A thematic analysis of Title X family planning program's (P.L. 91-572) legislative history: 1970-2008

Background: Title X, enacted in 1970, serves as the only federal policy which exclusively provides voluntary and confidential family planning services to all women regardless of age/economic status. Title X's achievements include preventing unintended pregnancy, decreasing the need for abortions, improving birth outcomes, providing related preventive services and often serving as the only source of health care for women. Regardless of Title's X importance to women's health, it has confronted political challenges throughout its history.

Purpose: To identify themes that emerged throughout the proposed bills included Title X's legislative history from 197-2008.

Methods: A thematic analysis was preformed on all federal bills (House/Senate) included in Title X's legislative history (N=302) by employing inter-related steps such as reading, coding, displaying, reducing, and interpreting.

Results: Language contained in the bills included both implicit and explicit meanings and changes to Title X policy. Emerging themes can be classified into the following seven major broad categories: Administration; Appropriation; Requirements of Funds/Services; Restrictions of Funds/Services; Related Legislation; Related Policies; and Technical Amendments. Bills included under these categories both supported and challenged the program. For instance, abortion, funding level, and providing services to adolescents were common issues raised throughout the proposed bills.

Conclusion: Women's health is intrinsically linked to the health of Title X. Despite significant public health achievements, Title X has endured many political challenges. Understanding the evolution of a policy and the oppositions which it has faced is needed to assist in advocacy and policy actions that promote safe reproductive services for all women.