 8, report the number of female and male users for whom
the primary family planning method at exit from the last family planning encounter is unknown or not reported.
Rely on Female Method(s)—In Table 8, report the number of male family planning users who rely on their female
partner’s family planning method(s) as their primary method. “Female” contraceptive methods include female
sterilization, IUDs, hormonal implants, 1- and 3-month hormonal injections, oral contraceptives, the contraceptive
patch, the vaginal ring, cervical cap/diaphragms, the contraceptive sponge, female condoms, LAM, and
spermicides.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 25–28.

Attachment F - 38

FAMILY PLANNING METHOD USE
Federal regulations specify that Title X projects are required to provide a broad range of
acceptable and effective medically approved family planning methods, including natural
family planning methods.6
Female Users by Primary Contraceptive Method (Exhibits 18 to 21)

In 2011, grantees reported that 85% (3,947,911) of all female users “used” (i.e., adopted or
continued use at exit from their last encounter in the reporting period) a primary contraceptive
method. Thirteen percent (590,597) of female users exited the encounter with no primary
method, either because they were pregnant or seeking pregnancy (8%) or for other reasons
(5%), and data on the type of primary method used were unknown for 2% (96,687) of female
users (Exhibits 18 and 19).
By level of method effectiveness, 9% of all female users used a contraceptive method that
was highly effective in preventing unintended pregnancy (vasectomy, female sterilization,
implant, or IUD), 53% used a moderately effective method (injectable contraception, vaginal
ring, patch, pill, or diaphragm), and 21% used a less-effective method (male condom, female
condom, sponge, withdrawal, a fertility-based awareness method [FAM], or spermicide)
(Exhibits 18 and 19).14 The most popular choice of method was the pill, used by 33% of all
female users, followed by male condoms (18%), injectable contraception (14%), IUDs (6%),
the vaginal ring (4%), female sterilization (2%), the contraceptive patch (2%), and the
hormonal implant (1%). Less than one percent of users relied on each of the following
methods: a FAM or the lactational amenorrhea method (LAM), vasectomy, or a female
barrier method (i.e., cervical cap or diaphragm, contraceptive sponge, female condom, or
spermicide). Two percent of female users reported relying on abstinence, and another 2%
reported use of withdrawal or other methods not listed in FPAR Table 7 (Exhibits 18 and 19).
Across all age groups, between 82% and 89% of female users exited the encounter with a
primary contraceptive method, and between 45% (over 44) and 67% (15 to 17) used a highly
or moderately effective method.14 Among female users 18 to 44, the pill (24% to 38%), male
condoms (17% to 24%), and injectable contraception (13% to 16%) were the three leading
methods. Female users under 18 relied on the pill (33% to 38%), injectable contraception
(21% to 23%), and male condoms (15% to 18%), and those over 44 used male condoms
(26%), the pill (17%), and female sterilization (13%). Ten percent of female users under 15
also practiced abstinence. The percentage of female users for whom information on primary
method use was unknown exceeded the national average of 2% in the age groups under 15
(3%), 40 to 44 (3%), and over 44 (6%). Finally, nonuse of a contraceptive method due to
pregnancy or the desire for pregnancy was highest (7% to 9%) among users 18 to 39, between
3% and 5% among users under 18, and between 1% and 4% among users 40 and over
(Exhibits 18 and 19).
Across all regions, between 81% (I and II) and 89% (X) of female users exited the encounter
with a primary method, and between 54% (I and II) and 77% (VIII and X) used a highly or
moderately effective method.14 Pills, injectable contraception, and male condoms were the
leading methods in five regions (IV, V, VI, VII, and VIII), while in three others (I, II, and III)
male condoms and injectables were the second and third most popular methods after pills.

Attachment F - 39

Regions IX and X departed from the contraceptive use patterns exhibited in the other eight
regions. In Region X, IUD was the third most popular method among female users after pills
and injectables, while in Region IX, condoms were the most popular method, followed by
pills and injectables (Exhibits 20 and 21).
Exhibit A–7a presents trends (1999 to 2011) in the number of all female family planning
users by primary method status, including use of no method. Between 1999 and 2011, the
percentage of female users relying on any primary method increased from 83% (3,584,057) of
female users in 1999 to 85% (3,947,911) in 2011. Numerically, this represented a 10%
increase in the number of female users that used a primary contraceptive method. The
percentage of females using no primary method, because they were either pregnant or seeking
pregnancy or for other reasons, ranged between 12% and 15% for these years, and the
percentage for which the type of primary method was unknown ranged between 2% and 6%
(Exhibits A–7a).
Exhibits A–7b and A–7c present trends (1999 to 2011) in the distribution of female users by
type of primary method used; these exhibits exclude female users who exited with no method
or for whom the type of primary method was unknown. Among female users who used a
primary method, the percentage relying on highly effective methods14 (vasectomy, female
sterilization, implant, or IUD) increased from 5% (182,505) in 1999 to 11% (437,426) in
2011, and the percentage using highly effective reversible methods (implant or IUD)
increased from 2% (70,896) in 1999 to 9% (338,356) in 2011. Numerically, the number of
female users relying on highly effective reversible methods more than quadrupled between
1999 and 2011, due primarily to the large increase—from 48,015 in 1999 to 272,683 in
2011—in the number of IUD users. Hormonal implant use during this period was low, but is
increasing. After a decline in the number of implant users between 1999 and 2006, the
number of users relying on implants grew rapidly, from 2,506 users in 2006 to 65,673 in
2011, because of the increasing availability of a new U.S. Food and Drug Administration
(FDA)-approved hormonal implant in mid-2006 (Exhibits A–7a, A–7b, and A–7c).
In contrast, the percentage of female method users relying on moderately effective methods
(injectable, vaginal ring, patch, pill, or diaphragm) decreased from 75% (2,696,412) of female
method users in 1999 to 62% (2,456,402) in 2011. The pill was the most popular of all
methods (39% to 55%) during this period, followed by injectables (15% to 20%). Increased
use of newer, short-term hormonal methods (i.e., vaginal ring and patch) partially offset the
16-point decline in pill use between 1999 and 2011. Although the FDA approved the vaginal
ring and contraceptive patch in late 2001, the FPAR form was not revised to track use of these
methods until 2005. Since the addition of separate reporting categories for these two methods,
the percentage of female method users relying on the vaginal ring has increased from 2% in
2005 to 5% in 2011, while the percentage using the contraceptive patch decreased from 7% to
2% (Exhibits A–7b and A–7c).

Attachment F - 40

Finally, the percentage of female contraceptive users relying on less effective methods (male
condom, female condom, sponge, withdrawal, FAM, or spermicide) increased from 20%
(705,140) of female method users in 1999 to 25% (984,159) in 2011.14 About 8 of every 10
female method users in this group rely on male condoms (Exhibits A–7b and A–7c).
Male Users by Primary Contraceptive Method (Exhibits 22 to 25)

In 2011, grantees reported that 89% (344,340) of all male users had adopted or continued use
of a primary contraceptive method at exit from their last family planning encounter in the
reporting period. The leading contraceptive method among male users was male condoms
(75%), followed by reliance on a female method (6%), abstinence (4%), withdrawal or other
method (3%), vasectomy (1%), and fertility-based awareness methods (< 1%). Seven percent
(28,156) of male users exited the encounter with no primary method, either because their
partners were pregnant or seeking pregnancy (1%) or for other reasons (6%). Data on primary
method at exit was unknown or not reported for 4% (14,020) of male users (Exhibits 22
and 23).
Across male users in all age groups, between 83% and 91% of male users exited the
encounter with a primary contraceptive method. For male users 18 or over, male condoms and
reliance on a female method were the two leading methods. Between 63% and 81% of males
in these age groups used male condoms, and 4% to 9% relied on a female method. The two
leading methods among male users 15 to 17 were male condoms (70%) and abstinence
(13%), while those under 15 relied on abstinence (55%) and male condoms (30%).
Vasectomy prevalence ranged between 1% and 4% among male users 25 or over and was less
than 1% in the 20 to 24 age group. Between 2% and 3% of male users in each age group used
withdrawal or other methods not listed in FPAR Table 8, and less than 1% relied on a
fertility-based awareness method. Primary method use was unknown for between 4% and 7%
of male users (Exhibits 22 and 23).
By region, the percentage of males who used any method ranged from 73% (X) to 94% (IV
and IX). Male condoms, the leading method in all regions, were used by 49% (IV) to 86%
(IX) of male users. In seven regions (III, V, VI, VII, VIII, IX, and X), reliance on a female
method was the second most common primary method, with use ranging between 4% (IX)
and 22% (VIII) of male users in these regions. Abstinence was the second most common
primary method in Regions I (8%) and IV (25%). The percentage of male users who exited
the encounter with no method due to “other reasons” ranged between 2% (IX) and 25% (X),
while only 1% or fewer reported that they were not using a method because their partner was
pregnant or seeking pregnancy. The percentage of male users for whom the type of method
used was unknown exceeded the national average of 4% in four regions (III, V, VI, and VII)
(Exhibits 24 and 25).

Attachment F - 41

Exhibit 18. Number of female family planning users, by primary contraceptive method and age: 2011 (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

90,438

0

0

2

2,556

10,987

18,019

19,135

16,995

22,744

Intrauterine device

272,683

206

5,256

13,326

72,624

75,910

51,786

30,414

15,834

7,327

Hormonal implant

65,673

887

7,358

9,605

22,711

13,402

6,482

3,029

1,472

Hormonal injection

645,351

Oral contraceptive

a

a

a

a

43,500

25,671

15,520a

328,031

169,441

86,995

49,622

30,428

20,371

11,200

5,120

1,943

604

73,650

48,789

18,928

6,289

2,523

1,073

689

804

600

377

244

367

70

238

215

142

77

63

74

604

669

1,462

1,075

728

549

397

428

413

543

1,932

1,387

1,075

741

472

438

80,532

83,298

184,517

1,534,684

16,160

146,772

196,522

510,713

89,795

1,109

9,408

11,549

28,491

183,182

586

11,039

20,305

3,390

18

121

170

921

4

38

Female condom

5,939

27

Spermicide (used alone)

7,061

60

Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge

125,822

a

a

a

727

75,159

11,332

a

a

FAM or LAM b

17,105

71

487

964

4,009

3,868

2,767

1,986

1,298

1,655

Abstinence c

69,924

4,743

8,728

5,951

14,472

10,628

7,421

5,464

4,761

7,756

115,002

835

7,859

11,140

30,911

23,691

14,929

9,119

6,393

10,125

Withdrawal or other method d
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown e

8,632

0

7

88

587

1,183

1,654

1,783

1,662

1,668

838,131

7,446

68,840

92,119

236,093

164,573

105,660

68,781

48,543

46,076

361,056

1,587

20,760

42,056

122,683

88,286

51,194

24,156

8,149

2,185

229,541

2,884

16,065

23,313

62,429

44,601

28,868

18,509

12,860

20,012

96,687

1,342

6,837

9,231

24,726

18,114

12,144

8,001

5,689

10,603

Total Female Users

4,635,195

49,297

391,124

520,921

1,395,493

981,737

578,197

334,025

204,591

179,810

Using a Method

3,947,911

43,484

347,462

446,321

1,185,655

830,736

485,991

283,359

177,893

147,010

Not Using a Method

590,597

4,471

36,825

65,369

185,112

132,887

80,062

42,665

21,009

22,197

Method Unknown e

96,687

1,342

6,837

9,231

24,726

18,114

12,144

8,001

5,689

10,603

FAM=fertility awareness method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users. See Table 7 comments in the Field and Methodological Notes (Appendix C).
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
See Table 7 comments in the Field and Methodological Notes (Appendix C).

Attachment F - 42

Exhibit 19. Distribution of female family planning users, by primary contraceptive method and age: 2011 (Source: FPAR Table 7)
All Age
Groups

Primary Method

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

2%

0%

0%

0%†

0%†

1%

3%

6%

8%

13%

Intrauterine device

6%

0%†

1%

3%

5%

8%

9%

9%

8%

4%

Hormonal implant

1%

2%

2%

2%

2%

1%

1%

1%

1%

0%†

Hormonal injection

14%a

23%a

21%a

16%a

13%a

13%a

13%a

13%a

13%a

9%a

Oral contraceptive

33%

33%

38%

38%

37%

33%

29%

26%

24%

Contraceptive patch

2%

2%

2%

2%

2%

2%

2%

2%

1%

0%†

Vaginal ring

4%

1%

3%

4%

5%

5%

3%

2%

1%

1%

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

0%†

0%†

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

Abstinence c
Withdrawal or other method

d

Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason

17%

2%

10%

2%

1%

1%

1%

1%

2%

2%

4%

2%

2%

2%

2%

2%

2%

3%

3%

3%

6%

0%†

0%

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

18%

15%

18%

18%

17%

17%

18%

21%

24%

26%

8%

3%

5%

8%

9%

9%

9%

7%

4%

1%

5%

6%

4%

4%

4%

5%

5%

6%

6%

11%

Method Unknown e

2%

3%

2%

2%

2%

2%

2%

2%

3%

6%

Total Female Users

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Using a Method

85%

88%

89%

86%

85%

85%

84%

85%

87%

82%

Not Using a Method

13%

9%

9%

13%

13%

14%

14%

13%

10%

12%

Method Unknown e

2%

3%

2%

2%

2%

2%

2%

2%

3%

6%

Note: Due to rounding, percentages may not sum to 100%. FAM=Fertility Awareness Method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users. See Table 7 comments in the Field and Methodological Notes (Appendix C).
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
See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.

Attachment F - 43

Exhibit 20. Number of female family planning users, by primary contraceptive method and region: 2011 (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

90,438

6,279

9,130

13,167

15,749

5,854

8,540

7,421

2,877

18,252

3,169

Intrauterine device

272,683

11,442

27,801

20,654

38,699

19,756

29,395

9,418

10,685

87,830

17,003

Hormonal implant

65,673

1,106

2,384

7,078

Hormonal injection

645,351a

15,106a

43,610a

66,847a

Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAM b
Abstinence

c

Withdrawal or other method d
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason

8,698

4,454

9,410

4,826

3,443

21,242

3,032

189,306a

73,414

81,686a

33,762a

20,252

95,776a

25,592
71,996

1,534,684

49,331

132,799

170,157

326,202

167,379

152,578

70,634

62,448

331,160

89,795

2,696

9,470

7,534

10,010

9,271

13,530

2,801

2,855

25,329

6,299

183,182

5,826

18,712

20,601

18,101

22,812

11,497

7,088

9,583

55,552

13,410

3,390

214

383

901

328

246

203

101

120

652

242

921

36

59

76

256

17

275

15

9

153

25

5,939

69

658

1,096

292

378

221

45

59

3,059

62

7,061

67

339

1,397

2,625

327

1,376

69

49

599

213

17,105

555

1,146

1,819

6,728

290

1,988

419

177

3,677

306

69,924

5,904

4,462

8,397

13,112

4,292

5,519

2,637

2,634

19,972

2,995

115,002

6,950

16,451

7,641

35,097

5,150

7,597

2,562

765

29,926

2,863

8,632

662

681

589

1,093

634

896

623

682

2,045

727

838,131

32,555

100,669

93,444

109,019

62,761

58,912

17,788

12,644

334,155

16,184

361,056

13,173

53,928

32,333

55,838

32,655

42,321

15,089

11,122

90,191

14,406
4,788

229,541

15,521

30,588

28,114

63,478

24,611

21,352

10,764

4,103

26,222

Method Unknown e

96,687

3,461

2,653

26,244

19,287

8,693

5,799

5,780

2,559

22,028

183

Total Female Users

4,635,195

170,953

455,923

508,089

913,918

442,994

453,095

191,842

147,066

1,167,820

183,495

Using a Method

3,947,911

138,798

368,754

421,398

775,315

377,035

383,623

160,209

129,282

1,029,379

164,118

Not Using a Method

590,597

28,694

84,516

60,447

119,316

57,266

63,673

25,853

15,225

116,413

19,194

Method Unknown e

96,687

3,461

2,653

26,244

19,287

8,693

5,799

5,780

2,559

22,028

183

FAM=Fertility Awareness Method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users. See Table 7 comments in the Field and Methodological Notes (Appendix C).
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
See Table 7 comments in the Field and Methodological Notes (Appendix C).

Attachment F - 44

Exhibit 21. Distribution of female family planning users, by primary contraceptive method and region: 2011 (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

2%

4%

2%

3%

2%

1%

2%

4%

2%

2%

2%

Intrauterine device

6%

7%

6%

4%

4%

4%

6%

5%

7%

8%

9%

Hormonal implant

1%

1%

1%

1%

1%

1%

2%

3%

2%

2%

2%

Hormonal injection

14%a

9%a

10%a

13%a

21%a

17%

18%a

18%a

14%

8%a

14%

Oral contraceptive

33%

29%

29%

33%

36%

38%

34%

37%

42%

28%

Contraceptive patch

2%

2%

2%

1%

1%

2%

3%

1%

2%

2%

39%
3%

Vaginal ring

4%

3%

4%

4%

2%

5%

3%

4%

7%

5%

7%

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

0%†

0%†

0%†

0%†

1%

0%†

0%†

0%†

0%†

0%†

0%†

Abstinence c

2%

3%

1%

2%

1%

1%

1%

1%

2%

2%

2%

Withdrawal or other method d

2%

4%

4%

2%

4%

1%

2%

1%

1%

3%

2%

Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason

0%†

0%†

18%

0%†

19%

0%†

22%

0%†

18%

0%†

12%

0%†

14%

0%†

13%

0%†

9%

9%

29%

0%†

9%

0%†

8%

8%

12%

6%

6%

7%

9%

8%

8%

8%

8%

5%

9%

7%

6%

7%

6%

5%

6%

3%

2%

3%

Method Unknown e

2%

2%

1%

5%

2%

2%

1%

3%

2%

2%

0%†

Total Female Users

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Using a Method

85%

81%

81%

83%

85%

85%

85%

84%

88%

88%

89%

Not Using a Method

13%

17%

19%

12%

13%

13%

14%

13%

10%

10%

10%

Method Unknown e

2%

2%

1%

5%

2%

2%

1%

3%

2%

2%

Note: Due to rounding, percentages may not sum to 100%. FAM=Fertility Awareness Method. LAM=lactational amenorrhea method.
a
Includes both 3-month and 1-month hormonal injection users. See Table 7 comments in the Field and Methodological Notes (Appendix C).
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
See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.

0%†

Attachment F - 45

Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2011 (Source: FPAR Table 8)
All Age
Groups

Primary Method
Vasectomy
Male condom
FAM

a

Abstinence

b

Withdrawal or other method
Rely on female method

c

d

No Method
Partner pregnant/seeking pregnancy

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

4,409

0

0

0

150

654

1,051

951

728

875

289,141

2,999

22,725

32,307

91,109

60,097

31,807

17,351

12,119

18,627

930

7

48

33

213

246

154

88

54

87

16,691

5,512

4,354

1,145

1,711

1,115

709

454

411

1,280

10,635

204

786

943

2,824

2,124

1,489

709

555

1,001

22,534

216

821

1,751

6,111

4,749

2,918

1,753

1,450

2,765

3,160

22

170

238

745

670

548

337

195

235

24,996

690

2,107

2,216

6,906

4,577

2,732

1,711

1,402

2,655

14,020

404

1,567

1,294

2,953

2,287

1,514

1,021

924

2,056

Total Male Users

386,516

10,054

32,578

39,927

112,722

76,519

42,922

24,375

17,838

29,581

Using a Method

344,340

8,938

28,734

36,179

102,118

68,985

38,128

21,306

15,317

24,635

Other reason
Method Unknown e

Not Using a Method

28,156

712

2,277

2,454

7,651

5,247

3,280

2,048

1,597

2,890

Method Unknown e

14,020

404

1,567

1,294

2,953

2,287

1,514

1,021

924

2,056

FAM=Fertility Awareness Method.
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
See Table 8 comments in the Field and Methodological Notes (Appendix C).

a

Attachment F - 46

Exhibit 23. Distribution of male family planning users, by primary contraceptive method and age: 2011 (Source: FPAR Table 8)
All Age
Groups

Primary Method
Vasectomy
Male condom
FAM

a

15 to 17
Years

18 to 19
Years

1%

0%

0%

0%

75%

30%

70%

81%

0%†
b

Under 15
Years

0%†

0%†

20 to 24
Years
0%†
81%

25 to 29
Years

30 to 34
Years

35 to 39
Years

40 to 44
Years

Over 44
Years

1%

2%

4%

4%

3%

79%

74%

71%

68%

63%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

4%

55%

13%

3%

2%

1%

2%

2%

2%

4%

3%

2%

2%

2%

3%

3%

3%

3%

3%

3%

6%

2%

3%

4%

5%

6%

7%

7%

8%

9%

1%

0%†

1%

1%

1%

1%

1%

1%

1%

1%

6%

7%

6%

6%

6%

6%

6%

7%

8%

9%

4%

4%

5%

3%

3%

3%

4%

4%

5%

7%

Total Male Users

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Using a Method

89%

89%

88%

91%

91%

90%

89%

87%

86%

83%

Abstinence

Withdrawal or other method
Rely on female method

c

d

No Method
Partner pregnant/seeking pregnancy
Other reason
Method Unknown

e

Not Using a Method

7%

7%

7%

6%

7%

7%

8%

8%

9%

10%

Method Unknown e

4%

4%

5%

3%

3%

3%

4%

4%

5%

7%

Note: Due to rounding, percentages may not sum to 100%. FAM=Fertility Awareness Method.
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
See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
a

Attachment F - 47

Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2011 (Source: FPAR Table 8)
All
Regions

Primary Method
Vasectomy
Male condom
FAM a
Abstinence

b

Withdrawal or other method

c

Region I

Region II

Region III

Region IV

Region V

Region VI Region VII Region VIII Region IX

Region X

4,409

62

105

427

1,232

83

284

51

459

1,347

359

289,141

14,898

29,336

39,649

13,244

21,776

16,221

8,835

13,821

125,682

5,679

930

11

49

13

24

7

625

0

15

173

13

16,691

1,692

606

2,172

6,652

546

729

262

1,071

2,435

526

10,635

742

1,365

1,504

1,496

385

1,004

488

400

2,662

589

22,534

974

781

3,055

2,803

1,385

1,037

1,042

4,868

5,798

791

3,160

49

55

390

82

189

117

85

50

1,993

150

24,996

2,386

4,984

3,787

752

3,328

1,480

752

1,358

3,450

2,719

14,020

485

165

5,077

728

1,369

1,271

1,810

203

2,910

2

Total Male Users

386,516

21,299

37,446

56,074

27,013

29,068

22,768

13,325

22,245

146,450

10,828

Using a Method

344,340

18,379

32,242

46,820

25,451

24,182

19,900

10,678

20,634

138,097

7,957

Not Using a Method

28,156

2,435

5,039

4,177

834

3,517

1,597

837

1,408

5,443

2,869

Method Unknown e

14,020

485

165

5,077

728

1,369

1,271

1,810

203

2,910

2

Rely on female method d
No Method
Partner pregnant/seeking pregnancy
Other reason
Method Unknown e

FAM=Fertility Awareness Method.
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
See Table 8 comments in the Field and Methodological Notes (Appendix C).

a

Attachment F - 48

Exhibit 25. Distribution of male family planning users, by primary contraceptive method and region: 2011 (Source: FPAR Table 8)
Primary Method
Vasectomy
a

Abstinence

Region I

Region II

1%

0%†

0%†

75%

Male condom
FAM

All
Regions

0%†
b

Withdrawal or other method

c

Rely on female method d
No Method
Partner pregnant/seeking pregnancy

70%
0%†

78%
0%†

Region III

Region IV

1%

5%

71%

49%

0%†

0%†

Region V
0%†
75%
0%†

Region VI Region VII Region VIII Region IX
1%

0%†

71%

66%

3%

0%

Region X

2%

1%

3%

62%

86%

52%

0%†

0%†

0%†

4%

8%

2%

4%

25%

2%

3%

2%

5%

2%

5%

3%

3%

4%

3%

6%

1%

4%

4%

2%

2%

5%

6%

5%

2%

5%

10%

5%

5%

8%

22%

4%

7%

0%†

1%

0%†

1%

1%

1%

0%†

1%

1%

7%

3%

11%

7%

6%

6%

2%

25%

9%

3%

5%

6%

14%

1%

2%

1%

0%†

6%

11%

4%

2%

Total Male Users

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Using a Method

89%

86%

86%

83%

94%

83%

87%

80%

93%

94%

73%

Not Using a Method

7%

11%

13%

7%

3%

12%

7%

6%

6%

4%

26%

Method Unknown e

4%

2%

9%

3%

5%

6%

14%

1%

2%

Other reason
Method Unknown e

13%
0%†

0%†

0%†

Note: Due to rounding, percentages may not sum to 100%. FAM=Fertility Awareness Method.
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
See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
a

0%†

Attachment F - 49

Guidance for Reporting Cervical and Breast Cancer Screening Activities in FPAR Tables 9 and 10
In FPAR Tables 9 and 10, grantees report information on cervical (Table 9) and breast cancer (Table 10) screening
activities during the reporting period.
In FPAR Table 9, grantees report the following information on cervical cancer screening activities:

• Unduplicated number of users who obtained a Pap test;
• Number of Pap tests performed;
• Number of Pap tests with an ASC or higher result, according to the 2001 Bethesda System.15 ASC or higher
results include ASC-US; ASC-H; LSIL; HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; AIS;
adenocarcinoma; or other (e.g., endometrial cells in a woman ≥ 40 years of age); and

• Number of Pap tests with an HSIL or higher result according to the 2001 Bethesda System.15 HSIL or higher

results include HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; AIS; adenocarcinoma; or other
(e.g., endometrial cells in a woman ≥ 40 years of age).

In FPAR Table 10, grantees Report the following information on breast health screening and referral activities.

• Unduplicated number of users receiving a clinical breast exam (CBE).
• Unduplicated number of users referred for further evaluation based on CBE results.
The FPAR instructions provide the following guidance for reporting this information:
Tests—Report Pap tests and CBEs performed during the reporting period that are provided within the scope of the
agency’s Title X project.
Atypical Squamous Cells (ASC)—ASC refer to cytological changes that are suggestive of a squamous
intraepithelial lesion. The 2001 Bethesda System15 subdivides atypical squamous cells into two categories:

• Atypical squamous cells of undetermined significance (ASC-US)—ASC-US refers to cytological changes that are
16

suggestive of a squamous intraepithelial lesion, but lack criteria for a definitive interpretation.

• Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H refers to cytological changes that are

16

suggestive of a high-grade squamous intraepithelial lesion (HSIL), but lack criteria for a definitive interpretation.

Low-Grade Squamous Intraepithelial Lesions (LSIL)—LSIL refers to low-grade squamous intraepithelial lesions
16
encompassing human papillomavirus, mild dysplasia, and cervical intraepithelial neoplasia (CIN) 1.
High-Grade Squamous Intraepithelial Lesions (HSIL)—HSIL refers to high-grade squamous intraepithelial
16
lesions encompassing moderate and severe dysplasia, carcinoma in situ, CIN 2, and CIN 3.
Atypical Glandular Cells (AGC)—AGC refers to glandular cell abnormalities, including adenocarcinoma. The 2001
Bethesda System (see Exhibit 1 of the Title X FPAR: Forms and Instructions) classifies AGC less severe than
17
adenocarcinoma into three categories.

• Atypical glandular cells, either endocervical, endometrial, or “glandular cells” not otherwise specified;
• Atypical glandular cells, either endocervical or “glandular cells” favor neoplasia (AGC, favor neoplastic); and
• Endocervical adenocarcinoma in situ (AIS).
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 31–33.

Attachment F - 50

CERVICAL AND BREAST CANCER SCREENING
OPA requires Title X-funded service providers to develop and adhere to written clinical
protocols that reference and are consistent with current, evidence-based recommendations for
cervical and breast cancer screening established by health agencies or professional
organizations (e.g., U.S. Preventive Services Task Force, American Cancer Society, and
American College of Obstetricians and Gynecologists).18–25
Cervical Cancer Screening (Exhibit 26)

In 2011, Title X service sites provided Papanicolaou (Pap) testing to 31% (1,444,418) of
female family planning users and performed 1,522,777 tests, or an average of 3.3 Pap tests
per 10 female users. Of the total number of Pap tests performed, 15% (221,419) had a result
indicating a precancerous or cancerous condition (i.e., atypical squamous cell [ASC] or
higher result) that required further evaluation and possible treatment. Additionally, 1%
(12,473) of the total Pap tests performed had a result of high-grade squamous intraepithelial
lesion (HSIL) or higher, indicating the presence of a more severe condition. By region, the
percentage of total female users who received a Pap test ranged from 26% (IX) to 39% (VII),
and the percentage tested exceeded the national average of 31% in five regions (II, III, IV, VI,
and VII) (Exhibit 26).
Between 2005 and 2011, the percentage of female users who received a Pap test decreased
from 52% (2,447,498) of female users in 2005 to 31% (1,444,418) in 2011, and the number of
tests performed decreased 42%, from 2,644,413 in 2005 to 1,522,777 in 2011 (Exhibits A-8a
and A-8b). The downward trend in Pap testing is a result of several factors, including provider
adoption of updated national standards for cervical cancer screening.21–23 The updated
screening guidelines have increased both the age at which Pap testing should begin and the
testing interval for women with a normal result.
Breast Cancer Screening (Exhibit 26)

In 2011, Title X service sites provided clinical breast exams (CBEs) to 38% (1,933,162) of
family planning users. Service providers referred 3% (56,234) of users who received a CBE
for further evaluation based on the results of the exam. By region, between 19% (IX) and
61% (VI) of total users received a CBE, and the percentage examined was above the national
average of 38% in all but four regions (I, V, IX, and X). In addition, the percentage of users
who were referred for further evaluation on the basis of their CBE ranged from 1% (VI and
X) to 9% (IX) (Exhibit 26).

Attachment F - 51

Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2011 (Source: FPAR Tables 9 and 10)
Tests/Exams
Pap Tests
Users tested
Number a
Percentage b
Tests performed
Number
Tests per 10 users
ASC or higher result
Number
Percentage

c

HSIL or higher result
Number
Percentage c

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

1,444,418

50,085

151,588

161,985

315,676

125,356

165,594

74,259

31%

29%

33%

32%

35%

28%

37%

39%

1,522,777

51,825

157,181

173,874

329,102

129,864

174,890

3.3

3.0

3.4

3.4

3.6

2.9

3.9

221,419

7,298

22,875

25,726

54,383

17,758

15%

14%

15%

15%

17%

12,473

604

1,051

1,190

1%

1%

1%

1%

1,933,162

61,465

194,629

38%

32%

39%

56,234

1,309

3%

2%

Region VIII

Region IX

Region X

42,939

306,821

50,115

29%

26%

27%

77,409

44,411

332,943

51,278

4.0

3.0

2.9

2.8

22,339

10,692

5,650

48,176

6,522

14%

13%

14%

13%

14%

13%

3,550

1,252

1,268

614

399

2,097

448

1%

1%

1%

1%

1%

1%

1%

257,357

479,240

174,335

288,599

92,147

69,430

255,252

60,708

46%

51%

37%

61%

45%

41%

19%

31%

3,660

5,676

13,080

3,132

4,248

1,517

1,044

22,078

490

2%

2%

3%

2%

1%

2%

2%

9%

1%

Clinical Breast Exams
Users examined
Number d
Percentage e
Users referred based on exam
Number
Percentage
a
b
c
d
e
f

f

Unduplicated number of female users.
Denominator is the total unduplicated number of female users.
Denominator is the total number of Pap tests performed.
Unduplicated number of female and male users.
Denominator is the total unduplicated number of users (female and male).
Denominator is the total unduplicated number of users examined.

Attachment F - 52

SEXUALLY TRANSMITTED DISEASE TESTING
Sexually transmitted diseases (STDs) are a concern for clients served in Title X service
projects, particularly young (15 to 24), sexually active women, who have the highest reported
rates of chlamydia and gonorrhea.19,26 Title X Program Guidelines7 require Title X-funded
sites to provide family planning users with a thorough history and physical assessment that
includes screening for risk of STDs, both symptomatic and asymptomatic, in accordance with
the current CDC STD Treatment Guidelines.27 As part of a comprehensive family planning
visit, Title X providers offer—onsite or by referral—STD testing, treatment, and
management.
Chlamydia Testing (Exhibits 27 and 28)

CDC recommends routine chlamydia screening, at least annually, for all sexually active,
nonpregnant women 25 or under and for older, nonpregnant women at increased risk
(e.g., with a new or multiple sex partners).27,28 Although the evidence is insufficient for CDC
to recommend routine chlamydia screening for sexually active young men, the guidelines
suggest screening in high-prevalence settings (e.g., adolescent clinics and STD clinics).27
Through an interagency agreement between CDC and OPA, many Title X-funded service
sites participate in chlamydia prevention efforts through the national Infertility Prevention
Project (IPP).
In 2011, Title X-funded service sites tested 49% (2,287,270) of all female users for chlamydia
and 58% (1,357,231) of female users 24 or under. Chlamydia testing rates among female
users 24 or under were at or above the national rate of 58% in four regions (II, VI, VII, and
IX). By age group, rates of chlamydia testing were higher (58% to 59%) among female users
15 to 24 and lower among female users under 15 (49%) or over 24 (41%) (Exhibits 27 and
28). Between 2005 and 2011, the percentage of female users 24 or under who were tested for
chlamydia increased from 50% in 2005 to 58% in 2011 (Exhibits A–9a and A–9b).
Additionally, Title X-funded service sites tested 63% (245,326) of all male users for
chlamydia. Compared to female users, there was substantially more variation by region and
age in rates of male chlamydia testing. By region, service providers tested between 25% (IV)
and 76% (V) of all male users for chlamydia, and male testing rates were above the national
average of 63% in four regions (II, V, VIII, and IX). By age group, rates of chlamydia testing
were highest among male users 20 to 24 (74%) and lowest among male users under 15 (16%)
(Exhibits 27 and 28).
Gonorrhea Testing (Exhibit 29)

In 2011, Title X service sites performed 2,729,578 gonorrhea tests (2,470,645 female tests
and 258,933 male tests). On average, Title X service sites performed 5.3 gonorrhea tests for
every 10 female users and 6.7 tests for every 10 male users. By region, the rate of gonorrhea
testing ranged between 3.4 (VIII) and 6.4 (IX) tests for every 10 female users and 2.7 (IV)
and 8.0 (IX) tests for every 10 male users (Exhibit 29).

Attachment F - 53

Exhibit 27. Number of family planning users tested for chlamydia, by sex, age, and region: 2011 (Source: FPAR Table 11)
Age Group (Years)

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Female Users
Under 15

24,082

759

1,833

3,965

5,387

1,914

2,836

1,142

779

4,559

908

15 to 17

224,989

8,263

19,717

28,917

37,057

19,460

22,558

10,635

8,501

60,585

9,296

18 to 19

305,744

9,729

27,665

33,193

51,352

26,741

29,481

14,152

11,747

90,791

10,893

20 to 24

802,416

23,297

78,409

77,980

143,298

70,478

78,050

34,907

25,318

243,470

27,209

Over 24

930,039

31,208

108,875

87,891

167,885

69,495

108,362

31,964

19,467

283,803

21,089

2,287,270

73,256

236,499

231,946

404,979

188,088

241,287

92,800

65,812

683,208

69,395

1,357,231

42,048

127,624

144,055

237,094

118,593

132,925

60,836

46,345

399,405

48,306

1,632

90

113

443

156

138

60

55

41

513

23

15 to 17

16,159

846

1,662

2,851

472

1,341

912

569

674

6,404

428

18 to 19

26,705

1,368

2,937

3,680

806

2,494

1,710

949

1,508

10,653

600

20 to 24

83,012

4,413

9,377

9,866

2,187

8,060

4,456

2,892

5,321

34,601

1,839

Over 24

117,818

5,611

10,915

13,573

3,264

10,097

4,830

3,630

9,183

53,715

3,000

Subtotal

245,326

12,328

25,004

30,413

6,885

22,130

11,968

8,095

16,727

105,886

5,890

Subtotal
Under 25

a

Male Users
Under 15

All Users
Under 15

a

All Regions

25,714

849

1,946

4,408

5,543

2,052

2,896

1,197

820

5,072

931

15 to 17

241,148

9,109

21,379

31,768

37,529

20,801

23,470

11,204

9,175

66,989

9,724

18 to 19

332,449

11,097

30,602

36,873

52,158

29,235

31,191

15,101

13,255

101,444

11,493

20 to 24

885,428

27,710

87,786

87,846

145,485

78,538

82,506

37,799

30,639

278,071

29,048

Over 24

1,047,857

36,819

119,790

101,464

171,149

79,592

113,192

35,594

28,650

337,518

24,089

Total All Users

2,532,596

85,584

261,503

262,359

411,864

210,218

253,255

100,895

82,539

789,094

75,285

The U.S. Centers for Disease Control and Prevention (CDC) recommends annual screening for chlamydial infection for all sexually active, nonpregnant women 25 or under and for
older, nonpregnant women at increased risk (e.g., with a new sex partner or multiple sex partners). Similarly, the U.S. Preventive Services Task Force (USPSTF) recommends
screening for chlamydial infection for all sexually active, nonpregnant young women 24 or under and for older, nonpregnant women who are at increased risk. (Sources: CDC.
(2010). Sexually transmitted diseases treatment guidelines, 2010. MMWR, 59(No. RR–12): 1–114 and USPSTF. (2007). Screening for chlamydial infection: U.S. Preventive
Services Task Force recommendation statement. Annals of Internal Medicine, 147(2): 128–134.)

Attachment F - 54

Exhibit 28. Percentage of family planning users in each age group tested for chlamydia, by sex, age, and region: 2011 (Source: FPAR Table 11)
Age Group (Years)

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Female Users
Under 15

49%

30%

43%

52%

50%

41%

52%

47%

42%

60%

42%

15 to 17

58%

46%

56%

58%

51%

47%

59%

59%

59%

71%

48%

18 to 19

59%

51%

59%

59%

51%

47%

60%

61%

59%

72%

50%

20 to 24

58%

50%

59%

52%

51%

48%

61%

60%

54%

68%

50%

Over 24

41%

37%

46%

36%

37%

36%

47%

35%

30%

48%

24%

49%

43%

52%

46%

44%

42%

53%

48%

45%

59%

38%

58%

49%

58%

55%

51%

48%

60%

60%

56%

69%

50%

16%

12%

16%

33%

3%

41%

28%

22%

11%

39%

42%

15 to 17

50%

36%

54%

41%

13%

58%

54%

61%

59%

66%

67%

18 to 19

67%

67%

69%

54%

38%

74%

56%

67%

74%

76%

67%

20 to 24

74%

72%

75%

66%

41%

82%

59%

66%

78%

81%

67%

Over 24

62%

56%

65%

52%

29%

76%

47%

57%

77%

68%

46%

Subtotal

63%

58%

67%

54%

25%

76%

53%

61%

75%

72%

54%

Subtotal
Under 25

a

Male Users
Under 15

All Users
Under 15

a

All Regions

43%

26%

40%

50%

36%

41%

51%

45%

37%

57%

42%

15 to 17

57%

45%

56%

56%

49%

47%

59%

59%

59%

71%

49%

18 to 19

59%

52%

60%

58%

51%

48%

60%

62%

60%

72%

51%

20 to 24

59%

52%

60%

54%

51%

50%

61%

61%

57%

70%

51%

Over 24

42%

39%

47%

37%

37%

38%

47%

37%

38%

50%

26%

Total All Users

50%

45%

53%

47%

44%

45%

53%

49%

49%

60%

39%

The U.S. Centers for Disease Control and Prevention (CDC) recommends annual screening for chlamydial infection for all sexually active, nonpregnant women 25 or under and for
older, nonpregnant women at increased risk (e.g., with a new sex partner or multiple sex partners). Similarly, the U.S. Preventive Services Task Force (USPSTF) recommends
screening for chlamydial infection for all sexually active, nonpregnant young women 24 or under and for older, nonpregnant women who are at increased risk. (Sources: CDC.
(2010). Sexually transmitted diseases treatment guidelines, 2010. MMWR, 59(No. RR–12): 1–114 and USPSTF. (2007). Screening for chlamydial infection: U.S. Preventive
Services Task Force recommendation statement. Annals of Internal Medicine, 147(2): 128–134.)

Attachment F - 55

Exhibit 29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region: 2011 (Source: FPAR Table 12)
STD Tests

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

2,470,645

76,242

243,455

273,216

465,926

177,997

263,083

101,153

50,736

747,635

71,202

Male

258,933

12,921

24,958

31,705

7,353

22,512

12,781

8,698

14,479

117,239

6,287

Total

2,729,578

89,163

268,413

304,921

473,279

200,509

275,864

109,851

65,215

864,874

77,489

5.3

4.5

5.3

5.4

5.1

4.0

5.8

5.3

3.4

6.4

3.9

Male

6.7

6.1

6.7

5.7

2.7

7.7

5.6

6.5

6.5

8.0

5.8

Total

5.4

4.6

5.4

5.4

5.0

4.2

5.8

5.4

3.9

6.6

4.0

608,224

11,495

52,151

84,165

149,139

17,005

110,766

25,577

1,847

153,420

2,659

Male

135,557

4,872

12,588

21,222

6,016

6,217

8,989

4,335

1,618

68,512

1,188

Total

743,781

16,367

64,739

105,387

155,155

23,222

119,755

29,912

3,465

221,932

3,847

1.3

0.7

1.1

1.7

1.6

0.4

2.4

1.3

0.1

1.3

0.1

Male

3.5

2.3

3.4

3.8

2.2

2.1

3.9

3.3

0.7

4.7

1.1

Total

1.5

0.9

1.3

1.9

1.6

0.5

2.5

1.5

0.2

1.7

0.2

1,080,909

24,091

139,613

94,788

231,930

61,187

175,539

32,544

15,783

293,280

12,154

Male

202,466

10,395

22,554

24,411

7,756

12,790

10,323

6,272

10,265

93,930

3,770

Total

1,283,375

34,486

162,167

119,199

239,686

73,977

185,862

38,816

26,048

387,210

15,924

2.3

1.4

3.1

1.9

2.5

1.4

3.9

1.7

1.1

2.5

0.7

Male

5.2

4.9

6.0

4.4

2.9

4.4

4.5

4.7

4.6

6.4

3.5

Total

2.6

1.8

3.3

2.1

2.5

1.6

3.9

1.9

1.5

2.9

0.8

Positive Test Results

1,644

53

340

160

160

92

78

29

14

631

87

Anonymous HIV Tests

5,289

1,846

0

972

558

388

242

124

0

1,095

64

Gonorrhea Tests
Female

Tests per 10 Users
Female

Syphilis Tests
Female

Tests per 10 Users
Female

Confidential HIV Tests
Female

Tests per 10 Users
Female

All Regions

Region VIII

Region IX

Region X

Attachment F - 56

Syphilis Testing (Exhibit 29)

In 2011, Title X service sites performed 743,781 syphilis tests (608,224 female tests and
135,557 male tests). On average, Title X service sites performed 1.3 syphilis tests for every
10 female users and 3.5 tests for every 10 male users. By region, the rate of syphilis testing
ranged between 0.1 (VIII and X) and 2.4 (VI) tests for every 10 female users and 0.7 (VIII)
and 4.7 (IX) tests for every 10 male users (Exhibit 29).
Human Immunodeficiency Virus Testing (Exhibit 29)

CDC recommends29 that diagnostic HIV testing and opt-out HIV screening be part of routine
clinical care in all health care settings, including family planning, and that routine HIV
screening be provided to all persons seeking STD treatment or before initiating a new sexual
relationship, regardless of whether these individuals are known or suspected to have specific
behavioral risks for HIV infection.29–31 Furthermore, CDC recommends initial as well as
repeat screening at least annually for persons at high risk for HIV (e.g., injection-drug users
and their sex partners, persons who exchange sex for money or drugs, sex partners of HIVinfected persons, men who have sex with men, or heterosexual persons who themselves or
whose sex partners have had more than one sex partner since their most recent HIV test).
In 2011, Title X service sites performed 1,283,375 confidential HIV tests (1,080,909 female
tests and 202,466 male tests). On average, Title X service sites performed 2.3 confidential
HIV tests for every 10 female users and 5.2 tests for every 10 male users. By region, the rate
of HIV testing ranged between 0.7 (X) and 3.9 (VI) tests for every 10 female users and
2.9 (IV) and 6.4 (IX) tests for every 10 male users. Of the total number of confidential HIV
tests performed, 1,644 were positive for HIV. In addition, Title X service providers
performed 5,289 anonymous HIV tests (Exhibit 29).
Between 1999 and 2011, the number of confidential HIV tests performed increased 251%,
from 365,883 tests in 1999 to 1,283,375 in 2011. In addition, the average number of tests per
10 users increased from less than 1 (0.8) in 1999 to 2.6 in 2011 (Exhibits A–10a and A–10b).
Guidance for Reporting STD Testing Activities in FPAR Tables 11 and 12
In FPAR Tables 11 and 12, grantees report testing information for chlamydia (Table 11), gonorrhea (Table 12),
syphilis (Table 12), and HIV (Table 12).
In FPAR Table 11, grantees report the unduplicated number of family planning users tested for chlamydia, by age
group (< 15, 15–17, 18–19, 20–24, and 25 or over) and sex.
In FPAR Table 12, grantees report the following information on gonorrhea, syphilis, and HIV testing:

• Number of gonorrhea, syphilis, and confidential HIV tests performed, by sex;
• Number of positive, confidential HIV tests; and
• Number of anonymous HIV tests performed.
The FPAR instructions provide the following guidance for reporting this information:
Age—Use the client’s age as of June 30th of the reporting period.
Tests—Report STD (chlamydia, gonorrhea, and syphilis) and HIV (confidential and anonymous) tests performed
during the reporting period that are provided within the scope of the grantee’s Title X project. Do not report tests
performed in an STD clinic operated by the Title X-funded agency, unless the activities of the STD clinic are within
the defined scope of the agency’s Title X project.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 37–38.

Attachment F - 57

Guidance for Reporting Encounter and Staffing Data in FPAR Table 13
In FPAR Table 13, grantees report information on the number of family planning encounters and composition of
clinical services provider staff, including:

• 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.
The FPAR instructions provide the following guidance for reporting this information:
Family Planning Provider—A family planning provider is the individual who assumes primary responsibility for
assessing a client and documenting services in the client record. Providers include those agency staff who exercise
independent judgment as to the services rendered to the client during an encounter. Two general types of providers
deliver Title X family planning services: clinical services providers and other services providers.
Clinical Services Provider—Includes physicians (family and general practitioners, specialists), 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 assessment, as described in the Program Guidelines. Clinical services providers are able to offer client
education, counseling, referral, follow-up, and clinical services (physical assessment, treatment, and management)
relating to a client’s proposed or adopted method of contraception, general reproductive health, or infertility
treatment, in accordance with the Program Guidelines.
Other Services Provider—Includes 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 Program
Guidelines. 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 the Program Guidelines.
Family Planning Encounter—A family planning encounter is 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—whether clinical or non-clinical—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. To be counted
for purposes of the FPAR, a written record of the service(s) provided during the family planning encounter must be
documented in the client record. There are two types of family planning encounters at Title X service sites: (1) family
planning encounters with a clinical services provider and (2) family planning encounters with an other services
provider. The type of family planning provider who renders the care, regardless of the services rendered, determines
the type of family planning encounter. Although a client may meet with both clinical and other services providers
during an encounter, the provider with the highest level of training who takes ultimate responsibility for the client’s
clinical or non-clinical assessment and care during the visit is credited with the encounter.
Family Planning Encounter with a Clinical Services Provider—A face-to-face, documented encounter between
a family planning client and a clinical services provider that takes place in a Title X service site.
Family Planning Encounter with an Other Services Provider—A face-to-face, documented encounter between
a family planning client and an other services provider that takes place in a Title X service site.
Laboratory tests and related counseling and education, in and of themselves, do not constitute a family planning
encounter unless there is face-to-face contact between the client and provider, the provider documents the encounter
in the client’s record, and the test(s) is/are accompanied by family planning counseling or education.
Full-Time Equivalent (FTE)—For each type of clinical services provider, report the time in FTEs that these providers
are involved in the direct provision of Title X services (i.e., engaged in a family planning encounter).
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 41–43.

Attachment F - 58

STAFFING AND FAMILY PLANNING ENCOUNTERS
Staffing (Exhibit 30)

In 2011, 3,250 full-time equivalent (FTE) clinical services providers (CSPs), including
physicians, midlevel clinicians (physician assistants, nurse practitioners, and certified nurse
midwives), and “other” CSPs, delivered clinical family planning and related preventive health
services in Title X-funded services sites. 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 assessment, as described in the Program
Guidelines.7 Midlevel clinicians accounted for 66% (2,142 FTEs) of total CSP FTEs,
followed by other CSPs (19%, or 601 FTEs) and physicians (16%, or 506 FTEs). Nationally,
grantees reported an average of 4.2 midlevel CSP FTEs per physician FTE (Exhibit 30).
In all regions, Title X-funded agencies relied more extensively on midlevel clinicians than
physicians to provide clinical care. The number of midlevel clinician FTEs per physician FTE
ranged between 1.9 (III) and 13.3 (VIII), with five regions (IV, V, VI, VIII, and X) exceeding
the national average of 4.2. In all regions except Region IV, midlevel CSPs accounted for the
largest percentage (50% to 87%) of total CSP FTEs. In Region IV, other CSPs accounted for
54% of total CSP FTEs (Exhibit 30).
Family Planning Encounters (Exhibit 30)

In 2011, Title X-funded agencies reported 9,355,313 family planning encounters, or an
average of 1.9 encounters per family planning user. Across regions, the total number of
encounters per user ranged from 1.5 (X) to 2.1 (III, V, and VII), and in five regions (III, IV,
V, VI, and VII) the number of encounters per user was at or above the national average of 1.9
(Exhibit 30).
Encounters with a CSP accounted for 70% of total family planning encounters nationally and
between 55% (IV) and 88% (II) across regions. Nationally, CSPs provided 2,022 encounters
per CSP FTE, and between 1,248 (IV) and 2,729 (V) encounters per CSP FTE across regions
(Exhibit 30).

Attachment F - 59

Exhibit 30. Number and distribution of clinical services provider (CSP) full-time equivalent (FTE) staff by type of CSP and region, and number
and distribution of family planning encounters, by type of encounter and region: 2011 (Source: FPAR Table 13)
FTEs and FP Encounters
Number of CSP FTEs
Physician
PA/NP/CNM
Other CSP a

All
Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

506.4

24.4

60.0

115.7

37.7

29.9

39.0

21.1

5.6

155.6

17.5

2,142.3

95.8

209.8

216.5

329.3

194.4

253.9

85.4

74.2

569.4

113.7

601.3

0.0

8.0

103.2

437.5

20.5

0.0

0.0

8.4

23.8

0.0

3,250.0

120.2

277.8

435.3

804.5

244.7

292.9

106.5

88.2

748.8

131.1

16%

20%

22%

27%

5%

12%

13%

20%

6%

21%

13%

PA/NP/CNM

66%

80%

76%

50%

41%

79%

87%

80%

84%

76%

87%

Other CSP a

19%

0%

3%

24%

54%

8%

0%

0%

10%

3%

0%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

4.2

3.9

3.5

1.9

8.7

6.5

6.5

4.1

13.3

3.7

6.5

Total
Distribution of CSP FTEs
Physician

Total
Midlevel to Physician FTE b
Number of FP Encounters
With CSP

6,571,866

264,795

753,274

866,914

1,004,263

667,871

571,570

285,154

175,836

1,762,418

219,771

With other

2,783,447

53,971

99,615

311,573

820,372

301,174

349,505

155,063

117,025

499,561

75,588

Total

9,355,313

318,766

852,889

1,178,487

1,824,635

969,045

921,075

440,217

292,861

2,261,979

295,359

Distribution of FP Encounters
With CSP
With other
Total
FP Encounters per User
CSP Encounters per CSP FTE

70%

83%

88%

74%

55%

69%

62%

65%

60%

78%

74%

30%

17%

12%

26%

45%

31%

38%

35%

40%

22%

26%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

1.9

1.7

1.7

2.1

1.9

2.1

1.9

2.1

1.7

1.7

1.5

2,022

2,203

2,711

1,992

1,248

2,729

1,951

2,678

1,994

2,354

1,676

CNM=certified nurse midwife. CSP=clinical services provider. FP=family planning. FTE=full-time equivalent. NP=nurse practitioner. PA=physician assistant.
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 assessment, as described in the Program Guidelines.
b

Midlevel providers include physician assistants, nurse practitioners, and certified nurse midwives.

Attachment F - 60

REVENUE
In 2011, Title X grantees reported total program revenue of nearly $1.3 billion to support the
delivery of Title X-funded family planning and related preventive health services. The major
sources of revenue—Medicaid ($506.6 million) and Title X ($276.0 million)—accounted for
39% and 21%, respectively, of total revenue. Revenue from state governments
($125.4 million), local governments ($84.2 million), and client payment for services
($72.2 million) each accounted for 6% to 10% of total revenue, while all other sources each
contributed 4% or less (Exhibit 31).
Title X Services Grant

Revenue from Title X accounted for 21% of total national revenue and between 11% (IX) and
34% (VII) of total regional revenue. Title X was the largest source of revenue in three regions
(I, VII, and VIII) and the second largest source after Medicaid in six others (III, IV, V, VI,
IX, and X). In all but three regions (II, IX, and X), the percentage of total regional revenue
from Title X exceeded the national average of 21% (Exhibits 32 and 33).
Payment for Services: Client Collections

Nationally, revenue from client collections accounted for 6% ($72.2 million) of total revenue
and between 2% (IX) and 14% (VII) of total regional revenue. In three regions (VII, VIII, and
IX) revenue from client collections was the third most important source of revenue. The share
of revenue from client collections exceeded the national average of 6% in five regions (I, II,
V, VII, and VIII) (Exhibits 32 and 33).
Payment for Services: Third-Party Payers

Title X Program Guidelines7 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.”
Medicaid and Children’s Health Insurance Program (CHIP). Revenue from Medicaid
(federal and state shares) accounted for 39% ($506.6 million) of total national revenue and
between 2% (VIII) and 67% (IX) of total regional revenue. Medicaid accounted for the
largest share (26% to 67%) of total regional revenue in seven regions (II, III, IV, V, VI, IX,
and X), and was the second largest source of revenue after Title X in two regions (I and VII).
In 2011, grantees in 27 states and all 10 HHS regions reported revenue from state Medicaid
family planning eligibility expansions. The notes for FPAR Table 14 in Appendix C: Field
and Methodological Notes include a list of the 27 states. Separately reported (from Medicaid)
CHIP revenue accounted for less than 0.5% ($279,244) of total national revenue (Exhibits 32
and 33).
Medicare and Other Public. Revenue from Medicare ($2.0 million) and other public thirdparty payers ($4.1 million) together accounted for less than 1% of total national revenue.
Across all regions, revenue from these third-party payers represented 3% or less of total
regional revenue (Exhibits 32 and 33).

Attachment F - 61

Private. Revenue from private third-party payers ($51.7 million) accounted for 4% of total
national revenue and ranged from 1% (IV and VI) to 13% (I) of total regional revenue.
Revenue from private third-party payers exceeded the national average of 4% in seven
regions (I, II, III, V, VII, VIII, and X) (Exhibits 32 and 33).
Other Revenue

Block Grants and Temporary Assistance for Needy Families (TANF). Revenue from the
Title V Maternal and Child Health (MCH) Block Grant ($25.5 million), the Title XX Social
Services Block Grant ($23.7 million), and Temporary Assistance for Needy Families (TANF)
($14.5 million) each accounted for 1% to 2% of total national revenue. Across regions, the
share of total regional revenue from the MCH or Social Services Block Grants or TANF
ranged between 0% and 5% of total regional revenues, except in Region VI, where the Social
Services Block Grant accounted for 12% of total regional revenue (Exhibits 32 and 33).
State Governments. State government revenue accounted for 10% ($125.4 million) of total
national revenue and between 1% (VII and IX) and 22% (II) of total regional revenue. State
government revenue was the second largest source of revenue in Region II (22%) and the
third largest source in Regions I, III, IV, and X. In five regions (I, II, III, IV, and X), the
percentage of total regional revenue from state governments exceeded the national average of
10% (Exhibits 32 and 33).
Local Governments. Local government revenue accounted for 7% ($84.2 million) of total
national revenue, and between less than 0.5% (I) and 18% (VIII) of total regional revenue.
Local government revenue was the second largest source of revenue in Region VIII (18%),
after Title X. The percentage of total regional revenue from local governments was at or
above the national average of 7% in five regions (IV, V, VI, VIII, and X) (Exhibits 32 and
33).
Bureau of Primary Health Care. Revenue from the Health Resources Services
Administration (HRSA) Bureau of Primary Health Care (BPHC) accounted for less than 0.5%
($5.3 million) of total national revenue and 2% or less of total regional revenue across all
regions. Four regions (III, VI, VIII, and X) reported no BPHC revenue (Exhibits 32 and 33).
Other Revenue. Finally, 7% ($95.1 million) of total revenue came from a combination of
other public and private sources not listed separately in Table 14. Revenue from other sources
ranged from 1% (IV) to 30% (VIII), and in four regions (II, VII, VIII, and IX) the percentage
of total regional revenue from other sources was at or above the national average of 7%
(Exhibits 32 and 33). The notes for FPAR Table 14 in Appendix C: Field and
Methodological Notes include an illustrative list of other revenue sources.
Revenue per User

On average, grantees reported $256 in program revenue per user served in 2011. By region,
revenue per user ranged from $200 (VII) to $352 (X), and was above the national average of
$256 in four regions (II, VI, VIII, and X) (Exhibit 32).

Attachment F - 62

Guidance for Reporting Project Revenue in FPAR Table 14
In FPAR Table 14, grantees report the revenues (i.e., actual cash receipts or drawdown amounts) received during the
reporting period from each funding source to support activities within the scope of the grantee’s Title X services grant
(Section 1001), even if the funds were not expended during the reporting period. Grantees are instructed not to report
the monetary value of in-kind contributions as revenue in Table 14. The FPAR instructions provide the following
guidance for reporting this information:
Title X Grant (Row 1)—Report the amount received (cash receipts or drawdown amounts) during the reporting period
from the Title X Section 1001 family planning services grant. Do not report the amount of grant funds awarded unless
this figure is the same as the actual cash receipts or drawdown amounts.
Payment for Services (Rows 2–5)—Refers to funds collected directly from clients and revenues received from public
and private third party payers (capitated or fee-for-service) for services provided within the scope of the grantee’s Title
X project.
Total Client Collections/Self-Pay (Row 2)—Report the amount collected directly from clients during the reporting
period for services provided within the scope of the grantee’s Title X project.
Third-Party Payers (Rows 3a–3e)—For each third-party source listed, report the amount received (i.e., reimbursed)
during the reporting period for services provided within the scope of the grantee’s Title X project. Only revenue from
pre-paid (capitated) managed care arrangements (e.g., capitated Medicare, Medicaid, and private managed care
contracts) should be reported as prepaid. Revenues received after the date of service, even under managed care
arrangements, should be reported as not prepaid.
Medicaid (Row 3a)—Report the amount received from Medicaid (federal and state shares) during the reporting
period for services provided within the scope of the grantee’s Title X project, regardless of whether the
reimbursement was paid directly by Medicaid or through a fiscal intermediary or a health maintenance organization
(HMO). For example, in states with a capitated Medicaid program (i.e., the grantee has a contract with a private
plan like Blue Cross), the payer is Medicaid, even though the actual payment may come from Blue Cross. Include
revenue from family planning waivers (both federal and state shares) in Row 3a, Column B. If the amount reported
in Row 3a, Column B includes family planning waiver revenue, indicate this in the Table 14 “Notes” field.
Medicare (Row 3b)—Report the amount received from Medicare during the reporting period for services provided
within the scope of the grantee’s Title X project, 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.
State Children’s Health Insurance Program (CHIP) (Row 3c)—Report the amount of funds received during the
reporting period from CHIP for services provided within the scope of the grantee’s Title X project. If the grantee is
unable to report CHIP revenue separately from Medicaid (Row 3a), indicate this in the Table 14 “Notes” field.
Other Public Health Insurance (Row 3d)—Report the amount reimbursed by other federal, state, or local
government health insurance programs during the reporting period for services provided within the scope of the
grantee’s Title X project. Examples of other sources of public third-party insurance programs include health
insurance plans for military personnel and their dependents (e.g., TRICARE, CHAMPVA) and state health
insurance plans.
Private Health Insurance (Row 3e)—Report the amount of funds received from private third-party health
insurance plans during the reporting period for services provided within the scope of the grantee’s Title X project.
Other Revenue (Rows 6–17)—Refers to revenue received from other sources during the reporting period that
supported services provided within the scope of the grantee’s Title X project. Other revenue sources include block
grants, TANF, state and local governments (e.g., contracts, state and local indigent care programs), the Bureau of
Primary Health Care, private and client donations, or other public or private revenues.
Title V (Maternal and Child Health [MCH] Block Grant) (Row 6)—Report the amount of Title V funds received
during the reporting period that supported services provided within the scope of the grantee’s Title X project.
Title XX (Social Services Block Grant) (Row 7)—Report the amount of Title XX funds received in the reporting
period that supported services provided within the scope of the grantee’s Title X project.
(continued)

Attachment F - 63

Guidance for Reporting Project Revenue in FPAR Table 14 (continued)
Temporary Assistance for Needy Families (TANF) (Row 8)—Report the amount of TANF funds received in the
reporting period that supported services provided within the scope of the grantee’s Title X project.
Local Government Revenue (Row 9)—Report the amount of funds from local government sources (including
county and city grants or contracts) that were received during the reporting period and that supported services
provided within the scope of the grantee’s Title X project.
State Government Revenue (Row 10)—Report the amount of funds from state government sources (including
grants or contracts) that were received during the reporting period and that supported services provided within the
scope of the grantee’s Title X project. Do not report as “state government revenue” funding from sources like the
Centers for Disease Control and Prevention (CDC) (e.g., Infertility Prevention Project) or block grant funds that are
awarded to and distributed by the state. Report these revenues as “Other revenue” and specify their source(s).
Bureau of Primary Health Care (BPHC) (Row 11)—Report the amount of revenue received from BPHC grants
(e.g., Section 330) during the reporting period that supported services provided within the scope of the grantee’s
Title X project.
Other Revenue (Row 12–16)—Report the amount and specify the source of funds received during the reporting
period from other sources that supported services provided within the scope of the grantee’s Title X project. This
may include revenue from such sources as the CDC (infertility, STD, or HIV prevention; breast and cervical cancer
detection), private grants and donations, fundraising, interest income, or other sources.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued January 2011), pp. 45–47.

Trends

Between 1999 and 2011, there were notable changes in the growth and composition of total
revenue. During this period, inflation-adjusted (constant 1999 dollars)32 Title X revenue
decreased 6% (from $183.2 million in 1999 to $172.8 million in 2011), while inflationadjusted revenue from Medicaid increased 216%, (from $100.4 million in 1999 to
$317.2 million in 2011). In addition, inflation-adjusted revenue from all other sources (not
shown) decreased 31% (from $454.5 million in 1999 to $315.5 million in 2011) during this
period, with the largest declines in state government revenue ($91.2 million), client
collections ($52.2 million), and block grants ($35.3 million). The decrease in Title X and
other revenue sources was offset by the large increase in revenue from Medicaid, resulting in
a net increase of 9% in inflation-adjusted total program revenue between 1999
($738.0 million) and 2011 ($805.5 million) (Exhibits A–11a, A–11b, A–11c, A–11d, and
A-11e). Between 2010 and 2011, there was a decrease of 3% in inflation-adjusted total
revenue, with a 4% decrease in Title X revenue and a 2% increase in Medicaid revenue (not
shown).
Between 1999 and 2011, the share of total revenue from Medicaid grew from 14% in 1999 to
39% in 2011, while the share from Title X decreased from 25% to 21%. Between 2003 and
2004, there were large percentage-point changes in the shares of total revenue from Medicaid
and state governments. In 2004, revenue from California’s Medicaid family planning waiver
(Family Planning, Access, Care, and Treatment Program) was recategorized as Medicaid
rather than state government revenue, thereby increasing the Medicaid share of total revenue
from 17% in 2003 to 28% in 2004 and decreasing the state government share from 23% in
2003 to 13% in 2004. Since 2004, revenue from Medicaid family planning waivers has been
included in the total Medicaid figure, as have both the federal and state shares of Medicaid
(Exhibits A–12a, A–12b, and A–12c). (See Table 14 notes in Appendix C: Field and
Methodological Notes.)

Attachment F - 64

Exhibit 31. Amount and distribution of Title X project revenues, by revenue source: 2011
(Source: FPAR Table 14)
Revenue Source
Title X
Payment for Services
Client collections
Third-party payers a
Medicaid b
Medicare
Children’s Health Insurance Program
Other public

Amount

Distribution

$276,002,719

21%

$72,156,363

6%

$506,608,330

39%

$2,002,181

0%†

$279,244

0%†

$4,088,072

0%†

Private

$51,655,083

4%

Subtotal

$636,789,273

49%

Other Revenue
Maternal and Child Health Block Grant

$25,512,030

2%

Social Services Block Grant

$23,736,983

2%

Temporary Assistance for Needy Families

$14,517,155

1%

State government

$125,392,165

10%

Local government

$84,214,372

7%

$5,289,075

0%†

$95,120,838

7%

$373,782,618

29%

$1,286,574,610

100%

Bureau of Primary Health Care
Other

c

Subtotal
Total Revenue
Total Revenue 1999$

d

$805,519,433

Total Revenue 1981$

d

$266,470,714

Total Revenue per User

$256

NA = Not applicable.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
Prepaid and not prepaid.
b
Includes revenue from Medicaid family planning eligibility expansions in 27 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.”
d
Revenue is shown in constant 1999 dollars (1999$) or 1981 dollars (1981$), 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, Series ID. CUUR0000SAM, http://data.bls.gov/cgi-bin/srgate).
† Percentage is less than 0.5%.

Attachment F - 65

Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2011 (Source: FPAR Table 14)
Revenue Source

All Regions
(in $)

Title X

Region II
(in $)

Region III
(in $)

Region IV
(in $)

Region V
(in $)

Region VI
(in $)

Region VII
(in $)

Region VIII
(in $)

Region IX
(in $)

Region X
(in $)

$276,002,719

$14,907,648

$29,960,888

$28,515,360

$59,413,468

$36,821,397

$32,958,945

$13,948,545

$11,157,915

$36,888,781

$11,429,772

$72,156,363

$5,937,108

$15,767,628

$4,740,186

$8,928,791

$7,842,682

$4,829,489

$5,776,768

$5,884,196

$8,300,649

$4,148,866

$506,608,330

$8,685,549

$40,417,037

$33,883,412

$71,498,473

$42,171,869

$49,039,131

$9,696,375

$1,018,385 $225,814,488

$24,383,611

$2,002,181

$169,332

$177,681

$1,134,094

$227,960

$25,392

$18,444

$52,588

$2,624

$187,797

$279,244

$3,915

$4,748

$79,988

$0

$113,275

$6,337

$58,712

$12,269

$0

$0

$4,088,072

$981,679

$244,965

$2,291,260

$0

$300,555

$129,174

$98,776

$23,333

$2,175

$16,155

Private

$51,655,083

$5,936,920

$12,576,376

$7,374,174

$2,403,524

$5,491,654

$699,714

$5,028,274

$2,193,869

$5,769,912

$4,180,666

Subtotal

$636,789,273

$21,714,503

$69,188,435

$49,503,114

$83,058,748

$55,945,427

$54,722,289

$20,711,493

$9,134,676 $240,075,021

$32,735,567

Payment for Services
Client collections
Third-party payers
b
Medicaid

Region I
(in $)

a

Medicare
CHIP
Other public

$6,269

Other Revenue
MCH Block Grant

$25,512,030

$64,200

$4,932,119

$3,053,587

$9,488,942

$2,744,818

$1,666,100

$433,925

$512,911

$1,182,415

$1,433,013

SS Block Grant

$23,736,983

$1,008,219

$1,646,701

$2,142,792

$1,360,616

$2,481,653

$14,937,682

$0

$28,069

$0

$131,251

TANF

$14,517,155

$193,873

$0

$1,049,952

$10,924,483

$2,036,154

$0

$0

$95,317

$217,376

$0

State government

$125,392,165

$7,224,136

$35,185,766

$19,412,843

$35,174,359

$3,129,915

$8,811,970

$322,497

$2,775,527

$2,194,152

$11,161,000

Local government

$84,214,372

$94,247

$4,976,970

$6,500,074

$33,066,789

$9,157,803

$9,112,217

$547,510

$8,220,734

$2,255,077

$10,282,951

$5,289,075

$180,000

$1,200,644

$0

$3,028

$181,162

$0

$873,572

$0

$2,850,669

$0

$95,120,838

$1,372,874

$10,544,090

$2,992,239

$1,674,619

$5,154,672

$4,315,014

$4,276,332

$13,642,004

$49,896,430

$1,252,564

$373,782,618

$10,137,549

$58,486,290

$35,151,487

$91,692,836

$24,886,177

$38,842,983

$6,453,836

$25,274,562

$58,596,119

$24,260,779

BPHC
Other

c

Subtotal
Total Revenue

$46,759,700 $157,635,613 $113,169,961 $234,165,052 $117,653,001 $126,524,217

$41,113,874

$45,567,153 $335,559,921

$68,426,118

Total Revenue 1999$

d

$1,286,574,610
$805,519,433

$29,276,069

$98,695,053

$70,855,279 $146,609,842

$73,662,093

$79,216,327

$25,741,239

$28,529,420 $210,092,781

$42,841,330

Total Revenue 1981$

d

$266,470,714

$9,684,701

$32,648,922

$23,439,356

$48,499,425

$24,367,867

$26,205,242

$8,515,358

$9,437,705

$69,499,966

$14,172,172

$256

$243

$320

$201

$249

$249

$266

$200

$269

$255

$352

Total Revenue per User

BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Service. TANF=Temporary Assistance for Needy Families.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
b

c
d

Prepaid and not prepaid.
Includes revenue from Medicaid family planning eligibility expansions in 27 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.
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as “other.”
Revenue is shown in constant 1999 dollars (1999$) or 1981 dollars (1981$), 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, Series ID. CUUR0000SAM, http://data.bls.gov/cgi-bin/srgate).

Attachment F - 66

Exhibit 33. Distribution of Title X project revenues, by revenue source and region: 2011 (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

21%

32%

19%

25%

25%

31%

26%

34%

24%

11%

17%

Payment for Services
Client collections

6%

13%

10%

4%

4%

7%

4%

14%

13%

2%

6%

Third-party payers a
Medicaid b

39%

19%

26%

30%

31%

36%

39%

24%

2%

67%

36%

Title X

Medicare

0%†

0%†

0%†

1%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

CHIP

0%†

0%†

0%†

0%†

0%

0%†

0%†

0%†

0%†

0%

0%

Other public

0%†

2%

0%†

2%

0%

0%†

0%†

0%†

0%†

0%†

Private

4%

13%

8%

7%

1%

5%

1%

12%

5%

2%

6%

Subtotal

49%

46%

44%

44%

35%

48%

43%

50%

20%

72%

48%

0%†

Other Revenue
MCH Block Grant

2%

0%†

3%

3%

4%

2%

1%

1%

1%

0%†

2%

SS Block Grant

2%

2%

1%

2%

1%

2%

12%

0%

0%†

0%

0%†

TANF

1%

0%†

0%

1%

5%

2%

0%

0%

0%†

0%†

0%

22%

17%

15%

3%

7%

1%

6%

1%

16%

14%

8%

7%

1%

18%

1%

15%
0%

State government

10%

15%

Local government

7%

0%†

3%

6%

BPHC

0%†

0%†

1%

0%

0%†

0%†

0%

2%

0%

1%

Other c

7%

3%

7%

3%

1%

4%

3%

10%

30%

15%

2%

Subtotal

29%

22%

37%

31%

39%

21%

31%

16%

55%

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 Service. TANF=Temporary Assistance for Needy
Families.
a
Prepaid and not prepaid.
b
Includes revenue from Medicaid family planning eligibility expansions in 27 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%.

Attachment F - 67

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Attachment F - 68

4

References
1. Office of Population Affairs (OPA) Website. Title X Statute and Regulations.
Retrieved October 15, 2012, from http://www.hhs.gov/opa/title-x-familyplanning/title-x-policies/statutes-and-regulations/.
2. OPA Website. Title X Family Planning. Retrieved October 15, 2012, from
http://www.hhs.gov/opa/title-x-family-planning/.
3. OPA Website. Title X Funding History. Retrieved October 15, 2012, from
http://www.hhs.gov/opa/about-opa-and-initiatives/funding-history/.
4. 45 Code of Federal Regulations (CFR) Part 74. Uniform Administrative
Requirements for Awards and Subawards to Institutions of Higher Education,
Hospitals, Other Nonprofit Organizations, and Commercial Organizations; and
Certain Grants and Agreements with States, Local Governments, and Indian Tribal
Governments. Retrieved October 15, 2012, from http://www.hhs.gov/opa/grants-andfunding/grant-forms-and-references/45-cfr-74.html.
5. 45 CFR Part 92. Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments. Retrieved October 15, 2012, from
http://www.hhs.gov/opa/grants-and-funding/grant-forms-and-references/45-cfr92.html.
6. 42 CFR Part 59. Grants for Family Planning Services. Retrieved October 15, 2012,
from http://www.hhs.gov/opa/title-x-family-planning/title-x-policies/programguidelines/final-rules-42-cfr-59.html.
7. OPA/Office of Family Planning (OFP). (2001). Program Guidelines for Project
Grants for Family Planning Services. Bethesda, MD: U.S. Department of Health and
Human Services, Office of Public Health and Science/Office of Population
Affairs/Office of Family Planning, 30 pages. Retrieved October 15, 2012, from
http://www.hhs.gov/opa/pdfs/2001-ofp-guidelines-complete.pdf.
8. OPA/OFP. (2011). Family Planning Annual Report: Forms and Instructions
(Reissued January 2011). Rockville, MD: U.S. Department of Health and Human
Services, Office of Public Health and Science/Office of Population Affairs/Office of
Family Planning. Retrieved October 15, 2012, from http://www.hhs.gov/opa/pdfs/
fpar-forms-and-instructions-2011.pdf.
9. Office of Management and Budget (OMB). (1997). Revisions to the Standards for
the Classification of Federal Data on Race and Ethnicity, October 30, 1997. Federal
Register Notice. Retrieved October 15, 2012, from http://www.whitehouse.gov/omb/
fedreg_1997standards/.

Attachment F - 69

10. OPA. (2008). Verification of Income for Title X Clients. OPA Program Instruction
Series, OPA 08-1. Retrieved October 23, 2012 from http://www.hhs.gov/opa/pdfs/
opa-08-01.pdf.
11. OPA. (1997). Fees and Charges to Low-Income Clients and Teenagers (Revised).
OPA Program Instruction Series, OPA 97–1. Retrieved October 15, 2012, from
http://www.hhs.gov/opa/pdfs/opa-97-01.pdf.
12. U.S. Department of Health and Human Services (HHS). (2003). Guidance to Federal
Financial Assistance Recipients Regarding Title VI Prohibition Against National
Origin Discrimination Affecting Limited English Proficient Persons ("Revised HHS
LEP Guidance"), August 4, 2003. Retrieved October 15, 2012, from
http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html.
13. HHS. (2011). The 2011 HHS Poverty Guideline. Retrieved October 15, 2012, from
http://aspe.hhs.gov/poverty/11poverty.shtml.
14. Using method effectiveness (typical use) data from Trussell (2011), we classified
contraceptive methods into three tiers: high, moderate, and less effective.
Highly effective contraceptives 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 (Implanon), 0.05%
— Intrauterine device (Mirena), 0.2%
— Intrauterine device (ParaGard), 0.8%
Moderately effective contraceptives 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%
— Contraceptive patch (Evra), 9%
— Combined and progestin-only pills, 9%
— Diaphragm (with spermicidal cream/jelly), 12%
Less-effective contraceptives 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:
— Male condom, 18%
— Female condom, 21%
— Sponge, Nulliparous women, 12%
— Sponge, Parous women, 24%
— Withdrawal, 22%
— Fertility-based awareness method, 24%
— Spermicides, 28%

Attachment F - 70

Because of combined FPAR reporting categories (e.g., FAM and LAM, diaphragm
and cervical cap, or withdrawal and other), the methods included in the three
effectiveness categories may vary slightly from the categories described above. We
do not expect these discrepancies to have an impact on the findings because there are
so few users relying on the methods in the combined reporting categories, including
such methods as LAM, cervical cap, or other methods not listed in FPAR Table 7.
(Source: Trussell, J. [2011]. Chapter 26: Contraceptive: Efficacy. In RA Hatcher, J
Trussell, AL Nelson, W Cates, D Kowal, MS Policar (Eds.), Contraceptive
Technology: Twentieth Edition. New York, NY: Ardent Media, Inc.)
15. Solomon, D, Davey, D, Kurman, R, Moriarty, A, O’Connor, D, Prey, M, Raab, S,
Sherman, M, Wilbur, D, Wright, Jr., T, and Young, N. (2002) The 2001 Bethesda
System: Terminology for Reporting Results of Cervical Cytology. Journal of the
American Medical Association, 287(16): 2114–2119. Retrieved October 15, 2012,
from http://jama.jamanetwork.com/article.aspx?volume=287&page=2114.
16. Apgar, BS, Zoschnick, L, and Wright, TC. (2003). The 2001 Bethesda System
terminology. American Academy of Family Physicians, 2003(68): 1992–1998.
Retrieved October 15, 2012, from http://www.aafp.org/afp/2003/1115/p1992.pdf.
17. Wright, TC, Cox, JT, Massad, LS, Twiggs, LB, and Wilkinson, EJ. (2002). 2001
consensus guidelines for the management of women with cervical cytological
abnormalities. Journal of the American Medical Association, 287(16): 2120–2129.
Retrieved October 15, 2012, from http://jama.jamanetwork.com/article.aspx?
articleid=194862. For updated consensus guidelines for managing women with
abnormal tests, see Wright, T. C., Massad, L. S., Dunton, C. J., Spitzer, M.,
Wilkinson, E. J., & Solomon, D. (2007, October). 2006 consensus guidelines for the
management of women with abnormal cervical cancer screening tests. American
Journal of Obstetrics & Gynecology, 197(4): 337–339. Retrieved October 15, 2012,
from http://www.sciencedirect.com/science/article/pii/S0002937807009301.
18. OPA. (2009). Clinical Services in Title X Family Planning Clinics–Consistency with
Current Practice Recommendations. OPA Program Instruction Series, OPA 09-01.
Retrieved October 15, 2012, from http://www.hhs.gov/opa/pdfs/opa-09-01.pdf.
19. OPA. (2003). Screening for Cervical and Colorectal Cancer and Sexually
Transmitted Diseases (STD). OPA Program Instruction Series, OPA 03-01, 2 pages.
Retrieved October 15, 2012, from http://www.hhs.gov/opa/pdfs/opa-03-01.pdf.
20. Agency for Healthcare Research and Quality (AHRQ). (2010). The Guide to Clinical
Preventive Services, 2010–2011, Recommendations of the U.S. Preventive Services
Task Force. Rockville, MD: AHRQ, 292 pages. Retrieved October 15, 2012, from
http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdf.
21. U.S. Preventive Services Task Force (USPSTF). (March 2012) Screening for
Cervical Cancer. Accessed on October 15, 2012, from http://www.uspreventive
servicestaskforce.org/uspstf/uspscerv.htm.

Attachment F - 71

22. The American College of Obstetricians and Gynecologists. (March 2012). New
Cervical Cancer Screening Recommendations from the U.S. Preventive Services
Task Force and the American Cancer Society/American Society for Colposcopy and
Cervical Pathology/American Society for Clinical Pathology. Accessed on October
15, 2012, from http://www.acog.org/About_ACOG/Announcements/New_Cervical_
Cancer_Screening_Recommendations.
23. American Cancer Society. (2012). American Cancer Society Guidelines for the Early
Detection of Cancer. Accessed on October 15, 2012, from http://www.cancer.org/
Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-societyguidelines-for-the-early-detection-of-cancer.
24. USPSTF. (December 2009). Screening for Breast Cancer. Accessed on October 15,
2012, from http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.
25. The American College of Obstetricians and Gynecologists. (July 2011). Annual
Mammograms Now Recommended for Women Beginning at Age 40. Accessed on
October 15, 2012, from http://www.acog.org/About_ACOG/News_Room/News_
Releases/2011/Annual_Mammograms_Now_Recommended_for_Women_Beginning
_at_Age_40.
26. Centers for Disease Control and Prevention (CDC). (November 2011). Sexually
Transmitted Disease Surveillance, 2010. Atlanta, GA: U.S. Department of Health
and Human Services. Retrieved October 15, 2012, from http://www.cdc.gov/std/
stats10/surv2010.pdf.
27. CDC. (2010). Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR,
59(RR-12): 1–114. Retrieved October 15, 2012, from http://www.cdc.gov/std/
treatment/2010/STD-Treatment-2010-RR5912.pdf.
28. The U.S. Preventive Services Task Force (USPSTF) recommends screening for
chlamydial infection for all sexually active, nonpregnant young women 24 or under
and for older, nonpregnant women who are at increased risk. Source: USPSTF.
(2007). Screening for Chlamydial Infection: U.S. Preventive Services Task Force
Recommendation Statement. Annals of Internal Medicine, 147(2): 128–134.
Retrieved October 15, 2012, from http://www.annals.org/content/147/2/
128.full.pdf+html.
29. CDC. (2006). Revised Recommendations for HIV Testing of Adults, Adolescents,
and Pregnant Women in Health-Care Settings. MMWR, 55(No. RR-14): 1–17.
Retrieved October 15, 2012, from http://www.cdc.gov/mmwr/preview/mmwrhtml/
rr5514a1.htm.
30. CDC (2006) (see footnote 29) defines diagnostic HIV testing as “Performing an HIV
test for persons with clinical signs or symptoms consistent with HIV infection.”
31. CDC (2006) (see footnote 29) defines opt-out HIV screening as “Performing HIV
screening after notifying the patient that (1) the test will be performed and (2) the
patient may elect to decline or defer testing. Assent is inferred unless the patient
declines testing.”

Attachment F - 72

32. U.S. Department of Labor, Bureau of Labor Statistics (BLS). Consumer Price Index:
Series ID. CUUR0000SAM. Retrieved October 15, 2012, from http://data.bls.gov/cgibin/srgate.

Attachment F - 73

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62

Family Planning Annual Report: 2011 National Summary

Attachment F - 74

Appendix A
National and Regional Trend Exhibits

Attachment F - 75

Exhibit A–1a.

Number and distribution of all family planning users, by region and year: 1999–2011

Region

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

I

187,589

216,098

220,094

212,422

207,450

211,693

212,169

199,010

197,165

199,779

198,962

192,252

II

415,848

428,169

449,854

460,798

468,635

468,237

470,148

479,572

483,928

497,614

499,231

493,369

III

499,163

533,956

551,759

562,182

571,883

562,173

567,583

557,031

564,138

592,475

584,167

564,163

IV

1,025,865

1,043,788

1,077,707

1,065,310

1,052,584

1,051,887

1,051,330

1,018,656

1,019,264

1,010,012

989,770

940,931

V

532,036

595,982

617,372

607,756

610,058

600,145

582,313

531,679

507,431

492,741

492,359

472,062

VI

488,372

529,997

532,268

539,704

547,802

513,130

483,632

486,378

491,406

512,019

512,868

475,863

VII

247,863

254,278

260,651

260,034

257,833

243,299

245,133

234,592

210,012

209,350

214,032

205,167

VIII

138,469

148,353

143,595

147,730

154,924

157,150

156,482

149,395

151,261

160,919

176,892

169,311

IX

709,360

844,781

870,070

878,088

920,543

931,827

973,524

1,102,718

1,209,114

1,294,974

1,352,569

1,314,270

X

197,573

262,315

251,504

278,024

276,073

263,420

251,964

228,207

217,786

216,384

204,012

194,323

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,315,040

4,658,472

4,772,254

4,784,889

4,823,404

4,740,168

4,721,869

4,691,857

4,723,662

4,811,691

4,822,570

4,635,195

127,098

199,245

202,620

227,159

244,381

262,793

272,409

295,381

327,843

374,576

402,292

386,516

I

4%

4%

4%

4%

4%

4%

4%

4%

4%

4%

4%

4%

II

9%

9%

9%

9%

9%

9%

9%

10%

10%

10%

10%

10%

III

11%

11%

11%

11%

11%

11%

11%

11%

11%

11%

11%

11%

IV

23%

21%

22%

21%

21%

21%

21%

20%

20%

19%

19%

19%

V

12%

12%

12%

12%

12%

12%

12%

11%

10%

10%

9%

9%

VI

11%

11%

11%

11%

11%

10%

10%

10%

10%

10%

10%

9%

VII

6%

5%

5%

5%

5%

5%

5%

5%

4%

4%

4%

4%

Total
Female
Male

VIII

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

IX

16%

17%

17%

18%

18%

19%

19%

22%

24%

25%

26%

26%

X

4%

5%

5%

6%

5%

5%

5%

5%

4%

4%

4%

4%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

97%

96%

96%

95%

95%

95%

95%

94%

94%

93%

92%

92%

3%

4%

4%

5%

5%

5%

5%

6%

6%

7%

8%

8%

Total
Female
Male

Attachment F - 76

Exhibit A–1b.

Distribution of all family planning users, by region and year: 1999–2011

2011

4%

10%

11%

19%

9%

9%

4% 3%

26%

4%

5,021,711

2010

4%

10%

11%

19%

9%

10%

4% 3%

26%

4%

5,224,862

2009

4%

10%

11%

19%

25%

4%

5,186,267

2008

4%

10%

11%

20%

24%

4%

5,051,505

2007

4%

10%

11%

20%

5%

4,987,238

2006

4%

9%

11%

21%

12%

10%

19%

5%

4,994,278

2005

4%

9%

11%

21%

12%

10%

5% 3%

19%

5%

5,002,961

2004

4%

9%

11%

21%

12%

11%

5% 3%

18%

5%

5,067,785

2003

4%

9%

11%

21%

12%

18%

6%

5,012,048

2002

4%

9%

11%

22%

12%

2001

4%

9%

11%

21%

1999

4%

9%

11%

0%

20%

10%

10%

10%

10%

11%

12%

23%

4% 3%

10%

5% 3%

11%

22%

5% 3%

5% 3%

11%

5% 3%

17%

5%

4,974,874

11%

5% 3%

17%

5%

4,857,717

4%

4,442,138

12%

40%

4% 3%

11%

60%

6% 3%

80%

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

16%

100%

Attachment F - 77

Exhibit A–2a.

Number and distribution of all family planning users, by age and year: 1999–2011

Age Group
(Years)

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Under 15

—

—

—

—

—

70,840

67,627

68,918

71,738

74,287

73,383

59,351

Under 18

627,496

690,718

693,416

674,639

667,734

––

––

––

––

––

––

––

15 to 17

—

—

—

—

—

549,079

549,844

534,054

521,202

502,226

466,284

423,702

18 to 19

648,224

720,939

728,049

711,364

716,399

681,690

672,027

651,784

652,059

647,432

616,709

560,848

20 to 24

1,312,102

1,493,687

1,550,715

1,590,344

1,608,278

1,589,794

1,582,688

1,556,670

1,553,469

1,577,051

1,600,833

1,508,215

25 to 29

812,323

835,897

851,926

870,394

898,231

921,425

943,009

967,409

996,754

1,037,776

1,071,999

1,058,256

30 to 44

937,691

995,231

1,016,055

1,021,266

1,028,661

––

––

––

––

––

––

––

30 to 34

—

—

—

—

—

519,448

512,173

522,673

539,998

578,031

607,257

621,119

35 to 39

—

—

—

—

—

317,900

314,488

323,885

332,854

353,712

359,749

358,400

40 to 44

—

—

—

—

—

193,490

188,507

191,503

195,582

209,292

215,914

222,429

Over 44

104,302

121,245

134,713

144,041

148,482

159,295

163,915

170,342

187,849

206,460

212,734

209,391

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

Under 15

—

—

—

—

—

1%

1%

1%

1%

1%

1%

1%

Under 18

Total

14%

14%

14%

13%

13%

––

––

––

––

––

––

––

15 to 17

—

—

—

—

—

11%

11%

11%

10%

10%

9%

8%

18 to 19

15%

15%

15%

14%

14%

14%

13%

13%

13%

12%

12%

11%

20 to 24

30%

31%

31%

32%

32%

32%

32%

31%

31%

30%

31%

30%

25 to 29

18%

17%

17%

17%

18%

18%

19%

19%

20%

20%

21%

21%

30 to 44

21%

20%

20%

20%

20%

––

––

––

––

––

––

––

30 to 34

—

—

—

—

—

10%

10%

10%

11%

11%

12%

12%

35 to 39

—

—

—

—

—

6%

6%

6%

7%

7%

7%

7%

40 to 44

—

—

—

—

—

4%

4%

4%

4%

4%

4%

4%

Over 44

2%

2%

3%

3%

3%

3%

3%

3%

4%

4%

4%

4%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Total

— Data are not available.
– – Disaggregated data are presented in the table.

Attachment F - 78

Exhibit A–2b.

Distribution of all family planning users, by age and year: 1999–2011

2011

< 18, 10% 18–19, 11%

2010

< 18, 10%

2009

< 18, 11%

2008

< 18, 12%

18–19, 13%

2007

< 18, 12%

18–19, 13%

2006

< 18, 12%

18–19, 13%

20–24, 32%

2005

< 18, 12%

18–19, 14%

20–24, 32%

2004

< 18, 13%

18–19, 14%

20–24, 32%

2003

< 18, 13%

18–19, 14%

20–24, 32%

2002

< 18, 14%

18–19, 15%

2001

< 18, 14%

18–19, 15%

1999

< 18, 14%

18–19, 15%

0%

20–24, 30%

25–29, 21%

20–24, 31%

18–19, 12%
18–19, 12%

< 18

25–29, 21%

20–24, 30%

25–29, 20%

20–24, 31%

25–29, 20%

30–44, 23%

5,224,862

30–44, 22%

5,186,267
5,051,505

30–44, 21%

4,987,238

25–29, 19%

30–44, 20%

4,994,278

25–29, 18%

30–44, 21%

5,002,961

25–29, 18%

30–44, 20%

5,067,785

25–29, 17%

30–44, 20%

5,012,048

20–24, 31%

25–29, 17%

30–44, 20%

4,974,874

20–24, 31%

25–29, 17%

30–44, 20%

4,857,717

30–44, 21%

4,442,138

25–29, 19%

20–24, 30%

40%
18–19

5,021,711

30–44, 21%

20–24, 31%

20%

30–44, 24%

25–29, 18%

60%
20–24

25–29

80%
30–44

100%
> 44

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 the individual percentages
that are included in the aggregated categories.

Attachment F - 79

Exhibit A–3a.

Number and distribution of all family planning users, by race and year: 1999–2011

Race
Am Indian/Alaska Native

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

31,372

34,241

34,811

35,320

36,050

35,665

38,098

38,080

36,974

39,220

44,899

43,204

Asian

115,564

109,007

137,064

117,122

136,813

124,946

129,155

131,735

137,747

150,847

136,958

134,345

Black/African American

986,448

1,049,740

1,041,329

1,028,446

1,027,880

969,301

953,580

958,241

996,093

1,015,013

1,028,991

986,803

—

46,330

51,672

124,055

58,881

58,946

44,708

43,360

45,693

73,559

65,662

70,929

2,896,882

3,079,264

3,137,887

3,100,808

3,225,150

3,183,116

3,239,675

3,125,435

3,007,568

3,054,226

3,015,861

2,864,253

—

—

—

—

—

127,543

122,583

132,911

151,535

169,044

261,397

250,825

411,872

539,135

572,111

606,297

583,011

503,444

466,479

557,476

675,895

684,358

671,094

671,352

Nat Hawaiian/Pac Island
White
More than one race
UK/NR
Total All Users

a

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

Am Indian/Alaska Native

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

Asian

3%

2%

3%

2%

3%

2%

3%

3%

3%

3%

3%

3%

22%

22%

21%

21%

20%

19%

19%

19%

20%

20%

20%

20%

—

1%

1%

2%

1%

1%

1%

1%

1%

1%

1%

1%

65%

63%

63%

62%

64%

64%

65%

63%

60%

59%

58%

57%

—

—

—

—

—

3%

2%

3%

3%

3%

5%

5%

9%

11%

12%

12%

12%

10%

9%

11%

13%

13%

13%

13%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Black/African American
Nat Hawaiian/Pac Island
White
More than one race
UK/NR
Total All Users

a

Am Indian/Alaska Native=American Indian or Alaskan Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander. UK/NR=unknown or not reported.
a
In 1999, data for Pacific Islanders were combined with data for the Asian race category.
— Data are not available.

Attachment F - 80

Exhibit A–3b.

Distribution of all family planning users, by race and year: 1999–2011

2011

White, 57%

2010

White, 58%

2009

White, 59%

2008

White, 60%

2007

Black, 20%
Black, 20%

5,021,711

10%

13%

5,224,862

8%

13%

5,186,267

7%

13%

5,051,505

Black, 20%
Black, 20%

White, 63%

2006

13%

10%

Black, 19%

White, 65%

7%

Black, 19%

7%

2005

White, 64%

Black, 19%

7%

2004

White, 64%

Black, 20%

5%

2003

White, 62%

2002

White, 63%

2001

White, 63%

1999

Black, 21%
Black, 21%
Black, 22%

White, 65%

0%

20%

Black, 22%

40%
White

6%

Black

60%
Other

80%

4%
4%
3%

11%

4,987,238

9%

4,994,278

10%

5,002,961

12%

5,067,785

12%

5,012,048

12%

4,974,874

11%

4,857,717

9%

4,442,138
100%

Unknown

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 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 (2001–2011), and more than one race (2005–2011). For 1999 data, the Native Hawaiian or Other Pacific Islander race category was combined with Asian race into
a single category.

Attachment F - 81

Exhibit A–4a.
Ethnicity

Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 1999–2011
1999

2001

772,129

982,314

1,044,045

1,081,207

1,159,637

1,181,093

1,223,732

1,303,402

1,391,523

1,447,422

1,493,007

1,451,215

3,472,143

3,735,945

3,825,440

3,806,566

3,780,396

3,628,142

3,670,894

3,611,497

3,534,915

3,618,344

3,618,285

3,416,314

197,866

139,458

105,389

124,275

127,752

193,726

99,652

72,339

125,067

120,501

113,570

154,182

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

Hispanic or Latino

17%

20%

21%

22%

23%

24%

25%

26%

28%

28%

29%

29%

Not Hispanic or
Latino

78%

77%

77%

76%

75%

73%

74%

72%

70%

70%

69%

68%

4%

3%

2%

2%

3%

4%

2%

1%

2%

2%

2%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Hispanic or Latino
Not Hispanic or
Latino
UK/NR
Total All Users

UK/NR
Total All Users

UK/NR=unknown or not reported.

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Attachment F - 82

Exhibit A–4b.

Distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 1999–2011

2011

Not Hispanic/Latino, 68%

Hispanic/Latino, 29%

5,021,711

2010

Not Hispanic/Latino, 69%

Hispanic/Latino, 29%

5,224,862

2009

Not Hispanic/Latino, 70%

Hispanic/Latino, 28%

5,186,267

2008

Not Hispanic/Latino, 70%

Hispanic/Latino, 28%

5,051,505

2007

Not Hispanic/Latino, 72%

2006

Not Hispanic/Latino, 74%

2005

Not Hispanic/Latino, 73%

2004

Hispanic/Latino, 26%

4,987,238

Hispanic/Latino, 25%

4,994,278

Hispanic/Latino, 24%

Not Hispanic/Latino, 75%

Hispanic/Latino, 23%

5,002,961
5,067,785

2003

Not Hispanic/Latino, 76%

2002

Not Hispanic/Latino, 77%

Hispanic/Latino, 21%

4,974,874

2001

Not Hispanic/Latino, 77%

Hispanic/Latino, 20%

4,857,717

Hispanic/Latino, 17%

4,442,138

1999

Hispanic/Latino, 22%

Not Hispanic/Latino, 78%

0%

20%

40%
Not Hispanic/Latino

60%
Hispanic/Latino

80%
Unknown

5,012,048

100%

Attachment F - 83

Exhibit A–5a.

Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 1999–2011

Race/Ethnicity Trend
Not Hispanic
All races

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

3,472,143

3,735,945

3,825,440

3,806,566

3,780,396

––

––

––

––

––

––

––

Asian

—

—

—

—

—

118,499

123,192

126,320

127,850

139,831

126,413

121,777

Black or African
American

—

—

—

—

—

929,066

918,983

926,564

956,741

969,690

986,409

939,143

White

—

—

—

—

—

2,366,762

2,400,897

2,324,430

2,232,893

2,227,867

2,214,680

2,060,244

Other/unknown

—

—

—

—

—

213,815

227,822

234,183

217,431

280,956

290,783

295,150

Hispanic or Latino, all
races

772,129

982,314

1,044,045

1,081,207

1,159,637

1,181,093

1,223,732

1,303,402

1,391,523

1,447,422

1,493,007

1,451,215

Ethnicity UK/NR

197,866

139,458

105,389

124,275

127,752

193,726

99,652

72,339

125,067

120,501

113,570

154,182

Total All Users

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

Not Hispanic
All races

78%

77%

77%

76%

75%

––

––

––

––

––

––

––

Asian

—

—

—

—

—

2%

2%

3%

3%

3%

2%

2%

Black or African
American

—

—

—

—

—

19%

18%

19%

19%

19%

19%

19%

White

—

—

—

—

—

47%

48%

47%

44%

43%

42%

41%

Other/unknown

—

—

—

—

—

4%

5%

5%

4%

5%

6%

6%

17%

20%

21%

22%

23%

24%

25%

26%

28%

28%

29%

29%

Ethnicity UK/NR

4%

3%

2%

2%

3%

4%

2%

1%

2%

2%

2%

3%

Total All Users

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Hispanic or Latino, all
races

UK/NR=unknown or not reported.
Note: The “other” race category includes users who self-identified as American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander (2001–2011), and more than
one race (2005–2011). For 1999 data, the Native Hawaiian or Other Pacific Islander race category was combined with Asian race into a single category.
— Data are not available.
– – Disaggregated data are presented in the table.

Attachment F - 84

Exhibit A–5b.

2011

Distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 1999–2011

NH White, 41%

NH other,
8%

NH Black, 19%

2010

NH White, 42%

NH Black, 19%

2009

NH White, 43%

NH Black, 19%

2008

NH White, 44%

2007

NH other,
8%
NH other,
8%

NH Black, 19%

NH White, 47%

NH other,
7%

NH Black, 19%

2006

NH White, 48%

2005

NH White, 47%

NH Black, 18%
NH Black, 19%

NH other,
7%
NH other,
7%
NH other,
7%

Hispanic (all races), 29%

5,021,711

Hispanic (all races), 29%

5,224,862

Hispanic (all races), 28%

5,186,267

Hispanic (all races), 28%

5,051,505

Hispanic (all races), 26%

4,987,238

Hispanic (all races), 25%

4,994,278

Hispanic (all races), 24%

5,002,961

2004

NH (all race), 75%

2003

NH (all races), 76%

2002

NH (all races), 77%

Hispanic (all races), 21%

4,974,874

2001

NH (all races), 77%

Hispanic (all races), 20%

4,857,717

Hispanic (all race), 17%

4,442,138

1999

Hispanic (all races), 23%
Hispanic (all races), 22%

NH (all races), 78%

0%

20%
NH (all races)

40%
NH White

NH Black

60%
NH other

80%
Hispanic (all races)

5,067,785
5,012,048

100%
Unknown

NH=Not Hispanic or Latino.
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 the individual percentages
that are included in the aggregated categories. The “NH other” category (2005–2011) includes users who self-identified as not Hispanic or Latino and for whom either race was
unknown or not reported or race was 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.

Attachment F - 85

Exhibit A–6a.
Income Level a

Number and distribution of all family planning users, by income level and year: 1999–2011
1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2,886,684

3,177,934

3,256,554

3,374,895

3,461,649

3,316,699

3,353,129

3,455,335

3,553,222

3,632,506

3,618,813

3,466,912

101% to 150%

803,360

832,137

872,911

854,878

838,704

879,666

846,873

820,870

781,113

785,090

795,065

731,410

151% to 200%

328,084

328,019

335,792

318,001

312,393

324,358

311,958

303,992

278,881

277,103

281,294

269,478

Over 200%

Under 101%

346,735

422,460

408,346

370,790

355,025

––

––

––

––

––

––

––

201% to 250%

—

—

—

—

—

129,097

127,902

121,473

119,181

119,768

125,298

116,188

Over 250%

—

—

—

—

—

242,241

262,501

212,849

224,603

207,484

250,440

250,829

77,275

97,167

101,271

93,484

100,014

110,900

91,915

72,719

94,505

164,316

153,952

186,894

UK/NR

4,442,138

4,857,717

4,974,874

5,012,048

5,067,785

5,002,961

4,994,278

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

Under 101%

65%

65%

65%

67%

68%

66%

67%

69%

70%

70%

69%

69%

101% to 150%

18%

17%

18%

17%

17%

18%

17%

16%

15%

15%

15%

15%

151% to 200%

7%

7%

7%

6%

6%

6%

6%

6%

6%

5%

5%

5%

Over 200%

Total All Users

8%

9%

8%

7%

7%

––

––

––

––

––

––

––

201% to 250%

—

—

—

—

—

3%

3%

2%

2%

2%

2%

2%

Over 250%

—

—

—

—

—

5%

5%

4%

4%

4%

5%

5%

2%

2%

2%

2%

2%

2%

2%

1%

2%

3%

3%

4%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

UK/NR
Total All Users

UK/NR=unknown or not reported.
a
Title X-funded agencies calculate and 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/.
— Data are not available.
– – Disaggregated data are presented in the table.

Attachment F - 86

Exhibit A–6b.

Distribution of all family planning users, by income level and year: 1999–2011

2011

≤ 100%, 69%

2010

≤ 100%, 69%

2009

≤ 100%, 70%

2008

≤ 100%, 70%

101%–200%, 21%

2007

≤ 100%, 69%

101%–200%, 23%

101%–200%, 20%
101%–200%, 21%
101%–200%, 20%

2006

≤ 100%, 67%

101%–200%, 23%

2005

≤ 100%, 66%

101%–200%, 24%

2004

≤ 100%, 68%

2003

≤ 100%, 67%

101%–200%, 23%
101%–200%, 23%

5,021,711

>200%, 7%
>200%, 7%

5,224,862

>200%, 6%

5,186,267

>200%, 7%
>200%, 7%

5,051,505
4,987,238

>200%, 8%

4,994,278

>200%, 7%

5,002,961

>200%, 7%

5,067,785

>200%, 7%

5,012,048

2002

≤ 100%, 65%

101%–200%, 24%

>200%, 8%

4,974,874

2001

≤ 100%, 65%

101%–200%, 24%

>200%, 9%

4,857,717

1999

≤ 100%, 65%

101%–200%, 25%

0%

20%
≤ 100%

40%
101%–200%

60%
>200%

80%

>200%, 8%

4,442,138

100%

Unknown

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 the individual percentages
that are included in the aggregated categories.

Attachment F - 87

Exhibit A–7a.

Number of female family planning users, by primary contraceptive method and year: 1999–2011

Primary Method
1999
Highly Effective a
—
Vasectomy b
Sterilization b
111,609
Hormonal implant
22,881
Intrauterine device
48,015
Moderately Effective a
699,932
Hormonal injection c
Vaginal ring d
—
Contraceptive patch d
—
Oral contraceptive
1,981,664
Cervical cap/diaphragm
14,816
Less Effective a
527,248
Male condom
Female condom d
—
Contraceptive sponge d
—
Withdrawal/Other f
89,199
FAM e or LAM
9,931
Spermicide
78,762
Other
Abstinence d
—
No Method
Pregnant or seeking
261,399
pregnancy
Other reason
307,528
Method Unknown g
162,056
Total Female Users
4,315,040
Using a Method
3,584,057
Not Using a Method
568,927
Method Unknown g
162,056
Using a Method
83%
Not Using a Method
13%
Method Unknown g
4%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

—
117,787
12,390
63,045

—
115,742
12,791
68,802

—
110,513
13,180
72,378

—
105,103
5,602
77,773

7,060
95,264
3,395
88,342

6,605
89,428
2,506
110,338

6,546
89,447
7,300
138,714

6,312
87,167
18,738
179,876

6,905
92,616
30,135
216,390

8,683
92,652
48,015
252,121

8,632
90,438
65,673
272,683

799,521
—
—
2,111,124
10,442

809,170
—
—
2,111,088
9,021

765,266
—
—
1,994,310
7,863

740,028
—
—
1,974,050
11,717

602,721
65,320
286,214
1,852,654
5,477

571,588
98,689
170,815
1,859,542
4,753

591,861
139,656
128,324
1,826,518
4,087

597,572
149,627
101,763
1,734,786
3,612

615,188
165,121
106,266
1,696,319
12,278

643,682
186,238
93,499
1,684,201
4,402

645,351
183,182
89,795
1,534,684
3,390

616,696
—
—
88,579
17,573
65,309

679,656
—
—
133,529
18,265
45,977

698,248
—
—
293,383
22,972
33,483

737,169
—
—
313,688
25,906
19,861

686,992
8,862
2,826
104,779
9,702
23,226

747,323
6,031
1,076
133,099
9,446
22,075

716,646
3,925
1,827
123,844
8,784
16,882

727,440
4,753
1,337
111,160
10,409
13,627

737,991
4,635
991
105,705
12,633
15,598

787,329
5,944
1,581
116,635
14,379
8,346

838,131
5,939
921
115,002
17,105
7,061

—

—

—

—

44,939

49,022

53,987

61,329

62,380

75,534

69,924

244,706
335,520
175,780
4,658,472
3,902,466
580,226
175,780
84%
12%
4%

273,051
388,377
106,785
4,772,254
4,004,041
661,428
106,785
84%
14%
2%

265,190
379,671
128,432
4,784,889
4,011,596
644,861
128,432
84%
13%
3%

287,485
378,605
146,417
4,823,404
4,010,897
666,090
146,417
83%
14%
3%

358,492
298,658
195,245
4,740,168
3,887,773
657,150
195,245
82%
14%
4%

373,111
326,885
139,537
4,721,869
3,882,336
699,996
139,537
82%
15%
3%

383,303
308,061
142,145
4,691,857
3,858,348
691,364
142,145
82%
15%
3%

381,848
283,848
248,458
4,723,662
3,809,508
665,696
248,458
81%
14%
5%

395,633
260,946
273,961
4,811,691
3,881,151
656,579
273,961
81%
14%
6%

400,194
238,347
160,788
4,822,570
4,023,241
638,541
160,788
83%
13%
3%

361,056
229,541
96,687
4,635,195
3,947,911
590,597
96,687
85%
13%
2%

FAM=fertility awareness method. LAM=lactational amenorrhea method. Note: Due to rounding, percentages may not sum to 100%.
a
See reference note 14.
b
Sterilization figures for 1999–2004 include both female and male (vasectomy) sterilization users. Beginning in 2005, female and male sterilization figures are reported separately.
d
For 2005–2011, includes both 1- and 3-month hormonal injection users.
d
Prior to 2005, grantees reported these methods under the “other” method category.
e
For 1999–2004, the natural method category includes only safe period by temperature or cervical mucus test. In 2005, the natural method category was renamed fertility awareness method
(FAM) and from 2005 to 2010 FAMs included Calendar Rhythm, Standard Days™, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. In 2011, FAMs included Calendar
Rhythm, Standard Days™, TwoDay, Billings Ovulation, and SymptoThermal methods. From 2005 to 2011 the FAM category has also included postpartum women relying on LAM.
f
For 1999–2004, “other” methods include withdrawal, rhythm/calendar, sponge, vaginal suppositories, douching, abstinence, and other methods not included in FPAR Table 3 of the 2001
version of the Title X FPAR: Forms and Instructions. Beginning in 2005, “other” methods include withdrawal and other methods not listed in Table 7 of the Title X FPAR: Forms and Instructions
(Reissued January 2011).
g
See comments for Trend Exhibits in the Field and Methodological Notes (Appendix C).
— Data are not available.

Attachment F - 88

Exhibit A–7b.

Distribution of female family planning users who reported a primary contraceptive method at exit from the encounter, by
method and year: 1999–2011

Primary Method
Highly Effective
Vasectomy b
Sterilization

1999

2001

2002

2003

2004

—

—

—

—

—

2005

2006

2007

2008

2009

2010

2011

a

b

0%†

0%†

0%†

0%†

0%†

0%†

0%†

3%

3%

3%

3%

3%

2%

2%

2%

2%

2%

2%

2%

Hormonal implant

1%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

1%

1%

2%

Intrauterine device

1%

2%

2%

2%

2%

2%

3%

4%

5%

6%

6%

7%

Moderately Effective a
Hormonal injection

20%

20%

20%

19%

18%

16%

15%

15%

16%

16%

16%

16%

—

—

—

—

—

2%

3%

4%

4%

4%

5%

5%

Vaginal ring c
Contraceptive patch

c

Oral contraceptive
Cervical cap/diaphragm
Less Effective a
Male condom

—

—

—

—

—

55%

54%

53%

50%

49%

0%†

0%†

0%†

0%†

0%†

15%

16%

17%

17%

18%

Female condom c

—

—

—

—

—

c

—

—

—

—

—

Sponge

7%

4%

3%

3%

3%

2%

2%

48%

48%

47%

46%

44%

42%

39%

0%†
18%
0%†

0%†
19%
0%†

0%†
19%
0%†

0%†
19%
0%†

0%†
19%
0%†

0%†
20%
0%†

0%†
21%
0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Withdrawal/Other d

2%

2%

3%

7%

8%

3%

3%

3%

3%

3%

3%

3%

FAM or LAM e

0%†

0%†

0%†

1%

1%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Spermicide

2%

2%

1%

1%

0%†

1%

1%

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

2%

2%

2%

2%

Other
Abstinence c
Total Using a Method
Percentage
Number

—
100%
3,584,057

—
100%
3,902,466

—
100%
4,004,041

—
100%
4,011,596

—
100%
4,010,897

100%
3,887,773

100%
3,882,336

100%
3,858,348

100%
3,809,508

100%
3,881,151

100%
4,023,241

100%
3,947,911

FAM=fertility awareness method. LAM=lactational amenorrhea method. Note: Due to rounding, percentages may not sum to 100%.
a
See reference note 14.
b
Sterilization figures for 1999–2004 include both female and male (vasectomy) sterilization users. Beginning in 2005, female and male sterilization figures are reported separately.
c
Prior to 2005, grantees reported these methods under the “other” method category.
d
For 1999–2004, “other” methods include withdrawal, rhythm/calendar, sponge, vaginal suppositories, douching, abstinence, and other methods not included in FPAR Table 3 of the
2001 version of the Title X FPAR: Forms and Instructions. Beginning in 2005, “other” methods include withdrawal and other methods not listed in Table 7 of the Title X FPAR:
Forms and Instructions (Reissued January 2011).
e
For 1999–2004, the natural method category includes only safe period by temperature or cervical mucus test. In 2005, the natural method category was renamed fertility
awareness method (FAM) and from 2005 to 2010 FAMs included Calendar Rhythm, Standard Days™, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. In
2011, FAMs included Calendar Rhythm, Standard Days™, TwoDay, Billings Ovulation, and SymptoThermal methods.
— Data are not available.
† Percentage is less than 0.5%.

Attachment F - 89

Exhibit A–7c.

Distribution of female family planning users who reported a primary contraceptive method at exit from the encounter, by level
of method effectiveness14 and year: 1999–2011

2011

11%

Moderately effective, 62%

2010

10%

Moderately effective, 65%

2009

9%

Moderately effective, 67%

2008

8%

3,947,911

Less effective, 25%

4,023,241

Less effective, 23%
Less effective, 23%

3,881,151

Moderately effective, 68%

Less effective, 23%

3,809,508

Moderately effective, 70%

Less effective, 23%

3,858,348

Less effective, 24%

3,882,336

2007

6%

2006

5%

2005

5%

2004

5%

2003

5%

2002

5%

2001

5%

Moderately effective, 75%

Less effective, 20%

3,902,466

1999

5%

Moderately effective, 75%

Less effective, 20%

3,584,057

0%

Moderately effective, 70%
Moderately effective, 72%
Moderately effective, 68%

Highly effective

Moderately effective

4,011,596

Less effective, 26%

Moderately effective, 73%

40%

4,010,897

Less effective, 27%

Moderately effective, 69%

20%

3,887,773

Less effective, 22%

4,004,041

Less effective, 22%

60%
Less effective

80%

100%
Abstinence

Note: 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. Highly effective contraceptives are methods that result in less than 1% of women experiencing an unintended pregnancy during the first
year of typical use (shown in parentheses) and include male sterilization/vasectomy (0.15%), female sterilization (0.5%), implant (Implanon, 0.05%), and IUD (Mirena [0.2%] and
ParaGard [0.8%]). Moderately effective contraceptives are methods that result in 6% to 12% of women experiencing an unintended pregnancy during the first year of typical use
and include injectable contraception (Depo-Provera, 6%), vaginal ring (NuvaRing, 9%), contraceptive patch (Evra, 9%), pills (9%), and diaphragm with spermicical cream or jelly
(12%). Less-effective contraceptives are methods that result in 18% to 28% of women experiencing an unintended pregnancy during the first year of typical use and include male
condoms (18%), female condoms (21%), the sponge (12% [nulliparous] to 24% [parous]), withdrawal (22%), fertility awareness-based methods (FAM, 24%), and spermicides
(foams, creams, gels, vaginal suppositories, and vaginal film, 28%). (Source: Trussell, 2011, see reference note 14.) 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 three method-effectiveness categories.

Attachment F - 90

Exhibit A–8a.

Number and percentage of female users who received a Pap test, number of Pap tests performed, and percentage of Pap tests
performed with an atypical squamous cells or higher result, by year: 2005–2011

Pap Test Indicators

2005

2006

2007

2008

2009

2010

2011

Female Users Who Received a Pap Test
Number
Percentage

2,447,498

2,326,153

2,272,571

2,088,218

2,035,017

1,727,251

1,444,418

52%

49%

48%

44%

42%

36%

31%

Pap Tests Performed
Number
Percentage with ASC or higher result

2,644,413

2,477,209

2,470,674

2,209,087

2,190,127

1,810,620

1,522,777

9%

10%

10%

11%

12%

13%

15%

ASC=atypical squamous cells.
Number and percentage of female users who received a Pap test, by year: 2005–2011

3,000,000

60%
2,447,498

2,000,000

52%

2,326,153
49%

2,272,571

2,088,218

50%

2,035,017

48%

1,727,251
44%

1,444,418

42%

1,000,000

36%
31%

0

40%

2005

2006

2007

Female users tested

2008

2009

2010

Percentage of female users tested

2011

30%

20%

Percentage of female users who received
a Pap test

Number of female users who received
a Pap test

Exhibit A–8b.

Attachment F - 91

Exhibit A–9a.

Number and percentage of female users under 25 tested for chlamydia, by year: 2005–2011

Chlamydia Testing Indicators

2005

2006

2007

2008

2009

2010

2011

Female Users Under 25 Years Tested
Number

1,375,787

1,387,222

1,385,623

1,435,430

1,433,829

1,442,176

1,357,231

50%

51%

52%

55%

55%

57%

58%

Percentage

Number and percentage of female users under 25 tested for chlamydia, by year: 2005–2011

2,000,000

1,500,000

70%

1,375,787

1,387,222

1,385,623

1,435,430

1,000,000
55%

500,000

0

50%

2005

51%

2006

1,433,829

55%

1,442,176

57%

1,357,231

58%

52%

2007

Number of female users < 25 years tested for chlamydia

60%

50%

2008

2009

2010

2011

40%

Percentage of female users <25 years tested for
chlamydia

Number of female users <25 years tested for
chlamydia

Exhibit A–9b.

Percentage of female users < 25 years tested for chlamydia

Attachment F - 92

Exhibit A-10a.

Number of confidential HIV tests performed and number of tests per 10 users: 1999–2011

HIV Testing
Tests performed

1999

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

365,883

601,259

493,622

526,360

530,569

607,974

652,426

764,126

833,105

997,765

1,101,665

1,283,375

0.8

1.2

1.0

1.1

1.0

1.2

1.3

1.5

1.6

1.9

2.1

2.6

Tests per 10 users

Number of confidential HIV tests performed and number of tests per 10 users: 1999–2011

Number of confidential HIV tests performed

1,400,000

1,283,375

1,200,000

1,101,665

1,000,000
764,126

800,000
607,974

601,259

600,000
400,000

2.6

997,765

493,622

1.5

365,883

200,000

1.0

1.0

2003

2004

2.0

2.1

1.6

1.5

1.3

1.2
1.1

2.5

1.9

652,426

526,360 530,569

1.2

833,105

3.0

1.0

0.8

0

1999

2001

2002

2005

2006

Number of tests performed

2007

2008

2009

2010

Number of tests per 10 users

2011

0.5

Number of confidential HIV tests per 10 users

Exhibit A-10b.

Attachment F - 93

Exhibit A–11a. Actual and adjusted (constant 1999$ and 1981$) total, Title X, and Medicaid revenue, by year: 1999–2011

Revenue
Total
a
Actual

1999
(in $)

2001
(in $)

2002
(in $)

2003
(in $)

2004
(in $)

2005
(in $)

2006
(in $)

2007
(in $)

2008
(in $)

2009
(in $)

2010
(in $)

2011
(in $)

Change
1999–
2011

737,980,611

830,967,862

899,339,792

927,081,651

982,537,801

1,004,633,020

1,081,431,527

1,140,511,162

1,211,489,469

1,231,311,085

1,293,835,909

1,286,574,610

74%

1999$

b

737,980,611

763,345,111

789,126,582

781,981,359

794,014,747

778,963,598

806,087,866

814,154,225

833,914,990

821,501,274

834,719,951

805,519,433

9%

1981$

b

244,128,462

252,519,193

261,047,860

258,684,177

262,664,894

257,685,883

266,658,755

269,327,156

275,864,137

271,757,604

276,130,423

266,470,714

9%

Title X
a
Actual

183,163,632

226,582,287

231,549,999

245,714,562

252,141,527

249,562,677

262,983,478

255,337,864

259,743,981

266,393,881

279,295,186

276,002,719

51%

1999$

b

183,163,632

208,143,406

203,173,774

207,257,049

203,762,227

193,503,734

196,025,162

182,273,008

178,791,814

177,731,619

180,187,659

172,804,245

−6%

1981$

b

60,591,640

68,855,101

67,211,117

68,561,889

67,405,781

64,012,209

64,846,313

60,297,017

59,145,416

58,794,698

59,607,171

57,164,692

−6%

100,361,553

133,121,016

148,746,779

156,182,638

277,174,817

311,066,271

320,154,915

349,672,196

407,349,628

449,834,131

481,262,633

506,608,330

405%

Medicaid
a
Actual
1999$

b

100,361,553

122,287,854

130,518,007

131,738,031

223,992,290

241,191,855

238,640,160

249,613,599

280,394,481

300,118,561

310,487,225

317,185,534

216%

1981$

b

33,200,210

40,453,564

43,176,148

43,579,740

74,098,008

79,787,729

78,943,612

82,573,693

92,756,195

99,281,040

102,711,057

104,926,899

216%

a
b

Revenue is shown in actual dollars (unadjusted) for each year.
Revenue is shown in constant 1999 dollars (1999$) or 1981 dollars (1981$), 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).

Attachment F - 94

Exhibit A–11b. Total, Title X, and Medicaid adjusted (constant 1999$) revenue, by year: 1999–2011

$1,400,000

Revenue in thousands (constant 1999$)

$1,200,000
$1,000,000
$805,519

$800,000
$600,000

$737,981

$400,000
$200,000
$0

$183,164

$317,186
$172,804

$100,362
1999

2001

2002

2003

2004
Total revenue

2005

2006
Medicaid

2007

2008
Title X

2009

2010

2011

Attachment F - 95

Exhibit A–11c. Total actual (unadjusted) and adjusted (constant 1999$ and 1981$) revenue, by year: 1999–2011

$1,400,000

$1,286,575

Total revenue in thousands

$1,200,000
$1,000,000
$800,000

$805,519

$737,981

$600,000
$400,000

$266,471

$244,128
$200,000
$0

1999

2001

2002

2003
Actual

2004

2005

2006

Adjusted (1999$)

2007

2008

2009

Adjusted (1981$)

2010

2011

Attachment F - 96

Exhibit A–11d. Title X actual (unadjusted) and adjusted (constant 1999$ and 1981$) revenue, by year: 1999–2011

$450,000

Title X revenue in thousands

$400,000
$350,000
$276,003

$300,000
$250,000

$172,804

$200,000
$150,000
$100,000

$183,164

$60,592

$57,165

$50,000
$0

1999

2001

2002

2003

2004

Actual

2005

2006

Adjusted (1999$)

2007

2008

Adjusted (1981$)

2009

2010

2011

Attachment F - 97

Exhibit A–11e. Medicaid actual (unadjusted) and adjusted (constant 1999$ and 1981$) revenue, by year: 1999–2011

$600,000
$506,608

Medicaid revenue in thousands

$500,000

$400,000
$317,186
$300,000

$200,000
$100,362

$104,927

$100,000
$33,200
$0

1999

2001

2002

2003
Actual

2004

2005

2006

Adjusted (1999$)

2007

2008

Adjusted (1981$)

2009

2010

2011

Attachment F - 98

Exhibit A–12a. Amount of Title X project revenue, by revenue source and year: 1999–2011
Revenue Sources
Title X
Payment for Services
Client collections
Third-party payers
Medicaid
Medicare

1999
(in $)

2001
(in $)

2002
(in $)

2003
(in $)

2004
(in $)

2005
(in $)

2006
(in $)

2007
(in $)

2008
(in $)

2009
(in $)

2010
(in $)

2011
(in $)

183,163,632

226,582,287

231,549,999

245,714,562

252,141,527

249,562,677

262,983,478

255,337,864

259,743,981

266,393,881

279,295,186

276,002,719

97,376,797

95,257,186

96,842,560

97,561,767

99,774,741

101,353,959

102,527,805

94,273,992

94,531,003

80,940,857

84,540,815

72,156,363

100,361,553

133,121,016

148,746,779

156,182,638

277,174,817

311,066,271

320,154,915

349,672,196

407,349,628

449,834,131

481,262,633

506,608,330

468,189

127,709

329,980

585,762

755,938

850,289

695,725

523,170

826,424

843,164

1,913,519

2,002,181

CHIP

—

—

—

—

—

159,966

302,282

247,539

212,168

194,482

913,045

279,244

Other

10,345,386

17,893,603

20,413,354

12,035,788

15,231,967

2,137,736

3,173,806

3,042,991

3,855,406

4,903,482

2,466,949

4,088,072

Private

11,721,540

15,828,979

21,129,413

22,717,290

23,923,861

31,794,914

37,263,692

46,403,049

45,067,919

48,445,935

50,409,637

51,655,083

Subtotal

220,273,465

262,228,493

287,462,086

289,083,245

416,861,324

447,363,135

464,118,225

494,162,937

551,842,548

585,162,051

621,506,598

636,789,273

32,055,309

23,931,198

28,604,028

30,827,138

32,992,292

24,384,126

22,806,213

23,484,206

23,058,822

21,044,962

21,205,336

25,512,030

34,049,367

31,284,545

27,626,015

32,913,637

30,835,001

27,232,575

28,443,123

28,593,275

27,333,993

30,841,136

34,001,848

23,736,983

—

—

—

—

—

16,986,542

10,521,097

23,460,554

22,325,121

15,580,002

14,475,023

14,517,155

State government

169,673,542

171,766,076

193,508,723

211,814,774

125,848,881

115,558,888

133,618,734

138,760,608

147,447,953

153,830,395

135,464,470

125,392,165

Local government

44,383,037

52,744,977

61,587,837

57,939,837

50,028,918

56,251,710

93,388,186

99,510,026

101,295,242

84,666,243

91,289,586

84,214,372

Other Revenue
MCH Block Grant
SS Block Grant
TANF

BPHC

2,960,179

1,208,964

2,257,586

843,273

3,959,649

6,172,992

5,847,921

7,177,359

9,531,860

4,965,372

4,090,546

5,289,075

Other

51,422,080

61,221,322

66,743,518

57,945,185

69,870,209

61,120,375

59,704,550

70,024,333

68,909,949

68,827,043

92,507,316

95,120,838

Subtotal

334,543,514

342,157,082

380,327,707

392,283,844

313,534,950

307,707,208

354,329,824

391,010,361

399,902,940

379,755,153

393,034,125

373,782,618

Total Revenue
Actual

737,980,611

830,967,862

899,339,792

927,081,651

982,537,801

1,004,633,020

1,081,431,527

1,140,511,162

1,211,489,469

1,231,311,085

1,293,835,909

1,286,574,610

1999

a

737,980,611

763,345,111

789,126,582

781,981,359

794,014,747

778,963,598

806,087,866

814,154,225

833,914,990

821,501,274

834,719,951

805,519,433

1981

a

244,128,462

252,519,193

261,047,860

258,684,177

262,664,894

257,685,883

266,658,755

269,327,156

275,864,137

271,757,604

276,130,423

266,470,714

BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Service. TANF=Temporary Assistance for Needy Families.
WIC=Special Supplemental Nutrition Program for Women, Infants, and Children.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
Revenue is shown in constant 1999 dollars (1999$) or 1981 dollars (1981$), 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).
— Data are not available.

Attachment F - 99

Exhibit A–12b. Distribution of Title X project revenue, by revenue source and year: 1999–2011
Revenue Sources

1999
(in $)

2001
(in $)

2002
(in $)

2003
(in $)

2004
(in $)

2005
(in $)

2006
(in $)

2007
(in $)

2008
(in $)

2009
(in $)

2010
(in $)

2011
(in $)

Title X

25%

27%

26%

27%

26%

25%

24%

22%

21%

22%

22%

21%

Payment for Services
Client collections

13%

11%

11%

11%

10%

10%

9%

8%

8%

7%

7%

6%

Third-party payers
Medicaid

14%

16%

17%

17%

28%

31%

30%

31%

34%

37%

37%

39%

Medicare

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

CHIP

—

—

—

—

—

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Other

1%

2%

2%

1%

2%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Private

2%

2%

2%

2%

2%

3%

3%

4%

4%

4%

4%

4%

Subtotal

30%

32%

32%

31%

42%

45%

43%

43%

46%

48%

48%

49%

Other Revenue
MCH Block Grant

4%

3%

3%

3%

3%

2%

2%

2%

2%

2%

2%

2%

SS Block Grant

5%

4%

3%

4%

3%

3%

3%

3%

2%

3%

3%

2%

—

—

—

—

—

2%

1%

2%

2%

1%

1%

1%

TANF
State government

23%

21%

22%

23%

13%

12%

12%

12%

12%

12%

10%

10%

Local government

6%

6%

7%

6%

5%

6%

9%

9%

8%

7%

7%

7%

BPHC

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

1%

0%†

0%†

0%†

Other

7%

7%

7%

6%

7%

6%

6%

6%

6%

6%

7%

7%

Subtotal

45%

41%

42%

42%

32%

31%

33%

34%

33%

31%

30%

29%

Total Revenue
Actual

100%

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 Service. TANF=Temporary Assistance for Needy Families.
WIC=Special Supplemental Nutrition Program for Women, Infants, and Children.
— Data are not available.
†

Percentage is less than 0.5%.

Attachment F - 100

Exhibit A–12c. Distribution of Title X project revenue, by revenue source and year: 1999–2011

2011

Medicaid, 39%

2010

Medicaid, 37%

2009

Medicaid, 37%

2008

Title X, 21%
Title X, 22%

Medicaid, 31%

Title X, 22%

2006

Medicaid, 30%

Title X, 24%

Medicaid, 31%

2004

Medicaid, 17%

2002

Medicaid, 17%

Title X, 26%

2001

Medicaid, 16%

Title X, 27%

Medicaid, 14%

0%

20%
Medicaid

State, 12%

Title X

State, 21%

Local,
Client
7% Fees, 7%
Local,
8%

Client
Fees, 8%
Client
Fees, 8%

Local,
6%

Other, 16%

$1,231,311,085

Other, 17%

$1,211,489,469

Other, 18%

Client fees
9%
Client fees
10%

Client fees
11%

Other, 16%

$1,140,511,162
$1,081,431,527

Other, 17%

$1,004,633,020

Other, 18%

$982,537,801

Other, 17%

$927,081,651

Local,
7%

Client fees
11%

Other, 19%

$899,399,792

Local,
6%

Client fees
11%

Other, 18%

$830,967,862

Local,
6%

State, 23%

60%
State

$1,293,835,909

Local,
6%

State, 22%

40%

Other, 17%

Local, Client fees
10%
5%

State, 13%
State, 23%

Title X, 25%

Local,
Client
7%
Fees, 7%

Local,
9%

State, 12%

Title X, 27%

$1,286,574,610

Local,
9%

State, 12%

Title X, 26%

2003

1999

State, 12%

Title X, 25%

Medicaid, 28%

Other, 17%

State, 12%

Title X, 21%

2007

2005

State, 10%

Title X, 22%

Medicaid, 34%

Local, Client
7% Fees, 6%

State, 10%

Local

Client fees
13%

Other, 19%

80%
Client fees

$737,980,611
100%
Other

Notes: The “other” revenue category includes revenue from the Bureau of Primary Health Care and other federal grants, Children’s Health Insurance Program, other public, and private
third-parties, block grants, Temporary Assistance for Needy Families, and revenue reported as “other” revenue in the FPAR revenue table. 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.

Attachment F - 101

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A-28

Family Planning Annual Report: 2011 National Summary

Attachment F - 102

Appendix B
State Exhibits

Attachment F - 103

Exhibit B–1.

State-level number and distribution of family planning users, by user sex, and
distribution of all users by state: 2011 (Source: FPAR Table 1)
Total

% Female

% Male

State Users as a %
of All Users

State

Female

Male

Alabama

102,547

1,232

103,779

99%

1%

2%

Alaska

7,878

2,373

10,251

77%

23%

0%†

Arizona

38,977

3,640

42,617

91%

9%

1%

Arkansas

74,719

708

75,427

99%

1%

2%

California

1,063,297

133,188

1,196,485

89%

11%

24%

Colorado

54,762

10,176

64,938

84%

16%

1%

Connecticut

38,399

4,564

42,963

89%

11%

1%

Delaware

19,089

3,854

22,943

83%

17%

0%†

District of Columbia

25,601

5,667

31,268

82%

18%

1%

Florida

207,614

8,087

215,701

96%

4%

4%

Georgia

131,316

3,105

134,421

98%

2%

3%

Hawaii

21,566

762

22,328

97%

3%

0%†

Idaho

21,820

1,339

23,159

94%

6%

0%†

Illinois

113,211

3,492

116,703

97%

3%

2%

Indiana

42,099

3,459

45,558

92%

8%

1%

Iowa

64,625

3,915

68,540

94%

6%

1%

Kansas

35,597

2,864

38,461

93%

7%

1%

Kentucky

96,203

8,048

104,251

92%

8%

2%

Louisiana

38,634

989

39,623

98%

2%

1%

Maine

24,755

2,781

27,536

90%

10%

1%

Maryland

69,226

6,702

75,928

91%

9%

2%

56,719

8,236

64,955

87%

13%

1%

103,724

2,053

105,777

98%

2%

2%

Minnesota

53,815

5,888

59,703

90%

10%

1%

Mississippi

59,839

398

60,237

99%

1%

1%

Missouri

65,660

3,865

69,525

94%

6%

1%

Montana

24,035

2,494

26,529

91%

9%

1%

Nebraska

25,960

2,681

28,641

91%

9%

1%

Nevada

22,602

1,066

23,668

95%

5%

0%†

Massachusetts
Michigan

17,543

1,127

18,670

94%

6%

0%†

New Jersey

100,943

8,576

109,519

92%

8%

2%

New Mexico

30,872

4,032

34,904

88%

12%

1%

New York

332,465

27,347

359,812

92%

8%

7%

North Carolina

123,888

1,342

125,230

99%

1%

2%

North Dakota

11,594

1,391

12,985

89%

11%

0%†

New Hampshire

†

Percentage is less than 0.5%.

(continued)

Attachment F - 104

Exhibit B–1.

State-level number and distribution of family planning users, by user sex, and
distribution of all users by state: 2011 (Source: FPAR Table 1) (continued)
% Female

% Male

State Users as a %
of All Users

State

Female

Male

Total

Ohio

82,755

9,037

91,792

90%

10%

2%

Oklahoma

65,074

1,229

66,303

98%

2%

1%

66,637

3,727

70,364

95%

5%

1%

Pennsylvania

271,433

29,095

300,528

90%

10%

6%

Rhode Island

22,937

3,602

26,539

86%

14%

1%

South Carolina

82,361

4,640

87,001

95%

5%

2%

Oregon

8,988

456

9,444

95%

5%

0%†

Tennessee

110,150

161

110,311

100%

0%†

2%

Texas

243,796

15,810

259,606

94%

6%

5%

Utah

37,082

6,417

43,499

85%

15%

1%

Vermont

10,600

989

11,589

91%

9%

0%†

Virginia

72,352

6,027

78,379

92%

8%

2%

Washington

87,160

3,389

90,549

96%

4%

2%

West Virginia

50,388

4,729

55,117

91%

9%

1%

Wisconsin

47,390

5,139

52,529

90%

10%

1%

Wyoming

10,605

1,311

11,916

89%

11%

0%†

Jurisdictions/
Territories
Puerto Rico

18,925

1,365

20,290

93%

7%

0%†

3,590

158

3,748

96%

4%

0%†

21,378

7,794

29,172

73%

27%

1%

4,635,195

386,516

5,021,711

92%

8%

100%

South Dakota

U.S. Virgin Islands
Pacific region
Total All Users
a

†

a

The U.S. jurisdictions in the Pacific region include 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%.

Attachment F - 105

Exhibit B–2.

State-level number and distribution of family planning users, by user income level: 2011
(Source: FPAR Table 4)

Total

%
Over
250%

%
UK/NR

Alabama

80,911

21,066

1,606

196

103,779

78%

20%

2%

0%†

Alaska

7,686

2,026

533

6

10,251

75%

20%

5%

0%†

Arizona

32,608

4,116

5,835

58

42,617

77%

10%

14%

0%†

Arkansas

51,086

19,698

2,031

2,612

75,427

68%

26%

3%

3%

California

854,115

225,196

61,663

55,511

1,196,485

71%

19%

5%

5%

Colorado

50,509

12,633

1,796

0

64,938

78%

19%

3%

0%

Connecticut

16,411

21,253

2,432

2,867

42,963

38%

49%

6%

7%

Delaware

13,929

5,847

1,525

1,642

22,943

61%

25%

7%

7%

District of Columbia

16,843

4,419

1,871

8,135

31,268

54%

14%

6%

26%

Florida

109,895

39,113

17,407

49,286

215,701

51%

18%

8%

23%

Georgia

109,039

23,388

1,994

0

134,421

81%

17%

1%

0%

Hawaii

17,652

3,451

1,053

172

22,328

79%

15%

5%

1%

Idaho

15,460

6,890

808

1

23,159

67%

30%

3%

0%†

Illinois

91,447

21,559

3,648

49

116,703

78%

18%

3%

0%†

Indiana

33,596

10,029

1,933

0

45,558

74%

22%

4%

0%

Iowa

41,938

12,622

10,484

3,496

68,540

61%

18%

15%

5%

Kansas

21,835

12,826

1,862

1,938

38,461

57%

33%

5%

5%

Kentucky

75,150

23,446

3,982

1,673

104,251

72%

22%

4%

2%

Louisiana

36,391

3,082

127

23

39,623

92%

8%

0%†

0%†

Maine

13,662

8,689

2,331

2,854

27,536

50%

32%

8%

10%

Maryland

59,183

10,464

1,905

4,376

75,928

78%

14%

3%

6%

Massachusetts

37,703

20,775

2,501

3,976

64,955

58%

32%

4%

6%

Michigan

73,789

26,552

5,356

80

105,777

70%

25%

5%

0%†

Minnesota

37,076

16,295

5,650

682

59,703

62%

27%

9%

1%

Mississippi

51,792

8,249

189

7

60,237

86%

14%

0%†

0%†

Missouri

44,532

20,196

4,797

0

69,525

64%

29%

7%

0%

Montana

14,758

7,696

4,075

0

26,529

56%

29%

15%

0%

Nebraska

14,549

8,786

2,774

2,532

28,641

51%

31%

10%

9%

Nevada

14,295

5,111

2,582

1,680

23,668

60%

22%

11%

7%

9,634

5,143

1,361

2,532

18,670

52%

28%

7%

14%

44,988

60,824

3,707

0

109,519

41%

56%

3%

0%

New Jersey

Over
250%

%
101% to
250%

State

New Hampshire

101% to
250%

%
Under
101%

Under
101%

UK/NR

UK/NR=unknown or not reported.
(continued)
Note: Due to rounding, percentages may not sum to 100%. Title X-funded agencies calculate and 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%.

Attachment F - 106

Exhibit B–2.

State-level number and distribution of family planning users, by user income level: 2011
(Source: FPAR Table 4) (continued)
%
Over
250%

New Mexico

26,176

4,630

821

3,277

34,904

75%

13%

2%

9%

241,161

94,580

22,460

1,611

359,812

67%

26%

6%

0%†

North Carolina

73,184

31,111

6,605

14,330

125,230

58%

25%

5%

11%

North Dakota

5,963

4,682

2,249

91

12,985

46%

36%

17%

1%

Ohio

61,884

25,484

4,163

261

91,792

67%

28%

5%

0%†

Oklahoma

48,013

17,267

1,023

0

66,303

72%

26%

2%

0%

Oregon

52,248

16,053

1,489

574

70,364

74%

23%

2%

1%

Pennsylvania

187,306

78,638

28,784

5,800

300,528

62%

26%

10%

2%

Rhode Island

21,658

4,110

683

88

26,539

82%

15%

3%

0%†

South Carolina

80,822

4,991

1,188

0

87,001

93%

6%

1%

0%

South Dakota

6,306

2,276

621

241

9,444

67%

24%

7%

3%

96,760

11,234

2,317

0

110,311

88%

10%

2%

0%

192,960

60,491

2,947

3,208

259,606

74%

23%

1%

1%

28,831

12,089

2,387

192

43,499

66%

28%

5%

0%†

Vermont

4,910

2,675

930

3,074

11,589

42%

23%

8%

27%

Virginia

46,859

25,848

1,664

4,008

78,379

60%

33%

2%

5%

Washington

58,704

24,958

4,475

2,412

90,549

65%

28%

5%

3%

West Virginia

50,202

4,893

3

19

55,117

91%

9%

0%†

0%†

Wisconsin

36,378

13,237

2,725

189

52,529

69%

25%

5%

0%†

Wyoming

7,839

3,231

846

0

11,916

66%

27%

7%

0%

14,686

2,518

2,577

509

20,290

72%

12%

13%

3%

3,400

318

30

0

3,748

91%

8%

1%

0%

28,200

322

24

626

29,172

97%

1%

0%†

2%

3,466,912

1,117,076

250,829

186,894

5,021,711

69%

22%

5%

4%

Tennessee
Texas
Utah

Jurisdictions/
Territories
Puerto Rico
U.S. Virgin Islands
Pacific region
Total All Users

a

Over
250%

%
101% to
250%

State

New York

101% to
250%

%
Under
101%

Under
101%

UK/NR

Total

%
UK/NR

UK/NR=unknown or not reported.
Note: Due to rounding, percentages may not sum to 100%.Title X-funded agencies calculate and 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.
a
The U.S. jurisdictions in the Pacific region include 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%.

Attachment F - 107

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Attachment F - 108

Appendix C
Field and Methodological Notes

Attachment F - 109

Field and Methodological Notes
INTRODUCTION
This appendix presents additional information about the 2011 FPAR, including issues
identified by RTI during data validation and relevant table-specific notes from grantees and
HHS staff (Regional Program Consultants [RPC], other regional HHS staff, and the FPAR
Data Coordinator). The notes are organized according to the FPAR reporting table to which
they apply.

FPAR COVER SHEET: GRANTEE PROFILE
Between 2010 and 2011, there were two new grantees and a net increase of 20 delegates.
Nineteen grantees reported an increase in the number of delegates while 14 reported a
decrease. Seven grantees attributed the decrease in the number of delegates to one or more of
the following reasons: delegate closure, discontinuation of Title X services, consolidation of
delegates, and reduced funding.
Between 2010 and 2011, there was a net decrease of seven service sites. Twenty-five grantees
reported an increase in service sites while 36 reported a decrease. Eighteen grantees attributed
the decrease in number of sites to clinic closures and service consolidation, reduced funding,
staff shortages, and changes in subcontracting arrangements. Ten grantees attributed the
increase in number of sites to an underreporting of the number of sites.
Five grantees reported data for a different 12-month period (December 1, 2010 to November
30, 2011) than the 2011 calendar year.

FPAR TABLE 1: USERS BY AGE AND SEX
Between 2010 and 2011, there was a net decrease of 203,151 users. Of the 89 grantees
operating in both 2010 and 2011, 25 reported an increase in users and 64 reported a decrease.
Seventeen grantees attributed the increase in number of family planning users to one or more
of the following reasons: increased outreach to or services for selected client groups
(e.g., males, teens), expanded services (e.g., STD testing), increased availability of nontraditional operating hours, increased clinic efficiency (e.g., better appointment system), more
providers, or improved data collection and reporting.
Thirty-three grantees attributed the decrease in number of family planning users to one or
more of the following reasons: reduction in number of delegates or service sites, reduced
staffing or challenges recruiting and retaining qualified staff, reduced or modified hours of
operation, decrease in the size of the target population, improvements in data collection and
reporting, decreased efficiency during a transition to a new electronic health record systems,
Medicaid expansions or Affordable Care Act provisions that allow users to seek care
elsewhere or continue care with their provider, decrease in services offerings (e.g. STD

Attachment F - 110

testing), or changes in service policies that allow users to refill prescriptions less frequently or
extend the time between visits. Of the eight grantees that attributed a decrease in the number
of family planning users to reduced funding, seven were state health departments and two of
the seven noted the decrease in their respective state’s budget.

FPAR TABLE 2: FEMALE USERS BY ETHNICITY AND RACE
Between 2010 and 2011, the percentage of total female users with an unknown race (13%) or
unknown ethnicity (2%) remained stable. Female Hispanic or Latino users accounted for a
disproportionate share of female users with an unknown or not reported race. Of the 13% of
total female users for whom race was unknown or not reported in 2011, 71% identified as
Hispanic or Latino. Twenty grantees commented on female users who self-identify as
Hispanic or Latino, but who do not self-identify with one or more of the five minimum Office
of Management and Budget (OMB) race options in FPAR Table 2. Three grantees
commented that some users decline to select a race.
In addition, nine grantees attributed the large percentage of female users with unknown race
or ethnicity to problems with data collection, while one grantee attributed a reduction in
number of female users with an unknown race or ethnicity to improved data collection.

FPAR TABLE 3: MALE USERS BY ETHNICITY AND RACE
Between 2010 and 2011, the percentage of total male users with an unknown race decreased
from 16% to 15%, while unknown ethnicity increased from 3% to 4%. Male Hispanic or
Latino users accounted for a disproportionate share of male users with an unknown or not
reported race. Of the 15% of total male users for whom race was unknown or not reported in
2011, 69% identified as Hispanic or Latino. Fifteen grantees commented on male users who
self-identify as Hispanic or Latino, but who do not self-identify with one or more of the five
minimum OMB race options in FPAR Table 3, and two grantees noted that some users
refused to self-identify with any race categories.
In addition, four grantees attributed the large percentage of male users with unknown race or
ethnicity to data collection problems, while one grantee attributed the decrease in number of
male users with an unknown race or ethnicity to improved data collection.

FPAR TABLE 4: USERS BY INCOME LEVEL
Twelve grantees attributed the high or increased number of family planning users with
unknown or not reported income to problems with data collection, including client refusal to
report income data or a failure of sites to collect income data for specific client subgroups
(e.g., education-only users, users not applying for discounted services). Three grantees
attributed a decreased number of family planning users with unknown or not reported income
to improved data collection.

Attachment F - 111

FPAR TABLE 5: USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE STATUS
Two grantees attributed the high or increased number of family planning users with unknown
or not reported principal health insurance coverage status to data collection problems,
including clients lacking knowledge about their coverage status, refusal to report due to
confidentiality concerns, and failure to collect the data.

FPAR TABLE 6: USERS WITH LIMITED ENGLISH PROFICIENCY (LEP)
Six grantees attributed the high or increased number of LEP family planning users to one or
more of the following reasons: improved data collection, an increase in the number of users
who are immigrants, increased outreach to minority communities, or the addition of new sites
that serve an LEP population.
Five grantees attributed the decrease in the number of LEP users to one or more of the
following reasons: underreporting of LEP users, weaknesses in data collection practices, a
decline in LEP users due to emigration or fear, or loss of providers who serve LEP
populations.

FPAR TABLE 7: FEMALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Hormonal injection users—Eleven grantees in seven regions (I, II, III, IV, VI, VII, and IX)
reported a total of 262 female users who relied on 1-month hormonal injections as their
primary method. One-month hormonal injection users accounted for 0.04% of all 645,351
hormonal injection users reported in 2011.
Sterilization users under 20—Two grantees each reported one female user under 20 who
relied on female sterilization as their primary contraceptive method. Both grantees confirmed
that these users had been sterilized prior to seeking services at the Title X site.
Unknown method—Five grantees attributed the high or increased number of female users
with an unknown primary method to problems with data systems or failure to collect primary
method data for specific subgroups or encounters (e.g., standalone pregnancy, over-thecounter supply, or education-only visits). Two grantees attributed the low or decreased
number of female users with an unknown primary method to improved staff training or
improved data collection.

FPAR TABLE 8: MALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Unknown method—Seven grantees attributed the high or increased number of male users
with an unknown primary method to data system issues, problems collecting the data overall
or for specific client subgroups or encounters (e.g., standalone HIV testing, walk-in services
such as emergency contraception). Four grantees attributed the decrease in male users in the
unknown method category to improved data collection resulting from technical assistance,
improved staff training, and upgrades in the electronic medical records system.

Attachment F - 112

FPAR TABLE 9: CERVICAL CANCER SCREENING ACTIVITIES
Of the 89 grantees who reported data in both 2010 and 2011, 71 grantees reported a decrease
in the proportion of users who received a Pap, and 18 reported an increase. Thirty-nine
grantees attributed the decreases in the numbers of female users screened and Pap tests
performed to adoption of updated cervical cancer screening guidelines, while eight others
attributed the decrease in screening to a reduction in the number females served, budget or
staffing cuts, acceptance of Pap results from outside providers, reduced hours of operation,
reduced clinic efficiency during transition to an EMR system, and implementation of
“Hormonal Contraception without a Pelvic Exam” protocol. Two grantees attributed an
increase in cervical cancer screening to increased demand for Pap screening and receipt of
care from a clinical services provider.
One grantee noted that Pap testing data were incomplete for users with Medicaid or Medicaid
HMO coverage.

FPAR TABLE 10: BREAST CANCER SCREENING ACTIVITIES
Five grantees attributed an increase in the number of users who received a clinical breast
exam (CBE) to improved data collection, increased number of users, increased case
management, or initiatives to increase screening.
Fifteen grantees attributed a decrease in the number of users who received a CBE to provider
adherence to breast cancer screening guidelines, while nine grantees attributed decreased
breast cancer screening to fewer clients served or a decreased number receiving a physical
exam, site closures, staff shortages, or reduced clinic efficiency during transition to an EMR
system.
One grantee noted that the number of reported CBEs was an estimate based on the
comprehensive/global billing code for a complete physical exam, and another commented that
CBE data for users with Medicaid or Medicaid HMO coverage were unavailable. Five
grantees commented on difficulties or an inability tracking CBE-related referrals due to data
system issues.

FPAR TABLE 11: USERS TESTED FOR CHLAMYDIA BY AGE AND SEX
Nine grantees attributed the decrease in the unduplicated number of users tested for
chlamydia to a reduction in the number of users or the number of users receiving a physical
exam, site closures, staff shortages, a decrease in clinic operating or clinician hours,
adherence to CDC testing guidelines, or a decrease in funding. Four grantees attributed the
increase in number of users tested to high chlamydia prevalence in the population served, an
increase in users, increased adherence to CDC testing guidelines, mergers with STD clinics,
or the addition of new service sites.
Two grantees attributed the increase in females tested to improved adherence to CDC testing
guidelines, while two others attributed the decrease to low chlamydia prevalence and more
targeted testing. Among female users under 25, three grantees attributed the increase in

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testing to improved adherence to testing guidelines, while two other grantees attributed the
decrease in users tested to fewer service sites and fewer users receiving a physical exam.
Eight grantees attributed the increase in males tested for chlamydia to an increase in the
number of male users, increased efforts to identify high risk male clients, and better
adherence to CDC testing guidelines. Two grantees attributed the decrease in male chlamydia
testing to client refusal or a drop in the number of male users.
Two grantees noted that chlamydia testing data were incomplete due to problems with data
systems, including lack of data for selected delegates or user subgroups (e.g., users whose
services were paid for by Medicaid/Medicaid HMO).

FPAR TABLE 12: STD TESTING BY SEX
Gonorrhea—Ten grantees attributed the increase in the number of gonorrhea tests performed
to one or more of the following reasons: improved adherence to testing guidelines, more
efficient test collection and analysis, use of a combined test for chlamydia and gonorrhea,
increased number of users, increase in high-risk users, high prevalence or outbreaks in service
area, or mergers with STD clinics. Eight grantees attributed the decrease in the number of
gonorrhea tests performed to a decrease in users, data collection issues, greater adherence to
testing guidelines, decreased funding, decrease in users seeking physical exams, or client
refusal.
Syphilis—Ten grantees attributed the increase in the number of syphilis tests performed to
one or more of the following factors: increase in users due to closure of or merger with STD
clinics, comprehensive STD screening, local outbreaks, high prevalence in the population
served, increased case management, or more males presenting with STD symptoms. Nine
grantees attributed the decrease in the number of syphilis tests to improved adherence to
testing guidelines, users declining to be tested, low prevalence in the community, or data
collection issues.
HIV—Fifteen grantees attributed the increase in the number of confidential HIV tests
performed to one or more of the following reasons: implementation of opt-out testing, use of
rapid HIV testing technology, the integration of HIV testing services into family planning,
increased marketing and promotion of HIV testing programs, increased funding for HIV
testing, increased training for HIV testing, merger between FP and STD clinic, or improved
data collection. Seven grantees attributed the decrease in the number of confidential HIV tests
performed to one or more of the following reasons: decreased number of users, loss of
dedicated funding, improved data collection, more targeted testing, or a decrease in number of
sites. Two grantees commented that HIV test results were not available.

FPAR TABLE 13: ENCOUNTERS AND CLINICAL PROVIDER UTILIZATION
Staffing—Eight grantees attributed a decrease in the number of CSP FTEs to reduced
funding, less physician time allocated to direct patient care, staffing changes, better data, or a
decrease in number of delegates or service sites. Ten grantees attributed the increase in CSP
FTEs to the integration of family planning services into comprehensive primary care, better

Attachment F - 114

data collection, an expansion of services, new sites, additional staff, or additional funding.
One grantee commented that the reported CSP FTE data were estimates.
Encounters—Seven grantees attributed the increase in total encounters to an increase in
clients served, improvements in data collection, or more clients having multiple encounters
during the reporting period. Seven grantees attributed a decrease in total encounters to clinic
closures, staff shortages, better data, a decrease in users, or changes in prescribing practices
that have reduced the frequency of visits for refills.
Four grantees attributed the increase in CSP encounters to one or more of the following
reasons: expanded services, reassignment of non-CSPs for flu vaccination activities, increased
staffing, increased number of sites, or improved data collection. Five grantees attributed the
decrease in CSP encounters to budget cuts, staffing shortages or reductions, or reduction in
clinic operating hours. One grantee noted that encounter data were incomplete for users
covered by Medicaid or Medicaid HMO.
Seven grantees attributed the increase in non-CSP encounters to better data collection, CSP
shortages, restricted clinician hours, or improved reporting of non-CSP encounters. Three
grantees attributed a decrease in the number of non-CSP encounters to a reduction in number
of sites, additional funding, or increased delivery of care by CSPs.
Four grantees noted difficulties in identifying encounters with non-CSP staff because of a
default in the practice management systems that credits all visits to a CSP.

FPAR TABLE 14: REVENUE REPORT
Title X revenue (row 1)—Title X revenue includes 2011 cash receipts or drawdown amounts
from all family planning service grants, including supplemental awards (e.g., HIV and male
involvement).
Medicaid revenue (row 3a)—Medicaid revenue includes revenue from state Medicaid
family planning eligibility expansions in 27 states in all 10 HHS regions. The states, by
region, include the following:
Region I–Rhode Island
Region II–New York
Region III–Delaware, Maryland, Pennsylvania, and Virginia
Region IV–Alabama, Florida, Georgia, North Carolina, Mississippi, and South Carolina
Region V–Illinois, Michigan, Minnesota, and Wisconsin
Region VI–Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
Region VII–Iowa and Missouri
Region VIII–Wyoming
Region IX–California
Region X–Oregon and Washington

Attachment F - 115

Other revenue (rows 12 to 16)—An illustrative list of “other” revenue sources reported in
rows 12 to 16 include client and other donations, consultation fees, U.S. Centers for Disease
Control and Prevention funding (e.g., Infertility Prevention Project, Breast and Cervical
Cancer Early Detection Program, HIV/AIDS Prevention and Testing), Colorado Family
Planning Initiative, Community Services Block Grant, contraceptive revenue, interest income,
training and education services revenue, delegate support, private foundation or grants, other
federal grants, social service charities, rental income, interest or investment income, general
funds, Healthy Woman Program, Massachusetts Alliance for Teen Pregnancy, Refugee
Health Program, Show Me Healthy Women, and the State of Alaska Breast/Cervical
Program.

TREND EXHIBITS
Exhibits A–7a, A–7b, and A–7c—In the FPAR National Summaries for 1999 to 2004
(Table A–6) and 2005 (Exhibit A–7a), the primary contraceptive use trend data for 1999
excluded 8,271 female users from the total number because the grantee did not report a
method of contraception for them. The correct total number of female users in 1999 was
4,315,040 and not 4,306,769, as shown in these trend tables from previous reports. In the
FPAR 2011 National Summary, these 8,271 users are included in the unknown method cell of
the 1999 primary contraceptive use column, bringing the total number of female users with an
unknown method in 1999 to 162,056 (instead of 153,785) and the total number of female
primary method users to 3,746,113 (instead of 3,737,842).
Exhibit A–7b—In the FPAR National Summaries for 1999 to 2009, female users for whom
the primary contraceptive method was unknown or not reported were assumed to be using a
method, and these users were included in the table presenting the distribution of methods
across female method users. An assessment of grantee comments in the FPAR reports for
2005 to 2011 indicates that method use information for these female users is missing from the
client record. Therefore, we cannot assume that a method was continued or adopted at exit
from the encounter. In the 2011 FPAR National Summary, female users with an unknown or
not reported method in the 1999 to 2011 reporting periods are excluded from Exhibit A– 7b.

Attachment F - 116

RTI International
3040 E. Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709-1294
Phone: 919-541-6000
Web site: www.rti.org