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pdfAugust 2018
Title X
Family Planning
Annual Report
2017 National Summary
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Family Planning Annual Report: 2017 National Summary
August 2018
Family Planning Annual Report:
2017 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 East Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709
_________________________________
RTI International is a registered trademark and a trade name of Research Triangle Institute.
SUGGESTED CITATION
Fowler, C. I., Gable, J., Wang, J., & Lasater, B. (2018, August). Family Planning Annual
Report: 2017 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 https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html.
ACKNOWLEDGMENTS
This report was prepared by RTI International under OPA contract number
HHSP23320095651WC/HHSP23337041T. RTI staff who prepared the report include
Christina Fowler (Project Director and Health Scientist), Julia Gable (Statistician), Jiantong
Wang (Statistician), and Beth Lasater (Information Systems Analyst). The conclusions
expressed in this report are those of the authors and do not necessarily represent the views of
HHS or OPA. Sharon Barrell and Margaret Johnson (Editors); Roxanne Snaauw (Document
Preparation Specialist); and Kimberly Cone, Pam Tuck, Teresa Bass, and Danny Occoquan
(Web Conversion Team) provided publications assistance. Nathan Sikes, Yuying Zhang, AlNisa Berry, and Vesselina Bakalov provided support for web-based data collection.
For their help resolving data validation issues and reviewing the final report, the authors
thank U.S. Department of Health and Human Services (HHS) Office of Population Affairs
(OPA) staff Emily Decker (FPAR Data Coordinator) and Ana Carolina Loyola Briceño and
HHS/OPA Regional Project Officers.
Finally, publication of this report would not have been possible without the contributions of
Title X services grantees and subrecipients that collect, compile, and submit FPAR data to
OPA.
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Family Planning Annual Report: 2017 National Summary
CONTENTS
Executive Summary ....................................................................... ES-1
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 Validation ...................................................................................................................... 5
3
Findings .............................................................................................. 7
Title X Service Network Profile ............................................................................................ 7
Family Planning User Demographic Profile .......................................................................... 8
Total Users (Exhibit 3) .................................................................................................... 8
Users by Sex (Exhibits 4 and 5) ...................................................................................... 9
Users by Age (Exhibits 4 and 5) ..................................................................................... 9
Users by Race (Exhibits 6 through 14) ......................................................................... 12
Users by Ethnicity (Exhibits 6 through 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) .............................................................. 22
Primary Contraceptive Method Use ..................................................................................... 27
Female Users by Primary Contraceptive Method (Exhibits 18 through 21) ................. 27
Trends in Female Primary Contraceptive Method Use ................................................. 29
Male Users by Primary Contraceptive Method (Exhibits 22 through 25) ..................... 35
Cervical and Breast Cancer Screening ................................................................................. 41
Cervical Cancer Screening (Exhibit 26)........................................................................ 41
Breast Cancer Screening (Exhibit 26) ........................................................................... 41
Sexually Transmitted Disease Testing ................................................................................. 43
Chlamydia Testing (Exhibits 27 and 28)....................................................................... 43
Gonorrhea Testing (Exhibit 29) .................................................................................... 44
Syphilis Testing (Exhibit 29) ........................................................................................ 44
Human Immunodeficiency Virus Testing (Exhibit 29) ................................................. 44
Staffing and Family Planning Encounters............................................................................ 49
Family Planning Annual Report: 2017 National Summary
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Clinical Services Provider Staffing (Exhibit 30) ........................................................... 49
Family Planning Encounters (Exhibit 30) ..................................................................... 49
Revenue................................................................................................................................ 53
Title X Services Grant ................................................................................................... 53
Payment for Services: Client Fees ................................................................................ 53
Payment for Services: Third-Party Payers .................................................................... 53
Other Revenue............................................................................................................... 54
Revenue per User and Encounter .................................................................................. 55
Revenue Trends: 2007 vs. 2017 .................................................................................... 58
4
References ........................................................................................ 59
Appendixes
A National Trend Exhibits .............................................................................................. A-1
B State Exhibits............................................................................................................... B-1
C Field and Methodological Notes ................................................................................. C-1
Exhibits
1. U.S. Department of Health and Human Services regions ............................................... 2
2. Number of and percentage change in grantees, subrecipients, and service sites,
by year and region: 2016–2017 (Source: FPAR Grantee Profile Cover Sheet) .............. 7
3. Number, distribution, and percentage change in number of all family planning
users, by year and region: 2016–2017 (Source: FPAR Table 1) ..................................... 8
4. Number of all family planning users, by sex, age, and region: 2017
(Source: FPAR Table 1) ................................................................................................ 10
5. Distribution of all family planning users, by sex, age, and region: 2017
(Source: FPAR Table 1) ................................................................................................ 11
6. Number and distribution of all family planning users, by race and ethnicity:
2017 (Source: FPAR Tables 2 and 3) ............................................................................ 13
7. Number and distribution of female family planning users, by race and
ethnicity: 2017 (Source: FPAR Table 2) ....................................................................... 13
8. Number and distribution of male family planning users, by race and ethnicity:
2017 (Source: FPAR Table 3) ....................................................................................... 13
9. Number of all family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Tables 2 and 3) ..................................................................................... 14
10. Distribution of all family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Tables 2 and 3) ..................................................................................... 15
11. Number of female family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Table 2) ................................................................................................ 16
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Family Planning Annual Report: 2017 National Summary
12. Distribution of female family planning users, by race, ethnicity, and region:
2017 (Source: FPAR Table 2) ....................................................................................... 17
13. Number of male family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Table 3) ................................................................................................ 18
14. Distribution of male family planning users, by race, ethnicity, and region:
2017 (Source: FPAR Table 3) ....................................................................................... 19
15. Number and distribution of all family planning users, by income level and
region: 2017 (Source: FPAR Table 4) ........................................................................... 23
16. Number and distribution of all family planning users, by principal health
insurance coverage status and region: 2017 (Source: FPAR Table 5) .......................... 24
17. Number and distribution of all family planning users, by limited English
proficiency (LEP) status and region: 2017 (Source: FPAR Table 6) ............................ 25
18. Number of female family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 7)......................................................................... 30
19. Distribution of female family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 7)......................................................................... 31
20. Number of female family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 7) .................................................................... 32
21. Distribution of female family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 7) .................................................................... 33
22. Number of male family planning users, by primary contraceptive method and
age: 2017 (Source: FPAR Table 8) ............................................................................... 36
23. Distribution of male family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 8)......................................................................... 37
24. Number of male family planning users, by primary contraceptive method and
region: 2017 (Source: FPAR Table 8) ........................................................................... 38
25. Distribution of male family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 8) .................................................................... 39
26. Cervical and breast cancer screening activities, by screening test or exam and
region: 2017 (Source: FPAR Tables 9 and 10) ............................................................. 42
27. Number of family planning users tested for chlamydia, by sex, age, and region:
2017 (Source: FPAR Table 11) ..................................................................................... 46
28. Percentage of family planning users in each age group tested for chlamydia, by
sex, age, and region: 2017 (Source: FPAR Table 11) ................................................... 47
29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and
region, and number of positive HIV tests, by region: 2017
(Source: FPAR Table 12) .............................................................................................. 48
30. Number and distribution of FTE CSP staff, by type of CSP and region, and
number and distribution of FP encounters, by type of encounter and region:
2017 (Source: FPAR Table 13) ..................................................................................... 51
Family Planning Annual Report: 2017 National Summary
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31. Amount and distribution of Title X project revenues, by revenue source: 2017
(Source: FPAR Table 14) .............................................................................................. 55
32. Amount of Title X project revenues, by revenue source and region: 2017
(Source: FPAR Table 14) .............................................................................................. 56
33. Distribution of Title X project revenues, by revenue source and region: 2017
(Source: FPAR Table 14) .............................................................................................. 57
A–1a. Number of Title X-funded grantees, subrecipients, and service sites, by region
and year: 2007–2017 ................................................................................................... A-2
A–1b. Distribution of Title X-funded grantees, subrecipients, and service sites, by
region and year: 2007–2017 ........................................................................................ A-3
A–1c. Number of Title X-funded service sites and users per service site, by year:
2007–2017 ................................................................................................................... A-4
A–2a. Number and distribution of all family planning users, by region and year:
2007–2017 ................................................................................................................... A-6
A–2b. Number and distribution of all family planning users, by region and year:
2007–2017 ................................................................................................................... A-7
A–3a. Number and distribution of all family planning users, by age and year:
2007–2017 ................................................................................................................... A-8
A–3b. Number and distribution of all family planning users, by age and year:
2007–2017 ................................................................................................................... A-9
A–4a. Number and distribution of all family planning users, by race and year:
2007–2017 ................................................................................................................. A-10
A–4b. Number and distribution of all family planning users, by race and year:
2007–2017 ................................................................................................................. A-11
A–5a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2007–2017 ................................................................. A-12
A–5b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2007–2017 ................................................................. A-13
A–6a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2007–2017......................................................................... A-14
A–6b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2007–2017......................................................................... A-15
A–7a. Number and distribution of all family planning users, by income level and
year: 2007–2017 ........................................................................................................ A-16
A–7b. Number and distribution of all family planning users, by income level and
year: 2007–2017 ........................................................................................................ A-17
A–8a. Number and distribution of all family planning users, by primary health
insurance status and year: 2007–2017 ....................................................................... A-18
A–8b. Number and distribution of all family planning users, by primary health
insurance status and year: 2007–2017 ....................................................................... A-19
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Family Planning Annual Report: 2017 National Summary
A–9a. Number of all female family planning users, by primary contraceptive method
and year: 2007–2017 ................................................................................................. A-20
A–9b. Distribution of all female family planning users, by primary contraceptive
method and year: 2007–2017 .................................................................................... A-21
A–9c. Number and distribution of all female family planning users, by type of
primary contraceptive method and year: 2007–2017 ................................................ A-22
A–10a. Number and percentage of female users who received a Pap test, number of
Pap tests performed, and percentage of Pap tests performed with an ASC or
higher result, by year: 2007–2017 ............................................................................. A-23
A–10b. Number and percentage of female users who received a Pap test, by year:
2007–2017 ................................................................................................................. A-23
A–11a. Number and percentage of female users under 25 tested for chlamydia, by
year: 2007–2017 ........................................................................................................ A-24
A–11b. Number and percentage of female users under 25 tested for chlamydia, by
year: 2007–2017 ........................................................................................................ A-24
A-12a. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2007–2017 ............................................................. A-25
A-12b. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2007–2017 ............................................................. A-25
A–13a. Actual and adjusted (constant 2017$ and 2007$) total, Title X, and Medicaid
revenue, by year: 2007–2017 .................................................................................... A-26
A–13b. Total, Title X, and Medicaid adjusted (constant 2017$) revenue (in millions),
by year: 2007–2017 ................................................................................................... A-27
A–13c. Total actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in
millions), by year: 2007–2017................................................................................... A-28
A–13d. Title X actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue
(in millions), by year: 2007–2017 ............................................................................. A-29
A–13e. Medicaid actual (unadjusted) and adjusted (constant 2017$ and 2007$)
revenue (in millions), by year: 2007–2017................................................................ A-30
A–14a. Amount of Title X project revenue, by revenue source and year: 2007–2017 .......... A-32
A–14b. Distribution of Title X project revenue, by revenue source and year: 2007–
2017 ........................................................................................................................... A-33
A–14c. Amount (unadjusted) and distribution of Title X project revenue, by revenue
source and year: 2007–2017 ...................................................................................... A-34
B–1. Number and distribution of all family planning users, by sex and state, and
distribution of all users, by state: 2017 (Source: FPAR Table 1) ................................ B-2
B–2. Number and distribution of all family planning users, by user income level and
state: 2017 (Source: FPAR Table 4)............................................................................ B-4
B–3a. Number and distribution of all family planning users, by insurance status and
state: 2017 (Source: FPAR Table 5)............................................................................ B-6
Family Planning Annual Report: 2017 National Summary
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B–3b. Number and distribution of all family planning users in the 50 states and
District of Columbia, by insurance status and state according to the states’
Medicaid expansion status: 2017 (Source: FPAR Table 5) ......................................... B-8
B–4. Number and distribution of female family planning users at risk of unintended
pregnancy,a by level of effectiveness of the primary method used or adopted at
exit from the encounter and state: 2017 (Source: FPAR Table 7) ............................. B-10
B–5. Number and percentage of female family planning users under 25 years who
were tested for chlamydia, by state: 2017 (Source: FPAR Table 11) ....................... B-12
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Family Planning Annual Report: 2017 National Summary
Executive Summary
The Title X National Family Planning Program, administered by the U.S. Department of
Health and Human Services, Office of Population Affairs (OPA), is the only federal program
dedicated solely to supporting the delivery of family planning and related preventive health
care. The program is designed to provide contraceptive supplies and information to all who
want and need them, with priority given to persons from low-income families. In addition to
offering a broad range of effective and acceptable contraceptive methods on a voluntary and
confidential basis, Title X-funded service sites provide contraceptive education and
counseling; breast and cervical cancer screening; sexually transmitted disease (STD) and
human immunodeficiency virus (HIV) testing, referral, and prevention education; and
pregnancy diagnosis and counseling.1,2 The program is implemented through competitively
awarded grants to state and local public health departments and community health, family
planning, and other private nonprofit agencies. For many clients, Title X providers are their
only ongoing source of health care and health education.3 In fiscal year 2017, the Title X
program received approximately $286.5 million in federal Title X funding.4
Annual submission of the Family Planning Annual Report (FPAR)5 is required of all Title X
service grantees.6 The 15-table FPAR provides grantee-level data on the demographic and
social characteristics of Title X clients, their use of family planning and related preventive
health services, staffing, and revenue. FPAR data have multiple uses, which include
monitoring performance and compliance with statutory requirements, fulfilling federal
accountability and performance reporting requirements, and guiding strategic and financial
planning. In addition, OPA uses FPAR data to respond to inquiries from policy makers and
Congress about the program and to estimate the impact of Title X on key reproductive health
outcomes.5
The purpose of the Family Planning Annual Report: 2017 National Summary is to present the
national-, regional-, and state-level findings for the 2017 reporting period (calendar year) and
trends for selected measures. Below we highlight key findings.
KEY 2017 FPAR FINDINGS
A diverse network of public and private nonprofit health and community service
agencies delivers Title X services. In 2017, Title X-funded services were implemented
through grants to 89 agencies: 47 (53%) state and local health departments and 42 (47%)
nonprofit family planning and community health agencies. Title X funds supported a network
of 3,858 service sites operated either by grantees or 1,091 subrecipients in the 50 United
States, the District of Columbia, and eight U.S. territories and Freely Associated States.
Title X providers serve a socioeconomically disadvantaged population, most of whom
are female, low income, and young. In 2017, Title X-funded providers served
approximately 4.0 million family planning users (i.e., clients) through 6.6 million family
planning encounters. A family planning user is an individual who has at least one family
planning encounter at a Title X service site during the reporting period. A family planning
encounter is a documented, face-to-face interaction between an individual and a family
Family Planning Annual Report: 2017 National Summary
ES-1
planning provider that includes the delivery of family planning services (alone or in
conjunction with related preventive health services) to avoid unintended pregnancies or
achieve intended pregnancies. About 9 of every 10 users (88%) were female, 65% were under
30 years of age, and 67% had family incomes at or below the poverty level ($24,600 for a
family of four in the 48 contiguous states and the District of Columbia).7
Title X providers serve a population with low rates of health insurance. In 2017, the
percentage of users who were insured (57%) exceeded the percentage who were uninsured
(42%). This is the third consecutive year, since OPA began collecting insurance data in 2005,
that the percentage insured has exceeded the percentage uninsured. Although the increase in
health insurance coverage signals greater access to health care for Title X clients, the
percentage of Title X users who were uninsured (42%) in 2017 is more than triple the national
rate for adults (13%).8 Among insured users, 67% had coverage through Medicaid or other
public sources and 33% had private coverage.
Title X providers serve a racially and ethnically diverse population. Of the 4.0 million
family planning users served in 2017, 31% self-identified with at least one of the nonwhite
Office of Management and Budget9 race categories (black or African American, Asian,
Native Hawaiian or Pacific Islander, American Indian or Alaska Native, or more than one
race), 33% self-identified as Hispanic or Latino, and 14% were limited English proficient.
Title X providers offer clients a broad range of effective, medically safe contraceptive
methods approved by the U.S. Food and Drug Administration. In 2017, 80% (2.8 million)
of all female users exited their last encounter in the reporting period with a most effective
(vasectomy, female sterilization, implant, or IUD), moderately effective (injectable
contraception, vaginal ring, contraceptive patch, pills, diaphragm, or cervical cap), or less
effective (male condom, female condom, sponge, withdrawal, a fertility awareness-based
method [FAM], lactational amenorrhea method [LAM], or spermicide used alone)
contraceptive method.10 Nine percent (313,802) of all female users exited their last encounter
with no primary method because they were either pregnant or seeking pregnancy. Among the
3.1 million female clients at risk of unintended pregnancy (not pregnant, not seeking
pregnancy, or abstinent), 70% (2.2 million) exited their last encounter with either a most
(21%) or moderately effective (49%) contraceptive method.
Title X-funded cervical and breast cancer screening services are necessary for early
detection and treatment. In 2017, Title X providers conducted Papanicolaou (Pap) testing
on 18% (649,266) of female users. Fourteen percent of the 683,247 Pap tests performed had
an indeterminate or abnormal result requiring further evaluation and possible treatment. In
addition, providers performed clinical breast exams on 25% (878,491) of female users and
referred 5% of those examined for further evaluation based on abnormal findings.
Title X-funded STD and HIV services provide testing necessary for preventing disease
transmission and adverse health consequences. In 2017, Title X providers tested 61%
(939,250) of female users under 25 for chlamydia. Providers also performed 2.4 million
gonorrhea tests (6.1 tests per 10 users), 1.2 million confidential HIV tests (3.0 tests per 10
users), and 709,161 syphilis tests (1.8 tests per 10 users). Of the confidential HIV tests
performed, 2,195 (1.8 per 1,000 tests performed) were positive for HIV.
ES-2
Family Planning Annual Report: 2017 National Summary
Title X providers deliver male-focused family planning and reproductive health services
to a growing number of male clients. In 2017, 12% (463,011) of all Title X users were men,
a number that has grown by 57% since 2007. Most male users were in their 20s (44%) or 30s
(22%), and 76% (353,287) adopted or continued use of condoms or another contraceptive
method at exit from their last encounter. In addition, Title X providers tested 69% (321,280)
of all male users for chlamydia and provided testing for several other STDs, including
gonorrhea (7.6 tests per 10 male users), HIV (5.9 tests per 10 male users), and syphilis (3.6
tests per 10 male users).
A variety of qualified health providers deliver Title X-funded clinical services. In 2017,
3,525 full-time equivalent (FTE) clinical services providers (CSPs) delivered Title X-funded
care. Nurse practitioners, certified nurse midwives, and physician assistants accounted for
70% of total CSP FTEs, followed by physicians (23%) and registered nurses with an
expanded scope of practice (7%). A CSP attended 78% of the 6.6 million family planning
encounters in 2017.
Title X projects rely on revenue from a variety of public and private sources. In 2017,
Title X grantees reported total project revenue of almost $1.3 billion to support their approved
Title X services projects. Five sources accounted for 86% of total revenue: Medicaid (38%, or
$495.2 million), Title X (19%, or $244.6 million), state and local governments (15%, or
$188.2 million), private third-party payers (11%, or $140.1 million), and client service fees
(4%, or $52.4 million). In 2017, Title X projects reported a net decrease of 3% ($40.3 million
in constant 2017 dollars) in total revenue compared with 2016.
Summary. The FPAR data for 2017, and over time, show that Title X providers continue to
deliver family planning and related preventive care to a socioeconomically disadvantaged
population. Despite the recent decline in revenue, the number of clients served has remained
almost level since 2015, and the delivery of recommended preventive health care remains
high, both of which attest to the network’s efforts to deliver care meeting the highest national
standards.
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Family Planning Annual Report: 2017 National Summary
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,11 is administered by the Office of Population Affairs (OPA),
Office of the Assistant Secretary for Health (OASH), within the U.S. Department of Health
and Human Services (HHS). The Title X program is the only federal program dedicated
solely to the provision of family planning and related preventive health care. 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. In addition to offering a broad range
of effective and acceptable contraceptive methods on a voluntary and confidential basis, Title
X-funded centers provide contraceptive education and counseling; breast and cervical cancer
screening; sexually transmitted disease (STD) and human immunodeficiency virus (HIV)
testing, referral, and prevention education; and pregnancy diagnosis and counseling.1,2 By
law, Title X funds cannot be used in programs where abortion is a method of family
planning.1,2 The program is implemented through grants to approximately 90 public health
departments and community health, family planning, and other private nonprofit agencies.
These grants support delivery of Title X services in approximately 4,000 sites. For many
clients, Title X providers are their only ongoing source of health care and health education.3
In fiscal year 2017, the Title X program received approximately $286.5 million in federal
Title X funding.4
The HHS Regional Offices monitor the performance of the Title X grantees in their respective
regions (see Exhibit 1), with overall program oversight from OPA.
FAMILY PLANNING ANNUAL REPORT
The Family Planning Annual Report (FPAR)5 is the only source of uniform reporting by all
Title X services grantees. The FPAR provides consistent, national-level data on program
users, service providers, utilization of family planning and related preventive health services,
and sources of program revenue. Annual submission of the FPAR is required of all Title X
services grantees for purposes of monitoring and reporting program performance.6 The FPAR
data are presented in summary form to protect the confidentiality of the persons who receive
Title X-funded services.2
Title X administrators and grantees use FPAR data to
▪ monitor compliance with statutory requirements;
▪ comply with accountability and federal performance reporting requirements for Title X
family planning funds, including but not limited to the Government Performance and
Results Modernization Act and the Office of Management and Budget (OMB);
▪ guide strategic and financial planning and respond to inquiries from policy makers and
Congress about the program; and
Family Planning Annual Report: 2017 National Summary
1
▪ estimate the impact of Title X-funded activities on key reproductive health outcomes,
including prevention of unintended pregnancy, infertility, and invasive cervical cancer.5
Exhibit 1.
U.S. Department of Health and Human Services regions
The 10 HHS regions (and regional office locations) are as follows:
▪ Region I (Boston, MA)—Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont
▪ Region II (New York, NY)—New Jersey, New York, Puerto Rico, and the U.S. Virgin
Islands
▪ Region III (Philadelphia, PA)—Delaware; Maryland; Pennsylvania; Virginia;
Washington, DC; 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
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Family Planning Annual Report: 2017 National Summary
REPORT STRUCTURE
The Family Planning Annual Report: 2017 National Summary presents data for the
89 Title X services grantees that submitted an FPAR report for the 2017 reporting period
(January 1, 2017, through December 31, 2017). The National Summary has four 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 includes
definitions for table-specific FPAR terms and reporting guidance.
▪ Section 4—References—is a list of National Summary references.
Additional data for the National Summary are included in three appendices: Appendix A
presents trend data for selected indicators for 2007 through 2017. Appendix B presents 2017
data for selected indicators by state, which includes the 50 states, the District of Columbia,
and the eight U.S. territories and Freely Associated States (American Samoa, Commonwealth
of the Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico,
Republic of the Marshall Islands, Republic of Palau, and the U.S. Virgin Islands). The
Appendix B exhibits present information on the number and distribution of Title X family
planning users served by sex, income level, health insurance coverage status (overall and by
Medicaid expansion status), contraceptive use, and chlamydia testing. Appendix C presents
general and table-specific notes about the data presented in this report.
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 both the tabular and graphical presentations of
the 2017 or trend data. Each exhibit identifies the FPAR table that is the source for the data
presented.
Note:
Due to rounding, percentages cited in text may not match summed percentages from the
exhibits.
Family Planning Annual Report: 2017 National Summary
3
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 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 PROVIDERS—Include 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 assessments recommended for contraceptive, related preventive health, and basic infertility care. 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.12
OTHER SERVICES PROVIDERS—Include other agency staff (e.g., registered nurses, public health nurses, licensed
vocational or licensed practical nurses, certified nurse assistants, health educators, social workers, or clinic aides)
that offer client education, counseling, referral, or follow-up services relating to the client’s proposed or adopted
method of contraception, general reproductive health, or infertility treatment, as described in the Program
Guidelines.12 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.12
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 services provided during the family planning encounter must be
documented in the client record. 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 tests are accompanied by family planning counseling or
education.
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 nonclinical assessment and care
during the visit is credited with the encounter.
Family Planning Service Site—A family planning service site refers to an established unit where grantee or
subrecipient agency staff provide Title X services (clinical, counseling, educational, or referral) that comply with Title X
Program Guidelines12 and where at least some of the encounters between the family planning providers and the
individuals served meet the requirements of a family planning encounter. Established units include clinics, hospital
outpatient departments, homeless shelters, detention and correctional facilities, and other locations where Title X
agency staff provide these family planning services. Service sites may also include equipped mobile vans or schools.
Client Records—Title X projects must establish a medical record for every client who is counted as a Title X user,
including but not limited to those who obtain clinical services or other screening or laboratory services (e.g., blood
pressure check, urine-based pregnancy, or STD test). The medical record contains personal data; a medical history;
physical exam data; laboratory test orders, results, and follow-up; treatment and special instructions; scheduled
revisits; informed consent forms; documentation of refusal of services; and information on allergies and untoward
reactions to identified drug(s). The medical record also contains clinical findings; diagnostic and therapeutic orders;
and documentation of continuing care, referral, and follow-up. The medical record allows for entries by counseling and
social service staff. The medical record is a confidential record, accessible only to authorized staff and secured by lock
when not in use. The client medical record must contain sufficient information to identify the client, indicate where and
how the client can be contacted, justify the clinical impression or diagnosis, and warrant the treatment and end results.
If a family planning user receives no clinical services, the provider still must establish a client record that enables the
site to complete the required FPAR data reporting.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 7–10.
4
Family Planning Annual Report: 2017 National Summary
2
FPAR Methodology
DATA COLLECTION
The Title X Family Planning Annual Report (FPAR): Forms and Instructions (Reissued
October 2016)5 consists of 15 reporting tables. The FPAR instructions provide definitions for
key FPAR terms to ensure uniform reporting by Title X grantees. The key terms describe the
individuals receiving family planning and related preventive health services at Title X-funded
service sites, the range and scope of the services provided, and the family planning providers
that render care.
Title X services grantees are required to submit the FPAR by February 15 for the recently
completed reporting period (January 1 to December 31). In February 2018, 89 grantees
submitted FPARs for the 2017 reporting period. Almost all (99%) FPARs were submitted by
the due date, and all were submitted using the web-based FPAR Data System
(https://fpar.opa.hhs.gov/).
DATA VALIDATION
FPAR data undergo both electronic and manual validations prior to tabulation. During data
entry, the FPAR Data System performs a set of automated validation procedures that ensure
consistency within and across tables. These validation procedures include calculation of row
and column totals and cross-table comparisons of selected cell values. Each validation
procedure is based on a validation rule that defines which table cells to compare and what
condition or validation test to apply.
After a grantee submits an FPAR, it goes through two levels of review by HHS staff. First,
HHS regional staff review the FPAR and either accept it or return it to the grantee for
correction or clarification. Once the HHS regional 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 International extracts the FPAR data from the
FPAR Data System database and performs further electronic validations to identify potential
reporting errors and problems, including missing and out-of-range values for selected
measures (e.g., STD test-to-user ratios). RTI also performs a manual review of all comments
entered into the FPAR table “Note” fields.
RTI summarizes the results of the electronic and manual validations in a grantee-specific
report, compiled by region, which RTI sends to the FPAR Data Coordinator for follow-up
and resolution. Once HHS staff and grantees address all outstanding validation issues in the
FPAR Data System, RTI extracts the final data file for tabulation and analysis.
Family Planning Annual Report: 2017 National Summary
5
Guidance for Reporting User Demographic Profile Data in FPAR Tables 1 through 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 30 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 as follows:
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 as follows:
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 October 2016), pp. 15–17, A-1–A-2.
6
Family Planning Annual Report: 2017 National Summary
3
Findings
TITLE X SERVICE NETWORK PROFILE
In 2017, Title X-funded services were implemented through grants to 89 agencies: 47 (53%)
state and local health departments and 42 (47%) nonprofit family planning and community
health agencies. This funding supported a service network that included 1,091 subrecipients
(subcontractors) and 3,858 service sites in the 50 United States, the District of Columbia, and
the eight U.S. territories and Freely Associated States (Exhibit 2).
Compared with 2016, in 2017, the Title X program had two fewer grantees (89 vs. 91), 26
fewer subrecipients (1,091 vs. 1,117), and 40 fewer service sites (3,858 vs. 3,898). All but
three regions (II, III, and VIII) reported a decrease in subrecipients, while seven regions (I,
IV, V, VI, VII, VIII, and IX) reported a decrease in service sites (Exhibit 2).
Exhibit 2.
Number of and percentage change in grantees, subrecipients, and service sites, by year
and region: 2016–2017 (Source: FPAR Grantee Profile Cover Sheet)
Network
Feature
All
Region
Regions
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
Grantees
2017
89
11
6
10
9
11
6
5
6
17
8
2016
91
11
6
10
9
11
7
5
6
18
8
Difference
−2
0
0
0
0
0
−1
0
0
−1
0
% Change
−2%
0%
0%
0%
0%
0%
−14%
0%
0%
−6%
0%
Subrecipients
2017
1,091
68
68
225
277
113
39
91
69
85
56
1,117
69
68
223
281
118
41
92
68
99
58
Difference
−26
−1
0
2
−4
−5
−2
−1
1
−14
−2
% Change
−2%
−1%
0%
1%
−1%
−4%
−5%
−1%
1%
−14%
−3%
Service Sites
2017
3,858
221
244
653
912
365
415
210
162
465
211
3,898
225
244
640
914
374
425
221
180
469
206
Difference
−40
−4
0
13
−2
−9
−10
−11
−18
−4
5
% Change
−1%
−2%
0%
2%
0%†
−2%
−2%
−5%
−10%
−1%
2%
2016
2016
†
Percentage change is greater than –0.5% and less than 0.5%.
Family Planning Annual Report: 2017 National Summary
7
Since 2007, the change in the number of grantees and subrecipients has been smaller than the
change in the number of service sites. Compared with 2007, in 2017, there was no change in
the number of grantees (89 in 2017 and 2007), a 7% decrease in the number of subrecipients
(1,091 vs. 1,176), and a 15% decrease in the number of service sites (3,858 vs. 4,542).
Exhibits A–1a and A–1b in Appendix A present trends (2007–2017) in the number of
grantees, subrecipients, and service sites by region.
FAMILY PLANNING USER DEMOGRAPHIC PROFILE
Total Users (Exhibit 3)
In 2017, Title X-funded sites served over 4.0 million family planning users. Grantees in
Region IX served 27% of Title X users; those in Regions II, III, IV, V, and VI each served
between 9% and 17%; and those in Regions I, VII, VIII, and X served between 3% and 5%.
The number of users served in 2017 was 0.1% (or 3,306 users) lower than in 2016. Region
VII reported the largest numeric decline in users (by 15,148 users). Three other regions
reported client losses ranging from 5,671 (X) to 13,369 (III), and six others reported gains of
between 945 (II) and 15,713 (VI) (Exhibit 3). On average, the number of users per service
site increased by 10, from 1,028 in 2016 to 1,038 in 2017 (Exhibit A–1c).
In 2017, the number of family planning users served (4.0 million) was 20% (or 982,992
users) lower than the number served in 2007 (5.0 million) and 23% (or 1.2 million) lower
than the highest number of users (5.2 million) ever served by the program in a single year
(2010) (Exhibits A–2a and A–2b).
Exhibit 3.
Users
Number
2017
2016
Difference
% Change
Distribution
2017
2016
Number, distribution, and percentage change in number of all family planning users, by
year and region: 2016–2017 (Source: FPAR Table 1)
All
Regions
Region
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
4,004,246 194,952
429,091
464,216
677,146
391,901
350,646
120,759
126,922
1,093,827 154,786
4,007,552 183,383
428,146
477,585
669,743
390,541
334,933
135,907
124,021
1,102,836 160,457
945
−13,369
7,403
1,360
15,713 −15,148
2,901
−9,009
−5,671
−3%
1%
−3,306
0%†
11,569
6%
0%†
0%†
Region
IX
Region
X
5%
−11%
2%
−1%
−4%
100%
5%
11%
12%
17%
10%
9%
3%
3%
27%
4%
100%
5%
11%
12%
17%
10%
8%
3%
3%
28%
4%
Note: Due to rounding, percentages may not sum to 100%.
†
8
Percentage change is greater than –0.5% and less than 0.5%.
Family Planning Annual Report: 2017 National Summary
Users by Sex (Exhibits 4 and 5)
Of the 4.0 million family planning users served in 2017, 88% (3.5 million) were female and
12% (463,011) were male (Exhibits 4 and 5).
▪ By region, 84% (VIII) to 92% (X) of total users were female (Exhibit 5).
▪ By state, the percentage of total users who were female ranged from 73% to 100%
(Exhibit B–1 in Appendix B).
From 2007 through 2017, the percentage of users who were female declined from 94% to
88%, while the percentage of users who were male increased from 6% to 12%. Numerically,
the number of female users decreased 25%, from 4.7 million in 2007 to 3.5 million in 2017,
while the number of male users increased 57%, from 295,381 in 2007 to 463,011 in 2017
(Exhibits A–2a and A–2b).
Users by Age (Exhibits 4 and 5)
In 2017, 17% (693,724) of family planning users were under 20, 47% (1.9 million) were 20 to
29, and 35% (1.4 million) were 30 or older. Approximately the same percentages of female
and male users were in their teens (17% females and 16% males). A higher percentage of
female (48%) than male (44%) users was in their 20s, while a higher percentage of male
(40%) than female (35%) users was 30 or over (Exhibits 4 and 5).
▪ Across regions, there was higher variation in the age distribution of male and female users.
– Among female users, 15% (II) to 22% (VIII and X) were in their teens, 44% (I, III, and
VI) to 51% (V and IX) were in their 20s, and 29% (VIII) to 39% (VI) were 30 or over.
– Among male users, 11% (IX) to 24% (III) of male users were in their teens, 30% (IV) to
54% (V) were in their 20s, and 32% (II) to 51% (IV) were 30 or over.
See Exhibits A–3a and A–3b for trends (2007–2017) in the distribution of all family planning
users by age group.
▪ Numerically, the number of teenage users decreased 45%, from 1.3 million (2007) to
693,724 (2017), while the number of users 20 to 24 decreased 35%, from 1.6 million
(2007) to 1.0 million (2017).
▪ In contrast, the percentage of users 25 or over increased from 44% (2007) to 57% (2017).
Numerically, this represents a 6% increase, from 2.2 million users (2007) to 2.3 million
(2017).
Family Planning Annual Report: 2017 National Summary
9
Exhibit 4.
Number of all family planning users, by sex, age, and region: 2017 (Source: FPAR Table 1)
10
Age Group (Years)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
36,621
2,636
3,019
6,809
9,006
3,132
3,357
1,120
1,208
4,865
1,469
15 to 17
242,464
13,871
22,133
31,489
42,709
25,672
21,586
8,858
9,165
53,493
13,488
18 to 19
340,340
15,772
33,212
37,365
55,963
36,615
29,621
11,432
13,369
90,840
16,151
20 to 24
908,324
38,380
98,668
92,192
144,018
97,164
74,454
26,942
31,005
266,945
38,556
25 to 29
777,777
35,234
89,661
84,371
129,370
76,656
65,315
21,453
20,493
224,591
30,633
30 to 34
517,460
24,669
60,814
60,240
93,320
46,271
49,753
15,317
13,382
134,319
19,375
35 to 39
334,384
16,375
38,140
40,680
61,927
28,342
35,248
10,677
8,625
82,584
11,786
40 to 44
195,225
10,252
21,626
24,830
34,599
14,891
19,893
6,209
4,867
51,495
6,563
Over 44
Family Planning Annual Report: 2017 National Summary
188,640
9,590
19,287
26,057
38,863
13,233
16,799
6,556
3,914
49,343
4,998
Subtotal
3,541,235
166,779
386,560
404,033
609,775
341,976
316,026
108,564
106,028
958,475
143,019
Male Users
Under 15
12,439
1,191
1,245
2,983
4,137
535
795
103
378
1,018
54
28,965
3,281
2,958
6,433
4,618
1,775
2,108
545
1,036
5,594
617
18 to 19
32,895
2,090
3,474
4,874
3,864
3,520
2,931
1,075
1,446
8,795
826
20 to 24
105,619
5,500
11,239
11,973
10,351
14,170
7,520
3,430
5,324
33,260
2,852
25 to 29
99,811
5,677
9,972
10,302
10,090
12,688
6,849
2,765
4,926
33,758
2,784
30 to 34
63,373
3,713
6,055
6,758
7,690
7,161
4,663
1,740
3,023
20,627
1,943
35 to 39
40,372
2,342
3,201
4,767
6,200
4,098
3,304
1,041
1,836
12,402
1,181
40 to 44
25,523
1,414
1,708
3,172
5,268
2,237
2,189
612
1,126
7,126
671
Over 44
54,014
2,965
2,679
8,921
15,153
3,741
4,261
884
1,799
12,772
839
Subtotal
463,011
28,173
42,531
60,183
67,371
49,925
34,620
12,195
20,894
135,352
11,767
15 to 17
All Users
Under 15
49,060
3,827
4,264
9,792
13,143
3,667
4,152
1,223
1,586
5,883
1,523
15 to 17
271,429
17,152
25,091
37,922
47,327
27,447
23,694
9,403
10,201
59,087
14,105
18 to 19
373,235
17,862
36,686
42,239
59,827
40,135
32,552
12,507
14,815
99,635
16,977
20 to 24
1,013,943
43,880
109,907
104,165
154,369
111,334
81,974
30,372
36,329
300,205
41,408
25 to 29
877,588
40,911
99,633
94,673
139,460
89,344
72,164
24,218
25,419
258,349
33,417
30 to 34
580,833
28,382
66,869
66,998
101,010
53,432
54,416
17,057
16,405
154,946
21,318
35 to 39
374,756
18,717
41,341
45,447
68,127
32,440
38,552
11,718
10,461
94,986
12,967
40 to 44
220,748
11,666
23,334
28,002
39,867
17,128
22,082
6,821
5,993
58,621
7,234
Over 44
242,654
12,555
21,966
34,978
54,016
16,974
21,060
7,440
5,713
62,115
5,837
4,004,246
194,952
429,091
464,216
677,146
391,901
350,646
120,759
126,922
1,093,827
154,786
Total All Users
Family Planning Annual Report: 2017 National Summary
Exhibit 5.
Distribution of all family planning users, by sex, age, and region: 2017 (Source: FPAR Table 1)
Age Group (Years)
11
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal
1%
7%
10%
26%
22%
15%
9%
6%
5%
100%
2%
8%
9%
23%
21%
15%
10%
6%
6%
100%
1%
6%
9%
26%
23%
16%
10%
6%
5%
100%
2%
8%
9%
23%
21%
15%
10%
6%
6%
100%
1%
7%
9%
24%
21%
15%
10%
6%
6%
100%
1%
8%
11%
28%
22%
14%
8%
4%
4%
100%
1%
7%
9%
24%
21%
16%
11%
6%
5%
100%
1%
8%
11%
25%
20%
14%
10%
6%
6%
100%
1%
9%
13%
29%
19%
13%
8%
5%
4%
100%
1%
6%
9%
28%
23%
14%
9%
5%
5%
100%
1%
9%
11%
27%
21%
14%
8%
5%
3%
100%
Male Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal
3%
6%
7%
23%
22%
14%
9%
6%
12%
100%
4%
12%
7%
20%
20%
13%
8%
5%
11%
100%
3%
7%
8%
26%
23%
14%
8%
4%
6%
100%
5%
11%
8%
20%
17%
11%
8%
5%
15%
100%
6%
7%
6%
15%
15%
11%
9%
8%
22%
100%
1%
4%
7%
28%
25%
14%
8%
4%
7%
100%
2%
6%
8%
22%
20%
13%
10%
6%
12%
100%
1%
4%
9%
28%
23%
14%
9%
5%
7%
100%
2%
5%
7%
25%
24%
14%
9%
5%
9%
100%
1%
4%
6%
25%
25%
15%
9%
5%
9%
100%
0%†
5%
7%
24%
24%
17%
10%
6%
7%
100%
All Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Total All Users
1%
7%
9%
25%
22%
15%
9%
6%
6%
100%
2%
9%
9%
23%
21%
15%
10%
6%
6%
100%
1%
6%
9%
26%
23%
16%
10%
5%
5%
100%
2%
8%
9%
22%
20%
14%
10%
6%
8%
100%
2%
7%
9%
23%
21%
15%
10%
6%
8%
100%
1%
7%
10%
28%
23%
14%
8%
4%
4%
100%
1%
7%
9%
23%
21%
16%
11%
6%
6%
100%
1%
8%
10%
25%
20%
14%
10%
6%
6%
100%
1%
8%
12%
29%
20%
13%
8%
5%
5%
100%
1%
5%
9%
27%
24%
14%
9%
5%
6%
100%
1%
9%
11%
27%
22%
14%
8%
5%
4%
100%
90%
10%
87%
13%
90%
10%
87%
13%
90%
10%
90%
10%
84%
16%
88%
12%
92%
8%
Female Users
88%
86%
Male Users
12%
14%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Users by Race (Exhibits 6 through 14)
In 2017, 54% (approximately 2.2 million) of all family planning users identified themselves
as white, 22% (869,574) as black or African American, 4% (143,215) as Asian, and 1% as
either American Indian or Alaska Native (35,587) or Native Hawaiian or Other Pacific
Islander (31,019). Four percent (144,397) of all users self-identified with two or more of the
five minimum race categories specified by OMB,9 and race was either unknown or not
reported for 16% (629,974) (Exhibit 6).
▪ By sex, the racial composition of female (Exhibits 7, 11, and 12) and male users
(Exhibits 8, 13, and 14) differed slightly in terms of the percentages in each group that
self-identified as white (54% of female users vs. 50% of male users) and black or African
American (21% of female users vs. 27% of male users). The distribution of users across the
remaining race categories and for whom race was unknown was within one percentage
point for female and male users.
▪ By region, the distribution of users by race varied widely (Exhibits 9 and 10). The
percentage of users who self-identified as white ranged from 44% (IX) to 75% (VII and
VIII), 5% (X) to 38% (IV) self-identified as black or African American, 1% (IV and VI) to
7% (IX) self-identified as Asian, and 2% (III, IV, VI, and VIII) to 8% (I) self-identified
with two or more race categories.
▪ Of the 629,974 users with an unknown race, 75% self-identified as Hispanic or Latino
ethnicity (Exhibit 6).
See Exhibits A–4a and A–4b for trends (2007–2017) in the distribution of all family planning
users by self-identified race.
Users by Ethnicity (Exhibits 6 through 14)
In 2017, 33% (1.3 million) of users self-identified as Hispanic or Latino ethnicity (Exhibit 6).
▪ By sex, 34% (1.2 million) of female users and 28% (130,066) of male users self-identified
as Hispanic or Latino, while ethnicity was unknown for 3% of female users and 4% of
male users (Exhibits 7 and 8).
▪ By region, grantees in Regions II, VI, and IX reported the highest percentages of female
(39% to 52%) and male (33% to 44%) users who self-identified as Hispanic or Latino
(Exhibits 11, 12, 13, and 14).
See Exhibits A–5a and A–5b for trends (2007–2017) in the distribution of all family planning
users by self-identified Hispanic or Latino ethnicity. See Exhibits A–6a and A–6b for trends
(2007–2017) in the distributions of all family planning users by self-identified race and
ethnicity.
12
Family Planning Annual Report: 2017 National Summary
Exhibit 6.
Number and distribution of all family planning users, by race and ethnicity: 2017
(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
13,463
21,103
1,021
35,587
0%†
1%
0%†
1%
5,256
130,688
7,271
143,215
0%†
3%
0%†
4%
Black/African American
40,452
806,970
22,152
869,574
1%
20%
1%
22%
Nat Hawaiian/Pac Island
5,453
24,508
1,058
31,019
0%†
1%
0%†
1%
706,762
1,394,432
49,286
2,150,480
18%
35%
1%
54%
Asian
White
More than one race
Unknown/not reported
Total All Users
79,973
58,948
5,476
144,397
2%
1%
0%†
4%
473,458
116,767
39,749
629,974
12%
3%
1%
16%
1,324,817
2,553,416
126,013
4,004,246
33%
64%
3%
100%
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Exhibit 7.
Number and distribution of female family planning users, by race and ethnicity: 2017
(Source: FPAR Table 2)
Hispanic
or Latino
Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total Female Users
12,346
Not
Hispanic or
Latino
18,960
Ethnicity
UK/NR
833
Total
32,139
%
Hispanic
or Latino
0%†
%
Not Hispanic
or Latino
1%
%
Ethnicity
UK/NR
0%†
%
Total
1%
4,758
119,071
6,569
130,398
0%†
3%
0%†
4%
34,613
690,969
18,149
743,731
1%
20%
1%
21%
4,893
22,794
965
28,652
1%
0%†
1%
642,470
1,233,668
42,916
1,919,054
18%
0%†
35%
1%
54%
70,839
52,005
4,534
127,378
2%
1%
0%†
4%
424,832
101,168
33,883
559,883
12%
3%
1%
16%
1,194,751
2,238,635
107,849
3,541,235
34%
63%
3%
100%
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Exhibit 8.
Number and distribution of male family planning users, by race and ethnicity: 2017
(Source: FPAR Table 3)
Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total Male Users
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR
Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
1,117
2,143
188
3,448
0%†
0%†
0%†
1%
498
11,617
702
12,817
0%†
3%
0%†
3%
5,839
116,001
4,003
125,843
1%
25%
560
1,714
93
2,367
64,292
160,764
6,370
231,426
14%
9,134
6,943
942
17,019
2%
48,626
15,599
5,866
70,091
130,066
314,781
18,164
463,011
1%
27%
0%†
1%
35%
1%
50%
1%
0%†
4%
11%
3%
1%
15%
28%
68%
4%
100%
0%†
0%†
Am Indian/Alaska Native=American Indian or Alaska Native. Nat Hawaiian/Pac Island=Native Hawaiian or Other Pacific Islander.
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
13
Exhibit 9.
Number of all family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Tables 2 and 3)
14
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Region I
Region II
Region III
Region IV
Region V
Region VI
13,463
21,103
1,021
35,587
284
645
40
969
2,705
1,133
56
3,894
903
4,087
131
5,121
2,204
1,738
37
3,979
1,149
1,677
101
2,927
581
3,423
31
4,035
335
949
33
1,317
5,256
130,688
7,271
143,215
168
10,118
108
10,394
442
14,570
110
15,122
511
8,816
396
9,723
460
6,601
99
7,160
183
8,471
433
9,087
153
3,594
61
3,808
40,452
806,970
22,152
869,574
4,181
28,250
330
32,761
15,632
100,494
589
116,715
3,747
142,660
5,041
151,448
6,819
250,061
2,183
259,063
1,867
98,709
2,352
102,928
5,453
24,508
1,058
31,019
581
237
16
834
928
569
22
1,519
489
417
39
945
746
599
90
1,435
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
706,762
1,394,432
49,286
2,150,480
21,986
90,949
3,231
116,166
61,403
126,789
3,175
191,367
37,537
178,384
9,456
225,377
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
79,973
58,948
5,476
144,397
9,740
5,915
449
16,104
16,504
2,400
68
18,972
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
473,458
116,767
39,749
629,974
12,975
3,682
1,067
17,724
1,324,817
2,553,416
126,013
4,004,246
49,915
139,796
5,241
194,952
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2017 National Summary
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region VII Region VIII
Region IX
Region X
556
1,409
60
2,025
4,287
4,740
455
9,482
459
1,302
77
1,838
280
2,082
107
2,469
69
2,477
133
2,679
2,834
67,023
5,593
75,450
156
6,936
231
7,323
1,378
79,134
345
80,857
1,888
16,487
473
18,848
297
6,540
329
7,166
4,232
77,834
10,204
92,270
411
6,801
306
7,518
309
434
37
780
321
592
12
925
57
198
5
260
86
544
39
669
1,628
19,789
767
22,184
308
1,129
31
1,468
109,228
253,661
2,767
365,656
34,916
193,774
4,711
233,401
149,684
91,120
742
241,546
23,504
64,789
1,841
90,134
21,747
70,993
2,144
94,884
230,580
235,164
18,644
484,388
16,177
88,809
2,575
107,561
5,553
3,019
351
8,923
3,632
7,406
156
11,194
3,259
9,795
492
13,546
2,610
4,893
35
7,538
1,400
1,743
156
3,299
930
1,379
159
2,468
35,216
18,006
3,596
56,818
1,129
4,392
14
5,535
65,648
15,451
403
81,502
39,942
17,479
5,258
62,679
19,695
7,493
1,471
28,659
21,657
5,663
1,912
29,232
5,947
5,713
277
11,937
2,518
924
990
4,432
13,047
2,350
1,634
17,031
275,582
51,648
26,005
353,235
16,447
6,364
732
23,543
163,262
261,406
4,423
429,091
88,682
354,862
20,672
464,216
142,784
527,559
6,803
677,146
63,340
318,523
10,038
391,901
160,674
188,469
1,503
350,646
29,982
87,172
3,605
120,759
36,732
85,692
4,498
126,922
554,359
474,204
65,264
1,093,827
35,087
115,733
3,966
154,786
Family Planning Annual Report: 2017 National Summary
Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Tables 2 and 3)
Race and Ethnicity
All Regions
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%†
1%
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
2%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
0%†
3%
0%†
4%
0%†
5%
0%†
5%
0%†
3%
0%†
4%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
2%
0%†
2%
0%†
6%
1%
7%
0%†
4%
0%†
5%
2%
14%
0%†
17%
4%
23%
0%†
27%
1%
37%
0%†
38%
0%†
25%
1%
26%
0%†
23%
0%†
23%
2%
14%
0%†
16%
0%†
5%
0%†
6%
0%†
7%
1%
8%
0%†
4%
0%†
5%
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%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
1%
20%
1%
22%
0%†
1%
0%†
1%
18%
35%
1%
54%
2%
1%
0%†
4%
15
Percentage is less than 0.5%.
11%
47%
2%
60%
14%
30%
1%
45%
5%
3%
0%†
8%
4%
1%
0%†
4%
12%
3%
1%
16%
7%
2%
1%
9%
15%
4%
0%†
19%
33%
64%
3%
100%
26%
72%
3%
100%
Note: Due to rounding, percentages may not sum to 100%.
†
Region I
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
38%
61%
1%
100%
1%
31%
1%
33%
0%†
0%†
0%†
0%†
8%
38%
2%
49%
1%
1%
0%†
2%
9%
4%
1%
14%
19%
76%
4%
100%
16%
37%
0%†
54%
9%
49%
1%
60%
43%
26%
0%†
69%
19%
54%
2%
75%
17%
56%
2%
75%
1%
1%
0%†
2%
1%
2%
0%†
3%
1%
1%
0%†
2%
1%
1%
0%†
3%
3%
1%
0%†
4%
6%
1%
0%†
7%
2%
2%
0%†
3%
2%
1%
1%
4%
10%
2%
1%
13%
25%
5%
2%
32%
46%
54%
0%†
100%
25%
72%
3%
100%
29%
68%
4%
100%
51%
43%
6%
100%
21%
78%
1%
100%
16%
81%
3%
100%
1%
1%
0%†
2%
21%
21%
2%
44%
3%
2%
0%†
5%
10%
57%
2%
69%
1%
3%
0%†
4%
11%
4%
0%†
15%
23%
75%
3%
100%
Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 2)
16
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
12,346
18,960
833
32,139
253
525
26
804
2,623
1,013
56
3,692
844
3,644
102
4,590
2,171
1,639
33
3,843
992
1,424
78
2,494
535
3,274
21
3,830
317
818
21
1,156
428
1,229
50
1,707
3,750
4,172
373
8,295
433
1,222
73
1,728
4,758
119,071
6,569
130,398
154
9,450
91
9,695
378
13,357
107
13,842
461
8,005
351
8,817
433
5,835
82
6,350
169
7,484
392
8,045
143
3,254
46
3,443
274
1,937
95
2,306
64
2,186
116
2,366
2,534
60,914
5,065
68,513
148
6,649
224
7,021
34,613
690,969
18,149
743,731
3,490
23,426
262
27,178
14,177
89,433
568
104,178
3,037
118,921
3,932
125,890
5,163
221,411
1,890
228,464
1,591
83,784
1,903
87,278
1,180
66,174
216
67,570
1,777
13,699
339
15,815
242
4,512
250
5,004
3,588
63,558
8,517
75,663
368
6,051
272
6,691
4,893
22,794
965
28,652
485
203
16
704
800
489
22
1,311
425
372
36
833
707
557
89
1,353
269
387
31
687
298
560
10
868
51
177
4
232
65
442
30
537
1,503
18,548
699
20,750
290
1,059
28
1,377
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
642,470
1,233,668
42,916
1,919,054
19,332
77,021
2,749
99,102
57,081
112,919
3,117
173,117
33,792
159,996
8,679
202,467
101,016
231,071
2,340
334,427
31,674
169,340
4,005
205,019
137,730
84,023
665
222,418
22,072
58,621
1,504
82,197
18,746
58,888
1,770
79,404
205,685
200,028
15,713
421,426
15,342
81,761
2,374
99,477
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
70,839
52,005
4,534
127,378
8,444
5,025
369
13,838
15,514
2,178
64
17,756
4,244
2,571
296
7,111
3,436
6,447
122
10,005
2,865
8,621
421
11,907
2,475
4,665
33
7,173
1,281
1,535
112
2,928
794
1,186
139
2,119
30,734
15,626
2,969
49,329
1,052
4,151
9
5,212
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
424,832
101,168
33,883
559,883
11,478
3,121
859
15,458
58,560
13,736
368
72,664
35,194
14,783
4,348
54,325
17,563
6,566
1,204
25,333
19,933
5,031
1,582
26,546
5,421
5,090
213
10,724
2,257
820
853
3,930
11,561
1,990
1,340
14,891
247,628
44,430
22,441
314,499
15,237
5,601
675
21,513
1,194,751
2,238,635
107,849
3,541,235
43,636
118,771
4,372
166,779
149,133
233,125
4,302
386,560
77,997
308,292
17,744
404,033
130,489
473,526
5,760
609,775
57,493
276,071
8,412
341,976
147,782
167,040
1,204
316,026
28,029
77,607
2,928
108,564
31,900
70,433
3,695
106,028
495,422
407,276
55,777
958,475
32,870
106,494
3,655
143,019
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2017 National Summary
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
Family Planning Annual Report: 2017 National Summary
Exhibit 12. Distribution of female family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 2)
Race and Ethnicity
All Regions
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%†
1%
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
2%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
0%†
3%
0%†
4%
0%†
6%
0%†
6%
0%†
3%
0%†
4%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
2%
0%†
2%
0%†
6%
1%
7%
0%†
5%
0%†
5%
2%
14%
0%†
16%
4%
23%
0%†
27%
1%
36%
0%†
37%
0%†
24%
1%
26%
0%†
21%
0%†
21%
2%
13%
0%†
15%
0%†
4%
0%†
5%
0%†
7%
1%
8%
0%†
4%
0%†
5%
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%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
1%
20%
1%
21%
0%†
1%
0%†
1%
18%
35%
1%
54%
2%
1%
0%†
4%
17
Percentage is less than 0.5%.
12%
46%
2%
59%
15%
29%
1%
45%
5%
3%
0%†
8%
4%
1%
0%†
5%
12%
3%
1%
16%
7%
2%
1%
9%
15%
4%
0%†
19%
34%
63%
3%
100%
26%
71%
3%
100%
Note: Due to rounding, percentages may not sum to 100%.
†
Region I
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
39%
60%
1%
100%
1%
29%
1%
31%
0%†
0%†
0%†
0%†
8%
40%
2%
50%
1%
1%
0%†
2%
9%
4%
1%
13%
19%
76%
4%
100%
17%
38%
0%†
55%
9%
50%
1%
60%
44%
27%
0%†
70%
20%
54%
1%
76%
18%
56%
2%
75%
1%
1%
0%†
2%
1%
3%
0%†
3%
1%
1%
0%†
2%
1%
1%
0%†
3%
3%
1%
0%†
4%
6%
1%
0%†
8%
2%
2%
0%†
3%
2%
1%
1%
4%
11%
2%
1%
14%
26%
5%
2%
33%
47%
53%
0%†
100%
26%
71%
3%
100%
30%
66%
3%
100%
52%
42%
6%
100%
21%
78%
1%
100%
17%
81%
2%
100%
1%
1%
0%†
2%
21%
21%
2%
44%
3%
2%
0%†
5%
11%
57%
2%
70%
1%
3%
0%†
4%
11%
4%
0%†
15%
23%
74%
3%
100%
Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 3)
18
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Region I
Region II
1,117
2,143
188
3,448
31
120
14
165
82
120
0
202
59
443
29
531
33
99
4
136
157
253
23
433
46
149
10
205
18
131
12
161
128
180
10
318
537
568
82
1,187
26
80
4
110
498
11,617
702
12,817
14
668
17
699
64
1,213
3
1,280
50
811
45
906
27
766
17
810
14
987
41
1,042
10
340
15
365
6
145
12
163
5
291
17
313
300
6,109
528
6,937
8
287
7
302
5,839
116,001
4,003
125,843
691
4,824
68
5,583
1,455
11,061
21
12,537
710
23,739
1,109
25,558
1,656
28,650
293
30,599
276
14,925
449
15,650
198
12,960
129
13,287
111
2,788
134
3,033
55
2,028
79
2,162
644
14,276
1,687
16,607
43
750
34
827
560
1,714
93
2,367
96
34
0
130
128
80
0
208
64
45
3
112
39
42
1
82
40
47
6
93
23
32
2
57
6
21
1
28
21
102
9
132
125
1,241
68
1,434
18
70
3
91
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
64,292
160,764
6,370
231,426
2,654
13,928
482
17,064
4,322
13,870
58
18,250
3,745
18,388
777
22,910
8,212
22,590
427
31,229
3,242
24,434
706
28,382
11,954
7,097
77
19,128
1,432
6,168
337
7,937
3,001
12,105
374
15,480
24,895
35,136
2,931
62,962
835
7,048
201
8,084
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
9,134
6,943
942
17,019
1,296
890
80
2,266
990
222
4
1,216
1,309
448
55
1,812
196
959
34
1,189
394
1,174
71
1,639
135
228
2
365
119
208
44
371
136
193
20
349
4,482
2,380
627
7,489
77
241
5
323
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
48,626
15,599
5,866
70,091
1,497
561
208
2,266
7,088
1,715
35
8,838
4,748
2,696
910
8,354
2,132
927
267
3,326
1,724
632
330
2,686
526
623
64
1,213
261
104
137
502
1,486
360
294
2,140
27,954
7,218
3,564
38,736
1,210
763
57
2,030
130,066
314,781
18,164
463,011
6,279
21,025
869
28,173
14,129
28,281
121
42,531
10,685
46,570
2,928
60,183
12,295
54,033
1,043
67,371
5,847
42,452
1,626
49,925
12,892
21,429
299
34,620
1,953
9,565
677
12,195
4,832
15,259
803
20,894
58,937
66,928
9,487
135,352
2,217
9,239
311
11,767
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Family Planning Annual Report: 2017 National Summary
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Family Planning Annual Report: 2017 National Summary
Exhibit 14. Distribution of male family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users
All Regions
19
Percentage is less than 0.5%.
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
0%†
0%†
0%†
1%
0%†
0%†
0%†
1%
0%†
0%†
0%
0%†
0%†
1%
0%†
1%
0%†
0%†
0%†
0%†
0%†
1%
0%†
1%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
1%
1%
0%†
2%
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
3%
0%†
3%
0%†
2%
0%†
2%
0%†
3%
0%†
3%
0%†
1%
0%†
2%
0%†
1%
0%†
1%
0%†
2%
0%†
2%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
5%
0%†
5%
0%†
2%
0%†
3%
2%
17%
0%†
20%
3%
26%
0%†
29%
0%†
10%
0%†
10%
0%†
11%
1%
12%
0%†
6%
0%†
7%
0%†
0%†
0%
0%†
0%†
0%†
0%
0%†
0%†
0%†
0%†
1%
0%†
1%
0%†
1%
0%†
1%
0%†
1%
1%
25%
1%
27%
0%†
0%†
0%†
1%
14%
35%
1%
50%
2%
1%
0%†
4%
9%
49%
2%
61%
10%
33%
0%†
43%
1%
39%
2%
42%
0%†
0%†
0%†
0%†
6%
31%
1%
38%
5%
3%
0%†
8%
2%
1%
0%†
3%
11%
3%
1%
15%
5%
2%
1%
8%
17%
4%
0%†
21%
8%
4%
2%
14%
28%
68%
4%
100%
22%
75%
3%
100%
33%
66%
0%†
100%
18%
77%
5%
100%
Note: Due to rounding, percentages may not sum to 100%.
†
Region I
2%
1%
0%†
3%
2%
43%
0%†
45%
0%†
0%†
0%†
0%†
12%
34%
1%
46%
1%
30%
1%
31%
0%†
0%†
0%†
0%†
6%
49%
1%
57%
1%
37%
0%†
38%
0%†
0%†
0%†
0%†
35%
20%
0%†
55%
1%
23%
1%
25%
0%†
0%†
0%†
0%†
12%
51%
3%
65%
14%
58%
2%
74%
0%†
1%
0%†
2%
1%
2%
0%†
3%
0%†
1%
0%†
1%
1%
2%
0%†
3%
3%
1%
0%†
5%
3%
1%
1%
5%
2%
2%
0%†
4%
2%
1%
1%
4%
7%
2%
1%
10%
21%
5%
3%
29%
16%
78%
6%
100%
23%
73%
4%
100%
44%
49%
7%
100%
18%
80%
2%
100%
12%
85%
3%
100%
37%
62%
1%
100%
1%
1%
0%†
2%
18%
26%
2%
47%
3%
2%
0%†
6%
7%
60%
2%
69%
1%
2%
0%†
3%
10%
6%
0%†
17%
19%
79%
3%
100%
Guidance for Reporting User Social and Economic Profile Data in FPAR Tables 4 through 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 family income
data from all users to determine charges based on the schedule of discounts.1,2 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).7 Report the unduplicated number of users by income level, using the most current
income information available. For additional guidance, see Program Requirements for Title X Funded Family
Planning Projects (Version 1.0).1
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, the Children’s Health Insurance
Program (CHIP), and other state or local government programs that provide a broad set of benefits. Also included
are public-paid or public-subsidized private insurance programs.
Private Health Insurance 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). Private insurance includes insurance purchased for public employees or
retirees or military personnel and their dependents (e.g., TRICARE or CHAMPVA).
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 Proficient (LEP) Users—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 as LEP any user who received Title X
services from bilingual staff in the user’s preferred non-English language, who was assisted by a competent agency
or contracted interpreter, or who opted to use a family member or friend as an interpreter after refusing the
provider’s offer of free language assistance services. Service providers should consult the Revised HHS LEP
Guidance13 for further information about identifying LEP individuals and complying with language assistance
requirements. Unless they are also LEP, do not include users who are visually or hearing impaired or have other
disabilities.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 21–23.
20
Family Planning Annual Report: 2017 National Summary
FAMILY PLANNING USER SOCIAL AND ECONOMIC PROFILE
Users by Income Level (Exhibit 15)
Federal regulations1,2 require Title X-funded providers to give priority in the delivery of care
to persons from low-income families. These regulations specify that individuals with family
incomes at or below the HHS poverty guideline (poverty) for 2017 ($24,600 for a family of
four in the 48 contiguous states and the District of Columbia)7 receive services at no charge
unless a third party (government or private) is authorized or obligated to pay for these
services. For individuals with incomes between 101% and 250% of the poverty guideline,
Title X-funded agencies are required to charge for services using a sliding fee scale based on
family size and income. For unemancipated minors seeking confidential services, the
assessment of income level is based on their own rather than their family’s income.
In 2017, 90% (3.6 million) of users had family incomes that qualified them for either
subsidized or no-charge services. Sixty-seven percent (2.7 million) of users had family
incomes at or below 100% of poverty, 23% (931,795) had incomes ranging from 101% to
250% of poverty, and 7% (277,975) had incomes over 250% of poverty. Family income data
were unknown or not reported for 3% (128,565) of users (Exhibit 15).
▪ By region, from 82% (I and III) to 95% (VI) of users had family incomes qualifying them
for either no-charge (from 49% to 77% of users) or subsidized (from 19% to 34% of users)
services. In Regions IV, VI, and IX, the percentage of users with incomes at or below
poverty exceeded the national average of 67% (Exhibit 15).
▪ By state, the percentages of users with incomes at or below poverty ranged from 36% to
100%, from 0% to 47% for users with incomes between 101% and 250% of poverty, and
from 0% to 26% for users over 250% of poverty (Exhibit B–2).
See Exhibits A–7a and A–7b for trends (2007–2017) in the distribution of family planning
users by income level.
Users by Insurance Coverage Status (Exhibit 16)
Title X regulations1,2 require Title X-funded agencies to bill all third parties authorized or
legally obligated to pay for services and to make reasonable efforts to collect charges without
jeopardizing client confidentiality. On the FPAR, grantees report the health insurance
coverage status for a client even though an insured client may not have used their health
insurance to pay for services received during their last family planning encounter. Users
whose family planning care was paid by a Medicaid family planning eligibility expansion but
who had no other public or private health insurance plan covering broad primary medical care
benefits are considered uninsured, as are users with single-service plans (e.g., vision or
dental) or those with coverage through the Indian Health Service (IHS) who received care in
non-IHS facilities.
In 2017, 57% (2.3 million) of family planning users had either public (38%, 1.5 million) or
private (19%, 760,051) insurance covering broad primary medical care benefits; 42% (1.7
million) were uninsured. Health insurance coverage status was unknown or not reported for
1% (56,837) of users (Exhibit 16).
Family Planning Annual Report: 2017 National Summary
21
▪ By region, from 20% (VIII) to 47% (II) of family planning users had public coverage, and
from 7% (IX) to 31% (I) had private coverage. The percentage of uninsured users ranged
from 26% (I) to 58% (VI), with the number of uninsured exceeding the number of insured
in three regions (VI, VIII, and IX) (Exhibit 16).
▪ By state, there was wide variation in the percentage of users who were publicly insured
(0% to 99%), privately insured (0% to 57%), and uninsured (1% to 100%) (Exhibit B–3a).
Among users in the 50 states and the District of Columbia, 72% (2.8 million) received Title
X services in 1 of 32 states (includes the District of Columbia) that expanded Medicaid
under the Affordable Care Act (ACA), and 28% (1.1 million users) received Title X care in
1 of 19 states that did not. Compared with users in “nonexpansion” states, on average,
users in “expansion” states were more likely to be publicly insured (42% vs. 26%), about
as likely to be privately insured (18% vs. 22%), and less likely to be uninsured (38% vs.
51%) (Exhibit B–3b).
See Exhibits A–8a and A–8b for trends (2007–2017) in the distribution of family planning
users by primary health insurance status.
Limited English Proficient Users (Exhibit 17)
As recipients of HHS assistance, Title X grantees and subrecipients, including those operating
in U.S. territories and Freely Associated States where English is an official language, are
required to ensure that limited English proficient (LEP) individuals have meaningful access to
the health and social services they provide.13 In 2017, 14% (553,241) of family planning users
were LEP. By region, the percentage of users who were LEP ranged from 6% (V) to 22%
(VI), with three regions (II, IV, and VI) exceeding the national LEP average of 14%
(Exhibit 17).
The percentage of family planning users who were LEP was 13% in 2007 vs. 14% in 2017.
During this period, the number of LEP users decreased 17%, from 662,714 (2007) to 553,241
(2017) (not shown).
22
Family Planning Annual Report: 2016 National Summary
Family Planning Annual Report: 2017 National Summary
Exhibit 15. Number and distribution of all family planning users, by income level and region: 2017 (Source: FPAR Table 4)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
2,665,911
94,737
276,750
274,896
479,362
231,030
268,722
68,933
83,456
797,477
90,548
101% to 150%
551,163
34,607
67,974
62,297
82,793
60,192
42,431
19,978
15,682
140,889
24,320
151% to 200%
257,155
20,392
29,209
26,831
34,039
32,608
16,268
9,598
9,314
64,202
14,694
201% to 250%
123,477
11,033
15,118
18,109
17,371
17,917
7,426
5,958
5,577
17,096
7,872
Over 250%
277,975
22,936
38,948
33,981
48,386
46,404
10,471
12,268
9,828
40,132
14,621
Unknown/not reported
128,565
11,247
1,092
48,102
15,195
3,750
5,328
4,024
3,065
34,031
2,731
4,004,246
194,952
429,091
464,216
677,146
391,901
350,646
120,759
126,922
1,093,827
154,786
Under 101%
67%
49%
64%
59%
71%
59%
77%
57%
66%
73%
58%
101% to 150%
14%
18%
16%
13%
12%
15%
12%
17%
12%
13%
16%
151% to 200%
6%
10%
7%
6%
5%
8%
5%
8%
7%
6%
9%
201% to 250%
3%
6%
4%
4%
3%
5%
2%
5%
4%
2%
5%
Over 250%
7%
12%
9%
7%
7%
12%
3%
10%
8%
4%
9%
Unknown/not reported
3%
6%
0%†
10%
2%
1%
2%
3%
2%
3%
2%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Income Levela
Under 101%
Total All Users
Total All Users
100%
Note: Due to rounding, percentages may not sum to 100%.
a
Title X-funded agencies calculate and report user family income as a percentage of poverty based on guidelines issued by the U.S. Department of Health and Human Services
(HHS). Each year, HHS announces updates to its poverty guidelines in the Federal Register and on the HHS Website at https://aspe.hhs.gov/poverty/.
† Percentage is less than 0.5%.
23
24
Exhibit 16. Number and distribution of all family planning users, by principal health insurance coverage status and region: 2017
(Source: FPAR Table 5)
Insurance Status
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
1,511,533
83,747
200,603
191,879
230,236
143,335
85,864
26,009
25,554
463,495
60,811
760,051
59,643
69,491
115,338
149,948
108,441
60,323
36,181
34,214
79,883
46,589
1,675,825
50,650
144,045
137,058
289,591
137,408
202,255
57,686
62,357
549,626
45,149
56,837
912
14,952
19,941
7,371
2,717
2,204
883
4,797
823
2,237
4,004,246
194,952
429,091
464,216
677,146
391,901
350,646
120,759
126,922
1,093,827
154,786
Public health insurance
38%
43%
47%
41%
34%
37%
24%
22%
20%
42%
39%
Private health insurance
19%
31%
16%
25%
22%
28%
17%
30%
27%
7%
30%
Uninsured
42%
26%
34%
30%
43%
35%
58%
48%
49%
50%
29%
3%
4%
1%
1%
1%
1%
4%
100%
100%
100%
100%
100%
100%
100%
Public health insurance
Private health insurance
Uninsured
Unknown/not reported
Total All Users
Unknown/not reported
Family Planning Annual Report: 2017 National Summary
Total All Users
1%
100%
0%†
100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
0%†
100%
1%
100%
Family Planning Annual Report: 2017 National Summary
Exhibit 17. Number and distribution of all family planning users, by limited English proficiency (LEP) status and region: 2017
(Source: FPAR Table 6)
All Regions
Region I
Region IIa
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IXb
Region X
553,241
27,980
79,899
54,515
102,189
23,471
75,997
14,505
13,494
148,618
12,573
3,418,253
156,702
348,551
391,337
573,944
367,691
274,638
104,693
113,380
945,114
142,203
32,752
10,270
641
18,364
1,013
739
11
1,561
48
95
10
4,004,246
194,952
429,091
464,216
677,146
391,901
350,646
120,759
126,922
1,093,827
154,786
LEP
14%
14%
19%
12%
15%
6%
22%
12%
11%
14%
8%
Not LEP
85%
80%
81%
84%
85%
94%
78%
87%
89%
86%
92%
1%
5%
100%
100%
LEP Status
LEP
Not LEP
Unknown/not reported
Total All Users
Unknown/not reported
Total All Users
0%†
100%
4%
100%
0%†
100%
0%†
100%
0%†
100%
1%
100%
0%†
100%
0%†
100%
0%†
100%
LEP=limited English proficient.
Note: Due to rounding, percentages may not sum to 100%.
a
Includes family planning users served by grantees in Puerto Rico and the U.S. Virgin Islands.
b
Includes family planning users served by grantees in American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the
Marshall Islands, and Republic of Palau.
† Percentage is less than 0.5%.
25
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 family planning 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 30 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 the following:
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 a contraceptive surgical (tubal ligation) or nonsurgical
(implant) procedure performed on a female user in the current or any previous reporting period.
Intrauterine Device or System (IUD/IUS)—In Table 7, report the number of female users who use a long-term
hormonal or other type of intrauterine device (IUD) or system (IUS) 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.
Contraceptive Patch—In Table 7, report the number of female users who use a transdermal 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 or 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)—FAMs refer to family planning
methods that rely on identifying the fertile days in each menstrual cycle when intercourse is most likely to result in a
pregnancy. FAMs include Standard Days®, Calendar Rhythm, TwoDay, Billings Ovulation, and SymptoThermal
methods. The LAM is the proactive application of exclusive breastfeeding during lactational amenorrhea for the first
6 months after delivery. To be effective, LAM requires full (i.e., no other liquid or solid given to infant) or nearly full
(i.e., infrequent supplementation in small amounts, but not by bottle) breastfeeding.14 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—In Tables 7 and 8, report the number of female and male users, respectively, who rely on abstinence
as their primary family planning method or who are not currently sexually active and therefore not using
contraception. For purposes of FPAR reporting, abstinence is defined as refraining from oral, vaginal, and anal
intercourse.15
Withdrawal and 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.
(continued)
26
Family Planning Annual Report: 2017 National Summary
PRIMARY CONTRACEPTIVE METHOD USE
Federal regulations1,2 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. In addition to offering a full range of methods for clients to
consider, the Quality Family Planning (QFP) Recommendations16 advise providers to identify
methods that are safe for the client, provide counseling to help the client choose a method and
use it correctly and consistently, conduct any physical assessments warranted by the selected
method, and provide the method on site (preferable) or by referral. The QFP
Recommendations also note that providers should ensure that services for adolescent clients
are provided in a “youth-friendly” way.
Female Users by Primary Contraceptive Method (Exhibits 18 through
21)
In 2017, 80% (2.8 million) of all female users adopted or continued use of a most,
moderately, or less effective contraceptive method at their last encounter in the reporting
period. Nine percent (313,802) of females exited the encounter with no primary method
because they were pregnant or seeking pregnancy, and another 5% (190,518) exited with no
method for other reasons. Three percent (92,385) of female users reported that they were
abstinent, and the type of primary method used was unknown or not reported for the
remaining 3% (116,331) (Exhibits 18 and 19).
Guidance for Reporting Primary Contraceptive Use Data in FPAR Tables 7 and 8 (continued)
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.
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 methods as their primary method. “Female” contraceptive methods include female
sterilization, IUD/IUS, hormonal implants, 1- and 3-month hormonal injections, oral contraceptives, the
contraceptive patch, the vaginal ring, cervical cap or diaphragms, the contraceptive sponge, female condoms, LAM,
and spermicides.
No Method–[Partner] Pregnant or Seeking Pregnancy—In Tables 7 and 8, report the number of female and
male users, respectively, 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 female and male 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, if either partner has had a
noncontraceptive surgical procedure that has rendered him or her unable to conceive or impregnate, or if the user
has a sexual partner of the same sex.
Method Unknown or Not Reported—In Tables 7 and 8, report the number of female and male users,
respectively, for whom the primary family planning method at exit from the last family planning encounter is
unknown or not reported.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 27–30.
Family Planning Annual Report: 2017 National Summary
27
Additional results include the following:
▪ By level of effectiveness10 in preventing pregnancy, 19% of all female users relied on a
most effective contraceptive method (vasectomy, female sterilization, implant, or IUD),
43% used a moderately effective method (injectable contraception, vaginal ring,
contraceptive patch, pills, diaphragm, or cervical cap), and 18% used a less effective
method (male condom, female condom, sponge, withdrawal, a fertility awareness-based
method [FAM] or LAM, or spermicide used alone) (Exhibits 18 and 19). See Table 7
comments in the Field and Methodological Notes (Appendix C) for information about the
three method-effectiveness categories.
▪ By type of method, the contraceptive pill was used by 25% of all female users, followed
by male condoms (15%), injectable contraception (14%), IUDs (9%), hormonal implants
(7%), female sterilization (3%), the vaginal ring (2%), and the contraceptive patch (1%).
Two percent of female users reported using withdrawal or other methods not listed in
FPAR Table 7, and less than 0.5% of female users relied on each of the following methods:
a FAM or LAM, vasectomy, female condom, cervical cap or diaphragm, spermicide (used
alone), or contraceptive sponge (Exhibits 18 and 19).
▪ By age group, from 56% (under 15) to 84% (18 to 19) of female users relied on a most,
moderately, or less effective method (Exhibits 18 and 19). The three leading methods by
age group were as follows:
– Females under 15: Abstinence (29%), pills (20%), and injectables (14%)
– Females 15 to 19: Pills (30% to 32%), injectables (18% to 23%), and male condoms
(12% to 14%)
– Females 20 to 39: Pills (20% to 29%), male condoms (16%), and injectables (12% to
14%)
– Females 40 to 44: Male condoms (18%), pills (18%), and injectables (13%)
– Females over 44: Male condoms (18%), female sterilization (16%), and pills (12%)
▪ Nonuse of contraception because of pregnancy or the desire for pregnancy was highest
among females 18 to 39 (8% to 11%) and was 5% or less among females in the younger
(under 18) and older (over 39) age groups.
▪ By region, from 72% (III) to 87% (VIII) of female users exited the encounter with a most,
moderately, or less effective contraceptive method (Exhibits 20 and 21).
– Most effective method use ranged from 13% (IV) to 26% (I). Among all methods,
IUDs were the second most common in Region I and the third most common in four
others (II, VIII, IX, and X).
– Moderately effective method use ranged from 37% (I) to 53% (X). Among all
methods, pills were the most common in all regions, with use ranging from 23% to 32%
of female users in each region. Injectable contraception was the second most common in
six regions (IV, V, VI, VII, VIII, and X) and the third most common in Region III.
– Less effective method use ranged from 11% (VIII) to 25% (IX). Among all methods,
male condoms were the second most common in three regions (II, III, and IX) and the
third most common in five others (I, IV, V, VI, and VII).
28
Family Planning Annual Report: 2017 National Summary
– Nonuse of contraception because of pregnancy or the desire for pregnancy ranged from
6% (III) to 12% (IV).
▪ By state, there was wide variation in the percentage of female users at risk of unintended
pregnancy who relied on most effective (0% to 37%), moderately effective (18% to 91%),
and less effective (1% to 42%) contraceptive methods (Exhibit B–4). Female users at risk
of unintended pregnancy were not pregnant, seeking pregnancy, or abstinent.
Trends in Female Primary Contraceptive Method Use
From 2007 through 2017, the percentage of all female users relying on most, moderately, or
less effective methods ranged from 79% to 84%; 13% to 15% used no method because they
were either pregnant, seeking pregnancy, or for other reasons; and 1% to 3% were abstinent
(Exhibits A–9a, A–9b, and A–9c).
Use of most effective methods: Among all female users, the percentage relying on the most
effective methods increased from 5% in 2007 to 19% in 2017 (Exhibits A–9a, A–9b, and
A–9c).
▪ IUD use among female users increased from 3% in 2007 to 9% in 2017. Numerically, the
number of IUD users more than doubled, from 138,714 in 2007 to 324,174 in 2017.
▪ Implant use increased from less than 0.5% of female users in 2007 to 7% in 2017.
Numerically, the number of implant users increased 32-fold, from 7,300 in 2007 to
239,029 in 2017.
Use of moderately effective methods: The percentage of all female users relying on
moderately effective methods decreased from 57% in 2007 to 43% in 2017 (Exhibits A–9a,
A–9b, and A–9c).
▪ The pill, used by 39% of female users in 2007 and 25% in 2017, was the preferred method
among female users in all years.
▪ Injectable contraception, used by 13% of female users in 2007 and 14% in 2017, was the
third most common method, except in 2014 and 2015 when it was the second most used
method.
▪ Use of the vaginal ring decreased from 3% of female users in 2007 to 2% in 2017, while
the percentage using the contraceptive patch decreased from 3% in 2007 to 1% in 2017. In
all years, less than 0.5% of female users relied on the cervical cap or diaphragm.
Use of less effective methods: The percentage of all female users relying on less effective
methods was 19% in 2007 and 18% in 2017 (Exhibits A–9a, A–9b, and A–9c). Across the
different methods in this category, there were small or no changes in the percentage of female
users who relied on male condoms (15% in 2007 and 2017); withdrawal or other methods not
listed in FPAR Table 7 (3% in 2007 vs. 2% in 2017); and all other less effective methods
(less than 0.5% for each method in 2007 and 2017), including FAM or LAM, female
condoms, contraceptive sponge, or spermicide.
Family Planning Annual Report: 2017 National Summary
29
Exhibit 18. Number of female family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 7)
30
Primary Method
Family Planning Annual Report: 2017 National Summary
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode
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
94,173
324,174
239,029
500,960a
894,128
48,256
76,252
2,219
169
2,537
1,991
15,287
92,385
73,047
0
406
2,723
6,610a
7,219
471
167
22
1
14
34
73
10,616
350
0
9,013
25,546
55,400a
73,193
4,015
2,967
159
5
133
205
482
13,668
2,472
1
19,744
33,224
61,489a
107,263
5,401
5,575
203
11
151
153
812
6,901
4,507
1,377
76,865
75,270
125,331a
267,725
14,574
21,974
381
32
517
384
3,056
13,633
15,600
7,510
83,158
51,951
97,026a
199,608
11,173
23,498
447
36
469
374
3,557
12,531
15,778
15,289
60,377
27,849
67,654a
116,559
6,808
14,097
384
25
345
309
2,729
9,527
11,723
20,770
39,824
14,224
46,032a
65,409
3,646
5,313
308
22
290
224
1,921
7,749
8,086
19,432
22,016
5,775
25,075a
34,323
1,556
1,895
158
16
231
152
1,320
5,943
5,596
29,794
12,771
2,467
16,343a
22,829
612
766
157
21
387
156
1,337
11,817
8,935
8,848
547,129
0
2,518
4
28,472
108
47,724
405
141,902
963
123,381
1,575
80,314
1,996
53,725
1,822
34,833
1,975
34,260
313,802
190,518
116,331
3,541,235
607
1,859
2,931
36,621
10,272
7,972
8,486
242,464
25,710
12,491
8,872
340,340
90,488
36,999
21,811
908,324
87,183
37,363
21,771
777,777
56,680
28,123
17,093
517,460
29,938
21,707
13,200
334,384
9,878
15,274
9,930
195,225
3,046
28,730
12,237
188,640
2,828,199
20,608
202,066
286,366
745,393
618,929
406,037
261,790
154,200
132,810
Most effectivee
666,224
3,129
34,563
53,077
153,917
143,582
105,090
76,814
49,045
47,007
Moderately effectivee
1,521,815
14,489
135,734
179,931
429,985
331,752
205,502
120,708
63,007
40,707
Less effectivee
640,160
2,990
31,769
53,358
161,491
143,595
95,445
64,268
42,148
45,096
Abstinence
92,385
10,616
13,668
6,901
13,633
12,531
9,527
7,749
5,943
11,817
Not Using a Method
504,320
2,466
18,244
38,201
127,487
124,546
84,803
51,645
25,152
31,776
Method Unknown
116,331
2,931
8,486
8,872
21,811
21,771
17,093
13,200
9,930
12,237
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c User refrained from oral, vaginal, and anal intercourse.
d Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch, and ring),
diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone), FAM or LAM, and
other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2017 National Summary
Exhibit 19. Distribution of female family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown
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
3%
9%
7%
14%a
25%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
2%
0%
1%
7%
18%a
20%
1%
0%†
0%†
0%†
0%†
0%†
0%†
29%
1%
0%
4%
11%
23%a
30%
2%
1%
0%†
0%†
0%†
0%†
0%†
6%
1%
0%†
6%
10%
18%a
32%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
1%
0%†
8%
8%
14%a
29%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
2%
1%
11%
7%
12%a
26%
1%
3%
0%†
0%†
0%†
0%†
0%†
2%
2%
3%
12%
5%
13%a
23%
1%
3%
0%†
0%†
0%†
0%†
1%
2%
2%
6%
12%
4%
14%a
20%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
2%
10%
11%
3%
13%a
18%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
3%
16%
7%
1%
9%a
12%
0%†
0%†
0%†
0%†
0%†
0%†
1%
6%
5%
0%†
15%
0%
7%
0%†
12%
0%†
14%
0%†
16%
0%†
16%
0%†
16%
1%
16%
1%
18%
1%
18%
9%
5%
3%
100%
2%
5%
8%
100%
4%
3%
3%
100%
8%
4%
3%
100%
10%
4%
2%
100%
11%
5%
3%
100%
11%
5%
3%
100%
9%
6%
4%
100%
5%
8%
5%
100%
2%
15%
6%
100%
80%
56%
83%
84%
82%
80%
78%
78%
79%
70%
19%
43%
18%
3%
14%
3%
9%
40%
8%
29%
7%
8%
14%
56%
13%
6%
8%
3%
16%
53%
16%
2%
11%
3%
17%
47%
18%
2%
14%
2%
18%
43%
18%
2%
16%
3%
20%
40%
18%
2%
16%
3%
23%
36%
19%
2%
15%
4%
25%
32%
22%
3%
13%
5%
25%
22%
24%
6%
17%
6%
31
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
Includes both 3-month and 1-month hormonal injection users.
b
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c User refrained from oral, vaginal, and anal intercourse.
d Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch, and ring),
diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone), FAM or LAM, and
other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
Exhibit 20. Number of female family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 7)
32
Primary Method
Family Planning Annual Report: 2017 National Summary
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown
All Regions
Region I
Region IV
Region V
Region VII
Region VIII
94,173
324,174
239,029
500,960a
894,128
48,256
76,252
2,219
169
2,537
1,991
15,287
92,385
73,047
6,930
21,400
13,626
17,157a
39,276
1,880
3,513
131
8
80
36
389
8,484
3,339
Region II
7,415
43,631
20,559
42,450
101,921
7,723
9,937
173
31
186
51
1,087
6,585
10,111
Region III
13,858
30,436
24,512
53,887a
91,582
2,915
7,944
509
9
886
874
848
11,467
6,046
16,064
30,381
33,778
124,175
141,353
6,252
6,961
108
26
354
307
5,783
20,236
20,705
8,419
32,252
21,168
55,382
99,044
4,252
9,064
168
5
169
68
403
6,430
4,111
Region VI
12,909
22,440
21,374
52,598a
71,675
2,490
4,793
139
23
184
459
2,201
11,971
8,496
4,773
11,063
6,992
20,725
29,377
688
1,787
36
3
84
29
544
1,989
1,367
1,419
15,360
9,432
16,776
32,937
504
3,988
43
11
49
18
179
2,623
1,262
Region IX
19,734
99,563
76,702
96,573a
241,731
18,117
22,995
807
47
517
104
3,591
19,617
15,249
Region X
2,652
17,648
10,886
21,237
45,232
3,435
5,270
105
6
28
45
262
2,983
2,361
8,848
547,129
580
20,358
639
66,057
1,381
56,355
929
61,104
794
44,740
1,266
42,131
437
11,925
428
9,921
1,771
220,691
623
13,847
313,802
190,518
116,331
3,541,235
11,879
10,583
7,130
166,779
37,796
28,004
2,204
386,560
23,226
24,749
52,549
404,033
75,504
45,422
20,333
609,775
29,546
14,662
11,299
341,976
32,419
26,420
2,038
316,026
10,310
4,113
2,322
108,564
7,181
3,195
702
106,028
73,707
29,370
17,589
958,475
12,234
4,000
165
143,019
2,828,199
128,703
311,971
292,042
448,280
280,039
243,178
89,830
92,327
818,192
123,637
666,224
1,521,815
640,160
92,385
504,320
116,331
42,536
61,957
24,210
8,484
22,462
7,130
72,244
162,204
77,523
6,585
65,800
2,204
70,187
156,837
65,018
11,467
47,975
52,549
81,152
278,849
88,279
20,236
120,926
20,333
62,633
167,910
49,496
6,430
44,208
11,299
57,989
131,695
53,494
11,971
58,839
2,038
23,265
52,613
13,952
1,989
14,423
2,322
26,639
54,248
11,440
2,623
10,376
702
197,770
380,223
240,199
19,617
103,077
17,589
31,809
75,279
16,549
2,983
16,234
165
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
b
c
d
e
Includes both 3-month and 1-month hormonal injection users.
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
User refrained from oral, vaginal, and anal intercourse.
Includes withdrawal or any other method not listed in FPAR Table 7.
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch, and ring),
diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone), FAM or LAM, and
other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2017 National Summary
Exhibit 21. Distribution of female family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
All Regions
Region I
Region II
3%
9%
7%
14%a
25%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
2%
4%
13%
8%
10%a
24%
1%
2%
0%†
0%†
0%†
0%†
0%†
5%
2%
2%
11%
5%
11%
26%
2%
3%
0%†
0%†
0%†
0%†
0%†
2%
3%
Region III
3%
8%
6%
13%a
23%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
1%
Region IV
3%
5%
6%
20%
23%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
3%
Region V
2%
9%
6%
16%
29%
1%
3%
0%†
0%†
0%†
0%†
0%†
2%
1%
Region VI
4%
7%
7%
17%a
23%
1%
2%
0%†
0%†
0%†
0%†
1%
4%
3%
Region VII
4%
10%
6%
19%
27%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
1%
Region VIII
1%
14%
9%
16%
31%
0%†
4%
0%†
0%†
0%†
0%†
0%†
2%
1%
Region IX
2%
10%
8%
10%a
25%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
2%
Region X
2%
12%
8%
15%
32%
2%
4%
0%†
0%†
0%†
0%†
0%†
2%
2%
0%†
15%
0%†
12%
0%†
17%
0%†
14%
0%†
10%
0%†
13%
0%†
13%
0%†
11%
0%†
9%
0%†
23%
0%†
10%
9%
5%
3%
100%
7%
6%
4%
100%
10%
7%
1%
100%
6%
6%
13%
100%
12%
7%
3%
100%
9%
4%
3%
100%
10%
8%
1%
100%
9%
4%
2%
100%
7%
3%
1%
100%
8%
3%
2%
100%
9%
3%
0%†
100%
Using Most, Moderately, or Less
Effective Methode
80%
77%
81%
72%
74%
82%
77%
83%
87%
85%
86%
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown
19%
43%
18%
3%
14%
3%
26%
37%
15%
5%
13%
4%
19%
42%
20%
2%
17%
1%
17%
39%
16%
3%
12%
13%
13%
46%
14%
3%
20%
3%
18%
49%
14%
2%
13%
3%
18%
42%
17%
4%
19%
1%
21%
48%
13%
2%
13%
2%
25%
51%
11%
2%
10%
1%
21%
40%
25%
2%
11%
2%
22%
53%
12%
2%
11%
0%†
33
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a Includes both 3-month and 1-month hormonal injection users.
b FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
c User refrained from oral, vaginal, and anal intercourse.
d Includes withdrawal or any other method not listed in FPAR Table 7.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch, and ring),
diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone), FAM or LAM, and
other methods not listed in Table 7. See Table 7 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
This page intentionally left blank.
34
Family Planning Annual Report: 2017 National Summary
Male Users by Primary Contraceptive Method (Exhibits 22 through 25)
In 2017, grantees reported that 76% (353,287) of all male users adopted or continued use of a
most, moderately, or less effective primary method at their last encounter in the reporting
period. Nine percent (42,327) of males used no primary method, either because their partners
were pregnant or seeking pregnancy (1%) or for other reasons (8%), and another 7% (33,275)
reported that they were abstinent. The type of primary contraceptive method used was
unknown or not reported for 7% (34,122) of male users (Exhibits 22 and 23).
▪ By type of method, two-thirds (65%) of all male users relied on male condoms, followed
by reliance on a female method (7%), withdrawal (3%), vasectomy (1%), and a FAM or
LAM (1%) (Exhibits 22 and 23).
▪ By age group, from 15% (under 15) to 84% (20 to 24) of male users relied on a most,
moderately, or less effective method. Across all age groups, the two leading contraceptive
methods were male condoms, which were the primary method for 11% to 76% of male
users, and reliance on a female method, a choice for 3% to 11% of male users (Exhibits 22
and 23). Other findings by age group were as follows:
– Vasectomy prevalence was 1% to 3% among males 30 or over and less than 0.5%
among males 20 to 29.
– Nonuse of contraception because a partner was pregnant or seeking pregnancy was less
than 0.5% among males under 18 and from 1% to 2% of males in all other age groups.
▪ By region, the percentage of males who exited the encounter with a most, moderately, or
less effective method ranged from 60% (IV) to 89% (IX) (Exhibits 24 and 25).
– Male condoms, the leading primary method for males in all regions, were used by 40%
(IV) to 81% (IX) of male users. The percentage of males relying on a female method, the
second most common primary method for males in four regions (III, V, VII, and VIII),
ranged from 3% (II and IX) to 17% (VIII).
– Nonuse of contraception because a partner was pregnant or seeking pregnancy ranged
from less than 0.5% (II) to 2% (V, VI, and IX).
Family Planning Annual Report: 2017 National Summary
35
Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 8)
36
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
3,402
0
0
0
57
280
604
717
686
1,058
299,268
1,420
14,880
23,632
79,995
73,477
43,768
25,278
13,987
22,831
2,585
8
52
102
493
606
374
307
261
382
Abstinence
33,275
8,001
7,927
2,593
2,982
2,411
1,786
1,442
1,172
4,961
Withdrawal or other methodc
14,407
130
431
668
2,216
2,390
1,982
1,573
1,252
3,765
Rely on female methodd
33,625
314
1,548
1,814
6,211
6,466
4,841
3,595
2,747
6,089
5,997
4
82
237
1,179
1,371
1,075
758
523
768
Other reason
36,330
905
1,620
2,092
7,342
7,060
4,824
3,421
2,433
6,633
Method Unknown
34,122
1,657
2,425
1,757
5,144
5,750
4,119
3,281
2,462
7,527
Total Male Users
463,011
12,439
28,965
32,895
105,619
99,811
63,373
40,372
25,523
54,014
Using most, moderately, or less
effective methode
353,287
1,872
16,911
26,216
88,972
83,219
51,569
31,470
18,933
34,125
Abstinence
33,275
8,001
7,927
2,593
2,982
2,411
1,786
1,442
1,172
4,961
Not using a method
42,327
909
1,702
2,329
8,521
8,431
5,899
4,179
2,956
7,401
Method unknown
34,122
1,657
2,425
1,757
5,144
5,750
4,119
3,281
2,462
7,527
Primary Method
Vasectomy
Male condom
FAM or LAM
a
b
No Method
Partner pregnant/seeking pregnancy
Family Planning Annual Report: 2017 National Summary
b
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring,
female barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2017 National Summary
Exhibit 23. Distribution of male family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 8)
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
1%
0%
0%
0%
Male condom
65%
11%
51%
72%
FAM or LAM
1%
Abstinence
7%
64%
Withdrawal or other methodc
3%
Rely on female methodd
Primary Method
Vasectomy
76%
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
1%
2%
3%
2%
74%
69%
63%
55%
42%
0%†
0%†
1%
1%
1%
1%
1%
27%
8%
3%
2%
3%
4%
5%
9%
1%
1%
2%
2%
2%
3%
4%
5%
7%
7%
3%
5%
6%
6%
6%
8%
9%
11%
11%
Partner pregnant/seeking pregnancy
1%
0%†
0%†
1%
1%
1%
2%
2%
2%
1%
Other reason
8%
7%
6%
6%
7%
7%
8%
8%
10%
12%
Method Unknown
7%
13%
8%
5%
5%
6%
6%
8%
10%
14%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
76%
15%
58%
80%
84%
83%
81%
78%
74%
63%
Abstinence
7%
64%
27%
8%
3%
2%
3%
4%
5%
9%
Not using a method
9%
7%
6%
7%
8%
8%
9%
10%
12%
14%
Method unknown
7%
13%
8%
5%
5%
6%
6%
8%
10%
14%
b
0%†
0%†
25 to 29
Years
0%†
a
0%†
20 to 24
Years
No Method
Total Male Users
Using most, moderately, or less
effective methode
b
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring,
female barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
37
Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 8)
38
Primary Method
Vasectomy
All
Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII Region VIII Region IX
Region X
3,402
219
151
356
674
441
206
86
327
692
250
299,268
15,897
31,299
29,694
26,968
35,645
20,860
8,222
13,053
110,006
7,624
2,585
22
29
169
1,079
10
905
45
13
307
6
Abstinence
33,275
4,033
1,580
3,459
12,661
1,942
3,874
263
1,254
3,730
479
Withdrawal or other methodc
14,407
766
1,551
1,122
3,175
361
332
231
357
5,238
1,274
Rely on female methodd
33,625
2,166
1,305
5,170
8,242
3,704
3,093
1,226
3,632
4,384
703
5,997
271
188
409
774
1,018
851
69
255
2,077
85
Other reason
36,330
3,306
5,552
4,031
6,786
3,788
3,762
787
1,929
5,092
1,297
Method Unknown
34,122
1,493
876
15,773
7,012
3,016
737
1,266
74
3,826
49
Total Male Users
463,011
28,173
42,531
60,183
67,371
49,925
34,620
12,195
20,894
135,352
11,767
Using most, moderately, or less
effective methode
353,287
19,070
34,335
36,511
40,138
40,161
25,396
9,810
17,382
120,627
9,857
Abstinence
33,275
4,033
1,580
3,459
12,661
1,942
3,874
263
1,254
3,730
479
Not using a method
42,327
3,577
5,740
4,440
7,560
4,806
4,613
856
2,184
7,169
1,382
Method unknown
34,122
1,493
876
15,773
7,012
3,016
737
1,266
74
3,826
49
Male condom
FAM or LAM
a
b
No Method
Partner pregnant/seeking pregnancy
Family Planning Annual Report: 2017 National Summary
b
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring,
female barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
Family Planning Annual Report: 2017 National Summary
Exhibit 25. Distribution of male family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 8)
Primary Method
Vasectomy
All
Regions
Region I
1%
1%
Male condom
65%
56%
FAM or LAM
1%
Abstinence
7%
Withdrawal or other methodc
Rely on female methodd
0%†
74%
Region III
Region IV
Region V
Region VI
Region VII Region VIII Region IX
Region X
1%
1%
1%
1%
1%
2%
1%
2%
49%
40%
71%
60%
67%
62%
81%
65%
0%†
0%†
2%
0%†
3%
0%†
0%†
0%†
0%†
14%
4%
6%
19%
4%
11%
2%
6%
3%
4%
3%
3%
4%
2%
5%
1%
1%
2%
2%
4%
11%
7%
8%
3%
9%
12%
7%
9%
10%
17%
3%
6%
Partner pregnant/seeking pregnancy
1%
1%
0%†
1%
1%
2%
2%
1%
1%
2%
1%
Other reason
8%
12%
13%
7%
10%
8%
11%
6%
9%
4%
11%
Method Unknown
7%
5%
2%
26%
10%
6%
2%
10%
0%†
3%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
76%
68%
81%
61%
60%
80%
73%
80%
83%
89%
84%
Abstinence
7%
14%
4%
6%
19%
4%
11%
2%
6%
3%
4%
Not using a method
9%
13%
13%
7%
11%
10%
13%
7%
10%
5%
12%
Method unknown
7%
5%
2%
26%
10%
6%
2%
10%
a
b
0%†
Region II
No Method
Total Male Users
Using most, moderately, or less
effective methode
b
0%†
3%
0%†
0%†
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
Note: Due to rounding, percentages may not sum to 100%.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
b
User refrained from oral, vaginal, and anal intercourse.
c
Includes withdrawal or any other method not listed in FPAR Table 8.
d
Primary method of user’s sex partner was female sterilization, intrauterine device, hormonal implant, hormonal injection, oral contraceptive, contraceptive patch, vaginal ring,
female barrier method (cervical cap, diaphragm, sponge, female condom), spermicide, or the lactational amenorrhea method.
e
Most effective methods include vasectomy, female sterilization, implant, and intrauterine device. Moderately effective methods include hormonal methods (injection, pill, patch,
and ring), diaphragm with spermicidal cream/jelly, and the cervical cap. Less effective methods include male and female condoms, withdrawal, sponge, spermicide (used alone),
FAM or LAM, and other methods not listed in Table 8. See Table 8 comments in the Field and Methodological Notes (Appendix C).
† Percentage is less than 0.5%.
39
Guidance for Reporting Cervical and Breast Cancer Screening Activities in FPAR Tables 9 and 10
In FPAR Table 9, grantees report the following information on cervical cancer screening activities:
▪ Unduplicated number of female users who obtained a Pap test;
▪ Number of Pap tests performed;
▪ Number of Pap tests with an ASC or higher result according to the 2014 Bethesda System.17 ASC or higher
results include ASC-US; ASC-H; LSIL; HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical
AIS; adenocarcinoma; or other malignant neoplasms; and
▪ Number of Pap tests with an HSIL or higher result according to the 2014 Bethesda System.17 HSIL or higher
results include HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical AIS; adenocarcinoma;
or other malignant neoplasms.
In FPAR Table 10, grantees report the following information on breast cancer screening and referral activities:
▪ Unduplicated number of female users receiving a clinical breast exam (CBE).
▪ Unduplicated number of female users referred for further evaluation based on CBE results.
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.
Squamous Cell Abnormalities—The 2014 Bethesda System17 classifies squamous cell abnormalities into the
following categories:
▪ Atypical squamous cells of undetermined significance (ASC-US) or atypical squamous cells, cannot
exclude HSIL (ASC-H)—ASC is a finding of abnormal squamous cells in the tissue lining the outer part of the
cervix. ASC-US is the most common abnormal finding in a Pap test. An ASC-US result may be caused by a
human papillomavirus (HPV), a benign growth (e.g., cyst or polyp), or low hormone levels in menopausal women.
ASC-H may be a sign of a high-grade squamous intraepithelial lesion (HSIL), which may become cervical cancer if
untreated.18
▪ Low-grade squamous intraepithelial lesion (LSIL) is a finding of slightly abnormal cells on the surface of the
cervix caused by certain types of HPV. LSIL is a common abnormal finding on a Pap test. Mild dysplasia and
cervical intraepithelial neoplasia (CIN) 1 are other terms for referring to LSILs.18
▪ High-grade squamous intraepithelial lesion (HSIL) is a growth on the surface of the cervix with moderately or
severely abnormal cells. HSILs are usually caused by certain types of HPV. If not treated, these abnormal cells
may become cancer and spread to normal tissue. HSIL encompasses moderate dysplasia (CIN 2) or severe
dysplasia and carcinoma in situ (CIN 3).18
▪ Squamous cell carcinoma is a finding of cancer in the squamous cells of the cervix.18
Glandular Cell Abnormalities—The 2014 Bethesda System17 classifies glandular cell abnormalities into the
following categories:
▪ Atypical glandular cells (AGCs) is a finding of abnormal cells that come from glands in the walls of the cervix.
The presence of these abnormal cells may be a sign of more serious lesions or cancer.18 The 2014 Bethesda
System17 subdivides AGCs into two categories:
– AGC—endocervical, endometrial, or glandular cells—not otherwise specified
– AGC—endocervical or glandular cells—favor neoplastic.
▪ Endocervical adenocarcinoma in situ (AIS) is a finding of abnormal cells found in the glandular tissue lining the
endocervical canal. AIS may become cancer and spread to nearby normal tissue.18
▪ Adenocarcinoma is a finding of cancer in endocervical, endometrial, extrauterine, or not otherwise specified
glandular tissue.18
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 33–35.
40
Family Planning Annual Report: 2017 National Summary
CERVICAL AND BREAST CANCER SCREENING
According to the QFP Recommendations,16 providers should assess clients’ need for related
preventive health services (e.g., cervical and breast cancer screening) and provide these
services according to federal and professional recommendations regarding frequency, client
eligibility, and procedures. This assessment is especially important for clients whose only
source of health care is the Title X service site.
Cervical Cancer Screening (Exhibit 26)
In 2017, Title X service sites provided Papanicolaou (Pap) testing to 18% (649,266) of female
family planning users and performed 683,247 Pap tests (1.1 tests per female tested). Of the
Pap tests performed, 14% had an indeterminate or abnormal result (i.e., atypical squamous
cell [ASC] or higher result) requiring further evaluation and possible treatment, and 1% had a
result of high-grade squamous intraepithelial lesion (HSIL) or higher, indicating the presence
of a more severe condition (Exhibit 26).
By region, the percentage of total female users who received a Pap test ranged from 14% (V)
to 25% (VII). From 12% (III and IV) to 20% (II) of Pap tests had an ASC or higher result,
and 1% of Pap tests in all regions except for Region I (2%) had an HSIL or higher result.
See Exhibits A–10a and A–10b for trends (2007–2017) in cervical cancer screening.
Breast Cancer Screening (Exhibit 26)
In 2017, Title X service sites provided clinical breast exams (CBEs) to 25% (878,491) of
female users and referred 5% (41,766) of those examined for further evaluation based on
CBE results.
By region, from 14% (IX) to 37% (IV, VII, and VIII) of female users received a CBE, and
from 1% (VIII and X) to 11% (IX) of those examined were referred for further evaluation
(Exhibit 26).
Family Planning Annual Report: 2017 National Summary
41
Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2017 (Source: FPAR Tables 9 and 10)
42
Tests/Exams
Pap Tests
Female users tested
Numbera
Percentage
b
Tests performed
Number
Tests per female tested
Tests with ASC or higher result
Number
Percentage
c
Tests with HSIL or higher result
Number
Family Planning Annual Report: 2017 National Summary
Percentagec
Clinical Breast Exams
Female users examined
Numbera
Percentage
b
Female users referred based on
exam
Number
Percentage
d
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region IX
Region X
649,266
24,468
72,940
77,007
135,660
47,176
75,466
27,009
18,913
145,880
24,747
18%
15%
19%
19%
22%
14%
24%
25%
18%
15%
17%
683,247
24,670
74,531
81,732
144,500
48,971
76,819
27,454
19,330
160,340
24,900
1.1
1.0
1.0
1.1
1.1
1.0
1.0
1.0
1.0
1.1
1.0
95,678
3,854
14,826
9,766
16,834
7,200
10,257
3,690
3,530
20,912
4,809
14%
16%
20%
12%
12%
15%
13%
13%
18%
13%
19%
7,304
404
1%
2%
798
772
1,480
518
931
323
217
1,576
285
1%
1%
1%
1%
1%
1%
1%
1%
1%
878,491
36,396
106,611
102,348
224,527
56,605
114,232
40,305
39,466
132,635
25,366
25%
22%
28%
25%
37%
17%
36%
37%
37%
14%
18%
41,766
2,348
2,959
6,645
3,968
2,705
5,938
2,074
370
14,394
365
5%
6%
3%
6%
2%
5%
5%
5%
1%
11%
1%
ASC=atypical squamous cells. HSIL=high-grade squamous epithelial lesion.
a
Unduplicated number of female users.
b
Denominator is the total unduplicated number of female users.
c
Denominator is the total number of Pap tests performed.
d
Denominator is the total unduplicated number of users examined.
Region VII Region VIII
SEXUALLY TRANSMITTED DISEASE TESTING
Sexually transmitted diseases (STDs) are a concern for clients served by Title X services
grantees, particularly young (15 to 24) sexually active women, a population that typically has
the highest reported rates of chlamydia and gonorrhea.19 According to the QFP
Recommendations,16 STD services are integral to family planning services because they
improve health and can affect a person’s ability to conceive and have a healthy birth outcome.
The QFP Recommendations advise providers to offer STD services to clients, both
symptomatic and asymptomatic, in accordance with the Centers for Disease Control and
Prevention’s (CDC’s) Sexually Transmitted Diseases Treatment Guidelines, 2015.20
Chlamydia Testing (Exhibits 27 and 28)
Chlamydia Testing of Female Users. CDC recommends routine annual chlamydia screening
for all sexually active women under 25 and for sexually active women 25 or older who may
be at increased risk of infection (e.g., new or multiple sex partners, a sex partner with
concurrent partners, or sexual partner with an STD). For sexually active women with HIV,
CDC recommends chlamydia screening at the first HIV evaluation and at least annually
thereafter unless risk behaviors and the local epidemiology warrant more frequent
screening.20
In 2017, Title X service sites tested 52% (1.8 million) of all female users for chlamydia and
61% (939,250) of females under 25 (Exhibits 27 and 28).
▪ By age group, chlamydia testing rates were higher among females 15 to 24 (61% to 63%)
than those under 15 (39%) or over 24 (45%) (Exhibits 27 and 28).
▪ By region, the chlamydia testing rate for females under 25 ranged from 49% (III) to 71%
(IX) (Exhibits 27 and 28).
▪ By state, chlamydia testing rates for females under 25 ranged from less than 0.5% to 83%
(Exhibit B–5).
See Exhibits A–11a and A–11b for trends (2007–2017) in chlamydia testing.
Chlamydia Testing of Male Users. CDC recommends that providers consider screening
young men for chlamydia in high-prevalence clinical settings (e.g., adolescent clinics,
correctional facilities, and STD clinics) and in populations with a high burden of infection
(e.g., men who have sex with men [MSM]). In addition, CDC recommends screening
sexually active MSM at anatomic sites of contact (urethra and rectum) at least annually or
more frequently (every 3 to 6 months) if at increased risk and sexually active men with HIV
at the first HIV evaluation and at least annually thereafter unless risk behaviors and the local
epidemiology warrant more frequent screening.20
In 2017, Title X service sites tested 69% (321,280) of all male users for chlamydia
(Exhibits 27 and 28).
▪ By age group, rates of chlamydia testing were higher for males 18 to 19 (73%) and 20 to
24 (82%) and lower for males 15 to 17 (50%) and under 15 (16%).
Family Planning Annual Report: 2017 National Summary
43
▪ By region, Title X service sites tested between 42% (IV) and 85% (V) of all male users for
chlamydia.
Gonorrhea Testing (Exhibit 29)
CDC recommends annual gonorrhea screening for all sexually active women under 25 and for
sexually active older women (25 or older) at increased risk of infection (e.g., new or multiple
sex partners, a sex partner with concurrent partners, a sex partner who has an STD,
inconsistent condom use among persons who are not in mutually monogamous relationships,
previous or coexisting STDs, and exchanging sex for drugs or money). CDC also
recommends screening sexually active MSM at anatomic sites of contact (urethra, rectum,
and pharynx) at least annually or more frequently (every 3 to 6 months) if at increased risk.
Finally, CDC recommends screening sexually active persons with HIV at the first HIV
evaluation and at least annually thereafter unless individual risk behaviors and the local
epidemiology warrant more frequent screening.20
In 2017, Title X service sites performed just over 2.4 million gonorrhea tests, or an average of
5.9 gonorrhea tests for every 10 female users and 7.6 tests for every 10 male users. By region,
the rate of gonorrhea testing ranged from 4.8 (I) to 6.5 (V and IX) tests for every 10 female
users and from 3.6 (IV) to 9.6 (V) tests for every 10 male users (Exhibit 29).
Syphilis Testing (Exhibit 29)
CDC recommends syphilis screening for sexually active MSM at least annually or more
frequently based on subsequent behavior. CDC also recommends screening sexually active
persons with HIV at the first HIV evaluation and at least annually thereafter unless individual
risk behaviors and the local epidemiology warrant more frequent screening.20
In 2017, Title X service sites performed 709,161 syphilis tests, or an average of 1.5 syphilis
tests for every 10 female users and 3.6 tests for every 10 male users. By region, the rate of
syphilis testing ranged from 0.3 tests (VIII and X) to 2.7 tests (IV) for every 10 female users
and from 1.6 tests (VIII) to 5.4 tests (VI) for every 10 male users (Exhibit 29).
Human Immunodeficiency Virus Testing (Exhibit 29)
CDC recommends HIV screening (opt-out approach) for men and women 13 to 64 in all
health care settings, including family planning, and for all persons who seek evaluation and
treatment for STDs. CDC also recommends HIV screening at least annually for sexually
active MSM if their HIV status is unknown or negative and the client or their partner(s) has
had more than one sex partner since their most recent HIV test.20
In 2017, Title X service sites performed approximately 1.2 million confidential HIV tests, or
an average of 2.6 confidential HIV tests for every 10 female users and 5.9 tests for every 10
male users. Of the confidential HIV tests performed, 2,195, or 1.8 tests per 1,000 tests
performed, were positive for HIV. In addition, Title X sites performed 2,083 anonymous HIV
tests. By region, the rate of HIV testing ranged from 1.1 test (X) to 3.3 tests (VI) for every 10
female users and from 2.6 tests (IV) to 7.2 tests (VIII and IX) for every 10 male users
(Exhibit 29).
See Exhibits A–12a and A–12b for trends (2007–2017) in confidential HIV testing among
female and male users.
44
Family Planning Annual Report: 2017 National Summary
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 tests performed, by sex;
Number of syphilis tests performed, by sex;
Number of confidential HIV tests performed, by sex;
Number of confidential HIV tests with a positive result; and
Number of anonymous HIV tests performed.
The FPAR instructions provide the following guidance for reporting this information:
Age Group—Use the client’s age as of June 30 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 October 2016), p. 39–40.
Family Planning Annual Report: 2017 National Summary
45
Exhibit 27. Number of family planning users tested for chlamydia, by sex, age, and region: 2017 (Source: FPAR Table 11)
46
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
14,129
766
1,100
2,077
3,325
1,296
1,425
428
446
2,568
698
15 to 17
146,839
7,062
13,617
15,345
23,590
15,545
13,088
5,681
5,661
38,669
8,581
18 to 19
215,830
8,908
21,418
18,830
33,619
23,172
17,713
7,096
8,557
65,933
10,584
20 to 24
562,452
21,747
59,157
46,002
86,110
59,694
44,006
16,357
18,200
186,999
24,180
Over 24
906,644
40,928
112,495
85,096
159,439
83,703
80,969
24,148
15,511
273,882
30,473
1,845,894
79,411
207,787
167,350
306,083
183,410
157,201
53,710
48,375
568,051
74,516
Under 25
939,250
38,483
95,292
82,254
146,644
99,707
76,232
29,562
32,864
294,169
44,043
Male Users
Under 15
1,976
249
93
654
527
73
32
28
27
267
26
15 to 17
14,434
1,348
1,436
2,786
1,444
1,274
646
432
499
4,045
524
18 to 19
24,104
1,462
2,509
3,024
2,080
3,091
1,561
904
1,089
7,643
741
20 to 24
86,537
4,513
9,349
8,307
6,543
12,829
5,308
2,854
4,302
29,990
2,542
Over 24
194,229
10,440
18,133
19,843
17,390
25,264
13,466
5,162
9,466
69,216
5,849
Subtotal
321,280
18,012
31,520
34,614
27,984
42,531
21,013
9,380
15,383
111,161
9,682
Subtotal
a
Family Planning Annual Report: 2017 National Summary
All Users
Under 15
a
All Regions
16,105
1,015
1,193
2,731
3,852
1,369
1,457
456
473
2,835
724
15 to 17
161,273
8,410
15,053
18,131
25,034
16,819
13,734
6,113
6,160
42,714
9,105
18 to 19
239,934
10,370
23,927
21,854
35,699
26,263
19,274
8,000
9,646
73,576
11,325
20 to 24
648,989
26,260
68,506
54,309
92,653
72,523
49,314
19,211
22,502
216,989
26,722
Over 24
1,100,873
51,368
130,628
104,939
176,829
108,967
94,435
29,310
24,977
343,098
36,322
Total All Users
2,167,174
97,423
239,307
201,964
334,067
225,941
178,214
63,090
63,758
679,212
84,198
The U.S. Centers for Disease Control and Prevention (CDC) recommends routine annual chlamydia screening for all sexually active women 24 years or younger and for older (25
years or older) women at increased risk of infection (e.g., with a new or multiple sex partners, a sex partner with concurrent partners, or sexual partner with an STD). The U.S.
Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection in sexually active women 24 years or younger and in older women who are at increased
risk for infection. In the absence of studies on screening intervals, the USPSTF recommends rescreening women whose sexual history reveals new or persistent risk factors since
the last negative test result. (Sources: CDC [2015]. Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64[No. RR–3], 1–137 [see reference 20] and USPSTF
[2014, September]. Gonorrhea and chlamydia: Screening [see reference 21].)
Family Planning Annual Report: 2017 National Summary
Exhibit 28. Percentage of family planning users in each age group tested for chlamydia, by sex, age, and region: 2017 (Source: FPAR Table 11)
Age Group (Years)
All Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
Female Users
Under 15
39%
29%
36%
31%
37%
41%
42%
38%
37%
53%
48%
15 to 17
61%
51%
62%
49%
55%
61%
61%
64%
62%
72%
64%
18 to 19
63%
56%
64%
50%
60%
63%
60%
62%
64%
73%
66%
20 to 24
62%
57%
60%
50%
60%
61%
59%
61%
59%
70%
63%
Over 24
45%
43%
49%
36%
45%
47%
43%
40%
30%
51%
42%
52%
48%
54%
41%
50%
54%
50%
49%
46%
59%
52%
Under 25
61%
54%
61%
49%
58%
61%
59%
61%
60%
71%
63%
Male Users
Under 15
16%
21%
7%
22%
13%
14%
4%
27%
7%
26%
48%
15 to 17
50%
41%
49%
43%
31%
72%
31%
79%
48%
72%
85%
18 to 19
73%
70%
72%
62%
54%
88%
53%
84%
75%
87%
90%
20 to 24
82%
82%
83%
69%
63%
91%
71%
83%
81%
90%
89%
Over 24
69%
65%
77%
58%
39%
84%
63%
73%
74%
80%
79%
Subtotal
69%
64%
74%
58%
42%
85%
61%
77%
74%
82%
82%
All Users
Under 15
Subtotal
a
a
33%
27%
28%
28%
29%
37%
35%
37%
30%
48%
48%
15 to 17
59%
49%
60%
48%
53%
61%
58%
65%
60%
72%
65%
18 to 19
64%
58%
65%
52%
60%
65%
59%
64%
65%
74%
67%
20 to 24
64%
60%
62%
52%
60%
65%
60%
63%
62%
72%
65%
Over 24
48%
46%
52%
39%
44%
52%
45%
44%
39%
55%
45%
Total All Users
54%
50%
56%
44%
49%
58%
51%
52%
50%
62%
54%
The U.S. Centers for Disease Control and Prevention (CDC) recommends routine annual chlamydia screening for all sexually active women 24 years or younger and for older (25
years or older) women at increased risk of infection (e.g., with a new or multiple sex partners, a sex partner with concurrent partners, or sexual partner with an STD). The U.S.
Preventive Services Task Force (USPSTF) recommends screening for chlamydial infection in sexually active women 24 years or younger and in older women who are at increased
risk for infection. In the absence of studies on screening intervals, the USPSTF recommends rescreening women whose sexual history reveals new or persistent risk factors since
the last negative test result. (Sources: CDC [2015]. Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64[No. RR–3], 1–137 [see reference 20] and USPSTF
[2014, September]. Gonorrhea and chlamydia: Screening [see reference 21].)
47
48
Exhibit 29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region, and number of positive HIV tests, by region:
2017 (Source: FPAR Table 12)
STD Tests
Region I
Region II
Region III
Region IV
Region V
Region VI
2,073,331
80,664
236,791
222,594
321,372
223,648
171,406
58,454
53,821
624,259
80,322
Male
351,585
18,453
34,100
45,009
24,137
48,037
22,267
9,959
17,308
121,763
10,552
Total
2,424,916
99,117
270,891
267,603
345,509
271,685
193,673
68,413
71,129
746,022
90,874
5.9
4.8
6.1
5.5
5.3
6.5
5.4
5.4
5.1
6.5
5.6
Male
7.6
6.5
8.0
7.5
3.6
9.6
6.4
8.2
8.3
9.0
9.0
Total
6.1
5.1
6.3
5.8
5.1
6.9
5.5
5.7
5.6
6.8
5.9
Gonorrhea Tests
Female
Tests per 10 Users
Female
Syphilis Tests
Female
All Regions
Region VII
Region VIII
Region IX
Region X
Family Planning Annual Report: 2017 National Summary
540,346
18,975
30,476
69,434
167,342
34,878
81,828
14,989
3,292
114,488
4,644
Male
168,815
8,259
11,881
25,517
18,650
15,807
18,859
4,099
3,390
59,240
3,113
Total
709,161
27,234
42,357
94,951
185,992
50,685
100,687
19,088
6,682
173,728
7,757
Tests per 10 Users
Female
1.5
1.1
0.8
1.7
2.7
1.0
2.6
1.4
0.3
1.2
0.3
Male
3.6
2.9
2.8
4.2
2.8
3.2
5.4
3.4
1.6
4.4
2.6
Total
1.8
1.4
1.0
2.0
2.7
1.3
2.9
1.6
0.5
1.6
0.5
Confidential HIV Tests
Female
917,623
36,485
116,670
106,972
155,190
84,706
105,566
20,292
14,299
261,042
16,401
Male
274,496
16,636
28,045
36,491
17,662
29,942
20,326
6,397
15,081
97,661
6,255
Total
1,192,119
53,121
144,715
143,463
172,852
114,648
125,892
26,689
29,380
358,703
22,656
Tests per 10 Users
Female
2.6
2.2
3.0
2.6
2.5
2.5
3.3
1.9
1.3
2.7
1.1
Male
5.9
5.9
6.6
6.1
2.6
6.0
5.9
5.2
7.2
7.2
5.3
Total
3.0
2.7
3.4
3.1
2.6
2.9
3.6
2.2
2.3
3.3
1.5
Positive Test Results
2,195
98
265
402
212
126
307
31
74
610
70
Anonymous HIV Tests
2,083
0
0
209
0
634
0
921
0
274
45
STAFFING AND FAMILY PLANNING ENCOUNTERS
Clinical Services Provider Staffing (Exhibit 30)
Highly trained clinical services providers (CSPs) participate in the delivery of Title X-funded
services. CSPs include physicians, physician assistants (PAs), nurse practitioners (NPs),
certified nurse midwives (CNMs), and registered nurses with an expanded scope of practice
(“other” CSPs) who are trained and permitted by state-specific regulations to perform exams
and medical procedures, as described in the Program Requirements for Title X Funded
Family Planning Projects1 and the QFP Recommendations.16
In 2017, 3,525 full-time equivalent (FTE) CSPs delivered medical family planning and
related preventive health services in Title X service sites (Exhibit 30).
▪ By CSP type, midlevel clinicians (i.e., PAs, NPs, and CNMs) accounted for 70% of total
FTEs, followed by physicians (23%) and other CSPs (7%). On average, there were 3.0
midlevel clinician FTEs for every 1.0 physician FTE.
▪ By region, from 7% (V) to 36% (I) of total FTEs were physician FTEs, 59% (III) to 86%
(VIII) were midlevel clinician FTEs, and 0% (VI, VII, VIII, and X) to 26% (V) were other
CSP FTEs. There were from 1.8 (I and III) to 9.1 (V) midlevel clinician FTEs for every 1.0
physician FTE.
Family Planning Encounters (Exhibit 30)
In 2017, Title X service sites reported a total of 6.6 million family planning encounters, or an
average of 1.7 encounters per user (Exhibit 30).
▪ By type, most family planning encounters (78%, or 5.2 million) were attended by a CSP,
resulting in an average of 1.3 CSP encounters per user and 1,465 CSP encounters per CSP
FTE.
▪ By region, the number and types of family planning encounters varied as follows:
– Total encounters: The average number of encounters per user ranged from 1.4 (X) to
1.8 (VII).
– CSP encounters: The percentage of encounters that were attended by a CSP ranged
from 56% (VI) to 91% (I). The number of CSP encounters per user ranged from 1.0 (VI)
to 1.4 (I, II, III, and IX), and the number of CSP encounters per CSP FTE ranged from
897 (X) to 2,208 (II).
– Non-CSP encounters: The percentage of encounters that were attended by non-CSP
staff ranged from 9% (I) to 44% (VI). The number of non-CSP encounters per user
ranged from 0.1 (I and II) to 0.7 (VI).
Family Planning Annual Report: 2017 National Summary
49
Guidance for Reporting Encounter and Staffing Data in FPAR Table 13
In FPAR Table 13, grantees report information on the number and type of family planning encounters and the use of
Clinical Services Providers to deliver Title X-funded family planning and related preventive health services. Table 13
reports the following provider staffing and encounter data:
▪ 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 Providers—Include 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 assessments recommended for contraceptive, related preventive health, and basic infertility care. 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.12
Other Services Providers—Include other agency staff (e.g., registered nurses, public health nurses, licensed
vocational or licensed practical nurses, certified nurse assistants, health educators, social workers, or clinic aides)
who 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.12 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.12
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 services provided during the family planning encounter
must be documented in the client record. 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 tests are accompanied by family
planning counseling or education.
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 nonclinical
assessment and care during the visit is credited with the encounter.
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-funded services (i.e., engaged in a family planning encounter).
A full-time equivalent (FTE) of 1.0 describes staff who, individually or as a group, work the equivalent of full time for 1
year. Each agency defines the number of hours for “full-time” work and may define it differently for different positions.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 43–45.
50
Family Planning Annual Report: 2017 National Summary
Family Planning Annual Report: 2017 National Summary
Exhibit 30. Number and distribution of FTE CSP staff, by type of CSP and region, and number and distribution of FP encounters, by type of
encounter and region: 2017 (Source: FPAR Table 13)
FTEs and FP Encounters
Number of CSP FTEs
Physician
All
Regions
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
819.9
57.3
71.6
218.5
209.4
22.0
40.9
14.9
11.2
133.7
40.4
2,465.7
102.7
194.6
393.1
547.4
200.1
149.0
72.2
69.7
578.7
158.3
239.4
1.4
9.0
58.0
80.5
79.7
0.0
0.0
0.0
10.8
0.0
3,525.0
161.4
275.2
669.7
837.4
301.7
189.9
87.1
80.9
723.2
198.6
23%
36%
26%
33%
25%
7%
22%
17%
14%
18%
20%
70%
64%
71%
59%
65%
66%
78%
83%
86%
80%
80%
7%
1%
3%
9%
10%
26%
0%
0%
0%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
3.0
1.8
2.7
1.8
2.6
9.1
3.6
4.9
6.2
4.3
3.9
5,162,855
274,191
607,590
632,593
761,690
511,560
338,400
145,326
137,585
1,575,771
178,149
With other
1,477,446
25,725
64,135
178,002
407,402
167,470
262,048
76,734
62,229
190,180
43,521
Total
6,640,301
299,916
671,725
810,595
1,169,092
679,030
600,448
222,060
199,814
1,765,951
221,670
78%
91%
90%
78%
65%
75%
56%
65%
69%
89%
80%
22%
9%
10%
22%
35%
25%
44%
35%
31%
11%
20%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
1.3
1.4
1.4
1.4
1.1
1.3
1.0
1.2
1.1
1.4
1.2
With other
0.4
0.1
0.1
0.4
0.6
0.4
0.7
0.6
0.5
0.2
0.3
Total
1.7
1.5
1.6
1.7
1.7
1.7
1.7
1.8
1.6
1.6
1.4
1,465
1,699
2,208
945
910
1,695
1,782
1,669
1,700
2,179
897
PA/NP/CNM
Other CSPa
Total
Distribution of CSP FTEs
Physician
PA/NP/CNM
Other CSP
a
Total
Midlevel to Physician FTEb
Number of FP Encounters
With CSP
Distribution of FP Encounters
With CSP
With other
Total
FP Encounters per User
With CSP
CSP Encounters per CSP FTE
1%
0%
51
CNM=certified nurse midwife. CSP=clinical services provider. FP=family planning. FTE=full-time equivalent. NP=nurse practitioner. PA=physician assistant.
Note: Due to rounding, percentages may not sum to 100%.
a
Other CSPs are registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user (male and
female) physical assessments recommended for contraceptive, related preventive health, and basic infertility care.
b
Midlevel providers include physician assistants, nurse practitioners, and certified nurse midwives.
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—Refers to funds received from the Title X Section 1001 family planning services grant. Report the
amount received (cash receipts or drawdown amounts) during the reporting period from the Title X services grant.
Include base Title X grant funding and other Title X funding for special initiatives (e.g., HIV integration and male
involvement). 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—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 (“Client Fees”)—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—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 prepaid
(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/Title XIX—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
“Note” field.
Medicare/Title XVIII—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.
Children’s Health Insurance Program (CHIP)—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 “Note” field.
Other Public Health Insurance—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. Other public health insurance programs include state or local government programs that provide a
broad set of benefits and public-paid or public-subsidized private insurance programs.
Private Health Insurance—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. Private health
insurance include plans obtained through an employer, union, or direct purchase, including insurance purchased
for public employees or retirees or military personnel and their dependents (e.g., TRICARE or CHAMPVA) that
provide a broad set of primary medical care benefits for the enrolled individual (beneficiary or dependent).
Other Revenue—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.
Maternal and Child Health (MCH) Block Grant/Title V—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.
Social Services Block Grant/Title XX—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)
52
Family Planning Annual Report: 2017 National Summary
REVENUE
In 2017, Title X grantees reported total program revenue of $1.3 billion to support the
delivery of Title X-funded family planning and related preventive health care. The major
sources of revenue—Medicaid (including Children’s Health Insurance Program [CHIP])
($496.5 million) and Title X ($244.6 million)—accounted for 38% and 19%, respectively, of
total revenue. Revenue from state governments ($119.0 million), private third-party payers
($140.1 million), local governments ($69.2 million), and client service fees ($52.4 million)
each accounted for 4% to 11% of total revenue, while all other sources each contributed 2%
or less (Exhibit 31).
Title X Services Grant
Revenue from Title X accounted for 19% ($244.6 million) of total national revenue and
between 9% (IX) and 32% (VII) of total regional revenue. Title X was the largest source of
revenue in three regions (VI, VII, and VIII) and the second largest source after Medicaid in
three others (III, IV, and V) (Exhibits 32 and 33).
Payment for Services: Client Fees
Revenue from client service fees accounted for 4% ($52.4 million) of total revenue and
between 2% (VI) and 9% (VII) of total regional revenue (Exhibits 32 and 33).
Payment for Services: Third-Party Payers
In 2017, revenue from third-party payers was 50% ($655.3 million) of total revenue, with
Medicaid/CHIP accounting for most (76%) of this amount.
Medicaid and CHIP. Medicaid revenue (federal and state shares) accounted for 38%
($495.2 million) of total revenue, and separately reported CHIP revenue accounted for less
than 0.5% ($1.3 million) of total revenue. Together, these two sources totaled $496.5 million,
or 38% of total 2017 revenue.
Guidance for Reporting Project Revenue in FPAR Table 14 (continued)
Temporary Assistance for Needy Families (TANF)—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—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—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) or block grant funds that are awarded to and distributed by the state. Report
these revenues as “Other revenue” and specify their sources.
Bureau of Primary Health Care (BPHC)—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—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 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 October 2016), pp. 47–49.
Family Planning Annual Report: 2017 National Summary
53
By region, Medicaid (including CHIP) accounted for 11% (VII) to 63% (IX) of total regional
revenue. Medicaid was the largest source (29% to 63%) of regional revenue in six regions (II,
III, IV, V, IX, and X) and the second largest source (25%) in Region I (Exhibits 32 and 33).
Medicaid revenue reported by grantees in 26 states included revenue from state Medicaid
family planning eligibility expansions. (See the FPAR Table 14 notes in Appendix C: Field
and Methodological Notes for a list of states.)
Medicare and Other Public. Revenue from Medicare ($7.2 million) and other public thirdparty payers ($11.4 million) together accounted for 1% of total national revenue. By region,
the share of revenue from Medicare and other public third-party payers ranged from less than
0.5% (IV, VIII, IX, and X) to 6% (VI) (Exhibits 32 and 33).
Private. Revenue from private third-party payers ($140.1 million) accounted for 11% of total
national revenue and between 5% (IV) and 26% (I) of total regional revenue. Private thirdparty payer revenue was the most important source of revenue in Region I, the second most
important source in Regions VII, VIII, and X, and the third most important source in Regions
III, V, and IX (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 ($13.0 million), the Title XX Social
Services block grant ($4.5 million), and TANF ($6.4 million) each accounted for 1% or less
of total national revenue. By region, the share of total regional revenue from block grants
(MCH or Social Services) or TANF ranged from 0% to 3% of total regional revenues. While
all regions reported some revenue from the MCH block grant, only five reported revenue
from the Social Services block grant (I, III, V, VIII, and IX) or TANF (I, IV, V, VII, and
VIII) (Exhibits 32 and 33).
State Governments. State government revenue accounted for 9% ($119.0 million) of total
national revenue and from less than 0.5% (VII) to 26% (VI) of total regional revenue. State
government revenue was the second largest source of regional revenue in Regions II and VI
(Exhibits 32 and 33).
Local Governments. Local government revenue accounted for 5% ($69.2 million) of total
national revenue and from less than 0.5% (I) to 22% (IV) of total regional revenue. Local
government revenue was the third largest source of regional revenue in Regions IV and VIII
(Exhibits 32 and 33).
Bureau of Primary Health Care. Revenue from the Health Resources Services
Administration Bureau of Primary Health Care (BPHC) accounted for 2% ($21.4 million) of
total national revenue. Two regions (III and VIII) reported no BPHC revenue, while eight
others reported BPHC revenue ranging from less than 0.5% (I, II, IV, VI, and X) to 11% (VII)
of total regional revenue (Exhibits 32 and 33).
54
Family Planning Annual Report: 2017 National Summary
Exhibit 31. Amount and distribution of Title X project revenues, by revenue source: 2017
(Source: FPAR Table 14)
Revenue Source
Amount
Distribution
$244,563,111
19%
$52,367,880
4%
Medicaidb
$495,245,884
38%
Medicare
$7,169,121
1%
Title X
Payment for Services
Client fees
Third-party payers
a
Children’s Health Insurance Program
$1,256,008
0%†
$11,445,695
1%
Private
$140,145,229
11%
Subtotal
$707,629,817
55%
$12,960,533
1%
$4,547,979
0%†
$6,385,879
0%†
Other public
Other Revenue
Maternal and Child Health block grant
Social Services block grant
Temporary Assistance for Needy Families
State government
$119,036,286
9%
Local government
$69,199,630
5%
Bureau of Primary Health Care
$21,389,246
2%
Other
$111,905,640
9%
Subtotal
$345,425,193
27%
$1,297,618,121
100%
c
Total Revenue
Total Revenue per User
$324
—
Total Revenue per Encounter
$195
—
— Not applicable.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year. Due to rounding, percentages may
not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from Medicaid family planning eligibility expansions in 26 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%.
All Other Revenue. Finally, 9% ($111.9 million) of total revenue came from a combination
of all other public and private sources not listed separately in Table 14. Revenue from other
sources ranged from 2% (III and IV) to 17% (IX) of total regional revenue (Exhibits 32 and
33). See the notes for FPAR Table 14 in Appendix C: Field and Methodological Notes for a
list of other revenue sources.
Revenue per User and Encounter
On average, in 2017 grantees reported $324 in program revenue per family planning user
served or $195 per family planning encounter. By region, revenue per user ranged from $202
(III) to $454 (X), and revenue per encounter ranged from $116 (III) to $317 (X) (Exhibit 32).
Family Planning Annual Report: 2017 National Summary
55
Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2017 (Source: FPAR Table 14)
56
Revenue Source
Title X
Region I
($)
Region II
($)
Region III
($)
Region IV
($)
Region V
($)
Region VI
($)
Region VII
($)
Region VIII
($)
Region IX
($)
Region X
($)
$25,895,531
$25,955,568
$50,096,697
$34,593,256
$29,647,951
$12,992,294
$10,411,761
$32,151,760
$9,825,069
$1,927,062
$8,224,845
$4,652,730
$6,523,021
$8,613,543
$2,205,405
$3,071,392
$3,626,520
$9,828,614
$3,694,748
$495,245,884 $13,214,930
$5,197,845 $229,908,942
$25,683,078
$244,563,111 $12,993,224
Payment for Services
Client fees
Third-party payersa
Medicaidb
Medicare
CHIP
Other public
All Regions
($)
c
$52,367,880
$62,470,700
$29,541,633
$58,275,198
$49,556,691
$16,875,782
$4,521,085
$7,169,121
$435,380
$1,958,623
$1,115,643
$506,261
$2,282,515
$64,915
$188,159
$46,400
$414,663
$156,562
$1,256,008
$20,730
$232,921
$43,676
$205,835
$516,288
$87,660
$81,899
$66,999
$0
$0
$11,445,695
$6,025,266
$263,201
$24,111
$351,641
$10,575
$7,029,482
$23,242,334
$14,402,876
$15,991,357 $263,746,194
$43,947,839
Family Planning Annual Report: 2017 National Summary
$1,731,986
$0
$1,768,371
$17,289
$1,253,255
Private
$140,145,229 $13,755,113
$20,925,515
$12,038,084
$10,254,322
$23,822,984
$7,543,839
$7,130,680
Subtotal
$707,629,817 $31,085,201
$93,812,604
$49,160,137
$75,781,926
$86,045,276
$32,802,867
$15,256,416
$2,579,856
$2,236,738
$1,463,738
$307,777
$359,505
$1,139,606
Other Revenue
MCH block grant
$12,960,533
$22,000
$2,614,678
$1,646,959
SS block grant
$4,547,979
$911,968
$0
$2,490,289
$0
$1,088,595
$0
$0
$34,825
$22,302
$0
TANF
$6,385,879
$76,928
$0
$0
$3,406,536
$2,475,168
$0
$424,059
$3,188
$0
$0
State government
$119,036,286
$5,967,060
$38,687,725
$11,030,307
$19,409,178
$4,285,935
$26,694,359
$155,337
$802,261
$2,241,976
$9,762,148
Local government
$69,199,630
$5,747
$2,867,008
$1,345,265
$43,179,062
$3,762,450
$5,024,775
$238,946
$6,590,523
$2,318,992
$3,866,862
$589,676
BPHC
$21,389,246
$88,923
$242,500
$0
$96,839
$13,053,310
$176,184
$4,580,207
$0
$3,107,672
$43,611
Otherd
$111,905,640
$1,342,597
$13,143,301
$2,182,252
$4,769,234
$9,248,677
$5,497,838
$6,506,429
$4,268,589
$62,748,549
$2,198,174
Subtotal
$345,425,193
$8,415,223
$57,555,212
$18,695,072
$73,440,705
$36,150,873
$38,856,894
$12,212,755
$12,058,891
$71,579,097
$16,460,471
$93,810,777 $199,319,328 $156,789,405 $101,307,712
$40,461,465
$38,462,009 $367,477,051
$70,233,379
Total Revenue
$1,297,618,121 $52,493,648 $177,263,347
Total Revenue per User
$324
$269
$413
$202
$294
$400
$289
$335
$303
$336
$454
Total Revenue per
Encounter
$195
$175
$264
$116
$170
$231
$169
$182
$192
$208
$317
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy Families.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
Prepaid and not prepaid.
b
Includes revenue from Medicaid family planning eligibility expansions in 26 states in all 10 HHS regions. See Table 14 comments in the Field and Methodological Notes (Appendix C) for a
list of states by region.
c
“All Regions” and “Region VI” amounts for “Other Public” third-party payment for services include revenue from the Texas Women’s Health Program.
d
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as “other.”
Family Planning Annual Report: 2017 National Summary
Exhibit 33. Distribution of Title X project revenues, by revenue source and region: 2017 (Source: FPAR Table 14)
Revenue Source
All Regions
Title X
Region I
Region II
Region III
Region IV
Region V
Region VI
Region VII
Region VIII
Region IX
Region X
19%
25%
15%
28%
25%
22%
29%
32%
27%
9%
14%
Payment for Services
Client fees
4%
4%
5%
5%
3%
5%
2%
8%
9%
3%
5%
Third-party payers
Medicaidb
38%
25%
35%
31%
29%
32%
17%
11%
14%
63%
37%
1%
1%
1%
1%
0%†
1%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%
0%
Medicare
CHIP
Other public
c
a
1%
3%
0%
2%
0%†
1%
6%
1%
Private
11%
26%
12%
13%
5%
15%
7%
18%
18%
6%
21%
Subtotal
55%
59%
53%
52%
38%
55%
32%
38%
42%
72%
63%
1%
2%
1%
1%
1%
1%
1%
Other Revenue
MCH block grant
1%
0%†
0%†
0%†
0%†
0%†
1%
SS block grant
0%†
2%
0%
3%
0%
1%
0%
0%
0%†
0%†
0%
TANF
0%†
0%†
0%
0%
2%
2%
0%
1%
0%†
0%
0%
State government
9%
22%
12%
10%
3%
26%
0%†
2%
1%
14%
Local government
5%
0%†
2%
1%
22%
2%
5%
1%
17%
1%
6%
BPHC
2%
0%†
0%†
0%
8%
0%†
11%
0%
1%
0%†
Other
d
11%
0%†
9%
3%
7%
2%
2%
6%
5%
16%
11%
17%
3%
Subtotal
27%
16%
32%
20%
37%
23%
38%
30%
31%
19%
23%
Total Revenue
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy
Families.
Note: Due to rounding, percentages may not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from Medicaid family planning eligibility expansions in 26 states in all 10 HHS regions. See Table 14 comments in the Field and Methodological Notes
(Appendix C) for a list of states by region.
c
“All Regions” and “Region VI” percentages for “Other Public” third-party payment for services include revenue from the Texas Women’s Health Program.
d
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as “other.”
† Percentage is less than 0.5%.
57
Revenue Trends: 2007 vs. 2017
Compared with 2007, in 2017, inflation-adjusted (constant 2017 dollars)22 total revenue
decreased 16% (by $246.6 million), from $1.5 billion in 2007 to $1.3 billion in 2017
(Exhibit A–13a). During this period, increases in revenue from third-party and “other”
revenue sources totaled $142.6 million. Medicaid (including CHIP) increased 5%, from
$473.8 million (2007) to $496.5 million (2017). In addition, private third-party payer revenue
increased 158% ($62.8 million in 2007 vs. $140.1 million in 2017), Medicare and other nonMedicaid public third-party payer revenue increased 286% ($4.8 million in 2007 vs.
$18.6 million in 2017), and “other” revenue sources combined increased 28% ($104.5 million
in 2007 vs. $133.3 million in 2017) (not shown).
The increase in revenue from these four sources, however, was too low to offset losses
totaling $389.2 million from Title X, client service fees, state and local governments, block
grants, and TANF. For each source, the decline in revenue between 2007 and 2017 was as
follows:
▪ Title X revenue decreased 29%, or by $101.2 million, between 2007 ($345.7 million) and
2017 ($244.6 million) (Exhibit A–13a).
▪ Client service fees revenue decreased 59%, or by $75.3 million, between 2007
($127.6 million) and 2017 ($52.4 million) (not shown).
▪ State government revenue decreased 37%, or by $68.8 million, between 2007
($187.9 million) and 2017 ($119.0 million) (not shown).
▪ Local government revenue decreased 49%, or by $65.5 million, between 2007
($134.7 million) and 2017 ($69.2 million) (not shown).
▪ Block grant revenue decreased 75%, or by $53.0 million, between 2007 ($70.5 million)
and 2017 ($17.5 million) (not shown).
▪ TANF revenue decreased 80%, or by $25.4 million, between 2007 ($31.8 million) and
2017 ($6.4 million) (not shown).
Since 2007, the composition of total revenue across major sources has changed. As a
percentage of total revenue, Medicaid (including CHIP) revenue grew from 31% (2007) to
38% (2017), Title X revenue decreased from 22% to 19%, and state and local government
revenue decreased from 21% to 15%. The share of total revenue from all other sources
combined fluctuated between 22% and 28% (Exhibit A–14c).
See Exhibits A–13a through A–13e for trends (2007–2017) in actual and inflation-adjusted
(constant 2017 dollars)22 total, Title X, and Medicaid revenue.
58
Family Planning Annual Report: 2017 National Summary
4
References
1. Office of Population Affairs. (2014). Program requirements for Title X funded
family planning projects (Version 1.0). Retrieved from
https://www.hhs.gov/opa/sites/default/files/ogc-cleared-final-april.pdf
2. 42 Code of Federal Regulations (CFR) Part 59 Subpart A. (2000, July 3).
Project grants for family planning services. Retrieved from
https://www.ecfr.gov/cgi-bin/textidx?SID=c1cbd72e13f7230f1e8328fa52b57899&mc=true&node=sp42.1.59.a
&rgn=div6
3. Frost, J. J. (2013). U.S. women’s use of sexual and reproductive health
services: Trends, sources of care and factors associated with use, 1995–2010.
New York: Guttmacher Institute. Retrieved from
https://www.guttmacher.org/pubs/sources-of-care-2013.pdf
4. Office of Population Affairs. (2018). Title X funding history. Retrieved from
https://www.hhs.gov/opa/about-opa-and-initiatives/funding-history/
5. Office of Population Affairs. (2016). Family planning annual report: Forms
and instructions (Reissued October 2016). Rockville, MD: U.S. Department of
Health and Human Services, Office of the Assistant Secretary for
Health/Office, Office of Population Affairs. Retrieved from
https://www.hhs.gov/opa/sites/default/files/fpar-forms-instructions-reissuedoct-2016.pdf
6. 45 Code of Federal Regulations (CFR) Part 75. (2016, October 1). Uniform
administrative requirements, cost principles, and audit requirements for HHS
awards. Retrieved from https://www.ecfr.gov/cgibin/retrieveECFR?gp=&SID=88c2f29440664f74c9444e7ff44bab5a&mc=true
&n=pt45.1.75&r=PART&ty=HTML
7. U.S. Department of Health and Human Services. (2016). 2017 poverty
guidelines, U.S. federal poverty guidelines used to determine financial
eligibility for certain federal programs. Retrieved from
https://aspe.hhs.gov/2017-poverty-guidelines
8. Cohen, R. A. Zammitti, E. P., & Martinez, M.E. (2018). Health insurance
coverage: Early release of estimates from the National Health Interview
Survey, 2017. Retrieved from
https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf
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9. Office of Management and Budget. (1997). Revisions to the standards for the
classification of federal data on race and ethnicity, October 30, 1997. Federal
Register Notice. Retrieved from https://www.gpo.gov/fdsys/pkg/FR-1997-1030/pdf/97-28653.pdf
10. Trussell, J. (2011). Chapter 26: Contraceptive: Efficacy. In R. A. Hatcher, J.
Trussell, A. L. Nelson, W. Cates, D. Kowal, & M. S. Policar (Eds.),
Contraceptive technology (20th ed.). New York, NY: Ardent Media, Inc.
11. Title X of the Public Health Service Act, 42 U.S. Code 300 et seq. (1970).
Retrieved from https://www.hhs.gov/opa/sites/default/files/title-x-statuteattachment-a_0.pdf
12. The Title X Family Planning Program Guidelines consist of two documents:
(1) Program requirements for Title X funded family planning projects
(“Program Requirements”) and (2) clinical recommendations as outlined in
Providing quality family planning services: Recommendations of CDC and the
U.S. Office of Population Affairs (“QFP”), and in updates (2015 and 2017) to
the Recommendations. Retrieved from
https://www.hhs.gov/opa/guidelines/program-guidelines/index.html
13. U.S. Department of Health and Human Services. (2003). Guidance to federal
financial assistance recipients regarding Title VI prohibition against national
origin discrimination affecting limited English proficient persons (“Revised
HHS LEP guidance”). Federal Register, 68(153), 47311–47323. Retrieved
from
https://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/policyguidance
document.html
14. Kennedy, K. I., & Trussell, J. (2011). Postpartum contraception and lactation.
In R. A. Hatcher, J. Trussell, A. L. Nelson, W. Cates, D. Kowal, & M. S.
Policar (Eds.), Contraceptive technology (20th ed., pp. 483–511). New York,
NY: Ardent Media.
15. U.S. Centers for Disease Control and Prevention. (2017). Sexual risk
behaviors: HIV, STD & teen pregnancy prevention. Retrieved from
https://www.cdc.gov/healthyyouth/sexualbehaviors/
16. U.S. Centers for Disease Control and Prevention and the U.S. Office of
Population Affairs. (2014). Providing quality family planning services:
Recommendations of CDC and the U.S. Office of Population Affairs. MMWR,
63(4), 1–54. Retrieved from https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf. For
the 2015 update to the Recommendations, see Gavin, L., & Pazol, K. (2016).
Update: Providing quality family planning services–Recommendations from
CDC and the U.S. Office of Population Affairs, 2015. MMWR, 65(9), 231–
234. Retrieved from
https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6509a3.pdf. For the 2017
update to the Recommendations, see Gavin, L., Pazol, K., & Ahrens, K.
(2017). Update: Providing quality family planning services–Recommendations
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from CDC and the U.S. Office of Population Affairs, 2017. MMWR, 66(50),
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17. Nayar, R., & Wilbur, D. C. (2015). The Pap test and Bethesda 2014. Acta
Cytologica 29, 121–132.
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from https://www.cancer.gov/publications/dictionaries
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https://www.cdc.gov/std/tg2015/tg-2015-print.pdf and Centers for Disease
Control and Prevention. (2016). Screening recommendations and
considerations referenced in treatment guidelines and original sources.
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62
Family Planning Annual Report: 2017 National Summary
Appendix A
National Trend Exhibits
A-2
Exhibit A–1a.
Region
Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
Family Planning Annual Report: 2017 National Summary
Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
Number of Title X-funded grantees, subrecipients, and service sites, by region and year: 2007–2017
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
10
7
9
10
11
8
5
6
15
8
89
10
7
9
10
11
8
5
6
15
7
88
10
7
9
10
11
8
5
6
16
7
89
10
7
9
10
12
6
5
6
16
8
89
11
7
9
10
12
6
5
6
17
8
91
11
7
9
13
11
6
5
6
17
8
93
11
6
10
13
11
7
5
6
18
8
95
12
6
10
14
10
6
5
6
17
8
94
11
6
10
10
12
6
5
6
17
8
91
11
6
10
9
11
7
5
6
18
8
91
11
6
10
9
11
6
5
6
17
8
89
70
91
226
187
158
93
107
73
107
64
1,176
70
91
222
185
146
95
107
78
112
64
1,170
69
89
222
190
136
94
107
73
116
61
1,157
71
82
218
188
130
90
105
74
104
60
1,122
72
80
230
183
135
79
106
74
121
62
1,142
67
75
265
184
129
78
101
75
113
61
1,148
66
71
271
214
133
90
97
74
105
60
1,181
67
70
258
253
120
45
93
74
95
59
1,134
71
70
316
226
122
47
94
74
102
59
1,181
69
68
223
281
118
41
92
68
99
58
1,117
68
68
225
277
113
39
91
69
85
56
1,091
240
293
662
1,117
428
573
286
187
479
277
4,542
233
292
651
1,093
410
571
294
190
508
280
4,522
230
296
656
1,104
373
588
296
185
501
286
4,515
221
272
641
1,091
371
580
289
184
495
245
4,389
228
263
639
1,076
392
553
267
179
539
246
4,382
238
253
633
1,044
364
521
251
185
474
226
4,189
225
256
627
1,019
362
571
242
182
460
224
4,168
233
251
615
1,183
340
442
223
182
441
217
4,127
224
247
648
936
383
457
218
177
461
200
3,951
225
244
640
914
374
425
221
180
469
206
3,898
221
244
653
912
365
415
210
162
465
211
3,858
Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
Family Planning Annual Report: 2017 National Summary
Exhibit A–1b.
Region
Distribution of Title X-funded grantees, subrecipients, and service sites, by region and year: 2007–2017
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
11%
8%
10%
11%
12%
9%
6%
7%
17%
9%
100%
11%
8%
10%
11%
13%
9%
6%
7%
17%
8%
100%
11%
8%
10%
11%
12%
9%
6%
7%
18%
8%
100%
11%
8%
10%
11%
13%
7%
6%
7%
18%
9%
100%
12%
8%
10%
11%
13%
7%
5%
7%
19%
9%
100%
12%
8%
10%
14%
12%
6%
5%
6%
18%
9%
100%
12%
6%
11%
14%
12%
7%
5%
6%
19%
8%
100%
13%
6%
11%
15%
11%
6%
5%
6%
18%
9%
100%
12%
7%
11%
11%
13%
7%
5%
7%
19%
9%
100%
12%
7%
11%
10%
12%
8%
5%
7%
20%
9%
100%
12%
7%
11%
10%
12%
7%
6%
7%
19%
9%
100%
Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
6%
8%
19%
16%
13%
8%
9%
6%
9%
5%
100%
6%
8%
19%
16%
12%
8%
9%
7%
10%
5%
100%
6%
8%
19%
16%
12%
8%
9%
6%
10%
5%
100%
6%
7%
19%
17%
12%
8%
9%
7%
9%
5%
100%
6%
7%
20%
16%
12%
7%
9%
6%
11%
5%
100%
6%
7%
23%
16%
11%
7%
9%
7%
10%
5%
100%
6%
6%
23%
18%
11%
8%
8%
6%
9%
5%
100%
6%
6%
23%
22%
11%
4%
8%
7%
8%
5%
100%
6%
6%
27%
19%
10%
4%
8%
6%
9%
5%
100%
6%
6%
20%
25%
11%
4%
8%
6%
9%
5%
100%
6%
6%
21%
25%
10%
4%
8%
6%
8%
5%
100%
Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total
5%
6%
15%
25%
9%
13%
6%
4%
11%
6%
100%
5%
6%
14%
24%
9%
13%
7%
4%
11%
6%
100%
5%
7%
15%
24%
8%
13%
7%
4%
11%
6%
100%
5%
6%
15%
25%
8%
13%
7%
4%
11%
6%
100%
5%
6%
15%
25%
9%
13%
6%
4%
12%
6%
100%
6%
6%
15%
25%
9%
12%
6%
4%
11%
5%
100%
5%
6%
15%
24%
9%
14%
6%
4%
11%
5%
100%
6%
6%
15%
29%
8%
11%
5%
4%
11%
5%
100%
6%
6%
16%
24%
10%
12%
6%
4%
12%
5%
100%
6%
6%
16%
23%
10%
11%
6%
5%
12%
5%
100%
6%
6%
17%
24%
9%
11%
5%
4%
12%
5%
100%
A-3
Note: Due to rounding, percentages in each year may not sum to 100%.
A-4
Exhibit A–1c.
Number of Title X-funded service sites and users per service site, by year: 2007–2017
5,000
2,000
4,542
4,522
4,515
4,389
4,382
4,189
4,168
4,127
4,000
3,951
3,898
3,858
3,000
1,098
1,117
1,149
1,190
1,146
1,137
1,094
1,001
1,017
1,028
1,038
1,000
2,000
500
1,000
0
2007
2008
2009
2010
2011
Number of service sites
2012
2013
2014
2015
Number of users per site
2016
2017
0
Number of users per site
Family Planning Annual Report: 2017 National Summary
Number of service sites
1,500
This page intentionally left blank.
Family Planning Annual Report: 2017 National Summary
A-5
A-6
Exhibit A–2a.
Region
Number and distribution of all family planning users, by region and year: 2007–2017
Family Planning Annual Report: 2017 National Summary
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
I
199,010
197,165
199,779
198,962
192,252
195,264
182,684
184,005
184,389
183,383
194,952
II
479,572
483,928
497,614
499,231
493,369
488,872
470,836
429,409
431,060
428,146
429,091
III
557,031
564,138
592,475
584,167
564,163
550,051
520,403
468,157
432,418
477,585
464,216
IV
1,018,656
1,019,264
1,010,012
989,770
940,931
907,020
852,400
770,501
660,156
669,743
677,146
V
531,679
507,431
492,741
492,359
472,062
434,587
401,935
377,552
390,446
390,541
391,901
VI
486,378
491,406
512,019
512,868
475,863
350,164
372,296
298,294
346,670
334,933
350,646
VII
234,592
210,012
209,350
214,032
205,167
186,716
167,286
148,405
140,055
135,907
120,759
VIII
149,395
151,261
160,919
176,892
169,311
163,068
152,248
137,509
131,031
124,021
126,922
IX
1,102,718
1,209,114
1,294,974
1,352,569
1,314,270
1,309,439
1,269,252
1,149,781
1,146,183
1,102,836
1,093,827
X
228,207
217,786
216,384
204,012
194,323
178,616
168,484
165,670
155,607
160,457
154,786
Total
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
Female
4,691,857
4,723,662
4,811,691
4,822,570
4,635,195
4,378,744
4,184,587
3,764,622
3,607,353
3,553,018
3,541,235
295,381
327,843
374,576
402,292
386,516
385,053
373,237
364,661
410,662
454,534
463,011
I
4%
4%
4%
4%
4%
4%
4%
4%
5%
5%
5%
II
10%
10%
10%
10%
10%
10%
10%
10%
11%
11%
11%
III
11%
11%
11%
11%
11%
12%
11%
11%
11%
12%
12%
IV
20%
20%
19%
19%
19%
19%
19%
19%
16%
17%
17%
V
11%
10%
10%
9%
9%
9%
9%
9%
10%
10%
10%
VI
10%
10%
10%
10%
9%
7%
8%
7%
9%
8%
9%
VII
5%
4%
4%
4%
4%
4%
4%
4%
3%
3%
3%
VIII
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
IX
22%
24%
25%
26%
26%
27%
28%
28%
29%
28%
27%
X
5%
4%
4%
4%
4%
4%
4%
4%
4%
4%
4%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
94%
94%
93%
92%
92%
92%
92%
91%
90%
89%
88%
6%
6%
7%
8%
8%
8%
8%
9%
10%
11%
12%
Male
Total
Female
Male
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2017 National Summary
Exhibit A–2b.
Number and distribution of all family planning users, by region and year: 2007–2017
2017
5%
11%
12%
17%
10%
9%
3% 3%
27%
4%
4.00 million
2016
5%
11%
12%
17%
10%
8%
3% 3%
28%
4%
4.01 million
2015
5%
11%
11%
3% 3%
29%
4%
4.02 million
2014
4%
10%
11%
19%
9%
7%
4% 3%
28%
4%
4.13 million
2013
4%
10%
11%
19%
9%
8%
4% 3%
28%
4%
4.56 million
2012
4%
10%
12%
19%
7%
4% 3%
27%
4%
4.76 million
2011
4%
10%
11%
19%
9%
9%
4% 3%
26%
4%
5.02 million
2010
4%
10%
11%
19%
9%
10%
4% 3%
26%
4%
5.22 million
2009
4%
10%
11%
19%
25%
4%
5.19 million
2008
4%
10%
11%
20%
24%
4%
5.05 million
2007
4%
10%
11%
20%
5%
4.99 million
16%
10%
9%
9%
10%
10%
10%
4% 3%
10%
11%
4% 3%
10%
5% 3%
22%
0%
100%
I
II
III
IV
Note: Due to rounding, percentages in each year may not sum to 100%.
V
VI
VII
VIII
IX
X
A-7
A-8
Exhibit A–3a.
Number and distribution of all family planning users, by age and year: 2007–2017
Age Group (Years)
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Under 15
68,918
71,738
74,287
73,383
59,351
53,012
45,633
45,863
46,045
58,649
49,060
15 to 17
534,054
521,202
502,226
466,284
423,702
368,965
327,152
298,839
280,785
275,499
271,429
18 to 19
651,784
652,059
647,432
616,709
560,848
505,356
454,044
404,197
379,710
373,253
373,235
20 to 24
1,556,670
1,553,469
1,577,051
1,600,833
1,508,215
1,405,487
1,320,188
1,169,948
1,091,549
1,043,071
1,013,943
25 to 29
967,409
996,754
1,037,776
1,071,999
1,058,256
1,023,503
999,476
912,130
887,225
876,921
877,588
30 to 34
522,673
539,998
578,031
607,257
621,119
616,259
622,258
573,010
570,708
572,573
580,833
35 to 39
323,885
332,854
353,712
359,749
358,400
351,820
355,877
331,439
344,385
359,108
374,756
40 to 44
191,503
195,582
209,292
215,914
222,429
222,621
220,836
200,955
204,360
211,324
220,748
Over 44
170,342
187,849
206,460
212,734
209,391
216,774
212,360
192,902
213,248
237,154
242,654
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
Under 15
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
15 to 17
11%
10%
10%
9%
8%
8%
7%
7%
7%
7%
7%
18 to 19
13%
13%
12%
12%
11%
11%
10%
10%
9%
9%
9%
20 to 24
31%
31%
30%
31%
30%
30%
29%
28%
27%
26%
25%
25 to 29
19%
20%
20%
21%
21%
21%
22%
22%
22%
22%
22%
30 to 34
10%
11%
11%
12%
12%
13%
14%
14%
14%
14%
15%
35 to 39
6%
7%
7%
7%
7%
7%
8%
8%
9%
9%
9%
40 to 44
4%
4%
4%
4%
4%
5%
5%
5%
5%
5%
6%
Over 44
3%
4%
4%
4%
4%
5%
5%
5%
5%
6%
6%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Total
Family Planning Annual Report: 2017 National Summary
Total
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2017 National Summary
Exhibit A–3b.
Number and distribution of all family planning users, by age and year: 2007–2017
30–44, 29%
25–29, 22%
20–24, 25%
15–17, 7% 18–19, 9%
2017
29%
22%
6%
4.00 million
6%
4.01 million
5%
4.02 million
2016
7%
9%
26%
2015
7%
9%
27%
2014
7%
10%
28%
22%
27%
5%
4.13 million
2013
7%
10%
29%
22%
26%
5%
4.56 million
2012
8%
5%
4.76 million
2011
8%
4%
5.02 million
2010
9%
23%
4%
5.22 million
2009
10%
22%
4%
5.19 million
2008
10%
13%
21%
4%
5.05 million
2007
11%
13%
21%
3%
4.99 million
21%
31%
12%
20%
30%
12%
24%
21%
30%
11%
25%
21%
30%
11%
28%
22%
20%
31%
19%
31%
0%
100%
<15
15–17
18–19
20–24
25–29
30–44
>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. The percentage of users under 15 is 1% each year from 2007 through 2017.
A-9
A-10
Exhibit A–4a.
Number and distribution of all family planning users, by race and year: 2007–2017
Race
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
American Indian/Alaska Native
38,080
36,974
39,220
44,899
43,204
45,785
34,051
29,327
30,526
33,467
35,587
Asian
131,735
137,747
150,847
136,958
134,345
136,412
135,567
128,797
131,676
135,555
143,215
Black/African American
958,241
996,093
1,015,013
1,028,991
986,803
969,776
939,941
863,136
857,659
859,886
869,574
43,360
45,693
73,559
65,662
70,929
70,519
52,263
39,266
40,941
35,479
31,019
3,125,435
3,007,568
3,054,226
3,015,861
2,864,253
2,664,736
2,530,204
2,238,847
2,142,835
2,174,833
2,150,480
More than one race
132,911
151,535
169,044
261,397
250,825
248,590
191,871
153,907
136,043
142,564
144,397
Unknown/not reported
557,476
675,895
684,358
671,094
671,352
627,979
673,927
676,003
678,335
625,768
629,974
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
American Indian/Alaska Native
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
Asian
3%
3%
3%
3%
3%
3%
3%
3%
3%
3%
4%
19%
20%
20%
20%
20%
20%
21%
21%
21%
21%
22%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
1%
63%
60%
59%
58%
57%
56%
56%
54%
53%
54%
54%
3%
3%
3%
5%
5%
5%
4%
4%
3%
4%
4%
11%
13%
13%
13%
13%
13%
15%
16%
17%
16%
16%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Native Hawaiian/Pacific Islander
White
Total All Users
Family Planning Annual Report: 2017 National Summary
Black/African American
Native Hawaiian/Pacific Islander
White
More than one race
Unknown/not reported
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2017 National Summary
Exhibit A–4b.
Number and distribution of all family planning users, by race and year: 2007–2017
2017
White, 54%
Black, 22%
Other, 9%
Unknown, 16%
4.00 million
2016
54%
21%
9%
16%
4.01 million
2015
53%
2014
54%
21%
21%
8%
17%
4.02 million
9%
16%
4.13 million
2013
56%
21%
9%
2012
56%
20%
11%
13%
4.76 million
2011
57%
10%
13%
5.02 million
2010
58%
10%
13%
5.22 million
2009
59%
8%
13%
5.19 million
2008
60%
7%
13%
5.05 million
20%
20%
20%
20%
63%
2007
0%
White
19%
Black
Other
Unknown
15%
7%
11%
4.56 million
4.99 million
100%
Note: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of the individual percentages
that are included in the aggregated categories. The Other race category includes users who self-identified as American Indian or Alaska Native, Asian, Native Hawaiian or Other
Pacific Islander, and more than one race.
A-11
A-12
Exhibit A–5a.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2007–2017
Ethnicity
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Hispanic or Latino
1,303,402
1,391,523
1,447,422
1,493,007
1,451,215
1,349,528
1,344,601
1,237,652
1,276,765
1,269,988
1,324,817
Not Hispanic or Latino
3,611,497
3,534,915
3,618,344
3,618,285
3,416,314
3,277,828
3,093,545
2,786,005
2,617,597
2,600,742
2,553,416
Unknown/not reported
72,339
125,067
120,501
113,570
154,182
136,441
119,678
105,626
123,653
136,822
126,013
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
Hispanic or Latino
26%
28%
28%
29%
29%
28%
30%
30%
32%
32%
33%
Not Hispanic or Latino
72%
70%
70%
69%
68%
69%
68%
67%
65%
65%
64%
Unknown/not reported
1%
2%
2%
2%
3%
3%
3%
3%
3%
3%
3%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Total All Users
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2017 National Summary
Family Planning Annual Report: 2017 National Summary
Exhibit A–5b.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2007–2017
2017
Not Hispanic/Latino, 64%
Hispanic/Latino, 33%
4.00 million
2016
65%
32%
4.01 million
2015
65%
32%
4.02 million
2014
67%
30%
4.13 million
2013
68%
30%
4.56 million
2012
69%
28%
4.76 million
2011
68%
29%
5.02 million
2010
69%
29%
5.22 million
2009
70%
28%
5.19 million
2008
70%
28%
5.05 million
26%
72%
2007
0%
4.99 million
100%
Not Hispanic/Latino
Note: Due to rounding, percentages in each year may not sum to 100%.
Hispanic/Latino
Unknown
A-13
A-14
Exhibit A–6a.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2007–2017
Ethnicity and Race
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Not Hispanic or Latino
Asian
126,320
127,850
139,831
126,413
121,777
124,790
128,015
119,454
122,310
124,233
130,688
926,564
956,741
969,690
986,409
939,143
917,539
890,133
816,061
811,244
806,815
806,970
2,324,430
2,232,893
2,227,867
2,214,680
2,060,244
1,951,410
1,812,924
1,583,629
1,439,284
1,445,887
1,394,432
234,183
217,431
280,956
290,783
295,150
284,089
262,473
266,861
244,759
223,807
221,326
1,303,402
1,391,523
1,447,422
1,493,007
1,451,215
1,349,528
1,344,601
1,237,652
1,276,765
1,269,988
1,324,817
72,339
125,067
120,501
113,570
154,182
136,441
119,678
105,626
123,653
136,822
126,013
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
3%
3%
3%
2%
2%
3%
3%
3%
3%
3%
3%
Black or African American
19%
19%
19%
19%
19%
19%
20%
20%
20%
20%
20%
White
47%
44%
43%
42%
41%
41%
40%
38%
36%
36%
35%
Other/unknown
5%
4%
5%
6%
6%
6%
6%
6%
6%
6%
6%
Hispanic or Latino
All races
26%
28%
28%
29%
29%
28%
30%
30%
32%
32%
33%
1%
2%
2%
2%
3%
3%
3%
3%
3%
3%
3%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Black or African American
White
Other/unknown
Hispanic or Latino
All races
Unknown/Not Reported
Total All Users
Family Planning Annual Report: 2017 National Summary
Not Hispanic or Latino
Asian
Unknown/Not Reported
Total All Users
Note: The Not Hispanic or Latino “Other/Unknown” category includes users who self-identified as not Hispanic or Latino and for whom either race was unknown/not reported or the
user self-identified as one of the following: Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or more than one race. Due to rounding,
percentages in each year may not sum to 100%.
Family Planning Annual Report: 2017 National Summary
Exhibit A–6b.
Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2007–2017
NH White, 35%
2017
NH Black, 20%
9%
Hispanic (all races), 33%
4.00 million
2016
36%
20%
9%
32%
4.01 million
2015
36%
20%
9%
32%
4.02 million
38%
2014
20%
40%
2013
9%
20%
9%
2012
41%
19%
2011
41%
19%
9%
8%
30%
4.13 million
30%
4.56 million
28%
4.76 million
29%
5.02 million
2010
42%
19%
8%
29%
5.22 million
2009
43%
19%
8%
28%
5.19 million
28%
5.05 million
44%
2008
47%
2007
19%
19%
7%
7%
0%
26%
4.99 million
100%
NH White
NH Black
NH Other/Unkown
Hispanic (all races)
Unknown
A-15
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 includes users who self-identified as not Hispanic or Latino and for whom either race was unknown/not
reported or the user self-identified as one of the following: Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or more than one race. The
“Unknown” category includes users with unknown or not reported Hispanic or Latino ethnicity.
A-16
Exhibit A–7a.
Number and distribution of all family planning users, by income level and year: 2007–2017
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
3,455,335
3,553,222
3,632,506
3,618,813
3,466,912
3,382,089
3,211,380
2,840,650
2,653,841
2,564,992
2,665,911
101% to 150%
820,870
781,113
785,090
795,065
731,410
649,462
636,484
572,948
556,141
575,420
551,163
151% to 200%
303,992
278,881
277,103
281,294
269,478
247,490
245,805
234,425
238,420
252,273
257,155
201% to 250%
121,473
119,181
119,768
125,298
116,188
103,061
103,246
100,402
105,975
128,874
123,477
Over 250%
212,849
224,603
207,484
250,440
250,829
230,947
222,718
226,918
255,093
297,988
277,975
72,719
94,505
164,316
153,952
186,894
150,748
138,191
153,940
208,545
188,005
128,565
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
Under 101%
69%
70%
70%
69%
69%
71%
70%
69%
66%
64%
67%
101% to 150%
16%
15%
15%
15%
15%
14%
14%
14%
14%
14%
14%
151% to 200%
6%
6%
5%
5%
5%
5%
5%
6%
6%
6%
6%
201% to 250%
2%
2%
2%
2%
2%
2%
2%
2%
3%
3%
3%
Over 250%
4%
4%
4%
5%
5%
5%
5%
5%
6%
7%
7%
Unknown/not reported
1%
2%
3%
3%
4%
3%
3%
4%
5%
5%
3%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Income Level
a
Under 101%
Unknown/not reported
Total All Users
Family Planning Annual Report: 2017 National Summary
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of individual percentages
included in the aggregated categories.
a
Title X-funded grantees and subrecipients report 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/.
Family Planning Annual Report: 2017 National Summary
Exhibit A–7b.
Number and distribution of all family planning users, by income level and year: 2007–2017
≤100%, 67%
2017
101%–150%, 14%
14%
69%
2014
6%
14%
66%
2015
6%
14%
64%
2016
7%
6%
4.00 million
7%
4.01 million
6%
4.02 million
5%
6%
4.13 million
2013
70%
14%
5%
5%
4.56 million
2012
71%
14%
5%
5%
4.76 million
5%
5%
2011
69%
15%
2010
69%
15%
2009
70%
15%
2008
70%
15%
6%
4%
5.05 million
2007
69%
16%
6%
4%
4.99 million
5%
5%
5.02 million
5%
5.22 million
4%
5.19 million
0%
100%
≤100%
101%–150%
151%–200%
201% – 250%
>250%
Unknown
Note: Title X-funded grantees and subrecipients 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/. 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.
A-17
A-18
Exhibit A–8a.
Number and distribution of all family planning users, by primary health insurance status and year: 2007–2017
Primary Insurance
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
1,036,976
1,063,937
1,021,164
1,184,795
1,236,343
1,121,372
1,131,406
1,215,648
1,395,201
1,499,672
1,511,533
433,058
460,969
426,308
438,042
429,919
447,341
453,535
559,845
621,066
715,090
760,051
3,202,642
3,305,185
3,419,915
3,483,360
3,230,784
3,050,415
2,865,672
2,239,377
1,934,154
1,737,488
1,675,825
314,562
221,414
318,880
118,665
124,665
144,669
107,211
114,413
67,594
55,302
56,837
4,987,238
5,051,505
5,186,267
5,224,862
5,021,711
4,763,797
4,557,824
4,129,283
4,018,015
4,007,552
4,004,246
Public insurance
21%
21%
20%
23%
25%
24%
25%
29%
35%
37%
38%
Private insurance
9%
9%
8%
8%
9%
9%
10%
14%
15%
18%
19%
64%
65%
66%
67%
64%
64%
63%
54%
48%
43%
42%
6%
4%
6%
2%
2%
3%
2%
3%
2%
1%
1%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Public insurance
Private insurance
Uninsured
Unknown/not reported
Total All Users
Uninsured
Family Planning Annual Report: 2017 National Summary
Unknown/not reported
Total All Users
Note: Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories may not match the sum of individual percentages
included in the aggregated categories.
Family Planning Annual Report: 2017 National Summary
Exhibit A–8b.
Number and distribution of all family planning users, by primary health insurance status and year: 2007–2017
2017
Public insurance, 38%
2016
37%
2012
24%
2011
25%
20%
2009
9%
2007
21%
9%
5.02 million
67%
5.22 million
66%
8%
9%
4.76 million
64%
8%
21%
4.56 million
64%
9%
2008
4.13 million
63%
10%
23%
2010
4.02 million
54%
14%
25%
2013
4.01 million
48%
15%
29%
2014
4.00 million
43%
18%
35%
2015
Uninsured, 42%
Private insurance, 19%
5.19 million
65%
5.05 million
64%
0%
4.99 million
100%
Public insurance
Private insurance
Note: Due to rounding, percentages in each year may not sum to 100%.
Uninsured
Unknown/Not reported
A-19
A-20
Exhibit A–9a.
Number of all female family planning users, by primary contraceptive method and year: 2007–2017
Primary Method
2007
Most Effectivea
Vasectomy
Sterilization
6,546
6,312
6,905
8,683
8,632
8,540
8,175
7,582
6,879
8,178
8,848
89,447
87,167
92,616
92,652
90,438
86,854
82,067
74,748
84,108
86,112
94,173
Hormonal implant
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
7,300
18,738
30,135
48,015
65,673
82,642
108,586
139,799
177,975
209,014
239,029
Intrauterine device
138,714
179,876
216,390
252,121
272,683
284,461
279,289
265,511
273,650
288,939
324,174
Moderately Effectivea
Hormonal injectionb
Vaginal ring
591,861
597,572
615,188
643,682
645,351
645,136
635,093
611,619
574,476
519,841
500,960
139,656
149,627
165,121
186,238
183,182
164,693
142,292
115,230
95,186
83,473
76,252
Contraceptive patch
128,324
101,763
106,266
93,499
89,795
83,145
78,547
69,469
49,010
47,030
48,256
1,826,518
1,734,786
1,696,319
1,684,201
1,534,684
1,409,300
1,316,671
1,135,950
1,000,062
946,383
894,128
4,087
3,612
12,278
4,402
3,390
4,116
8,245
2,379
1,660
2,130
2,219
716,646
727,440
737,991
787,329
838,131
745,265
692,678
578,139
572,607
559,356
547,129
3,925
4,753
4,635
5,944
5,939
3,722
3,914
3,308
3,558
2,929
2,537
1,827
1,337
991
1,581
921
765
541
651
660
138
169
123,844
111,160
105,705
116,635
115,002
113,016
95,798
70,982
61,504
75,191
73,047
Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom
Contraceptive sponge
Family Planning Annual Report: 2017 National Summary
Withdrawal or otherc
FAMd or LAM
8,784
10,409
12,633
14,379
17,105
12,676
11,753
12,648
13,503
14,392
15,287
16,882
13,627
15,598
8,346
7,061
4,926
4,028
2,911
1,873
1,848
1,991
53,987
61,329
62,380
75,534
69,924
71,737
72,486
70,098
73,896
89,102
92,385
383,303
381,848
395,633
400,194
361,056
377,547
356,750
330,279
321,229
321,706
313,802
308,061
283,848
260,946
238,347
229,541
183,613
181,657
175,111
171,068
175,371
190,518
142,145
248,458
273,961
160,788
96,687
96,590
106,017
98,208
124,449
121,885
116,331
Total Female Users
4,691,857
4,723,662
4,811,691
4,822,570
4,635,195
4,378,744
4,184,587
3,764,622
3,607,353
3,553,018
3,541,235
Using Most, Moderately, or Less
Effective Method
3,804,361
3,748,179
3,818,771
3,947,707
3,877,987
3,649,257
3,467,677
3,090,926
2,916,711
2,844,954
2,828,199
242,007
292,093
346,046
401,471
437,426
462,497
478,117
487,640
542,612
592,243
666,224
2,690,446
2,587,360
2,595,172
2,612,022
2,456,402
2,306,390
2,180,848
1,934,647
1,720,394
1,598,857
1,521,815
871,908
868,726
877,553
934,214
984,159
880,370
808,712
668,639
653,705
653,854
640,160
53,987
61,329
62,380
75,534
69,924
71,737
72,486
70,098
73,896
89,102
92,385
691,364
665,696
656,579
638,541
590,597
561,160
538,407
505,390
492,297
497,077
504,320
Spermicide
Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Most effectivea
Moderately effectivea
Less effectivea
Abstinent
Not Using a Method
FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
See Table 7 comments in the Field and Methodological Notes (Appendix C).
b
Hormonal injection figures include both 1- and 3-month hormonal injection users.
c
Withdrawal/Other category includes other methods not listed separately in FPAR Table 7.
d
For 2007–2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2017, the FAM
category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
Family Planning Annual Report: 2017 National Summary
Exhibit A–9b.
Distribution of all female family planning users, by primary contraceptive method and year: 2007–2017
Primary Method
2007
Most Effectivea
Vasectomy
Sterilization
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
2%
2%
2%
2%
2%
2%
2%
2%
2%
2%
3%
Hormonal implant
0%†
0%†
1%
1%
1%
2%
3%
4%
5%
6%
7%
0%†
Intrauterine device
3%
4%
4%
5%
6%
6%
7%
7%
8%
8%
9%
Moderately Effectivea
Hormonal injectionb
Vaginal ring
13%
13%
13%
13%
14%
15%
15%
16%
16%
15%
14%
3%
3%
3%
4%
4%
4%
3%
3%
3%
2%
2%
Contraceptive patch
3%
2%
2%
2%
2%
2%
2%
2%
1%
1%
1%
39%
37%
35%
35%
33%
32%
31%
30%
28%
27%
25%
Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom
0%†
15%
0%†
15%
0%†
15%
0%†
16%
0%†
18%
0%†
17%
0%†
17%
0%†
15%
0%†
16%
0%†
16%
0%†
15%
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Contraceptive sponge
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Withdrawal or otherc
3%
2%
2%
2%
2%
3%
2%
2%
2%
2%
2%
FAMd or LAM
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Spermicide
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
1%
1%
1%
2%
2%
2%
2%
2%
2%
3%
3%
Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Method
Most effectivea
Moderately effectivea
Less effectivea
Abstinent
Not Using a Method
8%
8%
8%
8%
8%
9%
9%
9%
9%
9%
9%
7%
6%
5%
5%
5%
4%
4%
5%
5%
5%
5%
3%
5%
6%
3%
2%
2%
3%
3%
3%
3%
3%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
81%
5%
57%
19%
79%
6%
55%
18%
79%
7%
54%
18%
82%
8%
54%
19%
84%
9%
53%
21%
83%
11%
53%
20%
83%
11%
52%
19%
82%
13%
51%
18%
81%
15%
48%
18%
80%
17%
45%
18%
80%
19%
43%
18%
1%
1%
1%
2%
2%
2%
2%
2%
2%
3%
3%
15%
14%
14%
13%
13%
13%
13%
13%
14%
14%
14%
A-21
FAM=fertility awareness-based method. LAM=lactational amenorrhea method. Note: Due to rounding, the percentages in each year may not sum to 100%.
a
See Table 7 comments in the Field and Methodological Notes (Appendix C).
b
Hormonal injection figures include both 1- and 3-month hormonal injection users.
c
Withdrawal/Other category includes other methods not listed separately in FPAR Table 7.
d
For 2007–2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2017, the FAM
category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
† Percentage is less than 0.5%.
A-22
Exhibit A–9c.
Number and distribution of all female family planning users, by type of primary contraceptive method and year: 2007–2017
Most effective, 19%
2017
Moderately effective, 43%
17%
2016
45%
15%
2015
48%
13%
2014
Family Planning Annual Report: 2017 National Summary
11%
2012
11%
2011
9%
53%
2010
8%
54%
52%
3.54 million
18%
14%
3.55 million
14%
3.61 million
18%
13%
3.76 million
19%
13%
4.18 million
20%
13%
4.38 million
21%
13%
4.64 million
53%
2009
7%
2008
6%
55%
2007
5%
57%
0%
No method, 14%
18%
51%
2013
Less effective, 18%
19%
54%
13%
18%
14%
18%
14%
19%
15%
Most effective
Moderately effective
Less effective
Abstinence
No method
Method unknown
4.82 million
,
4.81 million
4.72 million
4.69 million
100%
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. Most effective permanent methods include vasectomy (male sterilization) and female sterilization. Most effective reversible methods
include implants and intrauterine devices/systems. Moderately effective methods include injectable contraception, vaginal ring, contraceptive patch, pills, diaphragm with
spermicidal cream/jelly, and the cervical cap. Less effective methods include male condoms, female condoms, the sponge, withdrawal, fertility awareness-based (FAM) and
lactational amenorrhea (LAM) methods, spermicides, and other methods not listed in Table 7. Because of combined FPAR reporting categories (e.g., FAM and LAM, diaphragm
and cervical cap, or withdrawal and other), the FPAR data may vary slightly from the moderately and less effective method categories described in the Table 7 comments in the
Field and Methodological Notes (Appendix C).
Screening Measures
2007
Female Users Screened
Number
Pap Tests Performed
Number
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2,272,571
2,088,218
2,035,017
1,727,251
1,444,418
1,237,328
988,114
785,540
743,683
687,373
649,266
48%
44%
42%
36%
31%
28%
24%
21%
21%
19%
18%
2,470,674
2,209,087
2,190,127
1,810,620
1,522,777
1,308,667
1,043,671
813,858
769,807
720,215
683,247
10%
11%
12%
13%
15%
14%
14%
14%
14%
14%
14%
Percentage
Percentage with an ASC or
higher result
ASC=atypical squamous cells.
Exhibit A–10b. Number and percentage of female users who received a Pap test, by year: 2007–2017
2.27
2.09
2.0
2.04
1.73
60%
1.44
48%
1.0
0.0
80%
2007
1.24
44%
2008
42%
2009
40%
0.99
36%
2010
31%
2011
28%
2012
A-23
Number of female users screened (in millions)
24%
2013
0.79
0.74
21%
21%
19%
18%
2014
2015
2016
2017
0.69
0.65
20%
Percentage of female users screened
0%
Percentage of female users screened
100%
3.0
Number of female users screened (in
millions)
Family Planning Annual Report: 2017 National Summary
Exhibit A–10a. Number and percentage of female users who received a Pap test, number of Pap tests performed, and percentage of Pap tests
performed with an ASC or higher result, by year: 2007–2017
A-24
Exhibit A–11a. Number and percentage of female users under 25 tested for chlamydia, by year: 2007–2017
Chlamydia Testing Measures
Number tested
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
1,385,623
1,435,430
1,433,829
1,442,176
1,357,231
1,268,269
1,181,534
1,011,474
955,775
953,273
939,250
52%
55%
55%
57%
58%
59%
60%
58%
59%
61%
61%
Percentage tested
1.5
1.39
1.44
1.43
1.44
1.36
100%
1.27
1.18
80%
1.01
1.0
52%
55%
55%
57%
58%
59%
60%
58%
0.96
0.95
0.94
59%
61%
61%
60%
40%
0.5
20%
0.0
2007
2008
2009
2010
2011
2012
Number of female users <25 years tested (in millions)
2013
2014
2015
2016
2017
0%
Percentage of female users <25 years tested
Percentage of female users <25 years
tested
Family Planning Annual Report: 2017 National Summary
Number of female users <25 years tested
(in millions)
Exhibit A–11b. Number and percentage of female users under 25 tested for chlamydia, by year: 2007–2017
Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2007–2017
HIV Testing Measures
2007
2008
2009
Tests performed
764,126
833,105
Tests per 10 users
1.5
Tests per 10 female users
1.4
Tests per 10 male users
4.1
2010
2011
2012
2013
2014
2015
2016
2017
997,765
1,101,665
1,283,375
1,249,867
1,187,631
1,031,624
1,113,635
1,163,883
1,192,119
1.6
1.9
2.1
2.6
2.6
2.6
2.5
2.8
2.9
3.0
1.5
1.8
1.9
2.3
2.4
2.4
2.2
2.4
2.5
2.6
3.9
4.1
4.3
5.2
5.5
5.3
5.7
5.9
5.7
5.9
Exhibit A-12b. Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2007–2017
1.5
10.0
1.28
1.25
1.10
1.03
1.00
1.0
0.76
4.1
1.4
1.11
1.16
1.19
3.9
1.5
9.0
8.0
7.0
0.83
6.0
5.2
0.5
1.19
4.1
1.8
4.3
1.9
2.3
5.5
2.4
5.3
2.4
5.7
5.9
5.7
5.9
5.0
4.0
2.2
2.4
2.5
2.6
3.0
2.0
1.0
0.0
2007
2008
2009
2010
Number of tests performed (in millions)
2011
2012
2013
2014
Tests per 10 female users
2015
2016
2017
0.0
Tests per 10 male users
Tests per 10 users
Number of tests performed (in millions)
Family Planning Annual Report: 2017 National Summary
Exhibit A-12a.
A-25
A-26
Exhibit A–13a. Actual and adjusted (constant 2017$ and 2007$) total, Title X, and Medicaid revenue, by year: 2007–2017
Change
Revenue
2007
($)
2008
($)
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2007–
2017
2016–
2017
Total
Actuala
1,140,511,162 1,211,489,469 1,231,311,085 1,293,835,909 1,286,574,610 1,260,206,935 1,284,715,163 1,243,901,947 1,244,040,899 1,305,139,649 1,297,618,121
14%
−1%
2017$b
1,544,235,493 1,581,716,444 1,558,170,903 1,583,243,242 1,527,857,574 1,443,647,706 1,436,378,602 1,358,292,735 1,323,597,898 1,337,923,305 1,297,618,121
−16%
−3%
2007$b
1,140,511,162 1,168,193,108 1,150,803,305 1,169,320,741 1,128,415,080 1,066,221,008 1,060,852,336 1,003,181,207
−3%
977,556,975
988,137,153
958,369,341
−16%
Title X
Family Planning Annual Report: 2017 National Summary
Actuala
255,337,864
259,743,981
266,393,881
279,295,186
276,002,719
267,095,215
253,655,493
249,517,445
242,576,878
245,066,054
244,563,111
−4%
0%†
2017$b
345,723,747
339,120,840
337,109,930
341,768,390
327,764,003
305,974,665
283,600,080
272,463,383
258,089,783
251,221,841
244,563,111
−29%
−3%
2007$b
255,337,864
250,461,218
248,976,041
252,416,594
242,073,509
225,980,767
209,455,784
201,230,662
190,614,890
185,542,500
180,624,626
−29%
−3%
Actuala
349,919,735
407,561,796
450,028,613
482,175,678
506,887,574
499,181,475
508,494,458
493,061,463
503,186,368
505,508,702
496,501,892
42%
−2%
2017$b
473,786,222
532,111,266
569,491,739
590,029,523
601,948,782
571,844,331
568,523,343
538,404,016
535,365,372
518,206,518
496,501,892
5%
−4%
2007$b
349,919,735
392,996,302
420,604,038
435,772,432
444,575,525
422,341,570
419,888,820
397,643,878
395,399,656
382,726,806
366,696,629
5%
−4%
Medicaidc
a
Revenue is shown in actual dollars (unadjusted) for each year.
b
Revenue is shown in constant 2017 dollars (2017$) and 2007 dollars (2007$), based on the consumer price index for medical care, which includes medical care commodities and medical care
services (Source: U.S. Department of Labor, Bureau of Labor Statistics, http://data.bls.gov/cgi-bin/srgate).
c
Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
†
Percentage is less than 0.5%.
$1,800
$1,600
Total revenue (in millions)
Family Planning Annual Report: 2017 National Summary
Exhibit A–13b. Total, Title X, and Medicaid adjusted (constant 2017$) revenue (in millions), by year: 2007–2017
$1,544
$1,400
$1,298
$1,200
$1,000
$800
$600
$497
$474
$400
$200
$0
$346
$245
2007
2008
2009
2010
2011
Total revenue
2012
Medicaid
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
2013
2014
Title X
2015
2016
2017
A-27
A-28
Exhibit A–13c. Total actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017
$1,800
Family Planning Annual Report: 2017 National Summary
Total revenue (in millions)
$1,600
$1,544
$1,400
$1,200
$1,000
$1,298
$1,141
$1,298
$1,141
$958
$800
$600
$400
$200
$0
2007
2008
2009
2010
Actual (unadjusted)
2011
2012
2013
Adjusted (2017$)
2014
2015
2016
Adjusted (2007$)
2017
$700
$600
Title X revenue (in millions)
Family Planning Annual Report: 2017 National Summary
Exhibit A–13d. Title X actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017
$500
$400
$300
$200
$346
$255
$245
$255
$245
$181
$100
$0
2007
2008
2009
2010
Actual (unadjusted)
2011
2012
2013
Adjusted (2017$)
2014
2015
2016
Adjusted (2007$)
2017
A-29
A-30
Exhibit A–13e. Medicaid actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017
$700
Family Planning Annual Report: 2017 National Summary
Medicaid revenue (in millions)
$600
$500
$497
$474
$497
$400
$300
$350
$367
$350
$200
$100
$0
2007
2008
2009
2010
Actual (unadjusted)
2011
2012
2013
Adjusted (2017$)
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
2014
2015
2016
Adjusted (2007$)
2017
This page intentionally left blank.
Family Planning Annual Report: 2017 National Summary
A-31
A-32
Exhibit A–14a. Amount of Title X project revenue, by revenue source and year: 2007–2017
Revenue Sources
Title X
2007
($)
2008
($)
2009
($)
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
255,337,864
259,743,981
266,393,881
279,295,186
276,002,719
267,095,215
253,655,493
249,517,445
242,576,878
245,066,054
244,563,111
Payment for Services
Client fees
94,273,992
94,531,003
80,940,857
84,540,815
72,156,363
70,400,120
69,425,823
53,170,034
47,872,483
52,876,599
52,367,880
Third-party payers
Medicaid
349,672,196
407,349,628
449,834,131
481,262,633
506,608,330
498,739,261
505,709,855
490,470,842
501,418,354
504,313,859
495,245,884
Medicare
523,170
826,424
843,164
1,913,519
2,002,181
1,173,110
1,864,987
3,083,719
4,731,999
3,945,295
7,169,121
CHIP
247,539
212,168
194,482
913,045
279,244
442,214
2,784,603
2,590,621
1,768,014
1,194,843
1,256,008
Other
3,042,991
3,855,406
4,903,482
2,466,949
4,088,072
3,743,183
10,848,382
10,202,966
14,230,460
10,540,646
11,445,695
46,403,049
45,067,919
48,445,935
50,409,637
51,655,083
63,955,467
69,210,207
95,138,355
104,000,648
132,617,104
140,145,229
494,162,937
551,842,548
585,162,051
621,506,598
636,789,273
638,453,355
659,843,857
654,656,537
674,021,958
705,488,346
707,629,817
Other Revenue
MCH block grant
23,484,206
23,058,822
21,044,962
21,205,336
25,512,030
24,439,148
19,852,391
23,095,828
18,485,003
16,526,644
12,960,533
SS block grant
28,593,275
27,333,993
30,841,136
34,001,848
23,736,983
11,229,640
8,805,626
5,601,590
4,711,602
4,285,521
4,547,979
TANF
23,460,554
22,325,121
15,580,002
14,475,023
14,517,155
13,548,818
13,268,175
10,570,729
5,347,682
7,797,115
6,385,879
State government
138,760,608
147,447,953
153,830,395
135,464,470
125,392,165
117,468,476
131,054,838
120,974,720
119,983,576
133,484,660
119,036,286
Local government
99,510,026
101,295,242
84,666,243
91,289,586
84,214,372
87,010,991
93,770,370
80,388,864
73,018,511
66,637,455
69,199,630
BPHC
7,177,359
9,531,860
4,965,372
4,090,546
5,289,075
4,625,737
11,461,645
10,080,722
12,468,766
14,319,221
21,389,246
Other
70,024,333
68,909,949
68,827,043
92,507,316
95,120,838
96,335,555
93,002,768
89,015,512
93,426,923
111,534,633
111,905,640
391,010,361
399,902,940
379,755,153
393,034,125
373,782,618
354,658,365
371,215,813
339,727,965
327,442,063
354,585,249
345,425,193
Private
Subtotal
Family Planning Annual Report: 2017 National Summary
Subtotal
Total Revenue
Actual
1,140,511,162 1,211,489,469 1,231,311,085 1,293,835,909 1,286,574,610 1,260,206,935 1,284,715,163 1,243,901,947 1,244,040,899 1,305,139,649 1,297,618,121
2017$a
1,544,235,493 1,581,716,444 1,558,170,903 1,583,243,242 1,527,857,574 1,443,647,706 1,436,378,602 1,358,292,735 1,323,597,898 1,337,923,305 1,297,618,121
2007$a
1,140,511,162 1,168,193,108 1,150,803,305 1,169,320,741 1,128,415,080 1,066,221,008 1,060,852,336 1,003,181,207
977,556,975
988,137,153
958,369,341
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy Families.
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year.
a
Total revenue is shown in constant 2017 dollars (2017$) and 2007 dollars (2007$), based on the consumer price index for medical care, which includes medical care commodities and medical
care services (Source: U.S. Department of Labor, Bureau of Labor Statistics, http://data.bls.gov/cgi-bin/srgate).
Family Planning Annual Report: 2017 National Summary
Exhibit A–14b. Distribution of Title X project revenue, by revenue source and year: 2007–2017
Revenue Sources
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Title X
22%
21%
22%
22%
21%
21%
20%
20%
19%
19%
19%
Payment for Services
Client fees
8%
8%
7%
7%
6%
6%
5%
4%
4%
4%
4%
Third-party payers
Medicaid
31%
34%
37%
37%
39%
40%
39%
39%
40%
39%
38%
Medicare
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
1%
CHIP
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
0%†
Other
0%†
0%†
0%†
0%†
0%†
0%†
1%
1%
1%
1%
1%
Private
4%
4%
4%
4%
4%
5%
5%
8%
8%
10%
11%
Subtotal
43%
46%
48%
48%
49%
51%
51%
53%
54%
54%
55%
Other Revenue
MCH block grant
2%
2%
2%
2%
2%
2%
2%
2%
1%
1%
1%
SS block grant
3%
2%
3%
3%
2%
1%
1%
0%†
0%†
0%†
0%†
TANF
2%
2%
1%
1%
1%
1%
1%
1%
0%†
1%
0%†
State government
12%
12%
12%
10%
10%
9%
10%
10%
10%
10%
9%
Local government
9%
8%
7%
7%
7%
7%
7%
6%
6%
5%
5%
BPHC
1%
1%
0%†
0%†
0%†
0%†
1%
1%
1%
1%
2%
Other
6%
6%
6%
7%
7%
8%
7%
7%
8%
9%
9%
Subtotal
34%
33%
31%
30%
29%
28%
29%
27%
26%
27%
27%
Total Revenue
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
BPHC=Bureau of Primary Health Care. CHIP=Children’s Health Insurance Program. MCH=Maternal and Child Health. SS=Social Services. TANF=Temporary Assistance for Needy Families.
Note: Due to rounding, percentages in each year may not sum to 100%.
†
Percentage is less than 0.5%.
A-33
A-34
Exhibit A–14c. Amount (unadjusted) and distribution of Title X project revenue, by revenue source and year: 2007–2017
2017
Medicaid, 38%
Title X, 19%
2016
39%
19%
State/Local Govt,
15%
Other, 28%
27%
15%
$1.30 billion
$1.31 billion
Family Planning Annual Report: 2017 National Summary
2015
40%
19%
16%
25%
$1.24 billion
2014
40%
20%
16%
24%
$1.24 billion
2013
40%
20%
18%
23%
$1.28 billion
2012
40%
21%
16%
23%
$1.26 billion
2011
39%
21%
16%
23%
$1.29 billion
18%
24%
$1.29 billion
19%
22%
$1.23 billion
2010
37%
2009
37%
22%
22%
34%
2008
21%
31%
2007
22%
21%
21%
24%
26%
0%
$1.21 billion
$1.14 billion
100%
Medicaid
Title X
State/local government
Other
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program (CHIP) revenue. The Other revenue category includes revenue from the Bureau of Primary
Health Care and other federal grants; other public and private third parties; block grants; Temporary Assistance for Needy Families revenue; and revenue reported as Other in the
FPAR revenue table. Due to rounding, percentages in each year may not sum to 100%, and percentages in combined or aggregated categories (e.g., Medicaid plus CHIP) may not
match the sum of the individual percentages that are included in the aggregated categories.
Appendix B
State Exhibits
Exhibit B–1.
Number and distribution of all family planning users, by sex and state, and distribution of
all users, by state: 2017 (Source: FPAR Table 1)
State
Male
Total
Female
Male
State Users as %
of All Users
81,989
764
82,753
99%
1%
2%
Alaska
7,176
1,416
8,592
84%
16%
0%†
Arizona
30,405
5,997
36,402
84%
16%
1%
Arkansas
46,280
221
46,501
100%
California
891,739
127,239
1,018,978
88%
12%
25%
Colorado
44,143
9,075
53,218
83%
17%
1%
Connecticut
37,910
5,925
43,835
86%
14%
1%
Delaware
15,891
3,241
19,132
83%
17%
0%†
District of Columbia
39,984
14,570
54,554
73%
27%
1%
Florida
113,929
3,352
117,281
97%
3%
3%
Georgia
104,290
39,503
143,793
73%
27%
4%
Hawaii
15,954
961
16,915
94%
6%
0%†
Idaho
9,355
695
10,050
93%
7%
0%†
Illinois
101,619
10,807
112,426
90%
10%
3%
Indiana
21,793
2,094
23,887
91%
9%
1%
Iowa
28,322
2,514
30,836
92%
8%
1%
Kansas
19,688
2,729
22,417
88%
12%
1%
Kentucky
42,197
8,215
50,412
84%
16%
1%
Louisiana
37,808
10,647
48,455
78%
22%
1%
Maine
19,712
3,715
23,427
84%
16%
1%
Maryland
64,937
8,081
73,018
89%
11%
2%
Massachusetts
64,732
10,543
75,275
86%
14%
2%
Michigan
59,204
6,384
65,588
90%
10%
2%
Minnesota
46,318
9,082
55,400
84%
16%
1%
Mississippi
26,507
231
26,738
99%
1%
1%
Missouri
35,043
2,889
37,932
92%
8%
1%
Montana
15,508
2,601
18,109
86%
14%
0%†
Nebraska
25,511
4,063
29,574
86%
14%
1%
Nevada
10,179
608
10,787
94%
6%
0%†
New Hampshire
14,545
1,868
16,413
89%
11%
0%†
New Jersey
89,945
9,899
99,844
90%
10%
2%
New Mexico
13,154
1,881
15,035
87%
13%
0%†
279,688
31,673
311,361
90%
10%
8%
Alabama
New York
†
Female
Percentage is less than 0.5%.
B-2
0%†
1%
(continued)
Family Planning Annual Report: 2017 National Summary
Exhibit B–1.
Number and distribution of all family planning users, by sex and state, and distribution of
all users, by state: 2017 (Source: FPAR Table 1) (continued)
Total
Female
Male
State Users as
% of All Users
1,004
110,059
99%
1%
3%
5,736
1,291
7,027
82%
18%
0%†
Ohio
82,643
16,036
98,679
84%
16%
2%
Oklahoma
46,915
715
47,630
98%
2%
1%
Oregon
41,952
2,863
44,815
94%
6%
1%
Pennsylvania
175,295
25,267
200,562
87%
13%
5%
Rhode Island
21,198
4,901
26,099
81%
19%
1%
South Carolina
58,520
13,956
72,476
81%
19%
2%
South Dakota
4,707
348
5,055
93%
7%
0%†
73,288
346
73,634
100%
0%†
2%
Texas
171,869
21,156
193,025
89%
11%
5%
Utah
30,388
6,701
37,089
82%
18%
1%
Vermont
8,682
1,221
9,903
88%
12%
0%†
Virginia
47,374
3,201
50,575
94%
6%
1%
Washington
84,536
6,793
91,329
93%
7%
2%
West Virginia
60,552
5,823
66,375
91%
9%
2%
Wisconsin
30,399
5,522
35,921
85%
15%
1%
Wyoming
5,546
878
6,424
86%
14%
0%†
American Samoa
2,331
44
2,375
98%
2%
0%†
Comm. of the Northern
Mariana Islands
1,049
8
1,057
99%
1%
0%†
Federated States of
Micronesia
3,275
425
3,700
89%
11%
0%†
289
12
301
96%
4%
0%†
14,411
761
15,172
95%
5%
0%†
2,605
9
2,614
100%
0%†
0%†
649
49
698
93%
7%
0%†
2,516
198
2,714
93%
7%
0%†
3,541,235
463,011
4,004,246
88%
12%
73%–100%
0%†–27%
State
Female
North Carolina
109,055
North Dakota
Tennessee
Male
Territories & FAS
Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range
100%
0%†–25%
FAS=Freely Associated States.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
B-3
Exhibit B–2.
Number and distribution of all family planning users, by user income level and state:
2017 (Source: FPAR Table 4)
State
Alabama
Under
101%
101%
to 250%
Over
250%
UK/NR
Total
Under
101%
101%
to 250%
Over
250%
UK/NR
59,236
21,250
2,222
45
82,753
72%
26%
3%
0%†
Alaska
4,230
2,903
1,144
315
8,592
49%
34%
13%
4%
Arizona
23,628
9,450
3,025
299
36,402
65%
26%
8%
1%
Arkansas
35,832
9,639
1,030
0
46,501
77%
21%
2%
0%
California
745,570
205,748
35,475
32,185
1,018,978
73%
20%
3%
3%
Colorado
41,134
9,810
2,274
0
53,218
77%
18%
4%
0%
Connecticut
16,323
20,618
6,720
174
43,835
37%
47%
15%
0%†
Delaware
12,326
4,640
1,111
1,055
19,132
64%
24%
6%
6%
District of Columbia
31,832
14,337
2,361
6,024
54,554
58%
26%
4%
11%
Florida
68,469
26,020
19,963
2,829
117,281
58%
22%
17%
2%
Georgia
100,035
25,813
11,394
6,551
143,793
70%
18%
8%
5%
Hawaii
11,842
3,369
982
722
16,915
70%
20%
6%
4%
Idaho
6,002
3,422
610
16
10,050
60%
34%
6%
0%†
Illinois
78,293
23,125
10,649
359
112,426
70%
21%
9%
0%†
Indiana
14,761
7,609
1,517
0
23,887
62%
32%
6%
0%
Iowa
18,358
8,622
3,720
136
30,836
60%
28%
12%
0%†
Kansas
13,089
6,587
1,345
1,396
22,417
58%
29%
6%
6%
Kentucky
36,348
9,151
2,739
2,174
50,412
72%
18%
5%
4%
Louisiana
36,647
8,572
1,689
1,547
48,455
76%
18%
3%
3%
8,424
10,302
4,132
569
23,427
36%
44%
18%
2%
Maryland
61,093
7,788
1,560
2,577
73,018
84%
11%
2%
4%
Massachusetts
46,314
21,590
5,197
2,174
75,275
62%
29%
7%
3%
Michigan
35,671
22,634
7,223
60
65,588
54%
35%
11%
0%†
Minnesota
29,288
16,783
8,817
512
55,400
53%
30%
16%
1%
Mississippi
23,594
2,902
102
140
26,738
88%
11%
Missouri
20,071
12,460
5,401
0
37,932
53%
33%
14%
0%
Montana
8,333
5,155
1,766
2,855
18,109
46%
28%
10%
16%
Nebraska
17,415
7,865
1,802
2,492
29,574
59%
27%
6%
8%
Nevada
6,060
3,454
634
639
10,787
56%
32%
6%
6%
New Hampshire
7,506
5,765
2,470
672
16,413
46%
35%
15%
4%
New Jersey
53,374
43,304
2,867
299
99,844
53%
43%
3%
0%†
New Mexico
12,608
1,679
149
599
15,035
84%
11%
1%
4%
208,650
66,527
35,532
652
311,361
67%
21%
11%
0%†
Maine
New York
UK/NR=unknown or not reported.
† Percentage is less than 0.5%.
B-4
0%†
1%
(continued)
Family Planning Annual Report: 2017 National Summary
Exhibit B–2.
Number and distribution of all family planning users, by user income level and state:
2017 (Source: FPAR Table 4) (continued)
State
Under
101%
101%
to 250%
Over
250%
UK/NR
Total
Under
101%
101%
to 250%
Over
250%
UK/NR
North Carolina
73,095
26,490
7,203
3,271
110,059
66%
24%
7%
3%
North Dakota
2,608
2,384
1,862
173
7,027
37%
34%
26%
2%
Ohio
52,187
29,177
14,700
2,615
98,679
53%
30%
15%
3%
Oklahoma
33,781
12,767
1,022
60
47,630
71%
27%
2%
0%†
Oregon
29,028
12,996
2,652
139
44,815
65%
29%
6%
0%†
Pennsylvania
112,013
56,212
25,889
6,448
200,562
56%
28%
13%
3%
Rhode Island
12,103
4,176
2,597
7,223
26,099
46%
16%
10%
28%
South Carolina
62,050
8,192
2,234
0
72,476
86%
11%
3%
0%
South Dakota
3,162
1,330
526
37
5,055
63%
26%
10%
1%
56,535
14,385
2,529
185
73,634
77%
20%
3%
0%†
Texas
149,854
33,468
6,581
3,122
193,025
78%
17%
3%
2%
Utah
24,524
9,992
2,573
0
37,089
66%
27%
7%
0%
Vermont
4,067
3,581
1,820
435
9,903
41%
36%
18%
4%
Virginia
28,197
13,427
2,068
6,883
50,575
56%
27%
4%
14%
Washington
51,288
27,565
10,215
2,261
91,329
56%
30%
11%
2%
West Virginia
29,435
10,833
992
25,115
66,375
44%
16%
1%
38%
Wisconsin
20,830
11,389
3,498
204
35,921
58%
32%
10%
1%
Wyoming
3,695
1,902
827
0
6,424
58%
30%
13%
0%
American Samoa
2,365
0
4
6
2,375
100%
0%
0%†
0%†
Comm. of the Northern
Mariana Islands
1,008
38
5
6
1,057
95%
4%
0%†
1%
Federated States of
Micronesia
3,685
1
0
14
3,700
100%
0%†
0%
0%†
295
5
1
0
301
98%
2%
0%†
0%
12,175
2,310
546
141
15,172
80%
15%
4%
1%
2,454
0
0
160
2,614
94%
0%
0%
6%
570
122
6
0
698
82%
17%
1%
0%
2,551
160
3
0
2,714
94%
6%
0%†
0%
2,665,911
931,795
277,975
128,565
4,004,246
67%
23%
7%
3%
Tennessee
Territories & FAS
Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range
36%–100% 0%–47% 0%–26% 0%–38%
UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: Due to rounding, the percentages may not sum to 100%. Title X-funded agencies report user income as a percentage of
poverty based on guidelines issued by the U.S. Department of Health and Human Services (HHS). Each year, HHS announces
updates to its poverty guidelines in the Federal Register and on the HHS Website at http://aspe.hhs.gov/poverty/.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
B-5
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2017
(Source: FPAR Table 5)
State
Alabama
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
25,162
12,647
44,803
141
82,753
30%
15%
54%
0%†
Alaska
2,337
3,588
2,645
22
8,592
27%
42%
31%
0%†
Arizona
5,451
8,480
22,471
0
36,402
15%
23%
62%
0%
Arkansas
16,904
18,836
10,761
0
46,501
36%
41%
23%
0%
California
445,304
65,679
507,387
608
1,018,978
44%
6%
50%
0%†
Colorado
18,826
7,542
22,855
3,995
53,218
35%
14%
43%
8%
Connecticut
12,166
11,731
19,570
368
43,835
28%
27%
45%
1%
6,273
5,041
7,019
799
19,132
33%
26%
37%
4%
District of Columbia
41,888
4,641
8,018
7
54,554
77%
9%
15%
0%†
Florida
47,030
31,197
36,123
2,931
117,281
40%
27%
31%
2%
Georgia
42,128
45,797
55,699
169
143,793
29%
32%
39%
0%†
Hawaii
8,214
3,730
4,823
148
16,915
49%
22%
29%
1%
Idaho
964
2,673
6,117
296
10,050
10%
27%
61%
3%
Illinois
42,298
31,415
37,416
1,297
112,426
38%
28%
33%
1%
Indiana
5,592
5,433
12,768
94
23,887
23%
23%
53%
0%†
10,602
12,442
7,233
559
30,836
34%
40%
23%
2%
2,748
4,593
14,768
308
22,417
12%
20%
66%
1%
Kentucky
23,342
7,091
17,998
1,981
50,412
46%
14%
36%
4%
Louisiana
27,731
5,560
15,156
8
48,455
57%
11%
31%
0%†
5,112
11,038
7,236
41
23,427
22%
47%
31%
0%†
Maryland
26,600
17,091
25,790
3,537
73,018
36%
23%
35%
5%
Massachusetts
41,821
18,388
14,637
429
75,275
56%
24%
19%
1%
Michigan
22,368
18,225
24,832
163
65,588
34%
28%
38%
0%†
Minnesota
12,314
21,535
21,277
274
55,400
22%
39%
38%
0%†
Mississippi
7,403
508
18,730
97
26,738
28%
2%
70%
0%†
Missouri
9,706
11,016
17,210
0
37,932
26%
29%
45%
0%
Montana
4,322
8,199
5,463
125
18,109
24%
45%
30%
1%
Nebraska
2,953
8,130
18,475
16
29,574
10%
27%
62%
0%†
Nevada
2,804
1,829
6,129
25
10,787
26%
17%
57%
0%†
New Hampshire
4,911
7,720
3,738
44
16,413
30%
47%
23%
0%†
New Jersey
35,458
16,396
47,635
355
99,844
36%
16%
48%
0%†
New Mexico
4,476
1,207
9,346
6
15,035
30%
8%
62%
0%†
149,923
52,244
94,607
14,587
311,361
48%
17%
30%
5%
Delaware
Iowa
Kansas
Maine
New York
UK/NR=unknown or not reported.
† Percentage is less than 0.5%.
B-6
(continued)
Family Planning Annual Report: 2017 National Summary
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2017
(Source: FPAR Table 5) (continued)
State
North Carolina
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
31,740
17,409
58,866
2,044
110,059
29%
16%
53%
2%
493
3,992
2,435
107
7,027
7%
57%
35%
2%
38,704
26,507
32,579
889
98,679
39%
27%
33%
1%
8,942
7,584
31,104
0
47,630
19%
16%
65%
0%
Oregon
16,764
8,085
18,515
1,451
44,815
37%
18%
41%
3%
Pennsylvania
91,233
58,500
45,876
4,953
200,562
45%
29%
23%
2%
Rhode Island
16,528
6,232
3,309
30
26,099
63%
24%
13%
0%†
South Carolina
26,386
26,237
19,853
0
72,476
36%
36%
27%
0%
312
2,349
1,966
428
5,055
6%
46%
39%
8%
Tennessee
27,045
9,062
37,519
8
73,634
37%
12%
51%
0%†
Texas
27,811
27,136
135,888
2,190
193,025
14%
14%
70%
1%
Utah
1,182
10,148
25,759
0
37,089
3%
27%
69%
0%
Vermont
3,209
4,534
2,160
0
9,903
32%
46%
22%
0%
Virginia
8,096
8,099
32,959
1,421
50,575
16%
16%
65%
3%
Washington
40,746
32,243
17,872
468
91,329
45%
35%
20%
1%
West Virginia
17,789
21,966
17,396
9,224
66,375
27%
33%
26%
14%
Wisconsin
22,059
5,326
8,536
0
35,921
61%
15%
24%
0%
419
1,984
3,879
142
6,424
7%
31%
60%
2%
0
0
2,371
4
2,375
0%
0%
100%
0%†
Comm. of the Northern
Mariana Islands
532
156
364
5
1,057
50%
15%
34%
0%†
Federated States of
Micronesia
479
6
3,182
33
3,700
13%
0%†
86%
1%
18
2
281
0
301
6%
1%
93%
0%
14,040
649
473
10
15,172
93%
4%
3%
0%†
0
0
2,614
0
2,614
0%
0%
100%
0%
693
1
4
0
698
99%
0%†
1%
0%
1,182
202
1,330
0
2,714
44%
7%
49%
0%
1,511,533
760,051
1,675,825
56,837
4,004,246
38%
19%
42%
1%
0%–99%
0%–57%
North Dakota
Ohio
Oklahoma
South Dakota
Wyoming
Territories & FAS
American Samoa
Guam
Puerto Rico
Republic of the Marshall
Islands
Republic of Palau
U.S. Virgin Islands
Total Users
Range
1%–100% 0%–14%
UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: Due to rounding, the percentages may not sum to 100%.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
B-7
Exhibit B–3b. Number and distribution of all family planning users in the 50 states and District of
Columbia, by insurance status and state according to the states’ Medicaid expansion status:
2017 (Source: FPAR Table 5)
State
Public
Private
Uninsured UK/NR
Total
Public
Private
Uninsured
UK/NR
Expansion States
Alaska
Arizona
a
Arkansas
2,337
3,588
2,645
22
8,592
27%
42%
31%
0%†
5,451
8,480
22,471
0
36,402
15%
23%
62%
0%
16,904
18,836
10,761
0
46,501
36%
41%
23%
0%
California
445,304
65,679
507,387
608
1,018,978
44%
6%
50%
0%†
Colorado
18,826
7,542
22,855
3,995
53,218
35%
14%
43%
8%
Connecticut
12,166
11,731
19,570
368
43,835
28%
27%
45%
1%
a
Delaware
District of Columbia
Hawaii
Illinois
Indiana
6,273
5,041
7,019
799
19,132
33%
26%
37%
4%
41,888
4,641
8,018
7
54,554
77%
9%
15%
0%†
8,214
3,730
4,823
148
16,915
49%
22%
29%
1%
42,298
31,415
37,416
1,297
112,426
38%
28%
33%
1%
5,592
5,433
12,768
94
23,887
23%
23%
53%
0%†
Iowaa
10,602
12,442
7,233
559
30,836
34%
40%
23%
2%
Kentucky
23,342
7,091
17,998
1,981
50,412
46%
14%
36%
4%
Louisiana
27,731
5,560
15,156
8
48,455
57%
11%
31%
0%†
Maryland
26,600
17,091
25,790
3,537
73,018
36%
23%
35%
5%
Massachusetts
41,821
18,388
14,637
429
75,275
56%
24%
19%
1%
Michigan
22,368
18,225
24,832
163
65,588
34%
28%
38%
0%†
Minnesota
12,314
21,535
21,277
274
55,400
22%
39%
38%
0%†
Montana
4,322
8,199
5,463
125
18,109
24%
45%
30%
1%
Nevada
2,804
1,829
6,129
25
10,787
26%
17%
57%
0%†
4,911
7,720
3,738
44
16,413
30%
47%
23%
0%†
35,458
16,396
47,635
355
99,844
36%
16%
48%
0%†
a
a
a
New Hampshire
a
New Jersey
New Mexico
4,476
1,207
9,346
6
15,035
30%
8%
62%
0%†
149,923
52,244
94,607
14,587
311,361
48%
17%
30%
5%
493
3,992
2,435
107
7,027
7%
57%
35%
2%
Ohio
38,704
26,507
32,579
889
98,679
39%
27%
33%
1%
Oregon
16,764
8,085
18,515
1,451
44,815
37%
18%
41%
3%
Pennsylvania
91,233
58,500
45,876
4,953
200,562
45%
29%
23%
2%
Rhode Island
16,528
6,232
3,309
30
26,099
63%
24%
13%
0%†
3,209
4,534
2,160
0
9,903
32%
46%
22%
0%
Washington
40,746
32,243
17,872
468
91,329
45%
35%
20%
1%
West Virginia
17,789
21,966
17,396
9,224
66,375
27%
33%
26%
14%
516,102 1,089,716
46,553
2,849,762
42%
18%
38%
2%
New York
North Dakota
Vermont
Expansion States
Subtotal
Range
1,197,391
7%–77% 6%–57%
13%–62% 0%–14%
UK/NR=unknown or not reported.
a
Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire have approved Section 1115 waivers.
† Percentage is less than 0.5%.
B-8
(continued)
Family Planning Annual Report: 2017 National Summary
Exhibit B–3b. Number and distribution of all family planning users in the 50 states and District of
Columbia, by insurance status and state according to the states’ Medicaid expansion
status: 2017 (Source: FPAR Table 5) (continued)
State
Public
Private
Uninsured
UK/NR
Total
Public
Private
Uninsured
UK/NR
Nonexpansion States
Alabama
25,162
12,647
44,803
141
82,753
30%
15%
54%
0%†
Florida
47,030
31,197
36,123
2,931
117,281
40%
27%
31%
2%
Georgia
42,128
45,797
55,699
169
143,793
29%
32%
39%
0%†
964
2,673
6,117
296
10,050
10%
27%
61%
3%
Kansas
2,748
4,593
14,768
308
22,417
12%
20%
66%
1%
Maine
5,112
11,038
7,236
41
23,427
22%
47%
31%
0%†
Mississippi
7,403
508
18,730
97
26,738
28%
2%
70%
0%†
Missouri
9,706
11,016
17,210
0
37,932
26%
29%
45%
0%
Nebraska
2,953
8,130
18,475
16
29,574
10%
27%
62%
0%†
31,740
17,409
58,866
2,044
110,059
29%
16%
53%
2%
8,942
7,584
31,104
0
47,630
19%
16%
65%
0%
26,386
26,237
19,853
0
72,476
36%
36%
27%
0%
312
2,349
1,966
428
5,055
6%
46%
39%
8%
Tennessee
27,045
9,062
37,519
8
73,634
37%
12%
51%
0%†
Texas
27,811
27,136
135,888
2,190
193,025
14%
14%
70%
1%
Utah
1,182
10,148
25,759
0
37,089
3%
27%
69%
0%
Virginia
8,096
8,099
32,959
1,421
50,575
16%
16%
65%
3%
22,059
5,326
8,536
0
35,921
61%
15%
24%
0%
419
1,984
3,879
142
6,424
7%
31%
60%
2%
297,198
242,933
575,490
10,232
1,125,853
26%
22%
51%
1%
Idaho
North Carolina
Oklahoma
South Carolina
South Dakota
Wisconsin
Wyoming
Nonexpansion States
Subtotal
Range
3%–61% 2%–47%
24%–70%
0%–8%
All States
Total
1,494,589
759,035
1,665,206
56,785
Range
3,975,615
38%
19%
3%–77% 2%–57%
42%
13%–70%
1%
0%–14%
UK/NR=unknown or not reported.
Note: Due to rounding, the percentages may not sum to 100%. The exhibit excludes the eight U.S. Territories and Freely Associated
States.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
B-9
Exhibit B–4.
Number and distribution of female family planning users at risk of unintended
pregnancy,a by level of effectiveness of the primary method used or adopted at exit from
the encounter and state: 2017 (Source: FPAR Table 7)
State
Alabama
Most
Effective
Permanent
Methodsb
Most
Effective
Reversible
Methodsb
Moderately
Effective
Methodsc
Less
Effective
Methodsd
Total
At Riska
Most
Moderately
Effective
Effective
Methodsb Methodsc
Less
Effective
Methodsd
22
4,328
47,348
14,898
68,802
6%
69%
22%
Alaska
186
2,068
2,895
915
6,439
35%
45%
14%
Arizona
205
5,202
15,848
4,001
27,654
20%
57%
14%
Arkansas
2,422
5,935
22,045
5,796
40,085
21%
55%
14%
California
20,332
164,856
347,805
232,195
807,484
23%
43%
29%
Colorado
660
13,522
17,310
4,646
38,614
37%
45%
12%
2,006
7,393
15,755
7,103
35,559
26%
44%
20%
Delaware
445
3,051
5,330
2,137
14,680
24%
36%
15%
District of Columbia
875
6,047
9,356
1,387
35,206
20%
27%
4%
Florida
1,470
13,239
56,034
11,756
93,003
16%
60%
13%
Georgia
11,321
8,671
15,924
16,971
86,433
23%
18%
20%
Hawaii
595
2,919
5,722
1,894
12,570
28%
46%
15%
Idaho
366
1,536
5,279
860
8,190
23%
64%
11%
Illinois
2,607
17,703
44,764
14,843
90,373
22%
50%
16%
404
2,771
13,559
2,178
19,688
16%
69%
11%
1,130
5,820
13,956
3,106
25,868
27%
54%
12%
889
1,829
10,962
1,913
17,224
16%
64%
11%
Kentucky
1,436
2,553
16,700
13,934
37,379
11%
45%
37%
Louisiana
2,665
4,272
19,539
4,774
32,559
21%
60%
15%
745
4,807
8,317
1,927
17,814
31%
47%
11%
Maryland
1,789
12,225
26,870
12,763
58,246
24%
46%
22%
Massachusetts
1,767
13,628
21,756
9,796
56,468
27%
39%
17%
Michigan
794
7,328
35,181
9,311
53,966
15%
65%
17%
Minnesota
464
10,069
24,332
7,053
42,824
25%
57%
16%
Mississippi
676
1,581
20,633
1,207
25,757
9%
80%
5%
Missouri
1,467
4,144
19,210
4,497
30,116
19%
64%
15%
Montana
483
2,840
8,588
2,224
14,560
23%
59%
15%
1,724
6,262
8,485
4,436
23,057
35%
37%
19%
Nevada
236
1,962
5,710
879
9,131
24%
63%
10%
New Hampshire
658
3,431
6,341
1,269
12,645
32%
50%
10%
New Jersey
1,459
10,353
42,965
20,693
80,739
15%
53%
26%
New Mexico
29
3,469
5,575
2,004
11,818
30%
47%
17%
6,414
53,443
108,254
52,574
244,695
24%
44%
Connecticut
Indiana
Iowa
Kansas
Maine
Nebraska
New York
21%
(continued)
B-10
Family Planning Annual Report: 2017 National Summary
Exhibit B–4.
Number and distribution of female family planning users at risk of unintended
pregnancy,a by level of effectiveness of the primary method used or adopted at exit from
the encounter and state: 2017 (continued)
State
Most
Most
Effective
Effective
Permanent Reversible
Methodsb
Methodsb
Moderately
Effective
Methodsc
Less
Effective
Methodsd
Total
At Riska
Most
Effective
Methodsb
Moderately
Effective
Methodsc
Less
Effective
Methodsd
North Carolina
637
19,600
57,438
11,762
101,604
20%
57%
12%
North Dakota
166
772
3,672
475
5,337
18%
69%
9%
4,170
10,683
35,432
10,080
71,651
21%
49%
14%
4,454
38,341
17%
65%
12%
Ohio
Oklahoma
314
6,306
24,983
Oregon
1,333
10,598
19,958
4,523
37,763
32%
53%
12%
Pennsylvania
7,409
20,167
71,383
35,943
160,275
17%
45%
22%
Rhode Island
2,087
3,265
6,103
3,324
16,065
33%
38%
21%
South Carolina
1,149
6,964
31,145
10,933
50,191
16%
62%
22%
South Dakota
Tennessee
Texas
Utah
Vermont
50
417
3,706
274
4,526
10%
82%
6%
282
7,223
33,627
6,818
50,866
15%
66%
13%
8,745
23,832
59,553
36,466
148,833
22%
40%
25%
260
6,577
17,609
3,088
27,948
24%
63%
11%
247
2,502
3,685
791
7,865
35%
47%
10%
Virginia
1,028
9,426
24,247
7,799
44,455
24%
55%
18%
Washington
1,390
14,332
47,147
10,251
75,410
21%
63%
14%
West Virginia
14%
35%
9%
3,693
4,032
19,651
4,989
56,478
Wisconsin
774
4,866
14,642
6,031
27,498
21%
53%
22%
Wyoming
228
664
3,363
733
5,239
17%
64%
14%
31
74
1,519
450
2,225
5%
68%
20%
0
187
689
79
971
19%
71%
8%
61
644
1,486
665
2,881
24%
52%
23%
Territories & FAS
American Samoa
Comm. of the Northern
Mariana Islands
Federated States of
Micronesia
0
0
106
8
116
0%
91%
7%
Puerto Rico
46
306
10,049
3,227
14,303
2%
70%
23%
Republic of the
Marshall Islands
39
403
845
12
1,553
28%
54%
1%
Guam
Republic of Palau
U.S. Virgin Islands
Total Users
6
18
493
16
566
4%
87%
3%
135
88
936
1,029
2,442
9%
38%
42%
103,021
563,203
1,521,815
640,160
3,135,048
21%
49%
20%
0%–37%
18%–91%
1%–42%
Range
FAS=Freely Associated States.
Note: Percentages (row) do not sum to 100% because the table does not show the percentages for female users whose method is
unknown/not reported. Because of combined FPAR reporting categories (e.g., FAM and LAM, diaphragm and cervical cap, or withdrawal
and other), the FPAR data may vary slightly from the method-effectiveness categories described in the Table 7 comments in the Field
and Methodological Notes (Appendix C).
a
Female users at risk of unintended pregnancy exclude users who are pregnant, seeking pregnancy, or abstinent.
b
Most effective permanent methods include female sterilization and vasectomy (male sterilization). Most effective reversible
methods include implants and intrauterine devices/systems.
c
Moderately effective methods include injectable contraception, vaginal ring, contraceptive patch, pills, and diaphragm or cervical cap.
d
Less effective methods include male condoms, female condoms, the sponge, withdrawal, fertility-based awareness or lactational
amenorrhea methods, and spermicides.
Family Planning Annual Report: 2017 National Summary
B-11
Exhibit B–5.
Number and percentage of female family planning users under 25 years who were tested
for chlamydia, by state: 2017 (Source: FPAR Table 11)
State
Alabama
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
30,982
39,759
78%
Alaska
2,362
3,298
72%
Arizona
11,142
14,572
76%
Arkansas
15,019
21,068
71%
California
275,725
387,415
71%
Colorado
14,063
20,564
68%
Connecticut
8,238
15,039
55%
Delaware
5,999
7,198
83%
District of Columbia
8,311
13,339
62%
Florida
18,513
45,645
41%
Georgia
13,915
31,123
45%
Hawaii
3,819
6,742
57%
Idaho
2,207
4,165
53%
Illinois
21,102
43,720
48%
Indiana
6,157
9,018
68%
Iowa
7,695
13,196
58%
Kansas
4,568
7,797
59%
Kentucky
7,014
18,718
37%
Louisiana
11,719
15,418
76%
4,727
8,983
53%
Maryland
12,681
25,479
50%
Massachusetts
15,469
27,391
56%
Michigan
16,916
29,726
57%
Minnesota
18,939
25,833
73%
Mississippi
10,122
13,455
75%
Missouri
9,447
17,369
54%
Montana
5,489
8,645
63%
Nebraska
7,852
9,990
79%
Nevada
3,047
3,880
79%
New Hampshire
3,775
6,355
59%
New Jersey
21,732
32,606
67%
New Mexico
4,139
6,429
64%
71,647
116,344
62%
Maine
New York
(continued)
B-12
Family Planning Annual Report: 2017 National Summary
Exhibit B–5.
Number and percentage of female family planning users under 25 years who were tested
for chlamydia, by state: 2017 (Source: FPAR Table 11) (continued)
State
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
North Carolina
22,249
41,317
54%
North Dakota
1,626
2,730
60%
Ohio
26,755
39,970
67%
Oklahoma
15,033
24,629
61%
Oregon
10,129
18,552
55%
Pennsylvania
39,457
78,885
50%
Rhode Island
3,560
8,779
41%
South Carolina
18,998
25,969
73%
South Dakota
1,372
2,657
52%
Tennessee
24,851
35,710
70%
Texas
30,322
61,474
49%
Utah
8,980
17,437
51%
Vermont
2,714
4,112
66%
Virginia
7,630
17,187
44%
29,345
43,649
67%
West Virginia
8,176
25,767
32%
Wisconsin
9,838
14,316
69%
Wyoming
1,334
2,714
49%
Washington
Territories & FAS
American Samoa
45
578
8%
Comm. of the Northern Mariana
Islands
88
527
17%
Federated States of Micronesia
141
1,082
13%
97
150
65%
1,185
7,090
17%
1
976
Republic of Palau
64
221
29%
U.S. Virgin Islands
728
992
73%
939,250
1,527,749
61%
Guam
Puerto Rico
Republic of the Marshall Islands
Total Users
Range
0%†
0%†–83%
FAS=Freely Associated States.
†
Percentage is less than 0.5%.
Family Planning Annual Report: 2017 National Summary
B-13
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B-14
Family Planning Annual Report: 2017 National Summary
Appendix C
Field and Methodological Notes
INTRODUCTION
This appendix presents additional information about the 2017 FPAR, including issues RTI
identified during data validation and relevant table-specific notes from grantees and Health
and Human Services (HHS) Regional Project Officers. The notes are organized according to
the FPAR reporting table to which they apply.
FPAR COVER SHEET: GRANTEE PROFILE
Subrecipients—Of the 88 grantees that were active in both 2016 and 2017, 56 reported no
change in the number of subrecipients, 22 reported a decrease, and 10 reported an increase.
Some reasons given by several grantees for the decrease in subrecipients were because they
withdrew from Title X participation, agency mergers, and agency closures.
Service Sites—Of the 88 grantees active in both 2016 and 2017, 43 reported no change in the
number of service sites, 15 reported an increase, and 30 reported a decrease. Reasons given
by several grantees for the change in number of sites included subrecipient additions and
withdrawals and site closures or consolidations.
Reporting Period—Five grantees reported data for a reporting period that was less than 12
months, one grantee reported data for a different 12-month period, and all others (N=82)
reported data for the period from January 1, 2017, through December 31, 2017.
FPAR TABLE 1: USERS BY AGE AND SEX
Of the 88 grantees operating in both 2016 and 2017, 48 reported a decrease and 40 reported
an increase in the number of family planning users.
▪ Reasons given by grantees for the decrease in number of users included expiration of
state family planning waivers, site closures, site or subrecipient withdrawal from Title X
participation, reduced clinic hours, electronic health record (EHR) implementation or
transition, staffing shortages (e.g., furlough, medical leave, military leave, and clinical
services provider recruitment or retention), increased use of long-acting reversible
contraception (LARC) or adherence to screening guidelines resulting in a decline in
encounters, increased ability of newly insured clients to seek care from other providers,
delays and other challenges in executing contracts with new subrecipients and service sites,
various reporting issues, changes in contractors, data system issues and coding errors,
errors in reporting 2016 data, changes in payment policies for clinical services, and
weather-related disruptions in care delivery (e.g., hurricanes).
▪ Reasons given by grantees for the increase in the number of users included the following
reasons: new online scheduling systems, increase in providers, the addition of new
subrecipients, increase in state funding, improvement (e.g., standardization) in data
collection, integration of family planning services with sports health clearance visits,
increased or improved marketing efforts, increased outreach to males and teens, partnership
C-2
Family Planning Annual Report: 2017 National Summary
with university on research project, implementation of “One Key Question,” expanded
clinic hours, and improved data collection and reporting.
FPAR TABLE 2: FEMALE USERS BY ETHNICITY AND RACE
Female Hispanic or Latino users accounted for a disproportionate share of female users with
an unknown race. Of the 16% of total female users for whom race was unknown or not
reported in 2017, 76% self-identified as Hispanic or Latino.
▪ Reasons given by grantees for an increase in or continued high percentage of female
users with unknown race or ethnicity included client confusion about or refusal to report
race, loss of data during EHR implementation or transition, errors in the EHR system (e.g.,
reporting more than one race, refusing to report race, or reporting race as “Other”), coding
errors, staff failure to collect data, and not requiring clinic staff to collect and record
ethnicity information.
▪ Reasons given by grantees for a decrease in the percentage of female users with
unknown race or ethnicity included improvements in the collection, storage, and retrieval
of race and ethnicity data.
FPAR TABLE 3: MALE USERS BY ETHNICITY AND RACE
Male Hispanic or Latino users accounted for a disproportionate share of male users with an
unknown race. Of the 15% of total male users for whom race was unknown or not reported in
2017, 69% identified as Hispanic or Latino.
▪ Reasons given by grantees for an increase in or continued high percentage of male users
with unknown race or ethnicity included client confusion about or refusal to report race
information, failure of the EHR system to capture the data, difficulty with a new or
changing EHR system, coding errors, precoding client race to “unknown” when the
appointment was scheduled, and staff failure to collect data.
▪ Reasons given for a decrease in the percentage of male users with unknown race or
ethnicity included an improved workflow resulting in better capture of ethnicity and race
data, validation of EHR values, staff training, and improved data collection.
FPAR TABLE 4: USERS BY INCOME LEVEL
Unknown/not reported income status—Several grantees attributed the high or increased
number of family planning users with unknown or not reported income to problems with data
collection, including client (e.g., full-fee or insured clients) refusal to report income data,
difficulty retrieving information from EHR systems, EHR-related data collection issues,
problems entering data into regional data system, failure of sites to collect income data, and
system-related processing errors. Several other grantees attributed the decrease in number of
family planning users with unknown or not reported income to improvements to data
collection, data quality monitoring, and staff training.
Family Planning Annual Report: 2017 National Summary
C-3
FPAR TABLE 5: USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE STATUS
Of the 88 grantees operating in both 2016 and 2017, 55 reported an increase in the percentage
of users with health insurance, 31 reported a decrease, and 2 reported no change.
▪ Reasons grantees gave for an increase in the percentage of users with health insurance
included an increase in newly insured clients because of the Affordable Care Act (ACA)
and Medicaid expansion, improved data collection, onsite health insurance enrollment
assistance, training to improve the collection of health insurance data, use of an EHR
template to capture insurance status information, and increased capacity and effort to bill
private insurance.
▪ Reasons grantees gave for a decrease in the percentage of users with health insurance
included targeted outreach to populations that are typically uninsured, an increase in the
number of uninsured clients, and loss of insured clients to private providers.
Unknown/not reported health insurance status—Several grantees attributed the high or
increased number of family planning users with unknown or not reported health insurance
coverage status to staff turnover, an inadequate health insurance field in EHRs, problems
extracting accurate data from EHRs, clients not wanting to report their insurance status for
fear of denial of care or loss of confidentiality, and teens not knowing their insurance status.
FPAR TABLE 6: USERS WITH LIMITED ENGLISH PROFICIENCY (LEP)
Of the 88 grantees operating in both 2016 and 2017, 45 reported a decrease and 43 reported
an increase in the percentage of users who are LEP.
▪ Reasons given by grantees for the decrease in percentage of users who are LEP included
changing demographic characteristics of clients (i.e., fewer LEP users) and improved data
collection.
▪ Reasons given by grantees for the increase in percentage of users who are LEP included
changing demographic characteristics of clients, staff training on creating a welcoming
environment, increased capacity to service LEP population, and increased outreach to
minority communities.
Unknown/not reported LEP status—Several grantees attributed the high or increased
number of family planning users with unknown or not reported LEP status to data system
limitations, including extracting LEP status data from EHRs and changes in EHR systems.
FPAR TABLE 7: FEMALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Primary method category definitions—Contraceptive methods are grouped into three
categories—most, moderately, and less effective—based on the effectiveness of each method
in preventing pregnancy under typical use conditions. These categories correspond to the
three groups or tiers defined by Trussell (2011).10
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Family Planning Annual Report: 2017 National Summary
Most effective contraceptives (Tier 1) refer to methods that result in less than 1% of women
experiencing an unintended pregnancy during the first year of typical use. They include:
▪ Male sterilization/vasectomy, 0.15%
▪ Female sterilization, 0.5%
▪ Implant (Nexplanon/Implanon), 0.05%
▪ Intrauterine device (Mirena), 0.2%
▪ Intrauterine device (Skyla), 0.4%23
▪ Intrauterine device (Kyleena), 0.2%24
▪ Intrauterine device (Liletta), 0.2%25
▪ Intrauterine device (ParaGard), 0.8%
Moderately effective contraceptives (Tier 2) refer to methods that result in between 6% and
12% of women experiencing an unintended pregnancy during the first year of typical use.
They include:
▪ Injectable (Depo-Provera), 6%
▪ Vaginal ring (NuvaRing), 9%
▪ Contraceptive patch (Evra), 9%
▪ Combined and progestin-only pills, 9%
▪ Diaphragm (with spermicidal cream/jelly), 12%
Less effective contraceptives (Tier 3) refer to methods that result in between 18% and 28% of
women experiencing an unintended pregnancy during the first year of typical use. They
include:
▪ Sponge, nulliparous women, 12%
▪ Male condom, 18%
▪ Female condom, 21%
▪ Withdrawal, 22%
▪ Sponge, parous women, 24%
▪ Fertility awareness-based method, 24%
▪ Spermicides, 28%
Because the FPAR combines some methods into a single reporting category (e.g., fertility
awareness-based method [FAM] and lactational amenorrhea method [LAM], diaphragm and
cervical cap), the methods in two of the three effectiveness categories may differ slightly
from those listed above. We do not expect these differences to have an impact on the findings
Family Planning Annual Report: 2017 National Summary
C-5
because a limited number of Title X clients report using the methods in these combined
categories.
Hormonal injection users—Nine grantees in four regions (I, III, VI, and IX) reported a total
of 98 female users who relied on 1-month hormonal injections as their primary method. Onemonth hormonal injection users accounted for 0.02% of the 500,960 hormonal injection users
reported in 2017.
Sterilization among users under 20—One grantee reported a single female user under 20
relying on female sterilization as her primary contraceptive method. The grantee confirmed
that this female was sterilized prior to coming to the Title X site and that no Title X funding
was used for the sterilization.
Vasectomy among users under 18—Four grantees reported four female users under 18
relying on vasectomy as their primary contraceptive method. The grantees confirmed that
each of these females received noncoercion counseling.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of female users with an unknown primary method to one or more of
the following reasons: data collection/system problems (e.g., data entry errors, data
transfer/upload problems, and EHR issues related to implementation or transitions, missing
data fields, or data extraction), lack of staff training, staff turnover, outdated or inadequate
encounter forms, and failure to document primary method data for specific user subgroups
(e.g., users relying on third-party payer source) or encounters (e.g., nonclinical).
Grantees attributed the decrease in female users with an unknown primary method to
improved data collection, change in subrecipient reporting methodology, subrecipient
monitoring, and staff training.
FPAR TABLE 8: MALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Primary method category definitions—See note for FPAR Table 7 in above section.
Sterilization among users under 20—No grantees reported male users under 20 relying on
vasectomy as their primary contraceptive method.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of male users with an unknown primary method to one or more of
the following reasons: failure to record primary method for some, all, or certain subgroups of
users (e.g., adolescent and insured) or encounters (e.g., non-clinical or and STD-only
encounters); problems extracting data from electronic systems (practice management or
EHR); failure to collect data for “no method, other reason” category; outdated encounter
forms; lack of staff training; staff turnover; challenges transitioning to new EHR; and client
refusal. Several other grantees attributed a decrease in the number of male users with an
unknown primary method to improved data collection, staff training, and technical assistance.
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Family Planning Annual Report: 2017 National Summary
FPAR TABLE 9: CERVICAL CANCER SCREENING ACTIVITIES
Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 58 reported a decrease in
the percentage of female users who received a Papanicolaou (Pap) test, and 30 reported an
increase.
▪ Reasons given by grantees for a decrease in the percentage of females screened for
cervical cancer included adherence to cervical cancer screening guidelines, EHR-related
issues (e.g., loss of data or difficulty extracting data), decreased opportunities to screen
because of a decline in visits among some users (e.g., LARC users), newly insured clients
seeking screening elsewhere, and weather-related disruptions in care delivery (e.g.,
hurricanes).
▪ Reasons given by grantees for an increase in the percentage of females screened for
cervical cancer included improved data collection and reporting, increase in new patients
who are in need of screening, and underreporting in 2016.
FPAR TABLE 10: CLINICAL BREAST EXAMS (CBEs) AND REFERRALS
CBEs—Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 59 reported a
decrease in the percentage of female users who received a CBE, and 29 reported an increase.
▪ Reasons given by grantees for a decrease in the percentage of females that received a
CBE included adherence to breast cancer screening guidelines, a decrease in the frequency
of clients receiving other physical exams or tests during which a CBE might be performed
(e.g., Pap tests or physical exam), lack of qualified staff to perform CBEs, overreporting of
CBEs in 2016, and EHR-related issues (e.g., transition, mapping and location of CBE
reporting field).
▪ Reasons given by grantees for an increase in the percentage of females that received a
CBE included greater attention to this area of clinical care, adherence to guidelines, and
improved data collection.
CBE-Related Referrals—Of the 88 grantees that submitted an FPAR in both 2016 and 2017,
43 reported a decrease in the percentage of female users referred for further evaluation
following a CBE, 41 reported an increase, and 4 reported no change.
▪ Reasons given by grantees for a decrease in the percentage of CBE-related referrals
were related to their EHR systems (e.g., transition, mapping, and location of CBE reporting
fields).
▪ Reasons given by grantees for an increase in the percentage of CBE-related referrals
included an increase in the number of older clients screened, improved data collection,
adherence to protocols, and better documentation of referrals in the EHRs.
Family Planning Annual Report: 2017 National Summary
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FPAR TABLE 11: USERS TESTED FOR CHLAMYDIA BY AGE AND SEX
Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 50 reported an increase in
the percentage of female users under 25 tested for chlamydia, and 38 reported a decrease. In
addition, 61 grantees reported an increase in the percentage of male users tested, 26 reported a
decrease, and 1 reported no change.
▪ Reasons given for an increase in the chlamydia testing rate included high chlamydia
prevalence in the state or service area, improved data collection, increased staff training
and awareness, increased adherence to screening guidelines, greater availability of tests,
use of opt-out testing, chlamydia-focused quality improvement initiative, local and
statewide marketing of testing services, an increased number of male users at risk for
chlamydia, and increased outreach to males.
▪ Reasons given for a decrease in the chlamydia testing rate included a decrease in clients
who qualify for testing, inability to test in nontraditional encounter settings, decreased
funding or loss of dedicated funding, EHR-related issues (e.g., difficulty with data
extraction, problems with the lab–EHR interface, and challenges transitioning to a new
EHR), lab unable to process specimens, inconsistent data collection, clients tested at nonTitle X sites, and weather-related disruptions in care delivery.
FPAR TABLE 12: GONORRHEA, SYPHILIS, AND HIV TESTING BY SEX
General STD Testing—Several grantees commented on reasons for the increase or decrease
in STD testing activities without specifying the type of STD test.
▪ Reasons given for the increase in STD testing included improved data collection,
implementation of opt-out testing, increased initiatives with staff to screen for STDs, an
increase in the availability of testing reagents, efforts to increase awareness and encourage
STD/HIV testing, an increase in users at high risk, an increase in male clients, improved
integration of STD with family planning services, increased marketing, initiation of
Personal Responsibility Education Program and Teens Pregnancy Prevention programs,
introduction of well-person services that include preventive and preconception health care
for men, and underreporting of 2016 STD testing data.
▪ Reasons given for the decrease in STD testing included difficulty with mapping lab data
to EHR data, reporting errors, inconsistent reporting, staff turnover, improved compliance
with STD testing guidelines, and weather-related disruptions in care delivery.
Gonorrhea Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016 and
2017, 53 reported an increase and 35 reported a decrease in the number of gonorrhea tests per
female user. In addition, 61 grantees reported an increase, 26 reported a decrease, and 1
reported no change in the number of tests per male user.
▪ Reasons given by grantees for the increase in gonorrhea testing included an increase in
gonorrhea prevalence in the service area, increased use of the combined chlamydia and
gonorrhea test, an increased number of users at high risk, and increase in multisite
specimens.
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Family Planning Annual Report: 2017 National Summary
▪ Reasons given by grantees for the decrease in gonorrhea testing included reporting issues
with subrecipient, loss of data from EHR, weather-related disruptions in care delivery, and
mechanical problems with testing equipment.
Syphilis Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016 and 2017,
53 reported an increase, 34 reported a decrease, and 1 reported no change in the number of
syphilis tests per female user. In addition, 58 grantees reported an increase, 25 reported a
decrease, and 5 reported no change in the number of syphilis tests per male user.
▪ Reasons given for the increase in syphilis testing included high prevalence or an outbreak
in the service area, better reporting, combined HIV and syphilis testing, an increase in
high-risk clients, and repeat testing of pregnant women in high-prevalence settings.
▪ A reason given for the decrease in syphilis testing was adherence to testing guidelines.
Confidential HIV Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016
and 2017, 48 grantees reported an increase, 39 reported a decrease, and 1 reported no change
in the number of confidential HIV tests per female user. In addition, 50 grantees reported an
increase, 34 reported a decrease, and 4 reported no change in the number of confidential HIV
tests per male user.
▪ Reasons given by grantees for the increase in confidential HIV testing included an
increase in clients, an increase in clients with risk factors associated with abuse of opioids
and other substances, and continuation or implementation of opt-out testing.
▪ Reasons given by grantees for the decrease in confidential HIV testing included clients
obtaining testing elsewhere, withdrawal of a subrecipient that had a special focus on HIV
testing, a reduction in clients as a result of site closures, loss of targeted funding, a decrease
in rapid HIV testing because of weather-related disruptions in electricity, and adherence to
testing guidelines.
Positive Confidential HIV Tests—Of the 88 grantees that submitted an FPAR in both 2016
and 2017, 33 reported a decrease in the number of positive confidential HIV tests per 1,000
tests performed, 30 reported an increase, 23 reported no change (ratio was zero in both years),
and 2 conducted no confidential HIV testing.
▪ One grantee attributed the decrease in confidential HIV tests to improved data reporting
by subrecipients and the inability of subrecipients to report HIV testing data.
▪ Reasons cited by grantees for the increase in positive confidential HIV tests included
introduction of PrEP (pre-exposure prophylaxis) services, targeted outreach to high-risk
populations, an increase in clients with risk factors associated with abuse of opioids and
other substances, and improved reporting.
Family Planning Annual Report: 2017 National Summary
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FPAR TABLE 13: FAMILY PLANNING ENCOUNTERS AND STAFFING
Clinical Services Provider (CSP) Full-Time Equivalent (FTE)—Of the 88 grantees that
submitted an FPAR in both 2016 and 2017, 38 reported an increase in the total number of
FTE CSPs delivering Title X-funded services, 38 reported a decrease, and 12 reported no
change.
▪ Reasons given for an increase in CSP FTEs included better understanding of what
constitutes a family planning encounter and user, provision of training on CSP FTE
calculations for service site staff, increased hiring, improved data capture, and an increase
in CSP staffing associated with the addition of new subrecipients and service sites.
▪ Reasons given for a decrease in CSP FTEs included difficulty retaining or recruiting staff,
improved and standardized methodology for calculating FTEs, overreporting of FTEs in
the 2016 FPAR, and a response to the decline in users.
Physician FTEs—Thirty-six grantees reported an increase in physician FTEs, 29 reported a
decrease, and 23 reported no change. Reasons cited for the increase in physician FTEs
included an increased demand for care, the addition of Federally Qualified Health Centers to
the Title X network, and collaboration with physician residency programs. Reasons for a
decrease in physicians included not filling vacancies, recruitment difficulties, and a reduction
in physician CSP hours.
Midlevel Clinician FTEs—Thirty-six grantees reported an increase in midlevel clinician
FTEs, 38 reported a decrease, and 14 reported no change. In addition to the general reasons
cited above for the increase in CSP FTEs, there was a shift in staffing composition from
physician to midlevel FTEs.
Other CSP FTEs—Most grantees (N=72) reported zero other CSP FTEs in both years, 10
reported a decrease, 6 reported an increase, and 2 reported no change. In addition to the
reasons cited above for the change in CSP FTE levels, several grantees mentioned
overreporting of other CSP FTEs in 2016.
Family Planning Encounters—Of the 88 grantees that submitted an FPAR in both 2016 and
2017, 50 grantees reported a decrease in the number of total encounters and 38 reported an
increase. Several grantees gave the following reasons for the change in encounter numbers:
▪ Reasons given for the decrease in encounters included a decline in clients, patients
migrating to private health care because of their insured status, inconsistent data collection,
staff turnover and shortages, an increase in the number of LARC users who require fewer
visits, loss of productivity due to EHR implementation, and less frequent screening
requirements for selected services (e.g., Pap test).
▪ Reasons given for the increase in encounters included better understanding of what
constitutes a family planning encounter, underreporting of 2016 encounters, increased
staffing and capacity to serve more clients, clients’ reliance on Title X sites as a medical
home, clients returning for resupply visits and follow-up care, and provision of integrated
family planning services.
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Family Planning Annual Report: 2017 National Summary
FPAR TABLE 14: REVENUE REPORT
Total revenue (row 18)—All Regions—Of the 88 grantees that submitted an FPAR in both
2016 and 2017, 45 reported a decrease in total revenue, and 43 reported an increase.
Title X revenue (row 1)—All Regions—Title X revenue includes 2017 cash receipts or
drawdown amounts from all family planning service grants.
Medicaid revenue (row 3a)—All Regions— Medicaid revenue includes revenue from
federally approved Medicaid family planning eligibility expansions in the following 26 states:
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Region I—Connecticut, Maine, New Hampshire, and Rhode Island
Region II—New York
Region III—Maryland, Pennsylvania, and Virginia
Region IV—Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina
Region V—Indiana, Minnesota, and Wisconsin
Region VI—Louisiana, New Mexico, and Oklahoma
Region VII—Iowa
Region VIII—Montana and Wyoming
Region IX—California
Region X—Oregon and Washington
Other revenue (rows 12 through 16)—All Regions—An illustrative list of “other” revenue
sources reported in rows 12 through 16 includes the following: 340B Drug Discounting
Program; agency or applicant contribution/funds; bad debt; Breast and Cervical Cancer Early
Detection Program; Breast and Cervical Cancer Program; Breast, Cervical, and Colon Health
Program; cash; client contributions/donations; Community Service Block Grant; consultation
fees; contraceptives; contractual services; DC Campaign Teen Pregnancy Prevention Fund;
donations (foundation, individual, client, and other); Early Detection Works Program; earned
and special funds; earned interest; education and training fees; Every Woman Matters;
Farmworker Program; Foundation (private and corporate) grants and other funding; FPNTC
travel support; Health Safety Net; Healthy Woman Breast and Cervical Cancer Program; HIV
testing funds/grant; HRSA Ryan White; Individual donations/contributions; Insurance
Exchange; interest; Meaningful Use payment/incentive; Migrant Worker Program; mileage;
Net Assets Released From Restrictions; other federal grant (HRSA Ryan White or STD);
Personal Responsibility Education Program; Preventive Health and Health Service Block
Grant; Public Health Screening Program for low-income and at-risk individual under 40;
refunds (worker’s compensation, vendor); rental income; restricted donations and grants
(various sources); revenue recovery; School Based Health Center; Set-Off Program; St. James
Physician Hospital Organization; state and federal STD funding; subrecipients (contributions,
reimbursements, and unspecified); supplies; Tobacco Settlement; travel reimbursement;
UNFPA; United Way; university grants; and Yavapai County Investment Pool earned
interest.
Family Planning Annual Report: 2017 National Summary
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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
www.hhs.gov/opa
| File Type | application/pdf |
| File Title | Family Planning Annual Report: 2017 National Summary |
| Subject | Title X, Office of Population Affairs, FPAR, Family Planning Annual Report, family planning, family planning services, contracep |
| Author | HHS/OPA |
| File Modified | 2018-08-27 |
| File Created | 2018-08-06 |