For most of the three decades during which the U.S. government has subsidized family planning services both at home and overseas, it has been with broad-based support from lawmakers and the public at large. Recent polling indicates that, among the public, support for family planning programs is as strong as ever. But on the legislative front, the situation is radically different.

To be sure, family planning programs have always had their detractors and their share of political troubles. But in recent years, especially since Republicans took control of the House of Representatives in 1995, a determined, well-organized and politically credible opposition to government-subsidized family planning itself has surfaced.

Emboldened by the large contingent of ultraconservative ideologues in their ranks, and supported by a cadre of equally conservative lobby groups, the House leadership has mounted unprecedented attacks on both Title X, the core domestic family planning program, and on the United States Agency for International Development's (USAID) population assistance program—including attempts to defund and, thereby, abolish them outright. While these frontal efforts to abolish the programs failed, a parallel strategy aimed at raising anxieties about the programs and chipping away at members' support for them continues.

This war of attrition has kept family planning supporters, both in Congress and at the White House, on the defensive. Rather than championing funding increases and new program initiatives, advocates have been forced to concentrate on holding the line. Responding to perennial attacks on specific issues—largely around teen services and abortion—at face value rather than as assaults on the basic integrity of the programs, many have lost sight of the larger case to be made for family planning. Consequently, while Title X and the overseas program remain "intact," their funding has suffered and their base of congressional support has seriously eroded.

Title X Embattled

As the only federal domestic program devoted solely to the provision of family planning and closely related health services, Title X has been a ready target over the years. But perhaps no assault was as bold as the one in 1995, when the House leadership tried (and narrowly failed, due in large part to the tenacity of a small but critical band of Republican moderates who have remained among the program's strongest supporters) to eliminate Title X entirely by transferring all of its funding to other public health programs, without any requirement that the funds be spent on family planning.

Following this defeat, opponents intensified their parallel strategy. On three occasions during the last two years, they proposed amendments to require parental consent for family planning services, rather than provide confidential care while encouraging parental involvement. In each instance, the medical and public health communities were instrumental in defeating the amendment as contrary to the standards of good medical practice. However, the most recent attempt, in the fall of 1997, was defeated by the narrowest margin to date—a mere 10 votes. Buoyed by their improving vote margins on the issue in just the last few years, Title X foes have vowed to offer parental consent language again in 1998.

Attempting to transfer sizable chunks of Title X money to other worthy programs has emerged as another tactic of the program's opponents. Last year, an amendment diverting $9 million in Title X funds to an already well-financed senior meals program was accepted by the House. Title X supporters, fearing the amendment could not be defeated, let it pass on a voice vote. (The amendment was subsequently dropped during final negotiations with the Senate.)

Looking back, perhaps Title X's narrowest escape was from the Reagan-era "gag rule" aimed at prohibiting the provision of any abortion-related information by Title X-funded facilities. After protracted litigation, it was upheld by the Supreme Court. Although Congress then voted several times to rescind it, legislators could not quite muster the two-thirds majority necessary to override then-president George Bush. Only with the election of President Bill Clinton and his administrative revocation of the gag rule was Title X rescued.

Overseas Program Stymied

The gag rule continues to torment the international program, however, where proponents and opponents of U.S. population assistance—largely the same partisans as on Title X—also have been locked in a high-stakes political tug-of-war consistently since 1995. In each of the last three years, House program opponents have sought to impose a "global gag rule," which, in its most recent incarnation, would bar organizations in developing countries from receiving U.S. family planning funds if they use their own, non-U.S. funds to provide abortion services or if they participate—consistent with their own laws—in policy debates around abortion. This latter restriction is a direct attempt to block organizations in other countries from exercising the core democratic right of free speech—within their own borders and with their own funds.

Each time the House has endorsed the policy, the Senate and White House have rebuffed it. And each time, a "compromise" was reached only at the 11th hour in which the price for not accepting the gag rule was an onerous funding cut with additional administrative restrictions on how and when the money could be spent.

Gag rule proponents contend that giving U.S. funds to organizations such as International Planned Parenthood Federation effectively "frees up" their private funds to promote abortion worldwide. This "fungibility" argument has been especially potent in blurring the lines between family planning and abortion, and has deftly eroded congressional support for the overseas program.

Testing the extent of that erosion, Republican leaders gave their blessing to a House floor amendment last year that would have scrapped the international family planning program entirely because, according to its primary sponsor, it is "unnecessary, unconstitutional, intrusive and the cause of more not fewer abortions." While the amendment was handily defeated, the vote did signal that fully one-third of the House—including the full GOP leadership—was willing to vote to kill the program.

An Uncertain Future

So far, however, both programs survive. But the relentless assaults over the years have taken their toll, not least in terms of funding. In the case of Title X, which has been hammered by program opponents for almost two decades, funding in constant (inflation-adjusted) dollars, peaked in FY 1981 and has suffered from slow attrition ever since (see chart). In the case of USAID's population assistance program, by contrast, funding reductions have been brutally sharp since FY 1996.

Meanwhile, public opinion polls continue to document strong, broad-based support for family planning services, particularly government-financed services for low-income individuals and especially teenagers. According to an October 1997 survey conducted for Planned Parenthood Federation of America by a team of prominent Democratic and Republican pollsters, almost nine out of 10 voters (88%) believe family planning services are important; seven in 10 (71%) favor increased public funding for family planning services and counseling. Further, 85% of the voters consider teen access to family planning services and contraception critically important. Of these, two-thirds agree that teens should have confidential access to these services.

Similarly, in a 1995 University of Maryland survey on Americans' attitudes toward U.S. foreign assistance, fully 74% of those polled, when told how much was being spent for family planning overseas, thought that level should be maintained or increased.

Yet, congressional opponents persist in their attacks—and they are winning converts. Largely unbeknownst to the public, because the high-profile fights are generally over teenagers or portrayed as about "abortion," both the underlying Title X and the international family planning programs themselves are teetering on the edge. They may well plunge if these attacks on "side issues" aren't soon recognized—and addressed—as tantamount to direct assaults on family planning.

Money and Politics
Attacked for almost two decades, Title X has suffered decreased purchasing power since FY 1981...
Note: Deflator based on Consumer Price Index for Medical Care.

...whereas population assistance funding rose steadily until FY 1995 before being slashed by 35%