September 2021
Title X
Family Planning Annual Report
2020 National Summary
Family Planning Annual Report: 2020 National Summary
This page intentionally left blank.
September 2021
Family Planning Annual Report:
2020 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 200
Rockville, MD 20852
Prepared by
RTI International
3040 East Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709
ii Family Planning Annual Report: 2020 National Summary
SUGGESTED CITATION
Fowler, C. I., Gable, J., & Lasater, B. (2021, September). Family Planning Annual Report:
2020 National Summary. Washington, DC: Office of Population Affairs, Office of the
Assistant Secretary for Health, Department of Health and Human Services.
ADDITIONAL COPIES
This report can be viewed, downloaded, and printed from the Office of Population Affairs
Website at https://opa.hhs.gov/evaluation-research/title-x-services-research/family-planning-
annual-report.
ACKNOWLEDGMENTS
This report was prepared by RTI International under OPA contract number
HHSP233201500039I/75P00119F37024. RTI staff who prepared the report include Christina
Fowler (Project Director and Health Scientist), Julia Gable (Statistician), and Beth Lasater
(Information Systems Analyst). Kat Asman (Statistician) provided statistical support. The
conclusions expressed in this report are those of the authors and do not necessarily represent
the views of HHS or OPA. Amy Morrow and Margaret Johnson (Editors); Cathy Boykin and
Roxanne Snaauw (Document Preparation Specialists); and Kimberly Cone, Pam Tuck, and
Teresa Mink (Web Conversion Team) provided publications assistance. Al-Nisa Berry
(FPAR Data System Manager), Yuying Zhang (Programmer), and Vesselina Bakalov
(Programmer) provided support for web-based data collection.
For their help resolving data validation issues and reviewing the final report, the authors
thank the following U.S. Department of Health and Human Services (HHS) Office of
Population Affairs (OPA) staff: Jessica Swafford Marcella (Deputy Assistant Secretary for
Population Affairs), Jamie Kim and Roshni Menon (FPAR Data Coordinators), Amy
Margolis (Division Director), and HHS/OPA Project Officers Lisa Creatura, Naomie Gathua,
Tracy Georges, Lieutenant Commander Cynda Hall, Alissa Harvey, and Shenena Merchant.
Finally, publication of this report would not have been possible without the contributions of
Title X services grantees and subrecipients that ensure access to a broad range of family
planning and related preventive health services for millions of low-income or uninsured
individuals and collect, compile, and submit FPAR data to OPA.
_________________________________
RTI International is a trade name of Research Triangle Institute.
RTI and the RTI logo are U.S. registered trademarks of Research Triangle Institute.
Family Planning Annual Report: 2020 National Summary iii
Contents
EXECUTIVE SUMMARY ES-1
1 INTRODUCTION 1
Title X National Family Planning Program ........................................................................... 1
Background ..................................................................................................................... 1
Family Planning Annual Report ...................................................................................... 1
Factors Affecting Title X Performance in 2020 .............................................................. 2
Report Structure ..................................................................................................................... 3
2 FPAR METHODOLOGY 7
Data Collection ...................................................................................................................... 7
Data Validation ...................................................................................................................... 7
3 TITLE X NETWORK CHARACTERISTICS 9
Title X Service Network Profile ............................................................................................ 9
4 FAMILY PLANNING USER CHARACTERISTICS 11
Demographic Profile ............................................................................................................ 11
Total Users (Exhibit 3) .................................................................................................. 11
Users by Sex (Exhibits 4 and 5) .................................................................................... 12
Users by Age (Exhibits 4 and 5) ................................................................................... 12
Users by Race (Exhibits 6 through 14) ......................................................................... 16
Users by Ethnicity (Exhibits 6 through 14) ................................................................... 16
Social and Economic Profile ................................................................................................ 25
Users by Income Level (Exhibit 15) ............................................................................. 25
Users by Insurance Coverage Status (Exhibit 16) ......................................................... 25
Users by Limited English Proficiency Status (Exhibit 17)............................................ 26
5 CONTRACEPTIVE USE 31
Female Contraceptive Use (Exhibits 18 through 21) ........................................................... 31
Trends in Female Primary Contraceptive Method Use ................................................. 32
Male Contraceptive use (Exhibits 22 through 25) ............................................................... 33
iv Family Planning Annual Report: 2020 National Summary
6 RELATED PREVENTIVE HEALTH SERVICES 43
Cervical and Breast Cancer Screening ................................................................................. 43
Cervical Cancer Screening (Exhibit 26) ........................................................................ 43
Breast Cancer Screening (Exhibit 26) ........................................................................... 44
Sexually Transmitted Disease Testing ................................................................................. 46
Chlamydia Testing (Exhibits 27 and 28) ....................................................................... 46
Gonorrhea Testing (Exhibit 29) .................................................................................... 50
Syphilis Testing (Exhibit 29) ........................................................................................ 50
HIV Testing (Exhibit 29) .............................................................................................. 51
7 STAFFING AND SERVICE UTILIZATION 53
Staffing and Family Planning Encounters ............................................................................ 53
Clinical Services Provider Staffing (Exhibit 30) ........................................................... 53
Family Planning Encounters (Exhibit 30) ..................................................................... 53
8 PROJECT REVENUE 57
Revenue................................................................................................................................ 57
Title X Services Grant ................................................................................................... 57
Payment for Services: Client Fees................................................................................. 57
Payment for Services: Third-Party Payers .................................................................... 57
Other Revenue ............................................................................................................... 58
Revenue per User and Encounter .................................................................................. 58
Trends in Project Revenue 2020 vs. 2019 ..................................................................... 62
Trends in Project Revenue 2010 vs. 2020 ..................................................................... 62
9 REFERENCES 63
APPENDIXES
A. National Trend Exhibits......................................................................................................... A-1
B. State Exhibits ......................................................................................................................... B-1
C. Field and Methodological Notes ............................................................................................ C-1
D. Preliminary Analysis: Estimated Effects of the 2019 Final Rule and COVID-19
Pandemic on Title X User Counts and Total Revenue 2018 to 2020 .................................... D-1
Family Planning Annual Report: 2020 National Summary v
EXHIBITS
1. U.S. Department of Health and Human Services regions ................................................... 5
2. Number of and percentage change in grantees, subrecipients, and service sites,
by year and region: 2019–2020 (Source: FPAR Grantee Profile Cover Sheet) .................. 9
3. Number, distribution, and percentage change in number of all family planning
users, by year and region: 2019–2020 (Source: FPAR Table 1)....................................... 11
4. Number of all family planning users, by sex, age, and region: 2020
(Source: FPAR Table 1) ................................................................................................... 14
5. Distribution of all family planning users, by sex, age, and region: 2020
(Source: FPAR Table 1) ................................................................................................... 15
6. Number and distribution of all family planning users, by race and ethnicity: 2020
(Source: FPAR Tables 2 and 3) ........................................................................................ 17
7. Number and distribution of female family planning users, by race and ethnicity:
2020 (Source: FPAR Table 2) .......................................................................................... 17
8. Number and distribution of male family planning users, by race and ethnicity:
2020 (Source: FPAR Table 3) .......................................................................................... 17
9. Number of all family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Tables 2 and 3) ........................................................................................ 18
10. Distribution of all family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Tables 2 and 3) ........................................................................................ 19
11. Number of female family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Table 2) ................................................................................................... 20
12. Distribution of female family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Table 2) ................................................................................................... 21
13. Number of male family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Table 3) ................................................................................................... 22
14. Distribution of male family planning users, by race, ethnicity, and region: 2020
(Source: FPAR Table 3) ................................................................................................... 23
15. Number and distribution of all family planning users, by income level and
region: 2020 (Source: FPAR Table 4) .............................................................................. 27
16. Number and distribution of all family planning users, by principal health
insurance coverage status and region: 2020 (Source: FPAR Table 5) .............................. 28
17. Number and distribution of all family planning users, by limited English
proficiency (LEP) status and region: 2020 (Source: FPAR Table 6) ................................ 29
18. Number of female family planning users, by primary contraceptive method and
age: 2020 (Source: FPAR Table 7) ................................................................................... 34
19. Distribution of female family planning users, by primary contraceptive method
and age: 2020 (Source: FPAR Table 7) ............................................................................ 35
20. Number of female family planning users, by primary contraceptive method and
region: 2020 (Source: FPAR Table 7) .............................................................................. 36
vi Family Planning Annual Report: 2020 National Summary
21. Distribution of female family planning users, by primary contraceptive method
and region: 2020 (Source: FPAR Table 7) ....................................................................... 37
22. Number of male family planning users, by primary contraceptive method and
age: 2020 (Source: FPAR Table 8) ................................................................................... 38
23. Distribution of male family planning users, by primary contraceptive method and
age: 2020 (Source: FPAR Table 8) ................................................................................... 39
24. Number of male family planning users, by primary contraceptive method and
region: 2020 (Source: FPAR Table 8) .............................................................................. 40
25. Distribution of male family planning users, by primary contraceptive method and
region: 2020 (Source: FPAR Table 8) .............................................................................. 41
26. Cervical and breast cancer screening activities, by screening test or exam and
region: 2020 (Source: FPAR Tables 9 and 10) ................................................................. 45
27. Number of family planning users tested for chlamydia, by sex, age, and region:
2020 (Source: FPAR Table 11) ........................................................................................ 48
28. Percentage of family planning users in each age group tested for chlamydia, by
sex, age, and region: 2020 (Source: FPAR Table 11) ....................................................... 49
29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region,
and number of positive HIV tests, by region: 2020 (Source: FPAR Table 12) ................ 52
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: 2020
(Source: FPAR Table 13) ................................................................................................. 55
31. Amount and distribution of Title X project revenues, by revenue source: 2020
(Source: FPAR Table 14) ................................................................................................. 59
32. Amount of Title X project revenues, by revenue source and region: 2020
(Source: FPAR Table 14) ................................................................................................. 60
33. Distribution of Title X project revenues, by revenue source and region: 2020
(Source: FPAR Table 14) ................................................................................................. 61
A–1a. Number of Title X-funded grantees, subrecipients, and service sites, by region
and year: 2010–2020 ....................................................................................................... A-2
A–1b. Distribution of Title X-funded grantees, subrecipients, and service sites, by
region and year: 2010–2020 ........................................................................................... A-3
A–1c. Number of Title X-funded service sites and users per service site, by year:
2010–2020 ...................................................................................................................... A-4
A–2a. Number and distribution of all family planning users, by region and year, and
number and percentage of all family planning users, by sex and year: 2010–2020........ A-6
A–2b. Number and distribution of all family planning users, by region and year:
2010–2020 ...................................................................................................................... A-7
A–3a. Number and distribution of all family planning users, by age and year:
2010–2020 ...................................................................................................................... A-8
A–3b. Number and distribution of all family planning users, by age and year:
2010–2020 ...................................................................................................................... A-9
Family Planning Annual Report: 2020 National Summary vii
A–4a. Number and distribution of all family planning users, by race and year:
2010–2020 .................................................................................................................... A-10
A–4b. Number and distribution of all family planning users, by race and year:
2010–2020 .................................................................................................................... A-11
A–5a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2010–2020 ..................................................................... A-12
A–5b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2010–2020 ..................................................................... A-13
A–6a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2010–2020 ............................................................................ A-14
A–6b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2010–2020 ............................................................................ A-15
A–7a. Number and distribution of all family planning users, by income level and year:
2010–2020 .................................................................................................................... A-16
A–7b. Number and distribution of all family planning users, by income level and year:
2010–2020 .................................................................................................................... A-17
A–8a. Number and distribution of all family planning users, by primary health
insurance status and year: 2010–2020 .......................................................................... A-18
A–8b. Number and distribution of all family planning users, by primary health
insurance status and year: 2010–2020 .......................................................................... A-19
A–9a. Number of all female family planning users, by primary contraceptive method
and year: 2010–2020 ..................................................................................................... A-20
A–9b. Distribution of all female family planning users, by primary contraceptive
method and year: 2010–2020 ........................................................................................ A-21
A–9c. Number and distribution of all female family planning users, by type of primary
contraceptive method and year: 2010–2020 ................................................................. A-22
A–10a. Number of all male family planning users, by primary contraceptive method and
year: 2010–2020 ........................................................................................................... A-24
A–10b. Distribution of all male family planning users, by primary contraceptive method
and year: 2010–2020 ..................................................................................................... A-25
A–10c. Number and distribution of all male family planning users, by type of primary
contraceptive method and year: 2010–2020 ................................................................. A-26
A–11a. 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: 2010–2020............................................................................................ A-27
A–11b. Number and percentage of female users who received a Pap test, by year:
2010–2020 .................................................................................................................... A-27
A–12a. Number and percentage of female users under 25 tested for chlamydia, by year:
2010–2020 .................................................................................................................... A-28
A–12b. Number and percentage of female users under 25 tested for chlamydia, by year:
2010–2020 .................................................................................................................... A-28
viii Family Planning Annual Report: 2020 National Summary
A–13a. Number of gonorrhea, syphilis, and confidential HIV tests performed, number of
tests per 10 users, and number of positive confidential HIV tests and anonymous
HIV tests, by year: 2010–2020 ..................................................................................... A-30
A–13b. Number of gonorrhea tests performed and number of tests per 10 users
(all, female, and male), by year: 2010–2020................................................................. A-31
A–13c. Number of syphilis tests performed and number of tests per 10 users
(all, female, and male), by year: 2010–2020................................................................. A-32
A–13d. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2010–2020................................................................. A-33
A–14a. Number and distribution of full-time equivalent (FTE) clinical services provider
(CSP) staff and number and distribution of family planning encounters, by type
and year: 2010–2020 ..................................................................................................... A-34
A–14b. Number and distribution of clinical services provider (CSP) full-time equivalents
(FTEs), by CSP type and year: 2010–2020 .................................................................. A-35
A–14c. Number and distribution of family planning encounters, by type and year:
2010–2020 .................................................................................................................... A-36
A–15a. Actual and adjusted (constant 2020$ and 2010$) total, Title X, and Medicaid
revenue, by year: 2010–2020 ........................................................................................ A-37
A–15b. Total, Title X, and Medicaid adjusted (constant 2020$) revenue (in millions), by
year: 2010–2020 ........................................................................................................... A-38
A–15c. Total actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue
(in millions), by year: 2010–2020 ................................................................................. A-39
A–15d. Title X actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue
(in millions), by year: 2010–2020 ................................................................................. A-40
A–15e. Medicaid actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue
(in millions), by year: 2010–2020 ................................................................................. A-41
A–16a. Total actual (unadjusted) project revenue, by revenue source and year:
2010–2020 .................................................................................................................... A-42
A–16b. Distribution of total project revenue, by revenue source and year:
2010–2020 .................................................................................................................... A-43
A–16c. Amount (unadjusted) and distribution of total project revenue, by revenue source
and year: 2010–2020 ..................................................................................................... A-44
B–1. Number and distribution of all family planning users, by sex and state, and distribution of
all users, by state: 2020 (Source: FPAR Table 1) ........................................................... B-2
B–2. Number and distribution of all family planning users, by user income level and
state: 2020 (Source: FPAR Table 4) ............................................................................... B-4
B–3a. Number and distribution of all family planning users, by insurance status and
state: 2020 (Source: FPAR Table 5) .............................................................................. B-6
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 status of the states’
Medicaid expansion under the Affordable Care Act (ACA): 2020
(Source: FPAR Table 5) ................................................................................................. B-8
Family Planning Annual Report: 2020 National Summary ix
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: 2020 (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: 2020 (Source: FPAR Table 11) ........................... B-12
D–1. Preliminary analysis of the impact of the 2019 Final Rule and COVID-19
pandemic on Title X family planning user counts: 2018–2020 ...................................... D-8
D–2. Preliminary analysis of the impact of the 2019 Final Rule and COVID-19
pandemic on Title X project revenue: 2018–2020 .......................................................... D-9
x
Family Planning Annual Report: 2020 National Summary
This page intentionally left blank.
Family Planning Annual Report: 2020 National Summary ES-1
Executive Summary
The Title X National Family Planning Program, administered by the U.S. Department of
Health and Human Services (HHS), 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 Title X program is designed to provide “a broad range of acceptable and
effective family planning methods and services (including natural family planning methods,
infertility services, and services for adolescents),”
1
with priority given to persons from
low‑income families. In addition to offering these methods and services 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.
2,3
The program is implemented through competitively
awarded grants to state and local public health departments and family planning, community
health, and other private nonprofit agencies. In fiscal year 2020, 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
services 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 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: 2020 National Summary is to present the
national-, regional-, and state-level findings for the 2020 reporting period (calendar year) and
trends for selected measures. Below we highlight key findings.
2020 SNAPSHOT: KEY FINDINGS
A diverse network of public and private nonprofit agencies deliver Title X services. In
2020, Title X-funded services were implemented through 75 grants* to 41 state and local
health departments and 34 nonprofit community health and family planning agencies. Title X
funds supported a network of 3,031 service sites operated by either grantees or
* In this report, the terms “grantee” and “grant” are synonymous. If an agency receives multiple grants to
support Title X services in different geographic areas (e.g., different states), OPA will require the agency
to submit separate FPARs, and the agency will appear more than once in the Title X grantee count. In
2020, 70 agencies submitted one FPAR, one agency submitted two FPARs, and one agency submitted
three FPARs.
ES-2 Family Planning Annual Report: 2020 National Summary
867 subrecipients in 44
†
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 2020, Title X-funded providers served more than
1.5 million family planning users (i.e., clients) through 2.7 million family planning
encounters, of which at least 11% were telehealth encounters.
‡
Nearly 9 of every 10 users
(86%) were female, 56% were under 30 years of age, and 66% had family incomes at or
below the poverty level ($26,200 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 2020, 59% of
family planning users had either public (40%) or private (19%) health insurance, and 39%
were uninsured. Since 2015, the percentage of clients with health insurance has exceeded the
percentage without insurance. Nevertheless, the percentage of Title X users who were
uninsured (39%) in 2020 was triple the national uninsured rate for adults (13%).
8
Title X providers serve a racially and ethnically diverse population. Of the 1.5 million
family planning users served in 2020, 33% self-identified with at least one of the nonwhite
Office of Management and Budget race categories (black or African American, Asian, Native
Hawaiian or Pacific Islander, American Indian or Alaska Native, or more than one race),
9
35% self-identified as Hispanic or Latino, and 19% were limited English proficient.
Title X providers offer clients a broad range of acceptable and effective family planning
methods and services. In 2020, 74% of the 1.3 million female users served were using or
adopted a contraceptive method at their last encounter. Over one-third (38%) of female users
used or adopted a short-term hormonal method
like pills, injectables, the vaginal ring, or
patch; 15% used or adopted a long-acting
reversible method like an intrauterine device
or implant; 12% relied on barrier methods like
condoms, spermicide, or contraceptive
sponge; and 5% used permanent methods like
female sterilization or vasectomy. Eight
percent of all female users exited their last
encounter with no contraceptive method
because they were either pregnant or seeking
pregnancy.
†
In 2020, there were no Title X-funded service sites in six states: Hawaii, Maine, Oregon, Utah, Vermont,
and Washington.
‡
In January 2021, OPA revised the Title X Family Planning Annual Report (FPAR): Forms and
Instructions to capture the increase in virtual family planning encounters during the coronavirus disease
2019 (COVID-19) pandemic. The number of virtual encounters reported in the 2020 FPAR National
Summary is likely an underestimate because the data systems for some grantees and subrecipients were
not able to report these data by the 2020 FPAR due date (February 16, 2021).
A family planning user is an individual who has
at least one family planning encounter during the
reporting period.
A family planning encounter is a documented
contact between an individual and a family
planning provider that is either face-to-face in a
Title X service site or virtual using telehealth
technology. The purpose of a family planning
encounter is to provide family planning services,
alone or together with related preventive health
services, to avoid unintended pregnancies or
achieve intended pregnancies.
Family Planning Annual Report: 2020 National Summary ES-3
Title X-funded cervical and breast cancer screening services are necessary for early
detection and treatment. In 2020, Title X providers conducted Papanicolaou (Pap) testing
on 22% (297,037) of female users. Thirteen percent of the 312,757 Pap tests performed had
an indeterminate or abnormal result requiring further evaluation and possible treatment. In
addition, providers performed clinical breast exams on 25% (335,249) of female users and
referred 7% 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 2020, Title X providers tested 52%
(264,100) of female users under 25 for chlamydia. Providers also performed 772,620
gonorrhea tests (5.0 tests per 10 users), 429,545 confidential HIV tests (2.8 tests per
10 users), and 325,813 syphilis tests (2.1 tests per 10 users). Of the confidential HIV tests
performed, 1,359 (3.2 per 1,000 tests performed) were positive for HIV.
Title X providers deliver male-focused family planning and reproductive health services
to a growing number of male users. In 2020, 14% (209,749) of all Title X users were men.
Most male users were in their 20s (31%) or 30s (23%), and 60% adopted or continued use of
condoms or another contraceptive method at exit from their last encounter. In addition,
Title X providers tested 46% of all male users for chlamydia and provided testing for several
other STDs, including gonorrhea (5.5 tests per 10 male users), HIV (4.8 tests per 10 male
users), and syphilis (3.3 tests per 10 male users).
A variety of qualified health providers deliver Title X-funded clinical services. In 2020,
2,681 full-time equivalent (FTE) clinical services providers (CSPs) delivered Title X-funded
care. Nurse practitioners, certified nurse midwives, and physician assistants accounted for
65% of total CSP FTEs, followed by physicians (29%) and registered nurses with an
expanded scope of practice (6%). A CSP attended 79% of the 2.7 million family planning
encounters that took place in 2020.
Title X projects rely on revenue from a mixture of public and private sources. In 2020,
Title X grantees reported total project revenue of $605 million to support their approved
Title X services projects. Six sources accounted for 84% of total revenue: Title X (34%, or
$205.8 million); Medicaid, including the Children’s Health Insurance Program (CHIP) (25%,
or $150.6 million); state governments (10%, or $60.6 million); private third-party payers (8%,
or $48.7 million); local governments (4%, or $25.0 million); and client service fees (3%, or
$19.5 million).
PERFORMANCE COMPARISON: 2020 VS. 2019
In this section, we highlight 1-year changes (2020 vs. 2019) in key measures of Title X
performance. For those measures related to the size and reach of the Title X service network,
we have also included comparisons with data for 2018 because they are more typical of the
program’s performance prior to the Final Rule change (2019) and COVID-19 pandemic
(2020).
Title X service network. Title X had 25 fewer grantees in 2020 than in 2019 (75 vs. 100),
193 fewer subrecipients (867 vs. 1,060), and 794 fewer service sites (3,031 vs. 3,825). For
ES-4 Family Planning Annual Report: 2020 National Summary
comparison, there were 24 fewer grantees in 2020 than in 2018 (75 vs. 99), 261 fewer
subrecipients (867 vs. 1,128), and 923 fewer service sites (3,031 vs. 3,954).
Number of family planning users and encounters. The decrease in the size of the Title X
service network reduced both the availability of and access to Title X services. Title X served
1.6 million fewer family planning users in 2020 than in 2019 (1.5 million vs. 3.1 million), and
there were 302 fewer users per service site (507 vs. 809). Furthermore, Title X conducted
almost 2.0 million fewer family planning encounters in 2020 than in 2019 (2.7 million vs.
4.7 million), but those who accessed services had, on average, more encounters (1.8 vs. 1.5).
Compared with 2018, the program served 2.4 million fewer family planning users in 2020
than in 2018 (1.5 million vs. 3.9 million) and had 3.8 million fewer family planning
encounters (2.7 million vs. 6.5 million) and 489 fewer users per service site (507 vs. 996).
Client sociodemographic characteristics. Considering the large decrease in the number of
users served in 2020, the distribution of clients by sex, racial and ethnic group, income level,
and insurance status varied little (± 4 percentage points) between 2020 and 2019. There were
small changes in the percentages of users who were 18 to 29 (47% vs. 53%) or 35 or older
(29% vs. 24%).
Contraceptive use by female clients. Although substantially fewer female clients received
contraceptive services, the percentage using a most or moderately effective method was
almost unchanged (58% vs. 59%) between 2020 and 2019. In 2020, the number of female
users who adopted or used a most or moderately effective method decreased by 830,677
compared with 2019 (763,961 vs. 1.6 million). Among those using a most or moderately
effective method, there were only small differences (± 3 percentage points) between years in
the percentages using different types of methods within each category.
Contraceptive use by male clients. Between 2020 and 2019, there were decreases in both
the number and percentage of male clients who adopted or used contraception, most notably
condoms, at their last encounter. In 2020, the number of male users who adopted or used a
most, moderately, or less effective method decreased by 152,605 compared with 2019
(125,451 vs. 278,056). In addition, there were decreases in the percentages of male users
reporting use of any method (60% vs. 69%) and condoms specifically (44% vs. 56%).
Cancer screening. Compared with 2019, fewer women were screened for cervical or breast
cancer in 2020, but the percentages screened were about the same. In 2020 vs. 2019, the
number of female users screened for cervical cancer decreased by 244,624 (297,037 vs.
541,661), while the number who received a clinical breast exam decreased by 292,033
(335,249 vs. 627,282). The percentage of female users who received a Pap test (22% vs. 20%)
or clinical breast exam (25% vs. 23%) was about the same in both years.
STD testing. There were decreases in the number of users tested for STDs and the STD
testing rates. In 2020, the number of female users under 25 who were tested for chlamydia
decreased by 379,980 compared with 2019 (264,100 vs. 644,080); the percentage tested also
decreased (52% vs. 58%). Furthermore, there were decreases in the number of STD tests per
10 users for gonorrhea (5.0 vs. 5.7), syphilis (2.1 vs. 2.2), and HIV (2.8 vs. 3.1) and a
decrease in the number of positive HIV tests per 1,000 performed (3.2 vs. 3.8).
Family Planning Annual Report: 2020 National Summary ES-5
Clinical staff levels. There was a decrease in the number of CSP FTEs and a shift in the
distribution of FTEs across types of CSPs. In 2020, the number of CSP FTEs decreased by
997 FTEs compared with 2019 (2,681 vs. 3,678), with midlevel FTEs accounting for 72% of
this decrease. On average, there were 796 CSP encounters per FTE in 2020, compared with
979 in 2019.
Title X program revenue. Revenue from all sources decreased, with an especially large drop
in the revenue sources most closely linked to the numbers of users and encounters. In 2020,
total revenue in inflation-adjusted dollars ($2020s) was $473.8 million lower than in 2019
($605.0 million vs. $1.1 billion). Combined Medicaid and CHIP revenue decreased by
$235.5 million, private third-party payer revenue decreased by $63.2 million, and client
service fee revenue decreased by $22.2 million. Two other major revenues sources—state
government and Title X—decreased by $53.9 million and $32.6 million, respectively. Title X
revenue represents the amount of Title X grant funding drawn down by grantees during the
reporting period.
FACTORS AFFECTING 2020 PERFORMANCE
The marked decrease in Title X performance between 2020 and 2019 is attributable to two
main factors: the 2019 Final Rule and the COVID-19 pandemic.
Title X Final Rule. On March 3, 2019, HHS issued a Final Rule
10,11
that revised Title X
regulations governing several aspects of how Title X-funded projects deliver family planning
care. As a condition of their continued funding and pursuant to court orders, grantees were
required to comply with all requirements of the Final Rule by July 15, 2019, except for the
physical separation requirements. In addition, by August 19, 2019, grantees choosing to
remain in the program were required to submit an “Assurance and Action Plan” documenting
the steps they would take to comply with the Final Rule and a written statement with
supporting evidence demonstrating that their Title X project was complying. Compliance with
the physical separation requirements was required starting March 4, 2020.
After the implementation of the 2019 Title X Final Rule, 19 grantees (and their networks)
withdrew immediately from the program; 18 other grantees continued participating but
reported losses to their service networks. These departures reduced the size of the Title X
service network by 231 subrecipients and 945 service sites. OPA made supplemental awards
($33.7 million) to continuing grantees to compensate for these departures; nevertheless, the
program experienced a net decrease of more than 1,000 service sites. All Planned Parenthood
affiliates (grantees and subrecipients) and several state health departments also withdrew.
Withdrawals because of the Final Rule resulted in no Title X-funded services in six states
(Hawaii, Maine, Oregon, Utah, Vermont, and Washington) and substantially reduced services
in six others (Alaska, Connecticut, Massachusetts, Minnesota, New Hampshire, and New
York). OPA estimates that the Final Rule may have led to an estimated 181,477 unintended
pregnancies.
12
The 2019 FPAR National Summary did not fully capture the effects of the
Final Rule because the report included some data (3 to 8 months) for those grantees and
subrecipients that withdrew in mid-2019 when the Final Rule took effect.
Based on a preliminary analysis of FPAR data for 2018 (“typical year”) and 2020, an
estimated 63% (or 1.5 million) of the total decrease (2.4 million) in family planning users and
ES-6 Family Planning Annual Report: 2020 National Summary
86% (or $698.5 million) of the total decrease ($809.4 million) in total revenue (all sources)
between 2018 and 2020 can be attributed to the Final Rule.
COVI
D-19 pandemic. In 2020, the emergence of the novel coronavirus created a public
health emergency that affected all aspects of life around the world. To reduce community
transmission, most states and the District of Columbia announced stay-at-home orders and
other social distancing measures (e.g., closing schools, closing non-essential businesses),
which varied in both scope and duration.
13
Title X clinical operations and the lives of staff
members and clients were seriously disrupted, especially in the earlier months of the
pandemic as Title X providers adapted to the public health restrictions and safety protocols.
As 2020 progressed, some restrictions were lifted or reduced, but many were still in place at
the end of 2020, thereby requiring Title X providers to continuously adapt to changing
circumstances. In a memo dated April 3, 2020, OPA communicated to grantees that it was the
opinion of OPA and other health care organizations and associations that family planning
methods and services were “essential health services.”
14
Early on and throughout the
pandemic, OPA, the Centers for Disease Control and Prevention (CDC), the Family Planning
National Training Center, and other stakeholders offered technical guidance to ensure
continuity of family planning care during the pandemic.
15–18
OPA also provided guidance and
addressed grantees’ concerns about the acceptable uses of Title X funding during the
pandemic, the treatment of unexpended funds, and meeting performance goals.
15,19–21
Based on the preliminary analysis of FPAR data for 2018 and 2020, an estimated 37%
(or 877,354) of the total decrease (2.4 million) in family planning users and 14%
(or $110.8 million) of the total decrease ($809.4 million) in total revenue (all sources)
between 2018 and 2020 can be attributed to the COVID-19 pandemic.
SUMMARY
The 2020 reporting period was unprecedented in the history of the Title X program. During
2020, the Title X program confronted two main challenges: the COVID-19 pandemic and the
aftereffects of full implementation of the 2019 Final Rule. The Final Rule changed the
composition of the Title X service network and substantially reduced its size and capacity,
sharply decreasing the number of users and affecting most other FPAR metrics. This network
contraction left several states with no or limited Title X-funded services and some continuing
grantees with diminished service networks and less revenue, especially from revenue sources
linked to the numbers of clients and encounters. There were also some shifts in the clients’
sociodemographic characteristics and clinical staffing, which may have resulted from changes
in the composition of the service network.
For the predominantly low-income individuals who received Title X services in 2020, Title X
service providers continued to deliver high-quality contraceptive and related preventive health
care by implementing pandemic-related safety protocols, prioritizing clients based on need,
and managing supply and staffing challenges. Title X service providers exhibited creativity,
resilience, and flexibility in their actions to safeguard the continuity of Title X family
planning services and protect the wellbeing of clients and Title X staff.
Family Planning Annual Report: 2020 National Summary 1
1 Introduction
TITLE X NATIONAL FAMILY PLANNING PROGRAM
Background
The Title X National Family Planning Program, created in 1970 and authorized under Title X
of the Public Health Service Act,
1
is administered by the Office of Population Affairs (OPA),
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. It is designed to provide “a broad range of acceptable and effective
family planning methods and services (including natural family planning methods, infertility
services, and services for adolescents),”
1
with priority given to persons from low-income
families. In addition to offering these methods and services 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.
2,3
By law, Title X funds cannot be used by centers where abortion is a method of
family planning.
2,3
In fiscal year 2020, the Title X program received approximately
$286.5 million in federal Title X funding.
4
Family Planning Annual Report
The 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 about
the program; and
§
In this report, the terms “grantee” and “grant” are synonymous. If an agency receives multiple grants to
support Title X services in different geographic areas (e.g., different states), OPA requires the agency to
submit separate FPARs, and the agency will appear more than once in the Title X grantee count.
2 Family Planning Annual Report: 2020 National Summary
▪ estimate the impact of Title X-funded activities on key reproductive health outcomes,
including prevention of unintended pregnancy, infertility, and invasive cervical cancer.
5
Factors Affecting Title X Performance in 2020
The 2020 reporting period was unprecedented in Title X’s history. The program recorded the
largest, single-year changes (decreases) in the numbers of grantees, subrecipients, service
sites, and users and in revenue. We attribute these changes to two main factors: the 2019 Final
Rule and the coronavirus disease 2019 (COVID-19) pandemic.
Title X Final Rule. On March 3, 2019, HHS issued a Final Rule
10,11
that changed the Title X
regulations affecting various aspects of Title X-funded services, including the range of
contraceptive method options that projects must offer; information and services provided to
women who learn that they are pregnant (e.g., mandated referral to prenatal care, no abortion
referrals); eligibility for free or discounted care for women whose job-based insurance
excludes contraceptive coverage because of employers’ religious or moral objections;
physical and financial separation of projects from any abortion-related activities; and
procedures, assurances, and documentation requirements when serving minors. As a
condition of their continued funding and pursuant to court orders, grantees were required to
comply with all requirements of the Final Rule by July 15, 2019, except for the physical
separation requirements that took effect March 4, 2020. By August 19, 2019, grantees were
required to submit a plan (“Assurance and Action Plan”) and written statement with
supporting evidence to demonstrate their compliance with the Final Rule.
After the implementation of the 2019 Title X Final Rule, 19 grantees (and their networks)
withdrew immediately from the program; 18 other grantees continued participating but
reported losses to their service networks. These departures reduced the size of the Title X
service network by 231 subrecipients and 945 service sites. OPA made supplemental awards
($33.7 million) to continuing grantees to compensate for these departures; nevertheless, the
program experienced a net decrease of more than 1,000 service sites. The departing grantees
and subrecipients included all Planned Parenthood affiliates (grantees and subrecipients) and
several state health departments. These program withdrawals resulted in six states (Hawaii,
Maine, Oregon, Utah, Vermont, and Washington) without Title X-funded services in 2020
and six others (Alaska, Connecticut, Massachusetts, Minnesota, New Hampshire, and New
York) with substantially reduced services.
12
The full impact of the Final Rule was not reflected in the 2019 FPAR National Summary
because grantees and subrecipients that exited the program for this reason were active for up
to almost 8 months of 2019, before the Final Rule took effect. Based on a preliminary
analysis of FPAR data for 2018 (“typical year”) and 2020, an estimated 63% (or 1.5 million)
of the total decrease (2.4 million) in family planning users and 86% (or $698.5 million) of the
total decrease ($809.4 million) in total revenue (all sources) between 2018 and 2020 can be
attributed to the Final Rule. A description of the data, assumptions, methods, and findings of
this preliminary analysis is presented in Appendix D.
O
n April 15, 2021, OPA published a proposed rule in the Federal Register to revise the 2019
Final Rule. In this public notice, OPA states that the 2019 Final Rule “undermined the
mission of the Title X program by helping fewer individuals in planning and spacing births,
Family Planning Annual Report: 2020 National Summary 3
providing fewer preventive health services, and delivering fewer screenings for STIs”
12
and
may have led to as many as 181,477 unintended pregnancies.
COVID-19 pandemic. In 2020, COVID‑19 created a public health emergency that affected
all aspects of life around the world. To reduce community transmission, most states and the
District of Columbia announced stay-at-home orders and other social distancing measures
(e.g., closing school, closing non-essential businesses), which varied in both scope and
duration.
13
Title X clinical operations and the lives of staff members and clients were
seriously disrupted, especially in the earlier months of the pandemic as they adapted to the
public health restrictions and safety protocols. As 2020 progressed, some restrictions were
lifted or reduced, but many were still in place at the end of 2020, thereby requiring Title X
providers to continuously adapt to changing circumstances. In a memo dated April 3, 2020,
OPA communicated to grantees that it was the opinion of OPA and other health care
organizations and associations that family planning methods and services were “essential
health services.”
14
Early on and throughout the pandemic, OPA, the Centers for Disease
Control and Prevention (CDC), and other stakeholders provided technical guidance and
strategies to ensure continuity of Title X family planning and related preventive health care
during the pandemic.
15–18
OPA also provided guidance and addressed grantees’ concerns
about the acceptable uses of Title X funding during the pandemic, the treatment of
unexpended funds, and meeting performance goals.
15,19–21
In their comments on the 2020 FPAR, Title X grantees noted the challenges of the pandemic,
its effects on clinic operations, and the various strategies they implemented to deliver Title X
services to the greatest number of clients.
Based on the preliminary analysis of FPAR data for 2018 and 2020, an estimated 37%
(or 877,354) of the total decrease (2.4 million) in family planning users and 14%
(or $110.8 million) of the total decrease ($809.4 million) in total revenue (all sources)
between 2018 and 2020 can be attributed to the COVID-19 pandemic (see Appendix D).
REPORT STRUCTURE
The Family Planning Annual Report: 2020 National Summary presents data for the
75 Title X services grantees that submitted an FPAR for the 2020 reporting period
(January 1, 2020–December 31, 2020). The National Summary has eight 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.
▪ Sections 3 through 8—present the results for each FPAR table and include a discussion of
national and regional patterns and trends for selected indicators. These sections also
include text boxes with the definitions for key FPAR terms and selected guidance specific
to each FPAR table. Please see the Title X Family Planning Annual Report: Forms and
Instructions (Reissued January 2021) for complete FPAR reporting instructions.
5
▪ Section 9—References—is a list of National Summary references.
4 Family Planning Annual Report: 2020 National Summary
Additional data for the National Summary are included in four appendixes: Appendix A
presents trend data for selected indicators for 2010–2020. Appendix B presents 2020 data for
selected state-level indicators (number and distribution of users by sex, income, and insurance
status; contraceptive use among female users at risk for unintended pregnancy; and the
number and percentage of female users under 25 years who were tested for chlamydia) for 44
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
U.S. Virgin Islands). Appendix C presents general and table-specific notes about the data in
this report. Appendix D summarizes the results of a preliminary analysis of the effects of the
2019 Final Rule and COVID-19 pandemic on 2020 user counts and total revenue through a
comparison of FPAR data for 2018–2020.
Throughout this report, 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 2020 or
trend data. Exhibits in the main body of the report present results for Title X overall (i.e., all
regions) and for each of the 10 HHS regions (Exhibit 1); the source of data (i.e., FPAR
reporting table) for each exhibit is noted. The states in each of the 10 HHS regions are as
follows:
▪ Region I—Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and
Vermont (In 2020, there were no Title X services grantees in Maine or Vermont.)
▪ Region II—New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands
▪ Region III—Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and
Washington, DC
▪ Region IV—Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South
Carolina, and Tennessee
▪ Region V—Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
▪ Region VI—Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
▪ Region VII—Iowa, Kansas, Missouri, and Nebraska
▪ Region VIII—Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming (In
2020, there were no Title X services grantees in Utah.)
▪ Region IX—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 (In 2020, there were no Title X services grantees
in Hawaii.)
▪ Region X—Alaska, Idaho, Oregon, and Washington (In 2020, there were no Title X
services grantees in Oregon or Washington.)
Family Planning Annual Report: 2020 National Summary 5
Exhibit 1. U.S. Department of Health and Human Services regions
Note:
Due to rounding, percentages cited in text may not match summed percentages from the
exhibits.
6 Family Planning Annual Report: 2020 National Summary
This page intentionally left blank.
Family Planning Annual Report: 2020 National Summary 7
2 FPAR Methodology
DATA COLLECTION
The Title X Family Planning Annual Report (FPAR): Forms and Instructions (Reissued
January 2021)
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 Title X-funded family planning and related preventive health services,
the range and scope of the services provided, the family planning providers who render care,
and the revenue sources that support the grantees’ Title X projects.
Title X services grantees are required to submit the FPAR by February 15 for the recently
completed reporting period (January 1–December 31). In February 2021, FPARs for
75 grantees were submitted for the 2020 reporting period. Almost all FPARs (93%) were
submitted by the due date, and all were submitted using the web-based FPAR 1.0 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 1.0 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,
OPA Project Officers review the FPAR and either accept it or return it to the grantee for
correction or clarification. Once the OPA Project Officer accepts the FPAR, the FPAR Data
Coordinator performs a second and final review, either accepting the FPAR or returning it to
the OPA Project Officer 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 1.0 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 OPA staff and grantees address all outstanding validation issues in the
FPAR 1.0 Data System, RTI extracts the final data file for tabulation and analysis.
8 Family Planning Annual Report: 2020 National Summary
Selected Key Terms and Definitions for FPAR Reporting
Family Planning User—An individual who has at least one
family planning encounter during the reporting period. The
same individual may be counted as a family planning user
only once during a reporting period.
Family Planning Encounter—A documented contact
between an individual and a family planning provider that is
either face-to-face in a Title X service site or virtual using
telehealth technology. The purpose of a family planning
encounter is to provide family planning and related
preventive health services to clients who want to avoid
unintended pregnancies or achieve intended pregnancies.
Laboratory tests and related counseling and education do
not constitute a family planning encounter unless the
encounter is face-to-face or virtual contact between the client
and provider, the provider documents the encounter, and the
tests are accompanied by family planning counseling or
education. A virtual family planning encounter uses
telecommunications and information technology to provide
access to Title X family planning and related preventive
health services, including assessment, diagnosis,
intervention, consultation, education and counseling, and
supervision, at a distance. The two types of family planning
encounters are classified based on the type of family
planning provider who renders the care: encounter with a
Clinical Services Provider or encounter with an Other
Services Provider.
Family Planning Provider—The individual who assumes
primary responsibility for assessing a client and documenting
services in the client record. Providers exercise independent
judgment as to the services rendered to the client during an
encounter. There are two types of family planning providers:
■
Clinical Services Providers (CSPs) include physicians,
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. CSPs offer a range of clinical, counseling,
and educational services relating to a client’s proposed or
adopted method of contraception, general reproductive
health, or infertility treatment, in accordance with Title
X
program requirements.
2
■
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, in accordance with Title
X
program requirements.
2
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 Title
X program requirements.
2
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), either through face-to-
face or virtual contact, that comply with Title
X program
requirements
2
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. 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.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 7–10.
5
Family Planning Annual Report: 2020 National Summary 9
3 Title X Network Characteristics
TITLE X SERVICE NETWORK PROFILE
In 2020, Title X-funded services were implemented via 75 service grants to 41 (55%) state
and local health departments and 34 (45%) nonprofit family planning and community health
agencies. This funding supported a service network of 867 subrecipients and 3,031 service
sites in 44 states, the District of Columbia, and eight U.S. Territories and Freely Associated
States (Exhibit 2).
In 2020 vs. 2019, the Title X program had 25 fewer grantees (75 vs. 100), 193 fewer
subrecipients (867 vs. 1,060), and 794 fewer service sites (3,031 vs. 3,825) (Exhibit 2).
See Exhibits A–1a and A–1b in Appendix A for trends (2010–2020) in the numbers of
grantees, subrecipients, and service sites overall and by region.
Exhibit 2. Number of and percentage change in grantees, subrecipients, and service sites, by year and
region: 2019–2020 (Source: FPAR Grantee Profile Cover Sheet)
Network
Feature
All
Regions
Region
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
Grantees
2020
75 4 7 11 11 8 8 5 5 14 2
2019
100 10 8 12 12 12 9 6 6 19 6
Difference
−25 −6 −1 −1 −1 −4 −1 −1 −1 −5 −4
% Change
−25% −60% −13% −8% −8% −33% −11% −17% −17% −26% −67%
Subrecipients
2020
867 21 18 175 265 110 49 86 64 72 7
2019
1,060 61 68 173 271 134 46 92 62 86 67
Difference
−193 −40 −50 2 −6 −24 3 −6 2 −14 −60
% Change
−18% −66% −74% 1% −2% −18% 7% −7% 3% −16% −90%
Service Sites
2020
3,031 52 61 606 852 238 488 190 147 355 42
2019
3,825 214 237 614 910 394 466 197 157 391 245
Difference
−794 −162 −176 −8 −58 −156 22 −7 −10 −36 −203
% Change
−21% −76% −74% −1% −6% −40% 5% −4% −6% −9% −83%
10 Family Planning Annual Report: 2020 National Summary
Selected Guidance for Reporting User Demographic Profile Data in FPAR Tables 1 through 3
In FPAR Table 1, grantees report the unduplicated number
of female and male users by age group. Grantees
categorize users by age group base on the users’ age as
of June 30 of the reporting period.
In FPAR Table 2 and Table 3, grantees report the
unduplicated number of female (Table 2) and male
(Table 3) users by ethnicity and race.
The FPAR categories for reporting ethnicity and race
conform to the OMB 1997 Revisions to the Standards for the
Classification of Federal Data on Race and Ethnicity
9
and
are used by other HHS programs and compilers of such
national data sets as the National Survey of Family Growth.
The two minimum OMB categories for reporting ethnicity are:
■
Hispanic or Latino (All Races)—A person of Cuban,
Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin, regardless of race.
■
Not Hispanic or Latino (All Races)—A person not of
Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of
race.
The five minimum OMB categories for reporting race are:
■
American Indian or Alaska Native—A person having
origins in any of the original peoples of North and South
America (including Central America) and who maintains
tribal affiliation or community attachment.
■
Asian—A person having origins in any of the original
peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
■
Black or African American—A person having origins in
any of the black racial groups of Africa.
■
Native Hawaiian or Other Pacific Islander—A person
having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
■
White—A person having origins in any of the original
peoples of Europe, the Middle East, or North Africa.
OMB encourages self-identification of race, and the FPAR
tables allow grantees to report the number of users who
self-identify with two or more of the OMB race categories.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 15–17, A-1–A-2.
5
Family Planning Annual Report: 2020 National Summary 11
4 Family Planning User Characteristics
DEMOGRAPHIC PROFILE
Total Users (Exhibit 3)
In 2020, Title X-funded sites served over 1.5 million family planning users. Grantees in
Region IV served almost 1 of every 3 family planning users, while in each of Regions III, VI,
and IX, grantees served between 15% and 17% of all users.
As noted in Section 1, the COVID-19 pandemic posed major challenges to the Title X service
network, reducing both the availability of and demand for Title X services and requiring
providers to modify operations and service delivery practices to ensure continuity of care. The
number of users served in 2020 was 50% lower (by 1,558,923 users) than in 2019. All 10
regions reported a decline in users, with Region IX grantees reporting the largest numeric
decline (by 440,126) (Exhibit 3). On average, the number of users per service site decreased
by 302, from 809 in 2019 to 507 in 2020 (Exhibit A–1c).
See Exhibits A–2a and A–2b for trends (2010–2020) in the number and distribution of family
planning users overall and by region.
See Exhibit B–1 for 2020 data on the number and distribution of family planning users by
state.
Exhibit 3. Number, distribution, and percentage change in number of all family planning users, by year and
region: 2019–2020 (Source: FPAR Table 1)
Users
All
Regions
Region
I
Region
II
Region
III
Region
IV
Region
V
Region
VI
Region
VII
Region
VIII
Region
IX
Region
X
Number
2020
1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
2019
3,095,666 145,737 308,031 374,499 648,599 295,108 321,395 110,363 104,814 666,147 120,973
Difference
−1,558,923 −104,137 −262,975 −146,690 −150,369 −208,684 −63,576 −31,125 −41,376 −440,126 −109,865
% Change
−50% −71% −85% −39% −23% −71% −20% −28% −39% −66% −91%
Distribution
2020
100% 3% 3% 15% 32% 6% 17% 5% 4% 15% 1%
2019
100% 5% 10% 12% 21% 10% 10% 4% 3% 22% 4%
Note: Due to rounding, percentages may not sum to 100%.
12 Family Planning Annual Report: 2020 National Summary
Users by Sex (Exhibits 4 and 5)
Of the 1.5 million family planning users served in 2020, 86% (1.3 million) were female, and
14% (209,749) were male (Exhibits 4 and 5). The percentage of total users who were female
was high across all regions (81% to 90%) and in most states (42% to 100%) (Exhibit B–1).
See Exhibits A–2a and A–2b for trends (2010–2020) in the number and distribution of users
by region and the number and percentage of users by sex.
See Exhibit B–1 for the number and distribution of family planning users by sex and state for
2020.
Users by Age (Exhibits 4 and 5)
In 2020, 17% (257,722) of all family planning users were under 20 years of age, 39%
(597,642) were 20 to 29 years of age, and 44% (681,379) were 30 years of age or older. The
same percentages of female and male users were in their teens (17%), a higher percentage of
female (40%) than male (31%) users was in their 20s, and a higher percentage of male (51%)
than female (43%) users was 30 or over. Across regions, there was wider variation in the age
distribution of male users than of female users (Exhibits 4 and 5).
See Exhibits A–3a and A–3b for trends (2010–2020) in the number and distribution of users
by age group.
Family Planning Annual Report: 2020 National Summary 13
This page intentionally left blank.
14 Family Planning Annual Report: 2020 National Summary
Exhibit 4. Number of all family planning users, by sex, age, and region: 2020 (Source: FPAR Table 1)
Age Group (Years) All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Female Users
Under 15
20,531 1,042 218 4,542 7,606 898 2,378 815 936 1,927 169
15 to 17 90,315 2,801 1,347 16,703 28,662 5,627 14,220 5,369 5,255 9,463 868
18 to 19 110,644 2,566 2,593 16,665 35,673 6,854 19,628 7,038 5,964 12,755 908
20 to 24 281,970 6,174 9,056 37,695 92,369 15,800 51,960 16,361 13,920 36,654 1,981
25 to 29 249,644 6,163 7,827 34,762 81,577 13,609 44,733 12,668 9,727 36,925 1,653
30 to 34 206,922 5,507 6,454 29,873 67,753 10,660 36,667 9,952 7,433 31,258 1,365
35 to 39 154,346 4,042 5,159 22,120 48,694 7,871 27,586 7,583 5,147 24,967 1,177
40 to 44 104,533 2,822 4,010 15,355 31,493 5,218 17,899 4,844 3,161 18,836 895
Over 44 108,089 2,558 3,820 15,060 36,370 5,049 15,677 4,548 2,524 21,739 744
Subtotal 1,326,994 33,675 40,484 192,775 430,197 71,586 230,748 69,178 54,067 194,524 9,760
Male Users
Under 15
9,521 703 44 2,522 4,130 135 595 80 311 936 65
15 to 17 14,069 1,043 148 3,798 4,527 405 1,207 357 784 1,680 120
18 to 19 12,642 544 426 2,484 3,337 762 1,800 913 719 1,594 63
20 to 24 34,456 923 1,314 5,262 8,907 3,068 5,174 2,805 2,056 4,747 200
25 to 29 31,572 879 783 4,588 8,559 2,983 4,739 2,120 1,869 4,833 219
30 to 34 26,393 882 576 3,646 7,968 2,388 3,718 1,479 1,433 4,112 191
35 to 39 21,109 817 407 2,922 6,824 1,657 3,138 939 888 3,356 161
40 to 44 16,931 771 350 2,228 6,022 1,077 2,485 585 534 2,713 166
Over 44 43,056 1,363 524 7,584 17,759 2,363 4,215 782 777 7,526 163
Subtotal 209,749 7,925 4,572 35,034 68,033 14,838 27,071 10,060 9,371 31,497 1,348
All Users
Under 15
30,052 1,745 262 7,064 11,736 1,033 2,973 895 1,247 2,863 234
15 to 17 104,384 3,844 1,495 20,501 33,189 6,032 15,427 5,726 6,039 11,143 988
18 to 19 123,286 3,110 3,019 19,149 39,010 7,616 21,428 7,951 6,683 14,349 971
20 to 24 316,426 7,097 10,370 42,957 101,276 18,868 57,134 19,166 15,976 41,401 2,181
25 to 29 281,216 7,042 8,610 39,350 90,136 16,592 49,472 14,788 11,596 41,758 1,872
30 to 34 233,315 6,389 7,030 33,519 75,721 13,048 40,385 11,431 8,866 35,370 1,556
35 to 39 175,455 4,859 5,566 25,042 55,518 9,528 30,724 8,522 6,035 28,323 1,338
40 to 44 121,464 3,593 4,360 17,583 37,515 6,295 20,384 5,429 3,695 21,549 1,061
Over 44 151,145 3,921 4,344 22,644 54,129 7,412 19,892 5,330 3,301 29,265 907
Total All Users 1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
Family Planning Annual Report: 2020 National Summary 15
Exhibit 5. Distribution of all family planning users, by sex, age, and region: 2020 (Source: FPAR Table 1)
Age Group (Years) All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Female Users
Under 15 2% 3% 1% 2% 2% 1% 1% 1% 2% 1% 2%
15 to 17
7% 8% 3% 9% 7% 8% 6% 8% 10% 5% 9%
18 to 19
8% 8% 6% 9% 8% 10% 9% 10% 11% 7% 9%
20 to 24
21% 18% 22% 20% 21% 22% 23% 24% 26% 19% 20%
25 to 29
19% 18% 19% 18% 19% 19% 19% 18% 18% 19% 17%
30 to 34
16% 16% 16% 15% 16% 15% 16% 14% 14% 16% 14%
35 to 39
12% 12% 13% 11% 11% 11% 12% 11% 10% 13% 12%
40 to 44
8% 8% 10% 8% 7% 7% 8% 7% 6% 10% 9%
Over 44
8% 8% 9% 8% 8% 7% 7% 7% 5% 11% 8%
Subtotal
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Male Users
Under 15
5% 9% 1% 7% 6% 1% 2% 1% 3% 3% 5%
15 to 17
7% 13% 3% 11% 7% 3% 4% 4% 8% 5% 9%
18 to 19
6% 7% 9% 7% 5% 5% 7% 9% 8% 5% 5%
20 to 24
16% 12% 29% 15% 13% 21% 19% 28% 22% 15% 15%
25 to 29
15% 11% 17% 13% 13% 20% 18% 21% 20% 15% 16%
30 to 34
13% 11% 13% 10% 12% 16% 14% 15% 15% 13% 14%
35 to 39
10% 10% 9% 8% 10% 11% 12% 9% 9% 11% 12%
40 to 44
8% 10% 8% 6% 9% 7% 9% 6% 6% 9% 12%
Over 44
21% 17% 11% 22% 26% 16% 16% 8% 8% 24% 12%
Subtotal
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
All Users
Under 15
2% 4% 1% 3% 2% 1% 1% 1% 2% 1% 2%
15 to 17
7% 9% 3% 9% 7% 7% 6% 7% 10% 5% 9%
18 to 19
8% 7% 7% 8% 8% 9% 8% 10% 11% 6% 9%
20 to 24
21% 17% 23% 19% 20% 22% 22% 24% 25% 18% 20%
25 to 29
18% 17% 19% 17% 18% 19% 19% 19% 18% 18% 17%
30 to 34
15% 15% 16% 15% 15% 15% 16% 14% 14% 16% 14%
35 to 39
11% 12% 12% 11% 11% 11% 12% 11% 10% 13% 12%
40 to 44
8% 9% 10% 8% 8% 7% 8% 7% 6% 10% 10%
Over 44
10% 9% 10% 10% 11% 9% 8% 7% 5% 13% 8%
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Female Users
86% 81% 90% 85% 86% 83% 89% 87% 85% 86% 88%
Male Users
14% 19% 10% 15% 14% 17% 11% 13% 15% 14% 12%
Note: Due to rounding, percentages may not sum to 100%.
16 Family Planning Annual Report: 2020 National Summary
Users by Race (Exhibits 6 through 14)
In 2020, 59% (905,460) of all family planning users identified themselves as white, 26%
(406,686) as black or African American, 2% (25,026) as Asian, and 1% each as either
American Indian or Alaska Native (16,084) or Native Hawaiian or Other Pacific Islander
(13,265). Three percent (38,508) 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 9% (131,714). Of the 131,714 users with an unknown race, 67% self-identified as
Hispanic or Latino ethnicity (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 (60% of female users vs. 52% of male users) and black or African
American (25% of female users vs. 35% of 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 46% to 76%, 1% to 39%
self‑identified as black or African American, 1% to 4% self-identified as Asian, and 1% to
7% self-identified with two or more race categories.
See Exhibits A–4a and A–4b for trends (2010–2020) in the number and distribution of all
family planning users by self-identified race.
See Exhibits A–6a and A–6b for trends (2010–2020) in the number and distribution of all
family planning users by self-identified race and Hispanic or Latino ethnicity.
Users by Ethnicity (Exhibits 6 through 14)
In 2020, 35% (534,055) of users self-identified as Hispanic or Latino ethnicity (Exhibit 6).
▪ By sex, 36% of female users and 28% 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, 8, and 11–14).
▪ By region, the percentage of users who self-identified as Hispanic or Latino ranged from
14% to 73%, with grantees in Regions II, VI, and IX reporting the highest percentages
(49% to 73%) of Hispanic or Latino users (Exhibits 9 and 10).
See Exhibits A–5a and A–5b for trends (2010–2020) in the number and distribution of all
family planning users by self-identified Hispanic or Latino ethnicity.
See Exhibits A–6a and A–6b for trends (2010–2020) in the number and distribution of all
family planning users by self-identified race and Hispanic or Latino ethnicity.
Family Planning Annual Report: 2020 National Summary 17
Exhibit 6. Number and distribution of all family planning users, by race and ethnicity: 2020
(Source: FPAR Tables 2 and 3)
Race
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 7,004 8,539 541 16,084 0%† 1% 0%† 1%
Asian 1,054 22,431 1,541 25,026 0%† 1% 0%† 2%
Black/African American 14,291 381,858 10,537 406,686 1% 25% 1% 26%
Nat Hawaiian/Pac Island 2,141 10,801 323 13,265 0%† 1% 0%† 1%
White 400,891 481,594 22,975 905,460 26% 31% 1% 59%
More than one race 21,074 15,204 2,230 38,508 1% 1% 0%† 3%
Unknown/not reported 87,600 27,134 16,980 131,714 6% 2% 1% 9%
Total All Users 534,055 947,561 55,127 1,536,743 35% 62% 4% 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: 2020
(Source: FPAR Table 2)
Race
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR
Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 6,148 7,506 429 14,083 0%† 1% 0%† 1%
Asian 918 19,534 1,339 21,791 0%† 1% 0%† 2%
Black/African American 11,832 313,959 8,320 334,111 1% 24% 1% 25%
Nat Hawaiian/Pac Island 1,837 9,698 295 11,830 0%† 1% 0%† 1%
White 359,005 418,125 20,161 797,291 27% 32% 2% 60%
More than one race 18,301 13,440 1,931 33,672 1% 1% 0%† 3%
Unknown/not reported 77,544 22,748 13,924 114,216 6% 2% 1% 9%
Total Female Users 475,585 805,010 46,399 1,326,994 36% 61% 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: 2020
(Source: FPAR Table 3)
Race
Hispanic
or Latino
Not
Hispanic or
Latino
Ethnicity
UK/NR Total
%
Hispanic
or Latino
%
Not Hispanic
or Latino
%
Ethnicity
UK/NR
%
Total
Am Indian/Alaska Native 856 1,033 112 2,001 0%† 0%† 0%† 1%
Asian 136 2,897 202 3,235 0%† 1% 0%† 2%
Black/African American 2,459 67,899 2,217 72,575 1% 32% 1% 35%
Nat Hawaiian/Pac Island 304 1,103 28 1,435 0%† 1% 0%† 1%
White 41,886 63,469 2,814 108,169 20% 30% 1% 52%
More than one race 2,773 1,764 299 4,836 1% 1% 0%† 2%
Unknown/not reported 10,056 4,386 3,056 17,498 5% 2% 1% 8%
Total Male Users 58,470 142,551 8,728 209,749 28% 68% 4% 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%.
18 Family Planning Annual Report: 2020 National Summary
Exhibit 9. Number of all family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Tables 2 and 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino 7,004 42 637 1,920 2,317 161 427 231 520 725 24
Not Hispanic or Latino 8,539 92 36 1,819 1,265 442 2,094 368 801 1,546 76
Unknown/not reported 541 11 3 119 27 29 105 35 33 179 0
Subtotal 16,084 145 676 3,858 3,609 632 2,626 634 1,354 2,450 100
Asian
Hispanic or Latino 1,054 25 26 198 214 29 107 24 47 383 1
Not Hispanic or Latino 22,431 1,413 567 3,231 4,533 1,044 2,279 1,208 1,264 6,814 78
Unknown/not reported 1,541 45 6 228 59 23 61 135 27 957 0
Subtotal 25,026 1,483 599 3,657 4,806 1,096 2,447 1,367 1,338 8,154 79
Black or African American
Hispanic or Latino 14,291 2,428 3,285 2,999 2,624 376 1,181 285 274 835 4
Not Hispanic or Latino 381,858 10,931 6,263 65,159 188,200 24,752 54,227 13,988 5,208 13,022 108
Unknown/not reported 10,537 230 54 3,823 2,619 601 559 1,155 148 1,348 0
Subtotal 406,686 13,589 9,602 71,981 193,443 25,729 55,967 15,428 5,630 15,205 112
Native Hawaiian or Other Pacific Islander
Hispanic or Latino 2,141 343 24 246 733 125 250 47 51 320 2
Not Hispanic or Latino 10,801 90 22 222 583 152 345 155 125 9,087 20
Unknown/not reported 323 7 4 92 24 3 5 21 5 162 0
Subtotal 13,265 440 50 560 1,340 280 600 223 181 9,569 22
White
Hispanic or Latino 400,891 10,050 25,619 24,673 81,033 6,983 117,972 16,996 16,919 99,332 1,314
Not Hispanic or Latino 481,594 8,619 4,050 73,962 176,935 42,283 66,828 35,827 28,912 37,023 7,155
Unknown/not reported 22,975 401 43 8,008 2,093 508 635 3,443 649 7,192 3
Subtotal 905,460 19,070 29,712 106,643 260,061 49,774 185,435 56,266 46,480 143,547 8,472
More Than One Race
Hispanic or Latino 21,074 1,734 1,655 5,815 3,489 1,953 2,518 1,057 231 2,613 9
Not Hispanic or Latino 15,204 997 257 1,897 3,683 1,915 3,028 1,241 502 1,637 47
Unknown/not reported 2,230 222 26 293 874 42 41 197 13 522 0
Subtotal 38,508 2,953 1,938 8,005 8,046 3,910 5,587 2,495 746 4,772 56
Race Unknown or Not Reported
Hispanic or Latino
87,600 2,322 1,724 21,370 17,093 2,864 3,029 1,319 4,901 32,524 454
Not Hispanic or Latino 27,134 1,203 610 6,521 7,410 1,518 1,324 520 1,778 4,439 1,811
Unknown/not reported 16,980 395 145 5,214 2,422 621 804 986 1,030 5,361 2
Subtotal 131,714 3,920 2,479 33,105 26,925 5,003 5,157 2,825 7,709 42,324 2,267
All Races
Hispanic or Latino 534,055 16,944 32,970 57,221 107,503 12,491 125,484 19,959 22,943 136,732 1,808
Not Hispanic or Latino 947,561 23,345 11,805 152,811 382,609 72,106 130,125 53,307 38,590 73,568 9,295
Unknown/not reported 55,127 1,311 281 17,777 8,118 1,827 2,210 5,972 1,905 15,721 5
Total All Users 1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
Family Planning Annual Report: 2020 National Summary 19
Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Tables 2 and 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino 0%† 0%† 1% 1% 0%† 0%† 0%† 0%† 1% 0%† 0%†
Not Hispanic or Latino 1% 0%† 0%† 1% 0%† 1% 1% 0%† 1% 1% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 0%† 2% 2% 1% 1% 1% 1% 2% 1% 1%
Asian
Hispanic or Latino 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino 1% 3% 1% 1% 1% 1% 1% 2% 2% 3% 1%
Unknown/not reported 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
2% 4% 1% 2% 1% 1% 1% 2% 2% 4% 1%
Black or African American
Hispanic or Latino 1% 6% 7% 1% 1% 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino 25% 26% 14% 29% 38% 29% 21% 18% 8% 6% 1%
Unknown/not reported 1% 1% 0%† 2% 1% 1% 0%† 1% 0%† 1% 0%
Subtotal
26% 33% 21% 32% 39% 30% 22% 19% 9% 7% 1%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino 0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 4% 0%†
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 4% 0%†
White
Hispanic or Latino 26% 24% 57% 11% 16% 8% 46% 21% 27% 44% 12%
Not Hispanic or Latino 31% 21% 9% 32% 36% 49% 26% 45% 46% 16% 64%
Unknown/not reported 1% 1% 0%† 4% 0%† 1% 0%† 4% 1% 3% 0%†
Subtotal
59% 46% 66% 47% 52% 58% 72% 71% 73% 64% 76%
More Than One Race
Hispanic or Latino 1% 4% 4% 3% 1% 2% 1% 1% 0%† 1% 0%†
Not Hispanic or Latino 1% 2% 1% 1% 1% 2% 1% 2% 1% 1% 0%†
Unknown/not reported 0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
3% 7% 4% 4% 2% 5% 2% 3% 1% 2% 1%
Race Unknown or Not Reported
Hispanic or Latino 6% 6% 4% 9% 3% 3% 1% 2% 8% 14% 4%
Not Hispanic or Latino 2% 3% 1% 3% 1% 2% 1% 1% 3% 2% 16%
Unknown/not reported
1% 1% 0%† 2% 0%† 1% 0%† 1% 2% 2% 0%†
Subtotal
9% 9% 6% 15% 5% 6% 2% 4% 12% 19% 20%
All Races
Hispanic or Latino 35% 41% 73% 25% 22% 14% 49% 25% 36% 60% 16%
Not Hispanic or Latino 62% 56% 26% 67% 77% 83% 50% 67% 61% 33% 84%
Unknown/not reported 4% 3% 1% 8% 2% 2% 1% 8% 3% 7% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
20 Family Planning Annual Report: 2020 National Summary
Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Table 2)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino 6,148 34 580 1,786 1,949 144 365 214 463 589 24
Not Hispanic or Latino 7,506 74 30 1,589 1,137 316 1,995 311 665 1,327 62
Unknown/not reported 429 7 3 99 23 13 103 25 23 133 0
Subtotal 14,083 115 613 3,474 3,109 473 2,463 550 1,151 2,049 86
Asian
Hispanic or Latino 918 22 25 171 180 23 98 20 43 335 1
Not Hispanic or Latino 19,534 1,213 509 2,895 3,636 877 2,054 1,146 1,166 5,963 75
Unknown/not reported 1,339 35 4 192 43 16 57 118 19 855 0
Subtotal 21,791 1,270 538 3,258 3,859 916 2,209 1,284 1,228 7,153 76
Black or African American
Hispanic or Latino 11,832 1,913 2,886 2,312 2,265 308 1,031 237 221 656 3
Not Hispanic or Latino 313,959 8,795 5,433 50,763 160,098 18,259 46,242 10,525 3,781 9,986 77
Unknown/not reported 8,320 177 28 3,033 2,254 441 358 920 76 1,033 0
Subtotal 334,111 10,885 8,347 56,108 164,617 19,008 47,631 11,682 4,078 11,675 80
Native Hawaiian or Other Pacific Islander
Hispanic or Latino 1,837 271 22 199 674 91 228 39 41 270 2
Not Hispanic or Latino 9,698 80 22 186 530 115 325 141 107 8,175 17
Unknown/not reported 295 5 4 89 24 2 4 18 4 145 0
Subtotal 11,830 356 48 474 1,228 208 557 198 152 8,590 19
White
Hispanic or Latino 359,005 8,143 23,506 21,508 72,097 6,443 107,177 15,916 15,270 87,676 1,269
Not Hispanic or Latino 418,125 6,720 3,573 66,477 151,553 36,473 60,585 32,143 24,494 29,841 6,266
Unknown/not reported 20,161 280 35 7,573 1,863 437 532 2,829 493 6,116 3
Subtotal 797,291 15,143 27,114 95,558 225,513 43,353 168,294 50,888 40,257 123,633 7,538
More Than One Race
Hispanic or Latino 18,301 1,476 1,509 4,644 3,184 1,770 2,404 940 198 2,167 9
Not Hispanic or Latino 13,440 917 216 1,690 3,200 1,633 2,878 1,054 425 1,383 44
Unknown/not reported 1,931 193 20 265 763 36 41 164 10 439 0
Subtotal 33,672 2,586 1,745 6,599 7,147 3,439 5,323 2,158 633 3,989 53
Race Unknown or Not Reported
Hispanic or Latino
77,544 2,013 1,513 17,913 15,789 2,561 2,576 1,179 4,339 29,244 417
Not Hispanic or Latino 22,748 963 478 5,389 6,767 1,119 1,049 451 1,370 3,672 1,490
Unknown/not reported 13,924 344 88 4,002 2,168 509 646 788 859 4,519 1
Subtotal 114,216 3,320 2,079 27,304 24,724 4,189 4,271 2,418 6,568 37,435 1,908
All Races
Hispanic or Latino
475,585 13,872 30,041 48,533 96,138 11,340 113,879 18,545 20,575 120,937 1,725
Not Hispanic or Latino 805,010 18,762 10,261 128,989 326,921 58,792 115,128 45,771 32,008 60,347 8,031
Unknown/not reported 46,399 1,041 182 15,253 7,138 1,454 1,741 4,862 1,484 13,240 4
Total All Users 1,326,994 33,675 40,484 192,775 430,197 71,586 230,748 69,178 54,067 194,524 9,760
Family Planning Annual Report: 2020 National Summary 21
Exhibit 12. Distribution of female family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Table 2)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
0%† 0%† 1% 1% 0%† 0%† 0%† 0%† 1% 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 1% 0%† 0%† 1% 0%† 1% 1% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 0%† 2% 2% 1% 1% 1% 1% 2% 1% 1%
Asian
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
1% 4% 1% 2% 1% 1% 1% 2% 2% 3% 1%
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
2% 4% 1% 2% 1% 1% 1% 2% 2% 4% 1%
Black or African American
Hispanic or Latino
1% 6% 7% 1% 1% 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
24% 26% 13% 26% 37% 26% 20% 15% 7% 5% 1%
Unknown/not reported
1% 1% 0%† 2% 1% 1% 0%† 1% 0%† 1% 0%
Subtotal
25% 32% 21% 29% 38% 27% 21% 17% 8% 6% 1%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Not Hispanic or Latino
1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 4% 0%†
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 4% 0%†
White
Hispanic or Latino
27% 24% 58% 11% 17% 9% 46% 23% 28% 45% 13%
Not Hispanic or Latino
32% 20% 9% 34% 35% 51% 26% 46% 45% 15% 64%
Unknown/not reported
2% 1% 0%† 4% 0%† 1% 0%† 4% 1% 3% 0%†
Subtotal
60% 45% 67% 50% 52% 61% 73% 74% 74% 64% 77%
More Than One Race
Hispanic or Latino
1% 4% 4% 2% 1% 2% 1% 1% 0%† 1% 0%†
Not Hispanic or Latino
1% 3% 1% 1% 1% 2% 1% 2% 1% 1% 0%†
Unknown/not reported
0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
3% 8% 4% 3% 2% 5% 2% 3% 1% 2% 1%
Race Unknown or Not Reported
Hispanic or Latino
6% 6% 4% 9% 4% 4% 1% 2% 8% 15% 4%
Not Hispanic or Latino
2% 3% 1% 3% 2% 2% 0%† 1% 3% 2% 15%
Unknown/not reported
1% 1% 0%† 2% 1% 1% 0%† 1% 2% 2% 0%†
Subtotal
9% 10% 5% 14% 6% 6% 2% 3% 12% 19% 20%
All Races
Hispanic or Latino
36% 41% 74% 25% 22% 16% 49% 27% 38% 62% 18%
Not Hispanic or Latino
61% 56% 25% 67% 76% 82% 50% 66% 59% 31% 82%
Unknown/not reported
3% 3% 0%† 8% 2% 2% 1% 7% 3% 7% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
22 Family Planning Annual Report: 2020 National Summary
Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Table 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino 856 8 57 134 368 17 62 17 57 136 0
Not Hispanic or Latino 1,033 18 6 230 128 126 99 57 136 219 14
Unknown/not reported 112 4 0 20 4 16 2 10 10 46 0
Subtotal 2,001 30 63 384 500 159 163 84 203 401 14
Asian
Hispanic or Latino 136 3 1 27 34 6 9 4 4 48 0
Not Hispanic or Latino 2,897 200 58 336 897 167 225 62 98 851 3
Unknown/not reported 202 10 2 36 16 7 4 17 8 102 0
Subtotal 3,235 213 61 399 947 180 238 83 110 1,001 3
Black or African American
Hispanic or Latino 2,459 515 399 687 359 68 150 48 53 179 1
Not Hispanic or Latino 67,899 2,136 830 14,396 28,102 6,493 7,985 3,463 1,427 3,036 31
Unknown/not reported 2,217 53 26 790 365 160 201 235 72 315 0
Subtotal 72,575 2,704 1,255 15,873 28,826 6,721 8,336 3,746 1,552 3,530 32
Native Hawaiian or Other Pacific Islander
Hispanic or Latino 304 72 2 47 59 34 22 8 10 50 0
Not Hispanic or Latino 1,103 10 0 36 53 37 20 14 18 912 3
Unknown/not reported 28 2 0 3 0 1 1 3 1 17 0
Subtotal 1,435 84 2 86 112 72 43 25 29 979 3
White
Hispanic or Latino 41,886 1,907 2,113 3,165 8,936 540 10,795 1,080 1,649 11,656 45
Not Hispanic or Latino 63,469 1,899 477 7,485 25,382 5,810 6,243 3,684 4,418 7,182 889
Unknown/not reported 2,814 121 8 435 230 71 103 614 156 1,076 0
Subtotal 108,169 3,927 2,598 11,085 34,548 6,421 17,141 5,378 6,223 19,914 934
More Than One Race
Hispanic or Latino 2,773 258 146 1,171 305 183 114 117 33 446 0
Not Hispanic or Latino 1,764 80 41 207 483 282 150 187 77 254 3
Unknown/not reported 299 29 6 28 111 6 0 33 3 83 0
Subtotal 4,836 367 193 1,406 899 471 264 337 113 783 3
Race Unknown or Not Reported
Hispanic or Latino
10,056 309 211 3,457 1,304 303 453 140 562 3,280 37
Not Hispanic or Latino 4,386 240 132 1,132 643 399 275 69 408 767 321
Unknown/not reported 3,056 51 57 1,212 254 112 158 198 171 842 1
Subtotal 17,498 600 400 5,801 2,201 814 886 407 1,141 4,889 359
All Races
Hispanic or Latino
58,470 3,072 2,929 8,688 11,365 1,151 11,605 1,414 2,368 15,795 83
Not Hispanic or Latino 142,551 4,583 1,544 23,822 55,688 13,314 14,997 7,536 6,582 13,221 1,264
Unknown/not reported 8,728 270 99 2,524 980 373 469 1,110 421 2,481 1
Total All Users 209,749 7,925 4,572 35,034 68,033 14,838 27,071 10,060 9,371 31,497 1,348
Family Planning Annual Report: 2020 National Summary 23
Exhibit 14. Distribution of male family planning users, by race, ethnicity, and region: 2020 (Source: FPAR Table 3)
Race and Ethnicity All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
American Indian or Alaska Native
Hispanic or Latino
0%† 0%† 1% 0%† 1% 0%† 0%† 0%† 1% 0%† 0%
Not Hispanic or Latino
0%† 0%† 0%† 1% 0%† 1% 0%† 1% 1% 1% 1%
Unknown/not reported
0%† 0%† 0% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 0%† 1% 1% 1% 1% 1% 1% 2% 1% 1%
Asian
Hispanic or Latino
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Not Hispanic or Latino
1% 3% 1% 1% 1% 1% 1% 1% 1% 3% 0%†
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
2% 3% 1% 1% 1% 1% 1% 1% 1% 3% 0%†
Black or African American
Hispanic or Latino
1% 6% 9% 2% 1% 0%† 1% 0%† 1% 1% 0%†
Not Hispanic or Latino
32% 27% 18% 41% 41% 44% 29% 34% 15% 10% 2%
Unknown/not reported
1% 1% 1% 2% 1% 1% 1% 2% 1% 1% 0%
Subtotal
35% 34% 27% 45% 42% 45% 31% 37% 17% 11% 2%
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%
Not Hispanic or Latino
1% 0%† 0% 0%† 0%† 0%† 0%† 0%† 0%† 3% 0%†
Unknown/not reported
0%† 0%† 0% 0%† 0% 0%† 0%† 0%† 0%† 0%† 0%
Subtotal
1% 1% 0%† 0%† 0%† 0%† 0%† 0%† 0%† 3% 0%†
White
Hispanic or Latino
20% 24% 46% 9% 13% 4% 40% 11% 18% 37% 3%
Not Hispanic or Latino
30% 24% 10% 21% 37% 39% 23% 37% 47% 23% 66%
Unknown/not reported
1% 2% 0%† 1% 0%† 0%† 0%† 6% 2% 3% 0%
Subtotal
52% 50% 57% 32% 51% 43% 63% 53% 66% 63% 69%
More Than One Race
Hispanic or Latino
1% 3% 3% 3% 0%† 1% 0%† 1% 0%† 1% 0%
Not Hispanic or Latino
1% 1% 1% 1% 1% 2% 1% 2% 1% 1% 0%†
Unknown/not reported
0%† 0%† 0%† 0%† 0%† 0%† 0% 0%† 0%† 0%† 0%
Subtotal
2% 5% 4% 4% 1% 3% 1% 3% 1% 2% 0%†
Race Unknown or Not Reported
Hispanic or Latino
5% 4% 5% 10% 2% 2% 2% 1% 6% 10% 3%
Not Hispanic or Latino
2% 3% 3% 3% 1% 3% 1% 1% 4% 2% 24%
Unknown/not reported
1% 1% 1% 3% 0%† 1% 1% 2% 2% 3% 0%†
Subtotal
8% 8% 9% 17% 3% 5% 3% 4% 12% 16% 27%
All Races
Hispanic or Latino
28% 39% 64% 25% 17% 8% 43% 14% 25% 50% 6%
Not Hispanic or Latino
68% 58% 34% 68% 82% 90% 55% 75% 70% 42% 94%
Unknown/not reported
4% 3% 2% 7% 1% 3% 2% 11% 4% 8% 0%†
Total All Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
24 Family Planning Annual Report: 2020 National Summary
Selected Guidance for Reporting User Social and Economic Profile Data in FPAR Tables 4 through 6
In FPAR Table 4, grantees report the unduplicated number
of users by 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.
2,3
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
In FPAR Table 5, grantees report the unduplicated number
of users based on whether they have principal health
insurance covering primary medical care.
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. Grantees report the most current health
insurance coverage information available for the client even
though they may not have used this health insurance to pay
for family planning services received during their 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 principal health insurance covering primary
medical care include the following:
■
Public Health Insurance—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—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 Civilian Health and
Medical Program of the Department of Veterans Affairs
[CHAMPVA]).
■
Uninsured—Refers to users 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.
Limited English proficient (LEP) users are those 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. LEP
users include those who require language assistance
services (interpretation or translation) to optimize their use of
Title
X services, those who received Title X services from
bilingual staff in the user’s preferred non-English language,
those who were assisted by a competent agency or
contracted interpreter, or those who opted to use a family
member or friend as an interpreter after refusing the
provider’s offer of free language assistance services. Unless
they are also LEP, do not include users who are visually or
hearing impaired or have other disabilities.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 21–23.
5
Family Planning Annual Report: 2020 National Summary 25
SOCIAL AND ECONOMIC PROFILE
Users by Income Level (Exhibit 15)
Federal regulations
2,3
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 2020 ($26,200 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, on the
condition that the Title X provider has documented taking specific actions to encourage the
minor to involve a parent or guardian in their decision to seek family planning services.
2
In 2020, 87% (1.3 million) of users had family incomes that qualified them for either
no‑charge (<101% of poverty) or subsidized (101% to 250% of poverty) services. Sixty-six
percent (1.0 million) of users with family incomes at or below 100% of poverty qualified for
no-charge services, while 21% (320,118) with family incomes between 101% and 250% of
poverty qualified for subsidized care. Six percent (89,329) of users had incomes over 250% of
poverty, and family income data were unknown or not reported for 7% (106,297) of users
(Exhibit 15).
▪ By region, 79% to 96% of users had family incomes (<251% of poverty) qualifying them
for either no-charge (56% to 74% of users) or subsidized (13% to 36% of users) services
(Exhibit 15).
▪ By state, 36% to 100% of users had family incomes (<101% of poverty) qualifying them
for no-charge services, and 0% to 42% had incomes (101% to 250% of poverty) qualifying
them for subsidized care (Exhibit B–2).
See Exhibits A–7a and A–7b for trends (2010–2020) in the number and distribution of family
planning users by income level.
Users by Insurance Coverage Status (Exhibit 16)
Title X regulations
2,3
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.
26 Family Planning Annual Report: 2020 National Summary
In 2020, 59% (909,569) of family planning users had either public (40%, 616,012) or private
(19%, 293,557) insurance covering broad primary medical care benefits; 39% (593,562) were
uninsured. Health insurance coverage status was unknown or not reported for 2% (33,612) of
users (Exhibit 16).
▪ By region, 20% to 62% of family planning users had public coverage, 7% to 27% had
private coverage, and 11% to 57% were uninsured (Exhibit 16).
▪ By state, there was wide variation in the percentage of users who were publicly insured
(0% to 95%), privately insured (0% to 53%), and uninsured (3% to 100%) (Exhibit B–3a).
See Exhibits A–8a and A–8b for trends (2010–2020) in the number and distribution of family
planning users by primary health insurance status.
See Exhibit B–3b for the number and distribution of family planning users by primary health
insurance status and state according to states’ Medicaid expansion status for 2020.
Users by Limited English Proficiency Status (Exhibit 17)
As recipients of HHS funding, 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.
22
In 2020, 19% (291,234) of family planning users were LEP. By region, the percentage of
users who were LEP ranged from 6% to 59% (Exhibit 17). The number of users with LEP in
2020 was 37% lower (by 170,595 users) than in 2019 (not shown).
Family Planning Annual Report: 2020 National Summary 27
Exhibit 15. Number and distribution of all family planning users, by income level and region: 2020 (Source: FPAR Table 4)
Income Level
a
All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Under 101% 1,020,999 27,556 31,222 146,860 322,449 55,011 191,670 48,865 41,857 149,266 6,243
101% to 150% 187,565 3,028 7,901 27,997 57,654 11,832 30,628 10,879 7,338 28,015 2,293
151% to 200% 89,401 1,704 3,243 12,123 29,540 6,919 13,259 6,189 4,445 10,720 1,259
201% to 250% 43,152 577 839 7,559 14,262 4,225 5,469 3,563 2,930 3,250 478
Over 250% 89,329 4,596 903 12,436 40,424 5,385 5,380 8,209 6,434 4,728 834
Unknown/not reported 106,297 4,139 948 20,834 33,901 3,052 11,413 1,533 434 30,042 1
Total All Users 1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
Under 101% 66% 66% 69% 64% 65% 64% 74% 62% 66% 66% 56%
101% to 150% 12% 7% 18% 12% 12% 14% 12% 14% 12% 12% 21%
151% to 200% 6% 4% 7% 5% 6% 8% 5% 8% 7% 5% 11%
201% to 250% 3% 1% 2% 3% 3% 5% 2% 4% 5% 1% 4%
Over 250% 6% 11% 2% 5% 8% 6% 2% 10% 10% 2% 8%
Unknown/not reported 7% 10% 2% 9% 7% 4% 4% 2% 1% 13% 0%†
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 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/2020-poverty-guidelines.
† Percentage is less than 0.5%.
28 Family Planning Annual Report: 2020 National Summary
Exhibit 16. Number and distribution of all family planning users, by principal health insurance coverage status and region: 2020
(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
Public health insurance 616,012 25,764 22,400 110,870 187,012 36,314 74,939 15,792 19,792 120,277 2,852
Private health insurance 293,557 11,224 10,702 53,647 115,807 17,869 32,022 21,051 15,358 14,709 1,168
Uninsured 593,562 4,513 11,711 55,765 189,548 30,033 145,804 42,063 27,693 81,595 4,837
Unknown/not reported 33,612 99 243 7,527 5,863 2,208 5,054 332 595 9,440 2,251
Total All Users 1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
Public health insurance 40% 62% 50% 49% 38% 42% 29% 20% 31% 53% 26%
Private health insurance 19% 27% 24% 24% 23% 21% 12% 27% 24% 7% 11%
Uninsured 39% 11% 26% 24% 38% 35% 57% 53% 44% 36% 44%
Unknown/not reported 2% 0%† 1% 3% 1% 3% 2% 0%† 1% 4% 20%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2020 National Summary 29
Exhibit 17. Number and distribution of all family planning users, by limited English proficiency (LEP) status and region: 2020 (Source: FPAR Table 6)
LEP Status All Regions Region I Region II
a
Region III Region IV Region V Region VI Region VII Region VIII Region IX
b
Region X
LEP 291,234 7,943 26,573 41,455 60,754 6,508 52,910 11,302 10,869 72,221 699
Not LEP 1,221,905 33,608 18,435 184,486 417,524 78,574 204,759 67,777 52,569 153,764 10,409
Unknown/not reported 23,604 49 48 1,868 19,952 1,342 150 159 0 36 0
Total All Users 1,536,743 41,600 45,056 227,809 498,230 86,424 257,819 79,238 63,438 226,021 11,108
LEP 19% 19% 59% 18% 12% 8% 21% 14% 17% 32% 6%
Not LEP 80% 81% 41% 81% 84% 91% 79% 86% 83% 68% 94%
Unknown/not reported 2% 0%† 0%† 1% 4% 2% 0%† 0%† 0% 0%† 0%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 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%.
30 Family Planning Annual Report: 2020 National Summary
Selected Guidance for Reporting Primary Contraceptive Method Use in FPAR Tables 7 and 8
In FPAR Tables 7 and 8, grantees report the unduplicated
number of female (Table 7) and male (Table 8) family
planning users according to their primary method of family
planning and age group (as of June 30 of the reporting
period).
A user’s primary method of family planning is the
contraceptive method—adopted or continued—at the time
of exit from the user’s last encounter in the reporting
period. If the user reports that they are using more than
one family planning method, the grantee reports the most
effective one as the primary method.
The categories for reporting the primary method in Table 7
(female users) and Table 8 (male users) vary and include:
■
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)—Refers to
long-term hormonal or other type of IUD or IUS
■
Hormonal Implant—Refers to the long-term, subdermal
implant
■
1- or 3-Month Hormonal Injection—Refers to 1- or
3-month injectable hormonal contraception
■
Oral Contraceptive—Refers to combination and
progestin-only (“mini-pills”) formulations
■
Contraceptive Patch
■
Hormonal Vaginal Ring
■
Cervical Cap or Diaphragm—Used with or without
spermicidal jelly or cream
■
Contraceptive Sponge
■
Female Condom—Used with or without spermicidal foam
or film
■
Spermicide—Refers to spermicidal jelly, cream, foam, or
film used alone, i.e., not in conjunction with another
method of contraception
■
Fertility Awareness Method (FAM)—Refers to family
planning methods, e.g., Standard Days
®
, Calendar
Rhythm, TwoDay, Billings Ovulation, and SymptoThermal,
that rely on identifying the fertile days in each menstrual
cycle when intercourse is most likely to result in a
pregnancy
■
Lactational Amenorrhea Method (LAM)—Refers to the
proactive application of exclusive breastfeeding—meaning
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)—during the first 6 months after delivery
23
■
Abstinence—Refers to refraining from oral, vaginal, and
anal intercourse
24
and includes users who are not
currently sexually active and therefore not using
contraception
■
Withdrawal and Other Methods—Refers to the use of
withdrawal or other method to prevent pregnancy that is
not listed in Table 7 or 8
■
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
■
Male condom—Used with or without spermicidal foam or
film by a male user or the male partner of a female user
■
Rely on Female Method(s)—Male family planning users
who rely on female partners’ family planning methods as
their primary method are reported on this row. “Female
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.
■
Method Unknown or Not Reported—Users whose
primary method at exit from the last encounter is unknown
or not reported (i.e., missing from the client record)
Reasons for not using a method in both tables are:
■
[Partner] Pregnant or Seeking Pregnancy—Female
(Table 7) or male (Table 8) users who are not using any
method to avoid pregnancy because they (female users)
or their female partners (male users) are either pregnant
or seeking pregnancy.
■
No Method–Other Reason—Female (Table 7) or male
(Table 8) users who are not using any method to avoid
pregnancy for reasons that include: either partner is sterile
without having been sterilized surgically, either partner
has had a noncontraceptive surgical procedure that has
rendered them unable to conceive or impregnate, or the
user has a sexual partner of the same sex.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 21–23.
5
Family Planning Annual Report: 2020 National Summary 31
5 Contraceptive Use
Federal regulations
2,3
specify that Title X projects are required to provide a broad range of
acceptable and effective family planning methods (including fertility awareness-based
methods [FAMs]) and services (including infertility services, information about or referrals
for adoption, and services for adolescents).
Individual service sites may offer a single or
limited number of methods as long as the
project as a whole offers a broad range.
2
In
addition, the Quality Family Planning (QFP)
Recommendations
25
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.
In accordance with guidance and other resources
16–18
provided by OPA, CDC, and others,
Title X providers implemented various strategies (see text box) to ensure the continuity of
contraceptive services during the COVID-19 pandemic.
FEMALE CONTRACEPTIVE USE (EXHIBITS 18 THROUGH 21)
In 2020, 74% (979,274) of all female users adopted or continued use of a most, moderately,
or less effective contraceptive method (see text box on next page) at their last encounter in the
reporting period. Eight percent (101,318) of female users exited the encounter with no
method because they were pregnant or seeking pregnancy, and another 7% (90,152) exited
with no method for other reasons. Five percent (60,841) of female users reported that they
were abstinent, and the type of primary method used was unknown or not reported for the
remaining 7% (95,409) of users (Exhibits 18 and 19).
▪ By level of effectiveness in preventing pregnancy, 19% of all female users relied on a most
effective method, 38% used a moderately effective method, and 16% used a less effective
method (Exhibits 18 and 19). The grouping of methods by level of effectiveness aligns
with the OPA-developed and National Quality Forum-endorsed performance measures for
contraceptive care.
26
See Table 7 comments in the Field and Methodological Notes
(Appendix C) for more information about the performance measures
26
and
method‑effectiveness categories.
27
Strategies to ensure continuity of
contraceptive care during the COVID-19
pandemic
■ Prioritized in-person visits for clients having
problems with their method; LARC
placement, replacement, or removal; and
contraceptive injections
■ Offered curbside pickup for method
resupply, contraceptive injections, and
other nonclinical services
■ Offered self-administered contraceptive
injections
■ Extended prescriptions for contraception
■ Partnered with pharmacies to fill
prescriptions or re-supplied contraceptives
by mail
32 Family Planning Annual Report: 2020 National Summary
▪ By type of method, the contraceptive pill
was used by 20% of all female users,
followed by injectable contraception (16%),
male condoms (12%), intrauterine devices
(IUDs) (7%), hormonal implants (7%),
female sterilization (4%), the vaginal ring
(1%), the contraceptive patch (1%), and a
FAM or lactational amenorrhea method
(LAM) (1%). Four 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: vasectomy, female condom,
spermicide (used alone), cervical cap or diaphragm, and the contraceptive sponge
(Exhibits 18 and 19).
▪ By age group, 42% of female users under 15 and from 68% to 79% of those 15 or older
adopted or continued using a most, moderately, or less effective method
(Exhibits 18 and 19).
The three leading contraceptive methods by age group were as follows:
– Female users under 18: Pills, injectables, and implants
– Female users 18 to 44: Pills, injectables, and male condoms
– Female users over 44: Female sterilization, male condoms, and pills.
The rate of nonuse of contraception because of pregnancy or the desire for pregnancy was
1% to 4% in the youngest (under 18) and oldest (over 40) age groups and from 7% to 11%
among female users 18 to 39. The rate of nonuse of contraception because of abstinence
was 38% for those under 15, 8% to 11% for those 15 to 17 or over 44, and 3% to 4% for
those 18 to 44.
▪ By region, from 63% to 85% of female users exited the encounter with a most, moderately,
or less effective contraceptive method. Exhibits 20 and 21 present additional information
on contraceptive method mix for female users in each region.
▪ By state, there was wide variation in the percentage of female users at risk of unintended
pregnancy who relied on most effective (0% to 47%), moderately effective (14% to 74%),
or less effective (<1% to 41%) contraceptive methods (Exhibit B–4). Female users at risk
of unintended pregnancy are defined as those who were not pregnant, not seeking
pregnancy, and not abstinent.
Trends in Female Primary Contraceptive Method Use
From 2010 through 2020, the percentage of all female users relying on most, moderately, or
less effective methods ranged from 74% to 84%. Between 13% and 14% used no method
because they were either pregnant, seeking pregnancy, or for other reasons, and 2% to 5%
were abstinent (Exhibits A–9a, A–9b, and A–9c).
Contraceptive Methods by Level of
Effectiveness in Preventing Pregnancy
27
■ Most effective: vasectomy, female
sterilization, implant, or IUD
■ Moderately effective: injectable
contraception, vaginal ring, contraceptive
patch, pills, diaphragm, or cervical cap
■ Least effective: male condom, female
condom, sponge, withdrawal, a FAM or
LAM, or spermicide used alone
Family Planning Annual Report: 2020 National Summary 33
Among all female users:
▪ Use of most effective methods increased from 8% (2010) to 19% (2020).
▪ Use of moderately effective methods decreased from 54% (2010) to 38% (2020).
▪ Use of less effective methods decreased from 19% (2010) to 16% (2020).
During all years from 2010 to 2020, the IUD, the pill, and male condoms were the most
popular methods in their respective method effectiveness categories.
See Exhibits A–9a, A–9b, and A–9c for trends (2010–2020) in the number and distribution of
female family planning users by the type of primary contraceptive method used or adopted at
their last encounter in the reporting period.
MALE CONTRACEPTIVE USE (EXHIBITS 22 THROUGH 25)
In 2020, grantees reported that 60% (125,451) 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. Thirteen percent (26,818) of male clients used no primary method, either because their
partners were pregnant or seeking pregnancy (1%) or for other reasons (12%), and another
13% (26,569) reported that they were abstinent. The type of primary contraceptive method
used was unknown or not reported for 15% (30,911) of male users (Exhibits 22 and 23).
▪ By type of method, 44% of all male users relied on male condoms, followed by reliance
on a female method (10%), withdrawal (4%), a FAM or LAM (1%), or vasectomy (1%)
(Exhibits 22 and 23).
▪ By age group, 9% to 39% of male users under 18 and from 52% to 72% of those 18 or
over relied on a most, moderately, or less effective method (Exhibits 22 and 23). The rate
of nonuse of contraception because a partner was pregnant or seeking pregnancy was less
than 0.5% among male users under 18 and 1% to 2% among those 18 or over. By age
group, the two leading methods among male users were as follows:
– Male users under 15: Male condoms and withdrawal or other methods not listed on
FPAR Table 8
– Male users 15 and over: Male condoms and reliance on a female method.
▪ By region, the percentage of male users who exited the encounter with a most, moderately,
or less effective method ranged from 39% to 82%. Exhibits 24 and 25 present additional
information on contraceptive method mix for male users in each region.
▪ See Exhibits A–10a through A–10c for trends (2010–2020) in the number and distribution
of male family planning users by the type of primary contraceptive method used or adopted
at their last encounter in the reporting period.
34 Family Planning Annual Report: 2020 National Summary
Exhibit 18. Number of female family planning users, by primary contraceptive method and age: 2020 (Source: FPAR Table 7)
Primary Method
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
Female sterilization 56,063 0 0 0 497 3,706 8,049 11,146 11,270 21,395
Intrauterine device 99,491 124 2,203 4,621 18,243 21,138 20,169 15,945 10,428 6,620
Hormonal implant 93,062 1,134 8,646 10,230 24,378 19,859 14,310 8,452 4,238 1,815
Hormonal injection
213,854
a
2,941
a
22,088
a
22,877
a
45,617
a
38,177
a
32,728
a
24,272
a
15,339
a
9,815
a
Oral contraceptive 267,281 2,982 24,151 30,415 68,393 49,571 37,724 26,301 16,381 11,363
Contraceptive patch 12,193 258 1,482 1,734 3,214 2,242 1,599 961 492 211
Vaginal ring 16,967 54 825 1,380 4,411 4,158 3,295 1,808 716 320
Cervical cap or diaphragm 299 2 14 18 65 36 52 46 38 28
Contraceptive sponge 236 1 14 12 37 52 46 38 19 17
Female condom 2,061 25 87 131 325 373 319 262 271 268
Spermicide (used alone) 696 2 18 47 165 129 127 83 74 51
FAM or LAM
b
10,107 53 303 494 1,843 2,179 1,831 1,430 1,033 941
Abstinence
c
60,841 7,833 10,016 4,817 7,908 6,711 5,670 4,796 4,084 9,006
Withdrawal or other method
d
47,370 317 1,676 2,575 9,161 8,898 7,921 6,360 4,429 6,033
Rely on Male Method
Vasectomy 4,751 0 3 25 182 485 813 1,072 1,102 1,069
Male condom 154,843 777 7,132 12,349 35,088 29,788 24,001 18,412 13,913 13,383
No Method
Pregnant/seeking pregnancy 101,318 161 2,479 7,336 27,285 27,648 19,968 11,138 4,047 1,256
Other reason 90,152 759 3,212 5,452 17,319 17,253 14,290 10,682 8,238 12,947
Method Unknown 95,409 3,108 5,966 6,131 17,839 17,241 14,010 11,142 8,421 11,551
Total Female Users 1,326,994 20,531 90,315 110,644 281,970 249,644 206,922 154,346 104,533 108,089
Using Most, Moderately, or
Less Effective Method
e
979,274 8,670 68,642 86,908 211,619 180,791 152,984 116,588 79,743 73,329
Most effective
e
253,367 1,258 10,852 14,876 43,300 45,188 43,341 36,615 27,038 30,899
Moderately effective
e
510,594 6,237 48,560 56,424 121,700 94,184 75,398 53,388 32,966 21,737
Less effective
e
215,313 1,175 9,230 15,608 46,619 41,419 34,245 26,585 19,739 20,693
Abstinence 60,841 7,833 10,016 4,817 7,908 6,711 5,670 4,796 4,084 9,006
Not Using a Method 191,470 920 5,691 12,788 44,604 44,901 34,258 21,820 12,285 14,203
Method Unknown 95,409 3,108 5,966 6,131 17,839 17,241 14,010 11,142 8,421 11,551
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: 2020 National Summary 35
Exhibit 19. Distribution of female family planning users, by primary contraceptive method and age: 2020 (Source: FPAR Table 7)
Primary Method
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
Female sterilization 4% 0% 0% 0% 0%† 1% 4% 7% 11% 20%
Intrauterine device 7% 1% 2% 4% 6% 8% 10% 10% 10% 6%
Hormonal implant 7% 6% 10% 9% 9% 8% 7% 5% 4% 2%
Hormonal injection
16%
a
14%
a
24%
a
21%
a
16%
a
15%
a
16%
a
16%
a
15%
a
9%
a
Oral contraceptive 20% 15% 27% 27% 24% 20% 18% 17% 16% 11%
Contraceptive patch 1% 1% 2% 2% 1% 1% 1% 1% 0%† 0%†
Vaginal ring 1% 0%† 1% 1% 2% 2% 2% 1% 1% 0%†
Cervical cap or diaphragm 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Contraceptive sponge 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Female condom 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Spermicide (used alone) 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
FAM or LAM
b
1% 0%† 0%† 0%† 1% 1% 1% 1% 1% 1%
Abstinence
c
5% 38% 11% 4% 3% 3% 3% 3% 4% 8%
Withdrawal or other method
d
4% 2% 2% 2% 3% 4% 4% 4% 4% 6%
Rely on Male Method
Vasectomy 0%† 0% 0%† 0%† 0%† 0%† 0%† 1% 1% 1%
Male condom 12% 4% 8% 11% 12% 12% 12% 12% 13% 12%
No Method
Pregnant/seeking pregnancy 8% 1% 3% 7% 10% 11% 10% 7% 4% 1%
Other reason 7% 4% 4% 5% 6% 7% 7% 7% 8% 12%
Method Unknown 7% 15% 7% 6% 6% 7% 7% 7% 8% 11%
Total Female Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or
Less Effective Method
e
74% 42% 76% 79% 75% 72% 74% 76% 76% 68%
Most effective
e
19% 6% 12% 13% 15% 18% 21% 24% 26% 29%
Moderately effective
e
38% 30% 54% 51% 43% 38% 36% 35% 32% 20%
Less effective
e
16% 6% 10% 14% 17% 17% 17% 17% 19% 19%
Abstinence 5% 38% 11% 4% 3% 3% 3% 3% 4% 8%
Not Using a Method 14% 4% 6% 12% 16% 18% 17% 14% 12% 13%
Method Unknown 7% 15% 7% 6% 6% 7% 7% 7% 8% 11%
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%.
36 Family Planning Annual Report: 2020 National Summary
Exhibit 20. Number of female family planning users, by primary contraceptive method and region: 2020 (Source: FPAR Table 7)
Primary Method All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Female sterilization 56,063 2,132 1,377 7,673 16,090 3,303 12,202 3,173 828 8,992 293
Intrauterine device 99,491 3,021 3,429 13,713 20,969 4,662 16,234 8,204 8,516 19,512 1,231
Hormonal implant 93,062 2,470 1,420 13,366 23,536 4,664 19,074 5,815 6,771 15,385 561
Hormonal injection
213,854
a
4,299
a
4,269 27,816
a
79,947
a
14,168
a
39,965
a
12,844
a
8,483
a
20,647
a
1,416
Oral contraceptive 267,281 4,308 11,114 38,244 87,622 15,531 49,779 15,003 13,469 30,117 2,094
Contraceptive patch 12,193 420 307 1,958 3,291 726 2,620 759 483 1,601 28
Vaginal ring 16,967 274 599 2,594 4,731 1,200 3,187 873 1,542 1,732 235
Cervical cap or diaphragm 299 4 2 35 110 20 27 10 18 70 3
Contraceptive sponge 236 3 2 28 15 4 5 3 2 172 2
Female condom 2,061 21 20 194 1,022 116 68 34 42 537 7
Spermicide (used alone) 696 8 6 55 158 15 363 15 12 63 1
FAM or LAM
b
10,107 118 375 750 4,995 151 1,666 271 161 1,597 23
Abstinence
c
60,841 3,795 1,906 9,487 21,603 1,793 7,950 2,002 1,247 10,454 604
Withdrawal or other method
d
47,370 835 1,510 2,867 20,080 1,066 12,126 489 1,602 6,454 341
Rely on Male Method
Vasectomy
4,751 205 113 996 1,039 271 718 260 234 812 103
Male condom 154,843 2,973 8,633 19,412 41,014 8,387 33,405 8,349 4,037 27,851 782
No Method
Pregnant/seeking pregnancy
101,318 2,667 2,241 13,840 41,410 5,033 16,632 6,097 2,952 9,315 1,131
Other reason 90,152 4,283 1,208 13,680 23,923 6,787 12,667 4,325 3,404 18,971 904
Method Unknown 95,409 1,839 1,953 26,067 38,642 3,689 2,060 652 264 20,242 1
Total Female Users 1,326,994 33,675 40,484 192,775 430,197 71,586 230,748 69,178 54,067 194,524 9,760
Using Most, Moderately, or
Less Effective Method
e
979,274 21,091 33,176 129,701 304,619 54,284 191,439 56,102 46,200 135,542 7,120
Most effective
e
253,367 7,828 6,339 35,748 61,634 12,900 48,228 17,452 16,349 44,701 2,188
Moderately effective
e
510,594 9,305 16,291 70,647 175,701 31,645 95,578 29,489 23,995 54,167 3,776
Less effective
e
215,313 3,958 10,546 23,306 67,284 9,739 47,633 9,161 5,856 36,674 1,156
Abstinence 60,841 3,795 1,906 9,487 21,603 1,793 7,950 2,002 1,247 10,454 604
Not Using a Method 191,470 6,950 3,449 27,520 65,333 11,820 29,299 10,422 6,356 28,286 2,035
Method Unknown 95,409 1,839 1,953 26,067 38,642 3,689 2,060 652 264 20,242 1
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: 2020 National Summary 37
Exhibit 21. Distribution of female family planning users, by primary contraceptive method and region: 2020 (Source: FPAR Table 7)
Primary Method All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Female sterilization 4% 6% 3% 4% 4% 5% 5% 5% 2% 5% 3%
Intrauterine device 7% 9% 8% 7% 5% 7% 7% 12% 16% 10% 13%
Hormonal implant 7% 7% 4% 7% 5% 7% 8% 8% 13% 8% 6%
Hormonal injection
16%
a
13%
a
11% 14%
a
19%
a
20%
a
17%
a
19%
a
16%
a
11%
a
15%
Oral contraceptive 20% 13% 27% 20% 20% 22% 22% 22% 25% 15% 21%
Contraceptive patch 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 0%†
Vaginal ring 1% 1% 1% 1% 1% 2% 1% 1% 3% 1% 2%
Cervical cap or diaphragm 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Contraceptive sponge 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Female condom 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Spermicide (used alone) 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
FAM or LAM
b
1% 0%† 1% 0%† 1% 0%† 1% 0%† 0%† 1% 0%†
Abstinence
c
5% 11% 5% 5% 5% 3% 3% 3% 2% 5% 6%
Withdrawal or other method
d
4% 2% 4% 1% 5% 1% 5% 1% 3% 3% 3%
Rely on Male Method
Vasectomy
0%† 1% 0%† 1% 0%† 0%† 0%† 0%† 0%† 0%† 1%
Male condom 12% 9% 21% 10% 10% 12% 14% 12% 7% 14% 8%
No Method
Pregnant/seeking pregnancy 8% 8% 6% 7% 10% 7% 7% 9% 5% 5% 12%
Other reason 7% 13% 3% 7% 6% 9% 5% 6% 6% 10% 9%
Method Unknown 7% 5% 5% 14% 9% 5% 1% 1% 0%† 10% 0%†
Total Female Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or
Less Effective Method
e
74% 63% 82% 67% 71% 76% 83% 81% 85% 70% 73%
Most effective
e
19% 23% 16% 19% 14% 18% 21% 25% 30% 23% 22%
Moderately effective
e
38% 28% 40% 37% 41% 44% 41% 43% 44% 28% 39%
Less effective
e
16% 12% 26% 12% 16% 14% 21% 13% 11% 19% 12%
Abstinence 5% 11% 5% 5% 5% 3% 3% 3% 2% 5% 6%
Not Using a Method 14% 21% 9% 14% 15% 17% 13% 15% 12% 15% 21%
Method Unknown 7% 5% 5% 14% 9% 5% 1% 1% 0%† 10% 0%†
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%.
38 Family Planning Annual Report: 2020 National Summary
Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2020 (Source: FPAR Table 8)
Primary Method
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
Vasectomy 1,613 0 0 0 20 91 218 328 299 657
Male condom 92,016 625 4,770 7,140 20,804 16,992 12,840 9,356 6,710 12,779
FAM or LAM
a
2,115 3 7 25 227 335 273 386 433 426
Abstinence
b
26,569 6,149 5,818 2,026 2,103 1,517 1,361 1,143 1,145 5,307
Withdrawal or other method
c
7,996 137 324 356 1,104 1,235 1,113 1,036 838 1,853
Rely on female method
d
21,711 59 345 643 2,624 2,984 2,978 2,697 2,533 6,848
No Method
Partner pregnant/seeking pregnancy
2,614 7 26 85 455 598 530 356 215 342
Other reason 24,204 204 633 1,006 3,301 3,729 3,523 2,796 2,276 6,736
Method Unknown 30,911 2,337 2,146 1,361 3,818 4,091 3,557 3,011 2,482 8,108
Total Male Users 209,749 9,521 14,069 12,642 34,456 31,572 26,393 21,109 16,931 43,056
Using most, moderately, or less
effective method
e
125,451 824 5,446 8,164 24,779 21,637 17,422 13,803 10,813 22,563
Abstinence
b
26,569 6,149 5,818 2,026 2,103 1,517 1,361 1,143 1,145 5,307
Not using a method 26,818 211 659 1,091 3,756 4,327 4,053 3,152 2,491 7,078
Method unknown 30,911 2,337 2,146 1,361 3,818 4,091 3,557 3,011 2,482 8,108
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: 2020 National Summary 39
Exhibit 23. Distribution of male family planning users, by primary contraceptive method and age: 2020 (Source: FPAR Table 8)
Primary Method
All Age
Groups
Under 15
Years
15 to 17
Years
18 to 19
Years
20 to 24
Years
25 to 29
Years
30 to 34
Years
35 to 39
Years
40 to 44
Years
Over 44
Years
Vasectomy 1% 0% 0% 0% 0%† 0%† 1% 2% 2% 2%
Male condom 44% 7% 34% 56% 60% 54% 49% 44% 40% 30%
FAM or LAM
a
1% 0%† 0%† 0%† 1% 1% 1% 2% 3% 1%
Abstinence
b
13% 65% 41% 16% 6% 5% 5% 5% 7% 12%
Withdrawal or other method
c
4% 1% 2% 3% 3% 4% 4% 5% 5% 4%
Rely on female method
d
10% 1% 2% 5% 8% 9% 11% 13% 15% 16%
No Method
Partner pregnant/seeking pregnancy
1% 0%† 0%† 1% 1% 2% 2% 2% 1% 1%
Other reason 12% 2% 4% 8% 10% 12% 13% 13% 13% 16%
Method Unknown 15% 25% 15% 11% 11% 13% 13% 14% 15% 19%
Total Male Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using most, moderately, or less
effective method
e
60% 9% 39% 65% 72% 69% 66% 65% 64% 52%
Abstinence
b
13% 65% 41% 16% 6% 5% 5% 5% 7% 12%
Not using a method 13% 2% 5% 9% 11% 14% 15% 15% 15% 16%
Method unknown 15% 25% 15% 11% 11% 13% 13% 14% 15% 19%
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%.
40 Family Planning Annual Report: 2020 National Summary
Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2020 (Source: FPAR Table 8)
Primary Method
All
Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Vasectomy 1,613 74 40 244 609 121 150 52 105 200 18
Male condom 92,016 2,415 3,332 10,577 25,486 8,113 17,137 6,862 4,967 12,690 437
FAM or LAM
a
2,115 5 18 13 575 3 1,242 12 5 242 0
Abstinence
b
26,569 2,175 248 3,637 12,931 416 2,893 392 525 3,074 278
Withdrawal or other method
c
7,996 171 172 434 3,752 526 565 138 740 1,251 247
Rely on female method
d
21,711 442 170 2,544 11,783 460 1,405 854 1,743 2,236 74
No Method
Partner pregnant/seeking pregnancy
2,614 54 49 247 850 146 509 128 137 463 31
Other reason 24,204 2,076 124 2,610 4,954 3,444 2,391 1,144 957 6,241 263
Method Unknown 30,911 513 419 14,728 7,093 1,609 779 478 192 5,100 0
Total Male Users 209,749 7,925 4,572 35,034 68,033 14,838 27,071 10,060 9,371 31,497 1,348
Using most, moderately, or less
effective method
e
125,451 3,107 3,732 13,812 42,205 9,223 20,499 7,918 7,560 16,619 776
Abstinence
b
26,569 2,175 248 3,637 12,931 416 2,893 392 525 3,074 278
Not using a method 26,818 2,130 173 2,857 5,804 3,590 2,900 1,272 1,094 6,704 294
Method unknown 30,911 513 419 14,728 7,093 1,609 779 478 192 5,100 0
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: 2020 National Summary 41
Exhibit 25. Distribution of male family planning users, by primary contraceptive method and region: 2020 (Source: FPAR Table 8)
Primary Method
All
Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Vasectomy 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
Male condom 44% 30% 73% 30% 37% 55% 63% 68% 53% 40% 32%
FAM or LAM
a
1% 0%† 0%† 0%† 1% 0%† 5% 0%† 0%† 1% 0%
Abstinence
b
13% 27% 5% 10% 19% 3% 11% 4% 6% 10% 21%
Withdrawal or other method
c
4% 2% 4% 1% 6% 4% 2% 1% 8% 4% 18%
Rely on female method
d
10% 6% 4% 7% 17% 3% 5% 8% 19% 7% 5%
No Method
Partner pregnant/seeking pregnancy
1% 1% 1% 1% 1% 1% 2% 1% 1% 1% 2%
Other reason 12% 26% 3% 7% 7% 23% 9% 11% 10% 20% 20%
Method Unknown 15% 6% 9% 42% 10% 11% 3% 5% 2% 16% 0%
Total Male Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using most, moderately, or less
effective method
e
60% 39% 82% 39% 62% 62% 76% 79% 81% 53% 58%
Abstinence
b
13% 27% 5% 10% 19% 3% 11% 4% 6% 10% 21%
Not using a method 13% 27% 4% 8% 9% 24% 11% 13% 12% 21% 22%
Method unknown 15% 6% 9% 42% 10% 11% 3% 5% 2% 16% 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%.
42 Family Planning Annual Report: 2020 National Summary
Selected Guidance for Reporting Cervical and Breast Cancer Screening Activities in FPAR Tables 9 and 10
In FPAR Table 9, grantees report information on cervical
cancer screening activities, including the following:
■
Unduplicated number of female users who obtained a Pap
test
■
Number of Pap tests performed
■
Number of Pap tests with a result of Atypical Squamous
Cells (ASC) or higher according to the 2014 Bethesda
System.
28
ASC or higher results include ASC-US; ASC-H;
LSIL; HSIL; squamous cell carcinoma; atypical glandular
cells (AGC); AGC, favor neoplastic; endocervical
adenocarcinoma in situ (AIS); adenocarcinoma; or other
malignant neoplasms. These abbreviations and terms are
defined below.
■
Number of Pap tests with a result of High-Grade
Squamous Intraepithelial Lesion (HSIL) or higher
according to the 2014 Bethesda System.
28
HSIL or higher
results include HSIL; squamous cell carcinoma; AGC;
AGC, favor neoplastic; endocervical AIS;
adenocarcinoma; or other malignant neoplasms. These
abbreviations and terms are defined below.
The 2014 Bethesda System
28
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) 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.
29
■ 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.
29
■ 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).
29
■ Squamous cell carcinoma is a finding of cancer in the
squamous cells of the cervix.
29
The 2014 Bethesda System
28
classifies glandular cell
abnormalities into the following categories:
■
Atypical glandular cells (AGC) 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.
29
The 2014 Bethesda System
28
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.
29
■
Adenocarcinoma is a finding of cancer in endocervical,
endometrial, extrauterine, or not otherwise specified
glandular tissue.
29
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.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 33–35.
5
Family Planning Annual Report: 2020 National Summary 43
6 Related Preventive Health Services
To support effective contraceptive use and practices, federal regulations
2,3
specify that
Title X-funded projects must provide for medical services related to family planning and
referral to other medical facilities when
medically necessary. According to the QFP
Recommendations,
25
providers should assess a
client’s need for related preventive health
services (e.g., cervical and breast cancer
screening, STD services) 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. In 2020, Title X service providers implemented guidance from OPA, CDC, and
others
16,17
to prioritize in-person and virtual visits for related preventive health care during the
COVID-19 pandemic (see text box).
CERVICAL AND BREAST CANCER SCREENING
Cervical Cancer Screening (Exhibit 26)
In 2020, Title X service sites provided Papanicolaou (Pap) testing to 22% (297,037) of female
family planning users and performed 312,757 Pap tests (1.1 tests per female user tested). Of
the Pap tests performed, 13% had an indeterminate or abnormal result (i.e., atypical squamous
cells [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 11% to
25%. The percentage of Pap tests with an ASC or higher result ranged from 9% to 22%, and
the percentage of Pap tests with an HSIL or higher result ranged from 1% to 2% (Exhibit 26).
See Exhibits A–11a and A–11b for trends (2010–2020) in the number and percentage of
female users screened for cervical cancer.
Strategies to Ensure Continuity of Related
Preventive Health Care During the
COVID‑19 Pandemic
■ Prioritized in-person and virtual visits based
on reason for visit and need for immediate
care
■ Prioritized in-person visits and testing for
women with history of abnormal Pap tests
■ Postponed well-woman visits and routine
testing if there were no urgent concerns
44 Family Planning Annual Report: 2019 National Summary
Breast Cancer Screening (Exhibit 26)
In 2020, Title X service sites provided clinical breast exams (CBEs) to 25% (335,249) of
female users and referred 7% (22,522) of those examined for further evaluation based on the
results of the CBE (Exhibit 26).
By region, from 10% to 34% of female users received a CBE, and from 2% to 17% of those
examined were referred for further evaluation (Exhibit 26).
The number of female users who received a CBE was 47% lower in 2020 than in 2019
(335,249 vs. 627,282), while the number referred for further evaluation based on CBE results
was 29% lower (22,522 vs. 31,595) (not shown). The percentages of female users who
received a CBE (25% vs. 23%) and those who were referred for further evaluation (7% vs.
5%) were nearly the same in 2020 and 2019 (not shown).
Family Planning Annual Report: 2020 National Summary 45
Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2020 (Source: FPAR Tables 9 and 10)
Tests/Exams All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Pap Tests
Female users tested
Number
a
297,037 3,857 9,899 33,653 98,180 16,564 57,794 15,924 11,282 48,563 1,321
Percentage
b
22% 11% 24% 17% 23% 23% 25% 23% 21% 25% 14%
Tests performed
Number
312,757 3,997 10,162 36,211 106,577 17,372 59,016 16,229 11,442 50,415 1,336
Tests per female tested 1.1 1.0 1.0 1.1 1.1 1.0 1.0 1.0 1.0 1.0 1.0
Tests with ASC or higher result
Number 40,223 622 905 6,717 9,485 1,629 8,536 2,458 1,917 7,661 293
Percentage
c
13% 16% 9% 19% 9% 9% 14% 15% 17% 15% 22%
Tests with HSIL or higher result
Number 3,730 69 83 504 1,077 205 693 172 133 782 12
Percentage
c
1% 2% 1% 1% 1% 1% 1% 1% 1% 2% 1%
Clinical Breast Exams
Female users examined
Number
a
335,249 5,357 10,905 40,424 116,673 18,466 78,799 22,519 9,429 31,718 959
Percentage
b
25% 16% 27% 21% 27% 26% 34% 33% 17% 16% 10%
Female users referred based on
exam
Number
22,522 890 920 2,109 5,163 2,099 4,442 1,354 206 5,278 61
Percentage
d
7% 17% 8% 5% 4% 11% 6% 6% 2% 17% 6%
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.
46 Family Planning Annual Report: 2020 National Summary
SEXUALLY TRANSMITTED DISEASE TESTING
Through screening and testing, Title X service providers help to prevent and treat STDs. If
left untreated, STDs can be transmitted to others and lead to serious and lifelong health
consequences for women, men, infants, and unborn babies.
30
According to the QFP
Recommendations,
25
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 CDC’s recommendations, which include
the Sexually Transmitted Diseases Treatment Guidelines, 2015
31
and the Recommendations
for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020.
32
In response to the COVID-19 pandemic, OPA, CDC, and others provided resources and
guidance to safeguard the continuity of Title X
STD services during the pandemic.
15–17
In
addition, CDC issued several Dear Colleague
Letters (DCLs)
33–35
to provide guidance on
delivering effective STD care in case of
pandemic-related disruptions in in-person
clinical care and shortages of drugs or STD
kits and laboratory supplies, especially for
chlamydia and gonorrhea testing (see text
box). For those sites experiencing disruptions
in care, the DCLs encouraged prioritization of
clients with STD symptoms, those with STD
contact, and those at risk for complications.
Providers were also encouraged to defer
routine screening until after the emergency
response, use home or non-clinic-based
testing, implement phone- or telehealth-based
triage and syndromic management, and where legal, use expedited partner therapy.
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 a sex 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.
31
In 2020, Title X service sites tested 44% (583,086) of all female users for chlamydia and 52%
(264,100) of female users under 25 (Exhibits 27 and 28).
▪ By age group, chlamydia testing rates were higher among female users 15 to 24 (51% to
55%) than among those over 24 (39%) or under 15 (29%) (Exhibits 27 and 28).
Strategies to Ensure Continuity of STD
Services During the COVID-19 Pandemic
■ Prioritized in-person and virtual visits based
on reason for visit and need for immediate
care
■ Followed CDC guidance for prioritizing STD
testing when test kits are in short supply,
limited, or unavailable
■ Provided referrals to community
laboratories for testing
■ Provided presumptive treatment for
suspected infections
■ Responded to increased demand for
testing because of public STD clinic
closures
Family Planning Annual Report: 2020 National Summary 47
▪ By region, the chlamydia testing rate for female users under 25 ranged from 34% to 62%
(Exhibits 27 and 28).
▪ By state, the chlamydia testing rate for female users under 25 ranged from 2% to 86%
(Exhibit B–5).
See Exhibits A–12a and A–12b for trends (2010–2020) in the number and percentage of
female users under 25 years who were tested for chlamydia.
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), regardless of condom
use, at least annually or more frequently (every 3 to 6 months) if at increased risk. For
sexually active men 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.
31
In 2020, Title X service sites tested 46% (95,937) of all male users for chlamydia
(Exhibits 27 and 28).
▪ By age group, rates of chlamydia testing were higher for male users 18 to 19 (55%) and 20
to 24 (63%) and lower for male users over 24 (44%), 15 to 17 (37%), and under 15 (10%).
▪ By region, Title X service sites tested between 23% and 80% of all male users for
chlamydia.
Selected Guidance for Reporting STD Testing Activities in FPAR Tables 11 and 12
In FPAR Table 11, grantees report the unduplicated number
of family planning users tested for chlamydia, by age
(<15, 15–17, 18–19, 20–24, and 25 or over) and sex.
In FPAR Table 12, grantees report the number of STD and
HIV tests performed during the reporting period that are
provided within the scope of the grantee’s Title
X project.
STD tests that are performed in STD clinics operated by
Title
X-funded agencies should be excluded unless the
activities of the STD clinic are within the scope of the
agency’s Title
X project. STD testing information includes
the following:
■ 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
■ Number of anonymous HIV tests performed
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 39–40.
5
48 Family Planning Annual Report: 2020 National Summary
Exhibit 27. Number of family planning users tested for chlamydia, by sex, age, and region: 2020 (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
6,008 214 77 944 2,095 418 1,156 314 259 499 32
15 to 17 45,952 1,090 721 7,013 14,475 3,338 8,684 3,127 2,180 4,952 372
18 to 19 60,313 1,334 1,407 7,941 18,913 4,320 11,792 4,298 2,827 7,150 331
20 to 24 151,827 2,696 4,581 17,645 48,158 10,103 30,581 10,222 6,467 20,757 617
Over 24 318,986 7,304 10,697 39,277 102,603 20,680 60,630 17,690 9,721 49,467 917
Subtotal 583,086 12,638 17,483 72,820 186,244 38,859 112,843 35,651 21,454 82,825 2,269
Under 25
a
264,100 5,334 6,786 33,543 83,641 18,179 52,213 17,961 11,733 33,358 1,352
Male Users
Under 15
926 113 10 331 207 27 117 16 10 92 3
15 to 17 5,230 411 78 1,382 1,084 275 702 280 176 828 14
18 to 19 6,902 406 246 1,218 1,074 616 1,166 666 421 1,055 34
20 to 24 21,856 632 824 3,094 3,458 2,496 3,812 2,251 1,547 3,662 80
Over 24 61,023 1,819 1,249 9,106 10,039 7,752 9,770 4,863 4,032 12,132 261
Subtotal 95,937 3,381 2,407 15,131 15,862 11,166 15,567 8,076 6,186 17,769 392
All Users
Under 15
6,934 327 87 1,275 2,302 445 1,273 330 269 591 35
15 to 17 51,182 1,501 799 8,395 15,559 3,613 9,386 3,407 2,356 5,780 386
18 to 19 67,215 1,740 1,653 9,159 19,987 4,936 12,958 4,964 3,248 8,205 365
20 to 24 173,683 3,328 5,405 20,739 51,616 12,599 34,393 12,473 8,014 24,419 697
Over 24 380,009 9,123 11,946 48,383 112,642 28,432 70,400 22,553 13,753 61,599 1,178
Total All Users 679,023 16,019 19,890 87,951 202,106 50,025 128,410 43,727 27,640 100,594 2,661
a
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 31] and USPSTF [2014,
September]. Gonorrhea and chlamydia: Screening [see reference 36].)
Family Planning Annual Report: 2020 National Summary 49
Exhibit 28. Percentage of family planning users in each age group tested for chlamydia, by sex, age, and region: 2020 (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
29% 21% 35% 21% 28% 47% 49% 39% 28% 26% 19%
15 to 17 51% 39% 54% 42% 51% 59% 61% 58% 41% 52% 43%
18 to 19 55% 52% 54% 48% 53% 63% 60% 61% 47% 56% 36%
20 to 24 54% 44% 51% 47% 52% 64% 59% 62% 46% 57% 31%
Over 24 39% 35% 39% 34% 39% 49% 43% 45% 35% 37% 16%
Subtotal 44% 38% 43% 38% 43% 54% 49% 52% 40% 43% 23%
Under 25
a
52% 42% 51% 44% 51% 62% 59% 61% 45% 55% 34%
Male Users
Under 15
10% 16% 23% 13% 5% 20% 20% 20% 3% 10% 5%
15 to 17 37% 39% 53% 36% 24% 68% 58% 78% 22% 49% 12%
18 to 19 55% 75% 58% 49% 32% 81% 65% 73% 59% 66% 54%
20 to 24 63% 68% 63% 59% 39% 81% 74% 80% 75% 77% 40%
Over 24 44% 39% 47% 43% 21% 74% 53% 82% 73% 54% 29%
Subtotal 46% 43% 53% 43% 23% 75% 58% 80% 66% 56% 29%
All Users
Under 15
23% 19% 33% 18% 20% 43% 43% 37% 22% 21% 15%
15 to 17 49% 39% 53% 41% 47% 60% 61% 60% 39% 52% 39%
18 to 19 55% 56% 55% 48% 51% 65% 60% 62% 49% 57% 38%
20 to 24 55% 47% 52% 48% 51% 67% 60% 65% 50% 59% 32%
Over 24 39% 35% 40% 35% 36% 54% 44% 50% 41% 39% 17%
Total All Users 44% 39% 44% 39% 41% 58% 50% 55% 44% 45% 24%
a
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 31] and USPSTF [2014,
September]. Gonorrhea and chlamydia: Screening [see reference 36].)
50 Family Planning Annual Report: 2020 National Summary
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, or exchanging sex for drugs or money). CDC also recommends
screening sexually active MSM at least annually or more frequently (every 3 to 6 months) if
at increased risk at anatomic sites of contact (urethra, rectum, and pharynx), regardless of
condom use. Finally, CDC recommends screening sexually active persons with HIV for
gonorrhea at the first HIV evaluation and at least annually thereafter unless individual risk
behaviors and the local epidemiology warrant more frequent screening.
31
In 2020, Title X service sites performed 772,620 gonorrhea tests, or an average of 5.0
gonorrhea tests for every 10 family planning users (Exhibit 29).
▪ By user sex, Title X service sites performed 658,240 gonorrhea tests for female family
planning users (5.0 tests for every 10 female users) and 114,380 gonorrhea tests for male
family planning users (5.5 tests for every 10 male users) (Exhibit 29).
▪ By region, the rate of gonorrhea testing ranged from 2.6 to 6.7 tests for every 10 female
users and from 2.7 to 9.2 tests for every 10 male users (Exhibit 29).
See Exhibits A–13a and A–13b for trends (2010–2020) in gonorrhea testing.
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.
31
In 2020, Title X service sites performed 325,813 syphilis tests, or an average of 2.1 syphilis
tests for every 10 family planning users (Exhibit 29).
▪ By user sex, service sites performed 256,861 syphilis tests for female users (1.9 tests for
every 10 female users) and 68,952 syphilis tests for male users (3.3 tests for every 10 male
users) (Exhibit 29).
▪ By region, the rate of syphilis testing ranged from 0.5 tests to 2.4 tests for every 10 female
users and from 1.2 tests to 5.2 tests for every 10 male users (Exhibit 29).
See Exhibits A–13a and A–13c for trends (2010–2020) in syphilis testing.
Family Planning Annual Report: 2020 National Summary 51
HIV 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 if the client or their sex partner(s)
have had more than one sex partner since their most recent HIV test.
31
In 2020, Title X service sites performed 429,545 confidential HIV tests, or an average of 2.8
tests for every 10 family planning users. Of the HIV tests performed, 1,359 tests (3.2 tests per
1,000 tests performed) were positive for HIV. Title X service sites also performed
672 anonymous HIV tests.
▪ By user sex, service sites performed 328,495 HIV tests for female users (2.5 tests for every
10 female users) and 101,050 HIV tests for male users (4.8 tests for every 10 male users)
(Exhibit 29).
▪ By region, the rate of HIV testing ranged from 0.4 test to 3.4 tests for every 10 female
users and from 1.8 tests to 8.7 tests for every 10 male users. The number of positive
confidential HIV tests ranged from 0 to 322 (Exhibit 29).
See Exhibits A–13a and A–13d for trends (2010–2020) in confidential HIV testing.
52 Family Planning Annual Report: 2020 National Summary
Exhibit 29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region, and number of positive HIV tests, by region: 2020
(Source: FPAR Table 12)
STD Tests All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Gonorrhea Tests
Female
658,240 12,868 19,917 90,480 203,292 48,310 124,887 40,822 24,561 90,561 2,542
Male 114,380 3,894 2,437 19,244 18,448 13,277 17,059 9,268 6,880 23,447 426
Total 772,620 16,762 22,354 109,724 221,740 61,587 141,946 50,090 31,441 114,008 2,968
Tests per 10 Users
Female
5.0 3.8 4.9 4.7 4.7 6.7 5.4 5.9 4.5 4.7 2.6
Male 5.5 4.9 5.3 5.5 2.7 8.9 6.3 9.2 7.3 7.4 3.2
Total 5.0 4.0 5.0 4.8 4.5 7.1 5.5 6.3 5.0 5.0 2.7
Syphilis Tests
Female
256,861 4,819 6,387 36,491 91,089 12,508 55,986 11,363 2,919 34,843 456
Male 68,952 1,998 1,465 14,530 8,029 7,008 12,405 4,188 2,813 16,311 205
Total 325,813 6,817 7,852 51,021 99,118 19,516 68,391 15,551 5,732 51,154 661
Tests per 10 Users
Female
1.9 1.4 1.6 1.9 2.1 1.7 2.4 1.6 0.5 1.8 0.5
Male 3.3 2.5 3.2 4.1 1.2 4.7 4.6 4.2 3.0 5.2 1.5
Total 2.1 1.6 1.7 2.2 2.0 2.3 2.7 2.0 0.9 2.3 0.6
Confidential HIV Tests
Female
328,495 8,245 7,940 48,498 98,833 17,404 78,462 14,149 6,817 47,730 417
Male 101,050 3,889 1,699 17,805 15,273 8,332 15,058 5,626 5,846 27,278 244
Total 429,545 12,134 9,639 66,303 114,106 25,736 93,520 19,775 12,663 75,008 661
Tests per 10 Users
Female
2.5 2.4 2.0 2.5 2.3 2.4 3.4 2.0 1.3 2.5 0.4
Male 4.8 4.9 3.7 5.1 2.2 5.6 5.6 5.6 6.2 8.7 1.8
Total 2.8 2.9 2.1 2.9 2.3 3.0 3.6 2.5 2.0 3.3 0.6
Positive Test Results 1,359 44 74 284 322 109 231 26 73 196 0
Anonymous HIV Tests 672 0 0 382 0 184 0 65 0 41 0
Family Planning Annual Report: 2020 National Summary 53
7 Staffing and Service Utilization
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 all
aspects of the user (male and female) physical assessments recommended for contraceptive,
related preventive health, and basic infertility care, as described in the Title X program
requirements.
2
In 2020, 2,681 full-time equivalent (FTE) CSPs delivered medical family planning and
related preventive health services in Title X service sites (Exhibit 30).
▪ By type of CSP, midlevel clinicians (i.e., PAs, NPs, and CNMs) accounted for 65% of
total FTEs, followed by physicians (29%) and other CSPs (6%). On average, there were
2.2 midlevel clinician FTEs for every 1.0 physician FTE engaged in the direct delivery of
Title X services.
▪ By region, from 34% to 80% of total FTEs were midlevel clinician FTEs, 11% to 49%
were physician FTEs, and 0% to 27% were other CSP FTEs. There were from 0.9 to
7.1 midlevel clinician FTEs for every 1.0 physician FTE.
See Exhibits A–14a and A–14b for trends (2010–2020) in the number and distribution of CSP
FTE staffing by type.
Family Planning Encounters (Exhibit 30)
In 2020, Title X service sites reported a total of 2.7 million family planning encounters, or an
average of 1.8 encounters per user. Eleven percent (289,683) of total family planning
encounters were telehealth visits (Exhibit 30).
▪ By type, most family planning encounters (79%, or 2.1 million) were attended by a CSP,
resulting in an average of 1.4 CSP encounters per user and 796 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 to 2.0,
and the percentage that were telehealth encounters ranged from 1% to 32%.
– CSP encounters: The percentage of encounters with a CSP ranged from 68% to 97%,
and the number of CSP encounters per user ranged from 1.1 to 1.7. In addition, the
number of CSP encounters per CSP FTE ranged from 330 to 1,674.
54 Family Planning Annual Report: 2019 National Summary
– Non-CSP encounters: The percentage of encounters that were attended by non-CSP
staff ranged from 3% to 32%, and the number of non-CSP encounters per user was 0.5
or less across regions.
See Exhibits A–14a and A–14c for trends (2010–2020) in the number and distribution of
family planning encounters by type.
Selected Guidance for Reporting Staffing and Encounter Data in FPAR Table 13
In FPAR Table 13, grantees report the following
information on the level of clinical provider staffing and the
number of family planning encounters:
■
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.
Family Planning Provider—The individual who assumes
primary responsibility for assessing a client and
documenting services in the client record. Providers
exercise independent judgment as to the services
rendered to the client during an encounter. There are two
types of family planning providers:
■
Clinical Services Providers (CSPs) include
physicians, 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. CSPs offer
a range of clinical, counseling, and educational
services relating to a client’s proposed or adopted
method of contraception, general reproductive health,
or infertility treatment, in accordance with the Title X
program requirements.
2
■
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
Title X program requirements.
2
Family Planning Encounter— A documented contact
between an individual and a family planning provider that
is either face-to-face in a Title X service site or virtual
using telehealth technology. The purpose of a family
planning encounter is to provide family planning and
related preventive health services to clients who want to
avoid unintended pregnancies or achieve intended
pregnancies. Laboratory tests and related counseling and
education do not constitute a family planning encounter
unless the encounter is face-to-face or virtual contact
between the client and provider, the provider documents
the encounter, and the tests are accompanied by family
planning counseling or education. A virtual family planning
encounter uses telecommunications and information
technology to provide access to Title X family planning
and related preventive health services, including
assessment, diagnosis, intervention, consultation,
education and counseling, and supervision, at a distance.
The two types of family planning encounters are classified
based on the type of family planning provider who renders
the care: an encounter with a CSP or an encounter with
an Other Services Provider.
Full-Time Equivalent (FTE)—For each type of CSP,
grantees report the time in FTEs that CSP providers are
involved in the direct provision of Title
X-funded services
(i.e., engaged in a family planning encounter). An 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.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions
(Reissued January 2021), pp. 43–45.
5
Family Planning Annual Report: 2020 National Summary 55
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: 2020 (Source: FPAR Table 13)
FTEs and FP Encounters All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Number of CSP FTEs
Physician
779.0 75.9 18.3 205.2 222.2 28.7 40.2 20.8 9.2 147.3 11.2
PA/NP/CNM 1,733.7 77.6 15.8 483.2 565.0 95.8 165.5 71.2 65.7 170.1 23.8
Other CSP
a
168.7 2.1 12.5 35.1 76.4 16.2 4.0 0.0 7.0 14.3 1.0
Total 2,681.4 155.6 46.7 723.5 863.6 140.8 209.7 92.1 81.9 331.7 35.9
Distribution of CSP FTEs
Physician
29% 49% 39% 28% 26% 20% 19% 23% 11% 44% 31%
PA/NP/CNM 65% 50% 34% 67% 65% 68% 79% 77% 80% 51% 66%
Other CSP
a
6% 1% 27% 5% 9% 12% 2% 0% 9% 4% 3%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Midlevel to Physician FTE
b
2.2 1.0 0.9 2.4 2.5 3.3 4.1 3.4 7.1 1.2 2.1
Number of FP Encounters
With CSP
2,134,047 51,313 78,108 359,326 655,961 118,536 292,234 102,305 102,715 358,848 14,701
With other 576,673 5,918 2,218 49,760 241,742 34,573 140,587 37,911 21,311 38,953 3,700
Total 2,710,720 57,231 80,326 409,086 897,703 153,109 432,821 140,216 124,026 397,801 18,401
Distribution of FP Encounters
With CSP
79% 90% 97% 88% 73% 77% 68% 73% 83% 90% 80%
With other 21% 10% 3% 12% 27% 23% 32% 27% 17% 10% 20%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Number of FP Encounters by
Type of Encounter
In Person 2,421,037 47,155 75,371 340,328 858,587 146,913 418,750 135,904 109,440 270,333 18,256
Virtual/Telehealth
c
289,683 10,076 4,955 68,758 39,116 6,196 14,071 4,312 14,586 127,468 145
Total 2,710,720 57,231 80,326 409,086 897,703 153,109 432,821 140,216 124,026 397,801 18,401
Distribution of FP Encounters
by Type of Encounter
In Person
89% 82% 94% 83% 96% 96% 97% 97% 88% 68% 99%
Virtual/Telehealth
c
11% 18% 6% 17% 4% 4% 3% 3% 12% 32% 1%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
FP Encounters per User
With CSP
1.4 1.2 1.7 1.6 1.3 1.4 1.1 1.3 1.6 1.6 1.3
With other 0.4 0.1 0.0 0.2 0.5 0.4 0.5 0.5 0.3 0.2 0.3
Total 1.8 1.4 1.8 1.8 1.8 1.8 1.7 1.8 2.0 1.8 1.7
CSP Encounters per CSP FTE 796 330 1,674 497 760 842 1,394 1,111 1,254 1,082 409
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.
c
In January 2021, OPA revised the Title X Family Planning Annual Report (FPAR): Forms and Instructions to capture the increase in virtual family planning encounters during the COVID-19
pandemic. The number of virtual encounters reported in 2020 is likely an underestimate because data systems for some grantees and subrecipients were not able to these data by the FPAR
due date. See the Table 13 comments in Appendix C.
56 Family Planning Annual Report: 2020 National Summary
Selected Guidance for Reporting Project Revenue in FPAR Table 14
In FPAR Table 14, grantees report the revenue received
(i.e., actual cash receipts or drawdown amounts) during the
reporting period from various funding sources that support
activities within the scope of the grantee’s Title
X services
grant, even if the funds were not expended during the
reporting period. Table 14 excludes the monetary value of
in-kind contributions. Sources of revenue include the
following:
Title
X Grant—Refers to the amount received from the
Title
X Section 1001 family planning services grant, including
revenue received from other Title
X special initiatives (e.g.,
HIV integration).
Payment for Services—Refers to funds collected directly
from clients and revenues received (i.e., reimbursed) from
public and private third-party payers for services provided
within the scope of the grantee’s Title
X project.
■
Total Client Collections/Self-Pay (“Client Fees”)—
Grantees report the amount in fees collected directly from
clients.
■
Third-Party Payers—Grantees report revenue received
from public and private third-party payers. Third-party
payer revenue reported as “prepaid” (capitated) is from
managed care arrangements (e.g., capitated Medicare,
Medicaid, and private managed care contracts).
Third-party payer revenue reported as “not prepaid” is
received after the date of service, even under managed
care arrangements. Third-party payer sources include:
Medicaid/Title
XIX—Grantees report the amount
received from Medicaid (federal and state shares),
regardless of whether the reimbursement was paid
directly by Medicaid or through a fiscal intermediary or a
health maintenance organization (HMO). The Medicaid
amount includes revenue (federal and state shares) from
Medicaid family planning eligibility expansions (waivers or
State Plan Amendments).
Medicare/Title
XVIII—Grantees report the amount
received from Medicare, 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)—
Grantees report the amount received from CHIP.
Other Public Health Insurance—Grantees report the
amount received from other federal, state, or local
government health insurance programs. 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—Grantees report the amount
received from private third-party health insurance plans,
which include plans obtained through an employer, union,
or direct purchase that provide a broad set of primary
medical care benefits for the enrolled individual
(beneficiary or dependent). Private health insurance
includes coverage purchased for public employees or
retirees or military personnel and their dependents (e.g.,
TRICARE or CHAMPVA).
Other Revenue—Grantees report the amounts received
from various other sources, including
■
Maternal and Child Health Block Grants (Title V)
■
Social Services Block Grants (Title XX)
■
Temporary Assistance for Needy Families (TANF)
■
Local government sources (includes county and city
grants or contracts)
■
State government sources (includes grants or contracts)
■
Bureau of Primary Health Care grants (e.g., Section 330)
■
Private and client donations
■
Other public or private revenues.
Note: For detailed reporting guidance, please refer to the Title X Family Planning Annual Report: Forms and Instructions (Reissued
January 2021), pp. 47–49.
5
Family Planning Annual Report: 2020 National Summary 57
8 Project Revenue
REVENUE
In 2020, Title X grantees reported total program revenue of over $605.0 million to support the
delivery of Title X-funded family planning and related preventive health care. The two largest
sources of revenue—Title X ($205.8 million) and Medicaid and the Children’s Health
Insurance Program (CHIP) combined ($150.6 million)—accounted for 34% and 25%,
respectively, of total revenue. Revenue from state governments ($60.6 million), private third-
party payers ($48.7 million), local governments ($25.0 million), client service fees
($19.5 million), and Medicare and other public third-party payers ($18.7 million) each
accounted for 3% to 10% of total revenue, while all other sources each contributed 2% or less
(Exhibit 31).
Title X Services Grant
Revenue from Title X accounted for 34% ($205.8 million) of total national revenue and
between 26% and 55% of total regional revenue. Title X was the largest source of project
revenue in eight regions and the second largest source after state government or Medicaid in
two others (Exhibits 32 and 33).
Payment for Services: Client Fees
Revenue from client service fees accounted for 3% ($19.5 million) of total revenue and
between 1% and 6% of total regional revenue (Exhibits 32 and 33).
Payment for Services: Third-Party Payers
In 2020, revenue from third-party payers was 36% ($218.1 million) of total revenue, with
Medicaid/CHIP accounting for most (69%) of this amount (Exhibits 32 and 33).
Medicaid and CHIP. Medicaid revenue (federal and state shares) accounted for 25%
($149.2 million) of total revenue, and separately reported CHIP revenue accounted for less
than 0.5% ($1.5 million) of total revenue. Together, these two sources totaled $150.6 million,
or 25% of total 2020 revenue (Exhibits 32 and 33).
By region, Medicaid and CHIP revenue combined accounted for 6% to 35% of total regional
revenue, and Medicaid was the largest revenue source (35%) in one region
(Exhibits 32 and 33). In 20 states, grantees included revenue from federally approved
Medicaid family planning eligibility expansions in the amount they reported for Medicaid.
See the Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of
these states.
Medicare and Other Public. Revenue from Medicare ($5.7 million) and other public
third‑party payers ($13.0 million) together accounted for 3% ($18.7 million) of total national
revenue. By region, the share of revenue from Medicare and other public third-party payers
ranged from less than 0.5% to 9% (Exhibits 32 and 33).
58 Family Planning Annual Report: 2020 National Summary
Private. Revenue from private third-party payers ($48.7 million) accounted for 8% of total
national revenue and between 3% and 15% of total regional revenue. Private third‑party payer
revenue was the second or third most important revenue source in five regions
(Exhibits 32 and 33).
Other Revenue
Block Grants. Revenue from the Title V Maternal and Child Health (MCH) block grant
($10.3 million) and the Title XX Social Services block grant ($5.6 million) accounted for 2%
and 1%, respectively, of total national revenue. By region, the share of total regional revenue
from block grants ranged from 0% to 9%, with grantees in one region reporting no revenue
from the MCH block grant and grantees in three regions reporting no revenue from the Social
Services block grant (Exhibits 32 and 33).
Temporary Assistance for Needy Families (TANF). Revenue from TANF ($5.8 million)
accounted for 1% of total national revenue and from 0% to 3% of total regional revenue.
Grantees in five regions reported no TANF revenue (Exhibits 32 and 33).
State Governments. State government revenue accounted for 10% ($60.6 million) of total
national revenue and from 2% to 28% of total regional revenue. State government revenue
was the largest source of regional revenue in one region and the second or third largest source
in three others (Exhibits 32 and 33).
Local Governments. Local government revenue accounted for 4% ($25.0 million) of total
national revenue and from less than 0.5% to 12% of total regional revenue
(Exhibits 32 and 33).
Bureau of Primary Health Care (BPHC). Revenue from the Health Resources Services
Administration, BPHC accounted for 2% ($10.5 million) of total national revenue. Across
regions, BPHC revenue ranged from 0% to 8% of total regional revenue, with grantees in four
regions reporting no BPHC revenue (Exhibits 32 and 33).
All Other Sources. Finally, a combination of other public and private sources not listed
separately in Table 14 accounted for 7% ($43.9 million) of total revenue. Revenue from other
sources ranged from less than 0.5% to 19% of total regional revenue (Exhibits 32 and 33).
See the Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of
other revenue sources.
Revenue per User and Encounter
On average, in 2020, grantees reported $394 in program revenue per family planning user
served and $223 per family planning encounter. By region, revenue per user ranged from
$181 to $559, and revenue per encounter ranged from $132 to $315 (Exhibit 32).
Family Planning Annual Report: 2020 National Summary 59
Exhibit 31. Amount and distribution of Title X project revenues, by revenue source: 2020
(Source: FPAR Table 14)
Revenue Source Amount Distribution
Title X
$205,830,740 34%
Payment for Services
Client fees
$19,491,605
3%
Third-party payers
a
Medicaid
b
$149,159,998
25%
Children’s Health Insurance Program
$1,472,810
0%†
Medicare $5,684,335 1%
Other public $13,038,796 2%
Private $48,719,431 8%
Subtotal $237,566,975 39%
Other Revenue
Maternal and Child Health block grant
$10,308,958
2%
Social Services block grant $5,551,662 1%
Temporary Assistance for Needy Families $5,790,068 1%
State government $60,597,168 10%
Local government $25,008,232 4%
Bureau of Primary Health Care $10,500,084 2%
Other
c
$43,853,971 7%
Subtotal $161,610,143 27%
Total Revenue
$605,007,858 100%
Total Revenue per User $394 —
Total Revenue per Encounter $223 —
Note: Unless otherwise noted, revenue is shown in actual dollars (unadjusted) for each year. Due to rounding, percentages may
not sum to 100%.
a
Prepaid and not prepaid.
b
Includes revenue from federally approved Medicaid family planning eligibility expansions in 20 states in all 10 HHS regions.
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of states by region.
c
See Table 14 comments in the Field and Methodological Notes (Appendix C) for a list of the types of revenue reported as
“other.”
— Not applicable.
† Percentage is less than 0.5%.
60 Family Planning Annual Report: 2020 National Summary
Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2020 (Source: FPAR Table 14)
Revenue Source
All Regions
($)
Region I
($)
Region II
($)
Region III
($)
Region IV
($)
Region V
($)
Region VI
($)
Region VII
($)
Region VIII
($)
Region IX
($)
Region X
($)
Title X
$205,830,740 $4,182,480 $11,123,843 $30,699,891 $53,275,153 $25,046,927 $24,213,475 $14,229,666 $8,455,609 $32,548,581 $2,055,115
Payment for Services
Client fees
$19,491,605 $89,975 $630,971 $2,976,204 $8,349,060 $689,020 $936,114 $1,657,570 $1,774,895 $2,095,363 $292,433
Third-party payers
a
Medicaid
b
$149,159,998 $1,952,857 $1,744,605 $28,885,631 $44,920,116 $11,365,742 $12,462,951 $4,227,472 $5,023,550 $38,281,601 $295,473
CHIP
$1,472,810 $0 $2,633 $169,917 $493,076 $7,553 $685,820 $61,804 $50,142 $1,865 $0
Medicare
$5,684,335 $98,408 $28,790 $3,728,179 $1,357,807 $103,331 $39,894 $121,292 $35,557 $170,439 $638
Other public
c
$13,038,796 $41,229 $0 $3,689,420 $113,746 $213,736 $8,822,228 $26,849 $1,062 $37,136 $93,390
Private
$48,719,431 $688,097 $565,983 $13,902,407 $10,248,351 $1,915,705 $6,197,497 $4,151,328 $4,256,148 $6,005,649 $788,266
Subtotal
$237,566,975 $2,870,566 $2,972,982 $53,351,758 $65,482,156 $14,295,087 $29,144,504 $10,246,315 $11,141,354 $46,592,053 $1,470,200
Other Revenue
MCH block grant
$10,308,958 $0 $543,000 $2,761,626 $2,290,859 $1,738,200 $1,086,593 $34,447 $140,235 $1,223,236 $490,762
SS block grant
$5,551,662 $16,291 $1,557,000 $3,355,270 $0 $381,699 $0 $0 $51,806 $23,941 $165,655
TANF
$5,790,068 $12,510 $0 $546,216 $2,450,390 $1,634,891 $1,146,061 $0 $0 $0 $0
State government
$60,597,168 $455,735 $2,914,141 $3,117,047 $17,502,838 $2,143,559 $26,640,855 $539,686 $4,774,364 $2,083,475 $425,468
Local government
$25,008,232 $679 $190,966 $112,223 $12,487,099 $2,675,218 $4,637,461 $114,702 $3,018,333 $1,144,038 $627,513
BPHC
$10,500,084 $0 $1,793,266 $1,874,046 $293,834 $0 $620,675 $1,390,024 $0 $4,528,239 $0
Other
d
$43,853,971 $4,042 $751,384 $3,956,293 $4,675,907 $387,907 $6,158,498 $3,730,930 $2,762,644 $21,296,985 $129,381
Subtotal
$161,610,143 $489,257 $7,749,757 $15,722,721 $39,700,927 $8,961,474 $40,290,143 $5,809,789 $10,747,382 $30,299,914 $1,838,779
Total Revenue $605,007,858 $7,542,303 $21,846,582 $99,774,370 $158,458,236 $48,303,488 $93,648,122 $30,285,770 $30,344,345 $109,440,548 $5,364,094
Total Revenue per User
$394 $181 $485 $438 $318 $559 $363 $382 $478 $484 $483
Total Revenue per
Encounter
$223 $132 $272 $244 $177 $315 $216 $216 $245 $275 $292
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 federally approved Medicaid family planning eligibility expansions in 20 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: 2020 National Summary 61
Exhibit 33. Distribution of Title X project revenues, by revenue source and region: 2020 (Source: FPAR Table 14)
Revenue Source All Regions Region I Region II Region III Region IV Region V Region VI Region VII Region VIII Region IX Region X
Title X
34% 55% 51% 31% 34% 52% 26% 47% 28% 30% 38%
Payment for Services
Client fees
3% 1% 3% 3% 5% 1% 1% 5% 6% 2% 5%
Third-party payers
a
Medicaid
b
25% 26% 8% 29% 28% 24% 13% 14% 17% 35% 6%
CHIP
0%† 0% 0%† 0%† 0%† 0%† 1% 0%† 0%† 0%† 0%
Medicare
1% 1% 0%† 4% 1% 0%† 0%† 0%† 0%† 0%† 0%†
Other public
c
2% 1% 0% 4% 0%† 0%† 9% 0%† 0%† 0%† 2%
Private 8% 9% 3% 14% 6% 4% 7% 14% 14% 5% 15%
Subtotal
39% 38% 14% 53% 41% 30% 31% 34% 37% 43% 27%
Other Revenue
MCH block grant
2% 0% 2% 3% 1% 4% 1% 0%† 0%† 1% 9%
SS block grant 1% 0%† 7% 3% 0% 1% 0% 0% 0%† 0%† 3%
TANF 1% 0%† 0% 1% 2% 3% 1% 0% 0% 0% 0%
State government
10% 6% 13% 3% 11% 4% 28% 2% 16% 2% 8%
Local government 4% 0%† 1% 0%† 8% 6% 5% 0%† 10% 1% 12%
BPHC
2% 0% 8% 2% 0%† 0% 1% 5% 0% 4% 0%
Other
d
7% 0%† 3% 4% 3% 1% 7% 12% 9% 19% 2%
Subtotal 27% 6% 35% 16% 25% 19% 43% 19% 35% 28% 34%
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 federally approved Medicaid family planning eligibility expansions in 20 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%.
62 Family Planning Annual Report: 2020 National Summary
Trends in Project Revenue: 2020 vs. 2019
Comparing 2020 and 2019 revenue shows that inflation-adjusted (constant 2020 dollars)
37
total revenue decreased 44% (by $473.8 million), from $1.1 billion in 2019 to $605.0 million
in 2020 (Exhibits A–15a, A–15b, and A–15c). Revenue decreased among all sources, and the
declines were especially sharp for revenue sources more closely linked to the number of
clients served and encounters (e.g., revenue from third-party payers and client service fees).
Below we list the major Title X revenue sources ordered by the size of the inflation-adjusted
dollar amount decrease from 2019 to 2020 (not shown unless specified).
▪ Combined Medicaid and CHIP revenue decreased 61%, or by $235.5 million, from 2019
($386.1 million) to 2020 ($150.6 million) (Exhibit A–15a, A–15b, and A–15e).
▪ Private third-party payer revenue decreased 56%, or by $63.2 million, from 2019
($111.9 million) to 2020 ($48.7 million).
▪ State government revenue decreased 47%, or by 53.9 million, from 2019
($114.5 million) to 2020 ($60.6 million).
▪ Title X revenue decreased 14%, or by $32.6 million, from 2019 ($238.4 million) to 2020
($205.8 million) (Exhibit A–15a, A–15b, and A–15d).
▪ Client service fees revenue decreased 53%, or by $22.2 million, from 2019
($41.7 million) to 2020 ($19.5 million).
▪ Block grant revenue decreased 34%, or by $8.1 million, from 2019 ($24.0 million) to
2020 ($15.9 million).
▪ Local government revenue decreased 20%, or by $6.3 million, from 2019 ($31.3 million)
to 2020 ($25.0 million).
▪ Medicare and other public third-party payer revenue decreased 12%, or by
$2.4 million, from 2019 ($21.2 million) to 2020 ($18.7 million).
▪ TANF revenue decreased 8%, or by $537,391, from 2019 ($6.3 million) to 2020
($5.8 million).
▪ Revenue from a combination of all “other” sources decreased 47%, or by $49.0 million,
from 2019 ($103.4 million) to 2020 ($54.4 million).
Trends in Project Revenue: 2020 vs. 2010
Compared to 2010, inflation-adjusted total revenue in 2020 decreased by 65% (or
$1.1 billion), from $1.7 billion in 2010 to $605.0 million in 2020. Declines in revenue from
five sources—Medicaid and CHIP, Title X, state and local government, and client service
fees—accounted for 86% ($971.4 million) of the total decrease. Exhibits A–15a through
A– 15e present trends (2010−2020) in total, Title X, and Medicaid/CHIP revenue.
Finally, compared with 2010, there were changes in the distribution of total revenue by major
source in 2020. The percentage of total revenue from Title X increased from 22% (2010) to
34% (2020), and the percentage from Medicaid and CHIP decreased from 37% (2010) to 25%
(2020). Exhibits A–16a through A–16c present trends (2010−2020) in revenue (unadjusted)
for all major revenue sources.
Family Planning Annual Report: 2020 National Summary 63
9 References
1. Title X of the Public Health Service Act, 42 U.S. Code 300 et seq. (1970).
Retrieved from https://opa.hhs.gov/sites/default/files/2020-07/title-x-statute-
attachment-a_0.pdf
2. The Title X program requirements consist of the following two documents:
Compliance with statutory program integrity requirements (“Title X Final
Rule”) retrieved from https://opa.hhs.gov/grant-programs/title-x-service-
grants/title-x-statutes-regulations-and-legislative-mandates-0.
Providing quality family planning services: Recommendations of CDC and the
U.S. Office of Population Affairs (“QFP”) and updates (2015 and 2017) to the
Recommendations retrieved from https://opa.hhs.gov/grant-programs/title-x-
service-grants/about-title-x-service-grants/quality-family-planning
3. Project grants for family planning services, 42 C.F.R. § 59.A (2020).
https://www.ecfr.gov/cgi-bin/text-idx?SID=c1cbd72e13f7230f1e8328fa
52b57899&mc=true&node=sp42.1.59.a&rgn=div6
4. Further Consolidated Appropriations Act of 2020, Pub. L. No. 116–94, 133
Stat. 2558. https://www.congress.gov/116/plaws/publ94/PLAW-
116publ94.pdf
5. Office of Population Affairs. (2021). Title X Family Planning Annual Report:
Forms and instructions (Reissued January 2021). 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://opa.hhs.gov/sites/default/files/2021-02/fpar-forms-instructions-
reissued-jan-2021.pdf
6. Uniform administrative requirements, cost principles, and audit requirements
for HHS awards, 45 C.F.R. § 75 (2016). https://www.ecfr.gov/cgi-
bin/retrieveECFR?gp=1&SID=df3c54728d090168d3b2e780a6f6ca7c&ty=HT
ML&h=L&mc=true&n=pt45.1.75&r=PART
7. U.S. Department of Health and Human Services. (2021). 2020 poverty
guidelines, U.S. federal poverty guidelines used to determine financial
eligibility for certain federal programs. Retrieved from
https://aspe.hhs.gov/2020-poverty-guidelines
8. Cohen, R. A., Terlizzi, E. P., Cha, A.E., & Martinez, M. E. (2021). Health
insurance coverage: Early release of estimates from the National Health
Interview Survey, January-June 2020. Retrieved from
https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202102-508.pdf
64 Family Planning Annual Report: 2020 National Summary
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-1997-10-
30/pdf/97-28653.pdf
10. Office of the Assistant Secretary for Health, Office of the Secretary,
Department of Health and Human Services. (2019). Compliance with Statutory
Program Integrity Requirements. Federal Register, 84(42), 7714–7791.
Retrieved from https://www.federalregister.gov/documents/2019/03/04/2019-
03461/compliance-with-statutory-program-integrity-requirements
11. Napili, A., & Elliot, V. L. (Updated February 25, 2021). Title X Family
Planning Program: 2019 Final Rule. Congressional Research Service No. IF
11142. Retrieved from https://crsreports.congress.gov/product/pdf/IF/IF11142
12. Ensuring access to equitable, affordable, client-centered, quality family
planning services, 42 C.F.R. § 59 (2021). Retrieved from https://public-
inspection.federalregister.gov/2021-07762.pdf
13. National Academy for State Health Policy. (2020). 2020 COVID-19 state
restrictions, re-openings, and mask requirements. Retrieved from
https://www.nashp.org/2020-state-reopening-chart/
14. Foley, D. (2020, April 3). Essential family planning services. U.S. Department
of Health and Human Services.
15. U.S. Department of Health and Human Services, Office of the Assistant
Secretary for Health, Office of Population Affairs. (2020, March 19).
Conference call with Title X grantees to discuss COVID19-related questions.
U.S. Department of Health and Human Services.
16. Centers for Disease Control and Prevention. (2020, April 8). Interim CDC
guidance on handling non-COVID-19 public health activities that require
face-to-face interaction with clients in the clinic and field in the current
COVID-19 pandemic. CDC Stacks. Retrieved from
https://stacks.cdc.gov/view/cdc/87919
17. Family Planning National Training Center. (2020). Prioritization of in-person
and virtual visits during COVID-19: A decision-making guide for staff.
Reproductive Health National Training Center. Retrieved from
https://rhntc.org/sites/default/files/resources/fpntc_priority_decision_guide_20
20-04-29.pdf
18. Centers for Disease Control and Prevention. (2021). Ensuring access to family
planning services during COVID-19. Centers for Disease Control and
Prevention. Retrieved from
https://www.cdc.gov/reproductivehealth/contraception/covid-19-family-
planning-services.html
Family Planning Annual Report: 2020 National Summary 65
19. Foley, D. (2020, May 19). Use of Title X funds for COVID-19 testing. U.S.
Department of Health and Human Services.
20. Moore, S. (2020, March 20). Administrative relief for recipients of federal
financial assistance directly impacted by the novel coronavirus (COVID-19)
due to loss of operations. U.S. Department of Health and Human Services.
21. Office of Population Affairs. (2020, March 23). Frequently asked questions
from Title X family planning grantees about COVID19 implications. U.S.
Department of Health and Human Services.
22. 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/
policyguidancedocument.html
23. Kennedy, K. I., & Goldsmith, C. (2018). Contraception after pregnancy. In R.
A. Hatcher, A. L. Nelson, J. Trussell, C. Cwiak, P. Cason, M. S. Policar, A. R.
A. Aiken, J. Marrazzo, & D. Kowal (Eds.), Contraceptive technology (21st
ed., pp. 511–542). New York, NY: Ardent Media.
24. Centers for Disease Control and Prevention. (2021). Sexual risk behaviors can
lead to HIV, STDs & teen pregnancy. Retrieved from
https://www.cdc.gov/healthyyouth/sexualbehaviors/
25. 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 from CDC and the U.S. Office of Population Affairs, 2017.
MMWR, 66(50), 1383–1385. Retrieved from
https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6650a4-H.pdf
26. Office of Population Affairs. (2021). Contraceptive care measures. Retrieved
from https://opa.hhs.gov/evaluation-research/title-x-services-
research/contraceptive-care-measures
27. 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.
66 Family Planning Annual Report: 2020 National Summary
28. Nayar, R., & Wilbur, D. C. (2015). The Pap test and Bethesda 2014. Acta
Cytologica, 29, 121–132. Retrieved from https://www.karger.com/Article/
Pdf/381842
29. National Cancer Institute. (2020). NCI dictionary of cancer terms. Retrieved
from https://www.cancer.gov/publications/dictionaries/cancer-terms
30. Centers for Disease Control and Prevention. (2021). Reported STDs in the
United States, 2019. Atlanta, GA: U.S. Department of Health and Human
Services. Retrieved from
https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/STD-Trends-508.pdf
31. Centers for Disease Control and Prevention. (2015). Sexually transmitted
diseases treatment guidelines, 2015. MMWR, 64(RR-3), 1–137. Retrieved from
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm and Centers for
Disease Control and Prevention. (2016). Screening recommendations and
considerations referenced in treatment guidelines and original sources.
Retrieved from https://www.cdc.gov/std/tg2015/screening-recs-2015tg-
revised2016.pdf
32. Barrow, R. Y., Ahmed, F., Bolan, G. A., & Workowski, K. A. (2020).
Recommendations for providing quality sexually transmitted diseases clinical
services, 2020. MMWR Recommendations and Reports, 68(RR-5), 1–20.
Retrieved from
https://www.cdc.gov/mmwr/volumes/68/rr/rr6805a1.htm?s_cid=rr6805a1_w
33. Centers for Disease Control and Prevention. (2020, April 6). [Dear Colleague
Letter: Guidance to STD prevention programs during COVID-19]. Retrieved
from https://www.cdc.gov/std/dstdp/DCL-STDTreatment-COVID19-
04062020.pdf
34. Centers for Disease Control and Prevention. (2020, May 13). [Dear Colleague
Letter: Clarification of guidance for the use of expedited partner therapy
during COVID-19]. Retrieved from https://www.cdc.gov/std/dstdp/dcl-
clarification-may2020.pdf
35. Centers for Disease Control and Prevention. (2020, September 8). [Dear
Colleague Letter: Shortage of STI test kits and laboratory supplies]. Retrieved
from https://www.cdc.gov/std/general/DCL-Diagnostic-Test-Shortage.pdf
36. U.S. Preventive Services Task Force. (2014). Gonorrhea and chlamydia:
Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/
Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-
screening
37. U.S. Department of Labor, Bureau of Labor Statistics (BLS). (2020).
Consumer price index: Series ID. CUUR0000SAM. Retrieved from
https://data.bls.gov/cgi-bin/srgate
Family Planning Annual Report: 2020 National Summary 67
38. Henry J. Kaiser Family Foundation. (2021, April 13). Status of state action on
the Medicaid expansion decision. Retrieved from https://www.kff.org/health-
reform/state-indicator/state-activity-around-expanding-medicaid-under-the-
affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%
22:%22Location%22,%22sort%22:%22asc%22%7D
39. Bayer HealthCare Pharmaceuticals, Inc. (2018). Skyla: Highlights of
prescribing information. Retrieved from http://labeling.bayerhealthcare.com/
html/products/pi/Skyla_PI.pdf#IUDEfficacy
40. Bayer HealthCare Pharmaceuticals, Inc. (n.d.). Important safety information
about Kyleena. Retrieved June 10, 2021, from https://hcp.kyleena-
us.com/about-kyleena/efficacy/
41. Allergan USA, Inc. (2019). Liletta: Highlights of prescribing information.
Retrieved from https://www.allergan.com/assets/pdf/lilettashi_pi
42. Hatcher, R. A. (2018). Figure 3-1 Comparing typical effectiveness of
contraceptive methods. In D. Kowal, R. A. Hatcher, A. L. Nelson, J. Trussell,
C. Cwiak, P. Cason, M. S. Policar, A. B. Edelman, A. R. A. Aiken, & J. M.
Marrazzo (Eds.), Contraceptive technology (21st ed). Managing
Contraception, LLC. Retrieved from
http://www.contraceptivetechnology.org/the-book/take-a-peek/contraceptive-
efficacy/
68 Family Planning Annual Report: 2020 National Summary
This page intentionally left blank.
Family Planning Annual Report: 2020 National Summary A-1
Appendix A
National Trend Exhibits
A-2 Family Planning Annual Report: 2020 National Summary
Exhibit A–1a. Number of Title X-funded grantees, subrecipients, and service sites, by region and year: 2010–2020
Region 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Grantees
I
10
11 11 11 12 11 11 11 12 10 4
II
7
7 7 6 6 6 6 6 8 8 7
III 9 9 9 10 10 10 10 10 12 12 11
IV 10 10 13 13 14 10 9 9 11 12 11
V
12
12 11 11 10 12 11 11 13 12 8
VI 6 6 6 7 6 6 7 6 8 9 8
VII 5 5 5 5 5 5 5 5 5 6 5
VIII
6
6 6 6 6 6 6 6 6 6 5
IX 16 17 17 18 17 17 18 17 18 19 14
X 8 8 8 8 8 8 8 8 6 6 2
Total
89
91 93 95 94 91 91 89 99 100 75
Subrecipients
I
71
72 67 66 67 71 69 68 75 61 21
II 82 80 75 71 70 70 68 68 72 68 18
III 218 230 265 271 258 316 223 225 218 173 175
IV 188 183 184 214 253 226 281 277 267 271 265
V 130 135 129 133 120 122 118 113 131 134 110
VI 90 79 78 90 45 47 41 39 48 46 49
VII 105 106 101 97 93 94 92 91 93 92 86
VIII
74
74 75 74 74 74 68 69 68 62 64
IX 104 121 113 105 95 102 99 85 89 86 72
X 60 62 61 60 59 59 58 56 67 67 7
Total
1,122
1,142 1,148 1,181 1,134 1,181 1,117 1,091 1,128 1,060 867
Service Sites
I
221
228 238 225 233 224 225 221 242 214 52
II 272 263 253 256 251 247 244 244 241 237 61
III 641 639 633 627 615 648 640 653 626 614 606
IV 1,091 1,076 1,044 1,019 1,183 936 914 912 900 910 852
V 371 392 364 362 340 383 374 365 388 394 238
VI 580 553 521 571 442 457 425 415 468 466 488
VII 289 267 251 242 223 218 221 210 202 197 190
VIII 184 179 185 182 182 177 180 162 170 157 147
IX 495 539 474 460 441 461 469 465 478 391 355
X 245 246 226 224 217 200 206 211 239 245 42
Total 4,389 4,382 4,189 4,168 4,127 3,951 3,898 3,858 3,954 3,825 3,031
Family Planning Annual Report: 2020 National Summary A-3
Exhibit A–1b. Distribution of Title X-funded grantees, subrecipients, and service sites, by region and year: 2010–2020
Region 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Grantees
I
11% 12% 12% 12% 13% 12% 12% 12% 12% 10% 5%
II 8% 8% 8% 6% 6% 7% 7% 7% 8% 8% 9%
III 10% 10% 10% 11% 11% 11% 11% 11% 12% 12% 15%
IV 11% 11% 14% 14% 15% 11% 10% 10% 11% 12% 15%
V 13% 13% 12% 12% 11% 13% 12% 12% 13% 12% 11%
VI 7% 7% 6% 7% 6% 7% 8% 7% 8% 9% 11%
VII 6% 5% 5% 5% 5% 5% 5% 6% 5% 6% 7%
VIII 7% 7% 6% 6% 6% 7% 7% 7% 6% 6% 7%
IX 18% 19% 18% 19% 18% 19% 20% 19% 18% 19% 19%
X 9% 9% 9% 8% 9% 9% 9% 9% 6% 6% 3%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Subrecipients
I
6% 6% 6% 6% 6% 6% 6% 6% 7% 6% 2%
II 7% 7% 7% 6% 6% 6% 6% 6% 6% 6% 2%
III 19% 20% 23% 23% 23% 27% 20% 21% 19% 16% 20%
IV 17% 16% 16% 18% 22% 19% 25% 25% 24% 26% 31%
V 12% 12% 11% 11% 11% 10% 11% 10% 12% 13% 13%
VI 8% 7% 7% 8% 4% 4% 4% 4% 4% 4% 6%
VII 9% 9% 9% 8% 8% 8% 8% 8% 8% 9% 10%
VIII 7% 6% 7% 6% 7% 6% 6% 6% 6% 6% 7%
IX 9% 11% 10% 9% 8% 9% 9% 8% 8% 8% 8%
X 5% 5% 5% 5% 5% 5% 5% 5% 6% 6% 1%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Service Sites
I
5% 5% 6% 5% 6% 6% 6% 6% 6% 6% 2%
II 6% 6% 6% 6% 6% 6% 6% 6% 6% 6% 2%
III 15% 15% 15% 15% 15% 16% 16% 17% 16% 16% 20%
IV 25% 25% 25% 24% 29% 24% 23% 24% 23% 24% 28%
V 8% 9% 9% 9% 8% 10% 10% 9% 10% 10% 8%
VI 13% 13% 12% 14% 11% 12% 11% 11% 12% 12% 16%
VII 7% 6% 6% 6% 5% 6% 6% 5% 5% 5% 6%
VIII 4% 4% 4% 4% 4% 4% 5% 4% 4% 4% 5%
IX 11% 12% 11% 11% 11% 12% 12% 12% 12% 10% 12%
X 6% 6% 5% 5% 5% 5% 5% 5% 6% 6% 1%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
A-4 Family Planning Annual Report: 2020 National Summary
Exhibit A–1c. Number of Title X-funded service sites and users per service site, by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibits A–1a and A–1b.
Family Planning Annual Report: 2020 National Summary A-5
This page intentionally left blank.
A-6 Family Planning Annual Report: 2020 National Summary
Exhibit A–2a. Number and distribution of all family planning users, by region and year and number and percentage of all family planning users, by
sex and year: 2010–2020
Region 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
I 198,962 192,252 195,264 182,684 184,005 184,389 183,383 194,952 201,188 145,737 41,600
II 499,231 493,369 488,872 470,836 429,409 431,060 428,146 429,091 436,971 308,031 45,056
III 584,167 564,163 550,051 520,403 468,157 432,418 477,585 464,216 472,832 374,499 227,809
IV 989,770 940,931 907,020 852,400 770,501 660,156 669,743 677,146 642,224 648,599 498,230
V 492,359 472,062 434,587 401,935 377,552 390,446 390,541 391,901 403,080 295,108 86,424
VI 512,868 475,863 350,164 372,296 298,294 346,670 334,933 350,646 334,107 321,395 257,819
VII 214,032 205,167 186,716 167,286 148,405 140,055 135,907 120,759 116,928 110,363 79,238
VIII 176,892 169,311 163,068 152,248 137,509 131,031 124,021 126,922 131,148 104,814 63,438
IX 1,352,569 1,314,270 1,309,439 1,269,252 1,149,781 1,146,183 1,102,836 1,093,827 1,044,056 666,147 226,021
X 204,012 194,323 178,616 168,484 165,670 155,607 160,457 154,786 157,215 120,973 11,108
Total 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Female 4,822,570 4,635,195 4,378,744 4,184,587 3,764,622 3,607,353 3,553,018 3,541,235 3,446,504 2,690,552 1,326,994
Male 402,292 386,516 385,053 373,237 364,661 410,662 454,534 463,011 493,245 405,114 209,749
I 4% 4% 4% 4% 4% 5% 5% 5% 5% 5% 3%
II 10% 10% 10% 10% 10% 11% 11% 11% 11% 10% 3%
III 11% 11% 12% 11% 11% 11% 12% 12% 12% 12% 15%
IV 19% 19% 19% 19% 19% 16% 17% 17% 16% 21% 32%
V 9% 9% 9% 9% 9% 10% 10% 10% 10% 10% 6%
VI 10% 9% 7% 8% 7% 9% 8% 9% 8% 10% 17%
VII 4% 4% 4% 4% 4% 3% 3% 3% 3% 4% 5%
VIII 3% 3% 3% 3% 3% 3% 3% 3% 3% 3% 4%
IX 26% 26% 27% 28% 28% 29% 28% 27% 27% 22% 15%
X 4% 4% 4% 4% 4% 4% 4% 4% 4% 4% 1%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Female 92% 92% 92% 92% 91% 90% 89% 88% 87% 87% 86%
Male 8% 8% 8% 8% 9% 10% 11% 12% 13% 13% 14%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2020 National Summary A-7
Exhibit A–2b. Number and distribution of all family planning users, by region and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–2a.
Note: Due to rounding, percentages in each year may not sum to 100%.
A-8 Family Planning Annual Report: 2020 National Summary
Exhibit A–3a. Number and distribution of all family planning users, by age and year: 2010–2020
Age Group (Years) 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Under 15 73,383 59,351 53,012 45,633 45,863 46,045 58,649 49,060 53,998 47,836 30,052
15 to 17 466,284 423,702 368,965 327,152 298,839 280,785 275,499 271,429 264,389 206,305 104,384
18 to 19 616,709 560,848 505,356 454,044 404,197 379,710 373,253 373,235 363,399 276,270 123,286
20 to 24 1,600,833 1,508,215 1,405,487 1,320,188 1,169,948 1,091,549 1,043,071 1,013,943 970,356 724,585 316,426
25 to 29 1,071,999 1,058,256 1,023,503 999,476 912,130 887,225 876,921 877,588 841,832 629,510 281,216
30 to 34 607,257 621,119 616,259 622,258 573,010 570,708 572,573 580,833 573,004 460,181 233,315
35 to 39 359,749 358,400 351,820 355,877 331,439 344,385 359,108 374,756 380,153 320,185 175,455
40 to 44 215,914 222,429 222,621 220,836 200,955 204,360 211,324 220,748 225,997 202,397 121,464
Over 44 212,734 209,391 216,774 212,360 192,902 213,248 237,154 242,654 266,621 228,397 151,145
Total 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Under 15 1% 1% 1% 1% 1% 1% 1% 1% 1% 2% 2%
15 to 17 9% 8% 8% 7% 7% 7% 7% 7% 7% 7% 7%
18 to 19 12% 11% 11% 10% 10% 9% 9% 9% 9% 9% 8%
20 to 24 31% 30% 30% 29% 28% 27% 26% 25% 25% 23% 21%
25 to 29 21% 21% 21% 22% 22% 22% 22% 22% 21% 20% 18%
30 to 34 12% 12% 13% 14% 14% 14% 14% 15% 15% 15% 15%
35 to 39 7% 7% 7% 8% 8% 9% 9% 9% 10% 10% 11%
40 to 44 4% 4% 5% 5% 5% 5% 5% 6% 6% 7% 8%
Over 44 4% 4% 5% 5% 5% 5% 6% 6% 7% 7% 10%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2020 National Summary A-9
Exhibit A–3b. Number and distribution of all family planning users, by age and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–3a.
Notes: 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 was 1% each year from 2010 through 2018 and 2% each year in 2019 and 2020.
A-10 Family Planning Annual Report: 2020 National Summary
Exhibit A–4a. Number and distribution of all family planning users, by race and year: 2010–2020
Race 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
American Indian/Alaska Native 44,899 43,204 45,785 34,051 29,327 30,526 33,467 35,587 38,097 29,373 16,084
Asian 136,958 134,345 136,412 135,567 128,797 131,676 135,555 143,215 139,084 89,045 25,026
Black/African American 1,028,991 986,803 969,776 939,941 863,136 857,659 859,886 869,574 861,707 732,825 406,686
Native Hawaiian/Pacific Islander 65,662 70,929 70,519 52,263 39,266 40,941 35,479 31,019 29,545 22,327 13,265
White 3,015,861 2,864,253 2,664,736 2,530,204 2,238,847 2,142,835 2,174,833 2,150,480 2,076,854 1,677,624 905,460
More than one race 261,397 250,825 248,590 191,871 153,907 136,043 142,564 144,397 151,281 110,372 38,508
Unknown/not reported 671,094 671,352 627,979 673,927 676,003 678,335 625,768 629,974 643,181 434,100 131,714
Total All Users 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
American Indian/Alaska Native 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
Asian 3% 3% 3% 3% 3% 3% 3% 4% 4% 3% 2%
Black/African American 20% 20% 20% 21% 21% 21% 21% 22% 22% 24% 26%
Native Hawaiian/Pacific Islander 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
White 58% 57% 56% 56% 54% 53% 54% 54% 53% 54% 59%
More than one race 5% 5% 5% 4% 4% 3% 4% 4% 4% 4% 3%
Unknown/not reported 13% 13% 13% 15% 16% 17% 16% 16% 16% 14% 9%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2020 National Summary A-11
Exhibit A–4b. Number and distribution of all family planning users, by race and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–4a.
Notes: 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-12 Family Planning Annual Report: 2020 National Summary
Exhibit A–5a. Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2010–2020
Ethnicity 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Hispanic or Latino 1,493,007 1,451,215 1,349,528 1,344,601 1,237,652 1,276,765 1,269,988 1,324,817 1,306,370 1,036,801 534,055
Not Hispanic or Latino 3,618,285 3,416,314 3,277,828 3,093,545 2,786,005 2,617,597 2,600,742 2,553,416 2,453,448 1,920,228 947,561
Unknown/not reported 113,570 154,182 136,441 119,678 105,626 123,653 136,822 126,013 179,931 138,637 55,127
Total All Users 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Hispanic or Latino 29% 29% 28% 30% 30% 32% 32% 33% 33% 33% 35%
Not Hispanic or Latino 69% 68% 69% 68% 67% 65% 65% 64% 62% 62% 62%
Unknown/not reported 2% 3% 3% 3% 3% 3% 3% 3% 5% 4% 4%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2020 National Summary A-13
Exhibit A–5b. Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–5a.
Note: Due to rounding, percentages in each year may not sum to 100%.
A-14 Family Planning Annual Report: 2020 National Summary
Exhibit A–6a. Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2010–2020
Ethnicity and Race 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Not Hispanic or Latino
Asian
126,413 121,777 124,790 128,015 119,454 122,310 124,233 130,688 128,678 80,588 22,431
Black or African American 986,409 939,143 917,539 890,133 816,061 811,244 806,815 806,970 796,450 679,361 381,858
White 2,214,680 2,060,244 1,951,410 1,812,924 1,583,629 1,439,284 1,445,887 1,394,432 1,311,047 1,004,060 481,594
Other/unknown 290,783 295,150 284,089 262,473 266,861 244,759 223,807 221,326 217,273 156,219 61,678
Hispanic or Latino
All races 1,493,007 1,451,215 1,349,528 1,344,601 1,237,652 1,276,765 1,269,988 1,324,817 1,306,370 1,036,801
534,055
Unknown/Not Reported 113,570 154,182 136,441 119,678 105,626 123,653 136,822 126,013 179,931 138,637 55,127
Total All Users 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Not Hispanic or Latino
Asian
2% 2% 3% 3% 3% 3% 3% 3% 3% 3% 1%
Black or African American 19% 19% 19% 20% 20% 20% 20% 20% 20% 22% 25%
White 42% 41% 41% 40% 38% 36% 36% 35% 33% 32% 31%
Other/unknown 6% 6% 6% 6% 6% 6% 6% 6% 6% 5% 4%
Hispanic or Latino
All races
29% 29% 28% 30% 30% 32% 32% 33% 33% 33%
35%
Unknown/Not Reported 2% 3% 3% 3% 3% 3% 3% 3% 5% 4% 4%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Notes: 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: 2020 National Summary A-15
Exhibit A–6b. Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–6a.
NH=Not Hispanic or Latino.
Notes: 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/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.
The “Unknown” category includes users with unknown or not reported Hispanic or Latino ethnicity.
A-16 Family Planning Annual Report: 2020 National Summary
Exhibit A–7a. Number and distribution of all family planning users, by income level and year: 2010–2020
Income Level
a
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Under 101% 3,618,813 3,466,912 3,382,089 3,211,380 2,840,650 2,653,841 2,564,992 2,665,911 2,542,526 1,968,876 1,020,999
101% to 150% 795,065 731,410 649,462 636,484 572,948 556,141 575,420 551,163 566,040 426,239 187,565
151% to 200% 281,294 269,478 247,490 245,805 234,425 238,420 252,273 257,155 277,321 211,586 89,401
201% to 250% 125,298 116,188 103,061 103,246 100,402 105,975 128,874 123,477 134,010 103,816 43,152
Over 250% 250,440 250,829 230,947 222,718 226,918 255,093 297,988 277,975 289,208 226,957 89,329
Unknown/not reported 153,952 186,894 150,748 138,191 153,940 208,545 188,005 128,565 130,644 158,192 106,297
Total All Users 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Under 101% 69% 69% 71% 70% 69% 66% 64% 67% 65% 64% 66%
101% to 150% 15% 15% 14% 14% 14% 14% 14% 14% 14% 14% 12%
151% to 200% 5% 5% 5% 5% 6% 6% 6% 6% 7% 7% 6%
201% to 250% 2% 2% 2% 2% 2% 3% 3% 3% 3% 3% 3%
Over 250% 5% 5% 5% 5% 5% 6% 7% 7% 7% 7% 6%
Unknown/not reported 3% 4% 3% 3% 4% 5% 5% 3% 3% 5% 7%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 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 individual percentages
included in the aggregated categories.
a
Title X-funded grantees and subrecipients report users’ 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/.
Family Planning Annual Report: 2020 National Summary A-17
Exhibit A–7b. Number and distribution of all family planning users, by income level and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–7a.
Notes: Title X-funded grantees and subrecipients report users’ 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/. 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-18 Family Planning Annual Report: 2020 National Summary
Exhibit A–8a. Number and distribution of all family planning users, by primary health insurance status and year: 2010–2020
Primary Insurance 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Public insurance 1,184,795 1,236,343 1,121,372 1,131,406 1,215,648 1,395,201 1,499,672 1,511,533 1,502,777 1,186,684 616,012
Private insurance 438,042 429,919 447,341 453,535 559,845 621,066 715,090 760,051 794,535 607,961 293,557
Uninsured 3,483,360 3,230,784 3,050,415 2,865,672 2,239,377 1,934,154 1,737,488 1,675,825 1,580,113 1,255,337 593,562
Unknown/not reported 118,665 124,665 144,669 107,211 114,413 67,594 55,302 56,837 62,324 45,684 33,612
Total All Users 5,224,862 5,021,711 4,763,797 4,557,824 4,129,283 4,018,015 4,007,552 4,004,246 3,939,749 3,095,666 1,536,743
Public insurance 23% 25% 24% 25% 29% 35% 37% 38% 38% 38% 40%
Private insurance 8% 9% 9% 10% 14% 15% 18% 19% 20% 20% 19%
Uninsured 67% 64% 64% 63% 54% 48% 43% 42% 40% 41% 39%
Unknown/not reported 2% 2% 3% 2% 3% 2% 1% 1% 2% 1% 2%
Total All Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Note: Due to rounding, percentages in each year may not sum to 100%.
Family Planning Annual Report: 2020 National Summary A-19
Exhibit A–8b. Number and distribution of all family planning users, by primary health insurance status and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–8a.
Note: Due to rounding, percentages in each year may not sum to 100%.
A-20 Family Planning Annual Report: 2020 National Summary
Exhibit A–9a. Number of all female family planning users, by primary contraceptive method and year: 2010–2020
Primary Method 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Most Effective
a
Vasectomy 8,683 8,632 8,540 8,175 7,582 6,879 8,178 8,848 9,237 7,668 4,751
Sterilization
92,652 90,438 86,854 82,067 74,748 84,108 86,112 94,173 91,569 82,472 56,063
Hormonal implant
48,015 65,673 82,642 108,586 139,799 177,975 209,014 239,029 240,418 190,615 93,062
Intrauterine device
252,121 272,683 284,461 279,289 265,511 273,650 288,939 324,174 323,081 237,073 99,491
Moderately Effective
a
Hormonal injection
b
643,682 645,351 645,136 635,093 611,619 574,476 519,841 500,960 474,609 398,894 213,854
Vaginal ring
186,238 183,182 164,693 142,292 115,230 95,186 83,473 76,252 66,968 46,021 16,967
Contraceptive patch
93,499 89,795 83,145 78,547 69,469 49,010 47,030 48,256 46,384 32,714 12,193
Oral contraceptive
1,684,201 1,534,684 1,409,300 1,316,671 1,135,950 1,000,062 946,383 894,128 823,992 598,304 267,281
Cervical cap/diaphragm
4,402 3,390 4,116 8,245 2,379 1,660 2,130 2,219 1,652 877 299
Less Effective
a
Male condom 787,329 838,131 745,265 692,678 578,139 572,607 559,356 547,129 533,079 385,950 154,843
Female condom
5,944 5,939 3,722 3,914 3,308 3,558 2,929 2,537 3,782 3,159 2,061
Contraceptive sponge
1,581 921 765 541 651 660 138 169 371 377 236
Withdrawal or other
c
116,635 115,002 113,016 95,798 70,982 61,504 75,191 73,047 81,486 75,253 47,370
FAM
d
or LAM
14,379 17,105 12,676 11,753 12,648 13,503 14,392 15,287 17,320 17,370 10,107
Spermicide
8,346 7,061 4,926 4,028 2,911 1,873 1,848 1,991 1,135 995 696
Other
Abstinence 75,534 69,924 71,737 72,486 70,098 73,896 89,102 92,385 99,733 90,729 60,841
No Method
Pregnant/seeking pregnancy 400,194 361,056 377,547 356,750 330,279 321,229 321,706 313,802 279,025 207,880 101,318
Other reason
238,347 229,541 183,613 181,657 175,111 171,068 175,371 190,518 194,405 167,834 90,152
Method Unknown
160,788 96,687 96,590 106,017 98,208 124,449 121,885 116,331 158,258 146,367 95,409
Total Female Users
4,822,570 4,635,195 4,378,744 4,184,587 3,764,622 3,607,353 3,553,018 3,541,235 3,446,504 2,690,552 1,326,994
Using Most, Moderately, or Less
Effective Method 3,947,707 3,877,987 3,649,257 3,467,677 3,090,926 2,916,711 2,844,954 2,828,199 2,715,083 2,077,742 979,274
Most effective
a
401,471 437,426 462,497 478,117 487,640 542,612 592,243 666,224 664,305 517,828 253,367
Moderately effective
a
2,612,022 2,456,402 2,306,390 2,180,848 1,934,647 1,720,394 1,598,857 1,521,815 1,413,605 1,076,810 510,594
Less effective
a
934,214 984,159 880,370 808,712 668,639 653,705 653,854 640,160 637,173 483,104 215,313
Abstinent 75,534 69,924 71,737 72,486 70,098 73,896 89,102 92,385 99,733 90,729 60,841
Not Using a Method 638,541 590,597 561,160 538,407 505,390 492,297 497,077 504,320 473,430 375,714 191,470
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 2010, the FAM category includes Calendar Rhythm, Standard Days
®
, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2020, the FAM
category includes Calendar Rhythm, Standard Days
®
, TwoDay, Billings Ovulation, and SymptoThermal methods.
Family Planning Annual Report: 2020 National Summary A-21
Exhibit A–9b. Distribution of all female family planning users, by primary contraceptive method and year: 2010–2020
Primary Method 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Most Effective
a
Vasectomy 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Sterilization
2% 2% 2% 2% 2% 2% 2% 3% 3% 3% 4%
Hormonal implant
1% 1% 2% 3% 4% 5% 6% 7% 7% 7% 7%
Intrauterine device
5% 6% 6% 7% 7% 8% 8% 9% 9% 9% 7%
Moderately Effective
a
Hormonal injection
b
13% 14% 15% 15% 16% 16% 15% 14% 14% 15% 16%
Vaginal ring
4% 4% 4% 3% 3% 3% 2% 2% 2% 2% 1%
Contraceptive patch
2% 2% 2% 2% 2% 1% 1% 1% 1% 1% 1%
Oral contraceptive
35% 33% 32% 31% 30% 28% 27% 25% 24% 22% 20%
Cervical cap/diaphragm
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Less Effective
a
Male condom 16% 18% 17% 17% 15% 16% 16% 15% 15% 14% 12%
Female condom
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 other
c
2% 2% 3% 2% 2% 2% 2% 2% 2% 3% 4%
FAM
d
or LAM
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 1% 1%
Spermicide
0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Other
Abstinence 2% 2% 2% 2% 2% 2% 3% 3% 3% 3% 5%
No Method
Pregnant/seeking pregnancy 8% 8% 9% 9% 9% 9% 9% 9% 8% 8% 8%
Other reason
5% 5% 4% 4% 5% 5% 5% 5% 6% 6% 7%
Method Unknown
3% 2% 2% 3% 3% 3% 3% 3% 5% 5% 7%
Total Female Users
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or Less
Effective Method
82% 84% 83% 83% 82% 81% 80% 80% 79% 77% 74%
Most effective
a
8% 9% 11% 11% 13% 15% 17% 19% 19% 19% 19%
Moderately effective
a
54% 53% 53% 52% 51% 48% 45% 43% 41% 40% 38%
Less effective
a
19% 21% 20% 19% 18% 18% 18% 18% 18% 18% 16%
Abstinent 2% 2% 2% 2% 2% 2% 3% 3% 3% 3% 5%
Not Using a Method 13% 13% 13% 13% 13% 14% 14% 14% 14% 14% 14%
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 2010, the FAM category includes Calendar Rhythm, Standard Days
®
, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2020, the FAM
category includes Calendar Rhythm, Standard Days
®
, TwoDay, Billings Ovulation, and SymptoThermal methods.
† Percentage is less than 0.5%.
A-22 Family Planning Annual Report: 2020 National Summary
Exhibit A–9c. Number and distribution of all female family planning users, by type of primary contraceptive method and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibits A–9a and A–9b.
Notes: 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).
Family Planning Annual Report: 2020 National Summary A-23
This page intentionally left blank.
A-24 Family Planning Annual Report: 2020 National Summary
Exhibit A–10a. Number of all male family planning users, by primary contraceptive method and year: 2010–2020
Primary Contraceptive Method 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Vasectomy 4,676 4,409 5,132 3,619 2,763 3,309 3,296 3,402 3,933 2,913 1,613
Male condom 282,672 289,141 284,445 278,964 262,255 285,549 297,265 299,268 303,572 225,977 92,016
FAM
a
768 930 986 953 1,079 1,092 1,873 2,585 3,417 3,747 2,115
Abstinence
b
23,243 16,691 15,855 15,269 21,127 24,163 32,464 33,275 36,918 35,183 26,569
Withdrawal or other method 9,983 10,635 14,222 8,892 9,992 10,858 14,135 14,407 12,915 12,912 7,996
Rely on female method
c
35,606 22,534 26,233 22,128 22,063 22,173 28,729 33,625 34,905 32,507 21,711
No Method
Partner pregnant/seeking
pregnancy
3,630 3,160 3,565 2,900 3,253 4,981 5,730 5,997 3,967 4,916 2,614
Other reason 22,037 24,996 20,088 20,283 21,501 25,667 31,729 36,330 48,035 45,850 24,204
Method Unknown 19,677 14,020 14,527 20,229 20,628 32,870 39,313 34,122 45,583 41,109 30,911
Total Male Users 402,292 386,516 385,053 373,237 364,661 410,662 454,534 463,011 493,245 405,114 209,749
Using Most, Moderately, or Less
Effective Method
333,705 327,649 331,018 314,556 298,152 322,981 345,298 353,287 358,742 278,056 125,451
Abstinence
b
23,243 16,691 15,855 15,269 21,127 24,163 32,464 33,275 36,918 35,183 26,569
Not Using a Method 25,667 28,156 23,653 23,183 24,754 30,648 37,459 42,327 52,002 50,766 26,818
Method Unknown 19,677 14,020 14,527 20,229 20,628 32,870 39,313 34,122 45,583 41,109 30,911
FAM=fertility awareness-based method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods
b
User refrained from oral, vaginal, and anal intercourse.
c
Primary method of user’s sex partner was female sterilization, intrauterine device or system, 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.
Family Planning Annual Report: 2020 National Summary A-25
Exhibit A–10b. Distribution of all male family planning users, by primary contraceptive method and year: 2010–2020
Primary Contraceptive Method 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Vasectomy 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
Male condom 70% 75% 74% 75% 72% 70% 65% 65% 62% 56% 44%
FAM
a
0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 1% 1% 1%
Abstinence
b
6% 4% 4% 4% 6% 6% 7% 7% 7% 9% 13%
Withdrawal or other method 2% 3% 4% 2% 3% 3% 3% 3% 3% 3% 4%
Rely on female method
c
9% 6% 7% 6% 6% 5% 6% 7% 7% 8% 10%
No Method
Partner pregnant/seeking
pregnancy
1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%
Other reason 5% 6% 5% 5% 6% 6% 7% 8% 10% 11% 12%
Method Unknown 5% 4% 4% 5% 6% 8% 9% 7% 9% 10% 15%
Total Male Users 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Using Most, Moderately, or Less
Effective Method
83% 85% 86% 84%
82% 79% 76% 76% 73% 69% 60%
Abstinence
b
6% 4% 4% 4% 6% 6% 7% 7% 7% 9% 13%
Not Using a Method 6% 7% 6% 6% 7% 7% 8% 9% 11% 13% 13%
Method Unknown 5% 4% 4% 5% 6% 8% 9% 7% 9% 10% 15%
FAM=fertility awareness-based method.
a
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods
b
User refrained from oral, vaginal, and anal intercourse.
c
Primary method of user’s sex partner was female sterilization, intrauterine device or system, 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.
† Percentage is less than 0.5%.
A-26 Family Planning Annual Report: 2020 National Summary
Exhibit A–10c. Number and distribution of all male family planning users, by type of primary contraceptive method and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibits A–10a and A–10b.
Family Planning Annual Report: 2020 National Summary A-27
Exhibit A–11a. 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: 2010–2020
Screening Measures 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Female Users Screened
Number
1,727,251 1,444,418 1,237,328 988,114 785,540 743,683 687,373 649,266 625,808 541,661 297,037
Percentage 36% 31% 28% 24% 21% 21% 19% 18% 18% 20% 22%
Pap Tests Performed
Number
1,810,620 1,522,777 1,308,667 1,043,671 813,858 769,807 720,215 683,247 651,920 561,534 312,757
Percentage with an ASC or
higher result
13% 15% 14% 14% 14% 14% 14% 14% 14% 13% 13%
ASC=atypical squamous cells.
Exhibit A–11b. Number and percentage of female users who received a Pap test, by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–11a.
A-28 Family Planning Annual Report: 2020 National Summary
Exhibit A–12a. Number and percentage of female users under 25 tested for chlamydia, by year: 2010–2020
Chlamydia Testing Measures 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Number tested 1,442,176 1,357,231 1,268,269 1,181,534 1,011,474 955,775 953,273 939,250 900,603 644,080 264,100
Percentage tested
57% 58% 59% 60% 58% 59% 61% 61% 61% 58% 52%
Exhibit A–12b. Number and percentage of female users under 25 tested for chlamydia, by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–12a.
Family Planning Annual Report: 2020 National Summary A-29
This page intentionally left blank.
A-30 Family Planning Annual Report: 2020 National Summary
Exhibit A–13a. Number of gonorrhea, syphilis, and confidential HIV tests performed, number of tests per 10 users, and number of positive
confidential HIV tests and anonymous HIV tests, by year: 2010–2020
STD Tests 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Gonorrhea Tests
Female 2,471,475 2,470,645 2,409,406 2,285,723 1,966,864 1,885,899 1,989,889 2,073,331 2,004,847 1,476,781 658,240
Male 242,917 258,933 271,153 271,920 271,201 298,056 326,051 351,585 372,146 274,410 114,380
Total 2,714,392 2,729,578 2,680,559 2,557,643 2,238,065 2,183,955 2,315,940 2,424,916 2,376,993 1,751,191 772,620
Tests per 10 Users
Female 5.1 5.3 5.5 5.5 5.2 5.2 5.6 5.9 5.8 5.5 5.0
Male 6.0 6.7 7.0 7.3 7.4 7.3 7.2 7.6 7.5 6.8 5.5
Total 5.2 5.4 5.6 5.6 5.4 5.4 5.8 6.1 6.0 5.7 5.0
Syphilis Tests
Female 636,977 608,224 580,583 564,953 468,980 444,259 486,687 540,346 563,072 516,439 256,861
Male 115,807 135,557 133,957 122,620 121,135 132,447 149,155 168,815 189,216 158,325 68,952
Total 752,784 743,781 714,540 687,573 590,115 576,706 635,842 709,161 752,288 674,764 325,813
Tests per 10 Users
Female 1.3 1.3 1.3 1.4 1.2 1.2 1.4 1.5 1.6 1.9 1.9
Male 2.9 3.5 3.5 3.3 3.3 3.2 3.3 3.6 3.8 3.9 3.3
Total 1.4 1.5 1.5 1.5 1.4 1.4 1.6 1.8 1.9 2.2 2.1
Confidential HIV Tests
Female 927,005 1,080,909 1,036,695 989,872 822,723 869,678 902,905 917,623 946,231 745,213 328,495
Male 174,660 202,466 213,172 197,759 208,901 243,957 260,978 274,496 291,737 216,646 101,050
Total 1,101,665 1,283,375 1,249,867 1,187,631 1,031,624 1,113,635 1,163,883 1,192,119 1,237,968 961,859 429,545
Tests per 10 Users
Female 1.9 2.3 2.4 2.4 2.2 2.4 2.5 2.6 2.7 2.8 2.5
Male 4.3 5.2 5.5 5.3 5.7 5.9 5.7 5.9 5.9 5.3 4.8
Total 2.1 2.6 2.6 2.6 2.5 2.8 2.9 3.0 3.1 3.1 2.8
Positive Test Results 1,440 1,644 2,125 1,771 2,112 2,423 2,824 2,195 2,699 3,685 1,359
Anonymous HIV Tests 3,474 5,289 8,388 2,289 1,458 3,939 3,886 2,083 1,963 613 672
Family Planning Annual Report: 2020 National Summary A-31
Exhibit A–13b. Number of gonorrhea tests performed and number of tests per 10 users (all, female, and male), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–13a.
A-32 Family Planning Annual Report: 2020 National Summary
Exhibit A–13c. Number of syphilis tests performed and number of tests per 10 users (all, female, and male), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–13a.
Family Planning Annual Report: 2020 National Summary A-33
Exhibit A–13d. Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–13a.
A-34 Family Planning Annual Report: 2020 National Summary
Exhibit A–14a. Number and distribution of full-time equivalent (FTE) clinical services provider (CSP) staff and number and distribution of family
planning encounters, by type and year: 2010–2020
CSP Staffing and Utilization 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
FTEs by CSP Type
Number
Physician 474.0 506.4 538.2 578.3 563.5 768.5 779.6 819.9 836.7 884.0 779.0
PA/NP/CNM 2,151.2 2,142.3 2,140.4 2,112.6 2,052.5 2,256.9 2,511.8 2,465.7 2,514.0 2,449.6 1,733.7
Other 633.1 601.3 582.7 525.8 450.2 543.9 258.2 239.4 243.9 344.7 168.7
Total 3,258.3 3,250.0 3,261.3 3,216.8 3,066.2 3,569.2 3,549.6 3,525.0 3,594.6 3,678.3 2,681.4
Distribution
Physician
15% 16% 17% 18% 18% 22% 22% 23% 23% 24% 29%
PA/NP/CNM 66% 66% 66% 66% 67% 63% 71% 70% 70% 67% 65%
Other 19% 19% 18% 16% 15% 15% 7% 7% 7% 9% 6%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
FP Encounters by Staff Type
Number
With CSP
7,021,387 6,571,866 6,000,715 5,791,110 5,138,139 5,005,727 4,980,534 5,162,855 5,141,083 3,602,064 2,134,047
With non-CSP 2,745,349 2,783,447 2,628,104 2,379,041 2,076,893 1,878,836 1,710,025 1,477,446 1,331,384 1,071,605 576,673
Total 9,766,736 9,355,313 8,628,819 8,170,151 7,215,032 6,884,563 6,690,559 6,640,301 6,472,467 4,673,669 2,710,720
Distribution
With CSP
72% 70% 70% 71% 71% 73% 74% 78% 79% 77% 79%
With non-CSP 28% 30% 30% 29% 29% 27% 26% 22% 21% 23% 21%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
FP Encounters by Location
Number
In Person
9,766,736 9,355,313 8,628,819 8,170,151 7,215,032 6,884,563 6,690,559 6,640,301 6,472,467 4,673,669 2,421,037
Virtual/Telehealth
a
— — — — — — — — — — 289,683
Total 9,766,736 9,355,313 8,628,819 8,170,151 7,215,032 6,884,563 6,690,559 6,640,301 6,472,467 4,673,669 2,710,720
Distribution
In Person
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 89%
Virtual/Telehealth
a
— — — — — — — — — — 11%
Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Number of Encounters/user
With CSP
1.3 1.3 1.3 1.3 1.2 1.2 1.2 1.3 1.3 1.2 1.4
With non-CSP 0.5 0.6 0.6 0.5 0.5 0.5 0.4 0.4 0.3 0.3 0.4
Total 1.9 1.9 1.8 1.8 1.7 1.7 1.7 1.7 1.6 1.5 1.8
CSP Encounters/CSP FTE 2,155 2,022 1,840 1,800 1,676 1,402 1,403 1,465 1,430 979 796
a
In January 2021, OPA revised the Title X Family Planning Annual Report (FPAR): Forms and Instructions to capture the increase in virtual family planning encounters during the
COVID-19 pandemic. The number of virtual encounters reported in the 2020 FPAR National Summary is likely an underestimate because the data systems for some grantees and
subrecipients were not able to report these data by the 2020 FPAR due date (February 16, 2021).
— Not available.
Family Planning Annual Report: 2020 National Summary A-35
Exhibit A–14b. Number and distribution of clinical services provider (CSP) full-time equivalents (FTEs), by CSP type and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–14a.
CNM=certified nurse midwife; CSP=clinical services provider; FTE=full-time equivalent; NP=nurse practitioner; PA=physician assistant.
A-36 Family Planning Annual Report: 2020 National Summary
Exhibit A–14c. Number and distribution of family planning encounters, by type and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–14a.
CSP=clinical services provider.
Family Planning Annual Report: 2020 National Summary A-37
Exhibit A–15a. Actual and adjusted (constant 2020$ and 2010$) total, Title X, and Medicaid revenue, by year: 2010–2020
Revenue
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
2020
($)
Change
2010–
2020
2019–
2020
Total
Actual
a
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 1,321,225,497 1,036,300,250 605,007,858
−53% −42%
2020$
b
1,728,316,637 1,667,855,951 1,575,929,890 1,567,994,714 1,482,753,799 1,444,879,856 1,460,517,907 1,416,519,539 1,414,364,144 1,078,846,917 605,007,858 −65% −44%
2010$
b
1,293,835,909 1,248,574,408 1,179,757,597 1,173,817,241 1,110,005,001 1,081,652,171 1,093,358,979 1,060,421,341 1,058,807,789 807,636,085 452,915,210 −65% −44%
Title X
Actual
a
279,295,186 276,002,719 267,095,215 253,655,493 249,517,445 242,576,878 245,066,054 244,563,111 255,902,324 229,031,074 205,830,740
−26% −10%
2020$
b
373,084,804 357,797,188 334,011,281 309,586,501 297,429,344 281,738,683 274,241,427 266,972,555 273,941,937 238,434,245 205,830,740 −45% −14%
2010$
b
279,295,186 267,850,717 250,044,338 231,759,692 222,658,717 210,912,525 205,300,001 199,858,447 205,075,799 178,494,370 154,087,045 −45% −14%
Medicaid
c
Actual
a
482,175,678 506,887,574 499,181,475 508,494,458 493,061,463 503,186,368 505,508,702 496,501,892 521,679,227 370,902,048 150,632,808
−69% −59%
2020$
b
644,094,232 657,105,659 624,242,722 620,617,430 587,738,253 584,421,177 565,690,049 541,996,616 558,454,552 386,129,918 150,632,808
−77% −61%
2010$
b
482,175,678 491,916,168 467,314,630 464,600,698 439,987,003 437,503,805 423,481,486 405,744,335 418,064,918 289,060,895 112,765,295
−77% −61%
a
Revenue is shown in actual dollars (unadjusted) for each year.
b
Revenue is shown in constant 2020 dollars (2020$) and 2010 dollars (2010$), 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, https://data.bls.gov/cgi-bin/srgate).
c
Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
A-38 Family Planning Annual Report: 2020 National Summary
Exhibit A–15b. Total, Title X, and Medicaid adjusted (constant 2020$) revenue (in millions), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–15a.
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
Family Planning Annual Report: 2020 National Summary A-39
Exhibit A–15c. Total actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue (in millions), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–15a.
A-40 Family Planning Annual Report: 2020 National Summary
Exhibit A–15d. Title X actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue (in millions), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–15a.
Family Planning Annual Report: 2020 National Summary A-41
Exhibit A–15e. Medicaid actual (unadjusted) and adjusted (constant 2020$ and 2010$) revenue (in millions), by year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibit A–15a.
Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.
A-42 Family Planning Annual Report: 2020 National Summary
Exhibit A–16a. Total actual (unadjusted) project revenue, by revenue source and year: 2010–2020
Revenue Sources
2010
($)
2011
($)
2012
($)
2013
($)
2014
($)
2015
($)
2016
($)
2017
($)
2018
($)
2019
($)
2020
($)
Title X 279,295,186 276,002,719 267,095,215 253,655,493 249,517,445 242,576,878 245,066,054 244,563,111 255,902,324 229,031,074 205,830,740
Payment for Services
Client fees
84,540,815 72,156,363 70,400,120 69,425,823 53,170,034 47,872,483 52,876,599 52,367,880 54,674,193 40,051,795 19,491,605
Third-party payers
Medicaid
481,262,633 506,608,330 498,739,261 505,709,855 490,470,842 501,418,354 504,313,859 495,245,884 519,967,258 369,512,175 149,159,998
CHIP 913,045 279,244 442,214 2,784,603 2,590,621 1,768,014 1,194,843 1,256,008 1,711,969 1,389,873 1,472,810
Medicare 1,913,519 2,002,181 1,173,110 1,864,987 3,083,719 4,731,999 3,945,295 7,169,121 7,168,217 8,023,568 5,684,335
Other 2,466,949 4,088,072 3,743,183 10,848,382 10,202,966 14,230,460 10,540,646 11,445,695 12,052,800 12,299,248 13,038,796
Private 50,409,637 51,655,083 63,955,467 69,210,207 95,138,355 104,000,648 132,617,104 140,145,229 147,295,805 107,498,387 48,719,431
Subtotal 621,506,598 636,789,273 638,453,355 659,843,857 654,656,537 674,021,958 705,488,346 707,629,817 742,870,242 538,775,046 237,566,975
Other Revenue
MCH block grant
21,205,336 25,512,030 24,439,148 19,852,391 23,095,828 18,485,003 16,526,644 12,960,533 17,488,306 16,956,909 10,308,958
SS block grant 34,001,848 23,736,983 11,229,640 8,805,626 5,601,590 4,711,602 4,285,521 4,547,979 5,972,937 6,105,713 5,551,662
TANF 14,475,023 14,517,155 13,548,818 13,268,175 10,570,729 5,347,682 7,797,115 6,385,879 5,136,717 6,077,922 5,790,068
State government 135,464,470 125,392,165 117,468,476 131,054,838 120,974,720 119,983,576 133,484,660 119,036,286 134,279,658 109,977,858 60,597,168
Local government 91,289,586 84,214,372 87,010,991 93,770,370 80,388,864 73,018,511 66,637,455 69,199,630 43,605,003 30,059,604 25,008,232
BPHC 4,090,546 5,289,075 4,625,737 11,461,645 10,080,722 12,468,766 14,319,221 21,389,246 19,194,743 15,487,598 10,500,084
Other 92,507,316 95,120,838 96,335,555 93,002,768 89,015,512 93,426,923 111,534,633 111,905,640 96,775,567 83,828,526 43,853,971
Subtotal 393,034,125 373,782,618 354,658,365 371,215,813 339,727,965 327,442,063 354,585,249 345,425,193 322,452,931 268,494,130 161,610,143
Total Revenue
Actual
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 1,321,225,497 1,036,300,250 605,007,858
2020$
a
1,728,316,637 1,667,855,951 1,575,929,890 1,567,994,714 1,482,753,799 1,444,879,856 1,460,517,907 1,416,519,539 1,414,364,144 1,078,846,917 605,007,858
2010$
a
1,293,835,909 1,248,574,408 1,179,757,597 1,173,817,241 1,110,005,001 1,081,652,171 1,093,358,979 1,060,421,341 1,058,807,789 807,636,085 452,915,210
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 2020 dollars (2020$) and 2010 dollars (2010$), 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, https://data.bls.gov/cgi-bin/srgate).
Family Planning Annual Report: 2020 National Summary A-43
Exhibit A–16b. Distribution of total project revenue, by revenue source and year: 2010–2020
Revenue Sources 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Title X 22% 21% 21% 20% 20% 19% 19% 19% 19% 22% 34%
Payment for Services
Client fees
7% 6% 6% 5% 4% 4% 4% 4% 4% 4% 3%
Third-party payers
Medicaid 37% 39% 40% 39% 39% 40% 39% 38% 39% 36% 25%
CHIP 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%† 0%†
Medicare 0%† 0%† 0%† 0%† 0%† 0%† 0%† 1% 1% 1% 1%
Other 0%† 0%† 0%† 1% 1% 1% 1% 1% 1% 1% 2%
Private 4% 4% 5% 5% 8% 8% 10% 11% 11% 10% 8%
Subtotal 48% 49% 51% 51% 53% 54% 54% 55% 56% 52% 39%
Other Revenue
MCH block grant
2% 2% 2% 2% 2% 1% 1% 1% 1% 2% 2%
SS block grant 3% 2% 1% 1% 0%† 0%† 0%† 0%† 0%† 1% 1%
TANF 1% 1% 1% 1% 1% 0%† 1% 0%† 0%† 1% 1%
State government 10% 10% 9% 10% 10% 10% 10% 9% 10% 11% 10%
Local government 7% 7% 7% 7% 6% 6% 5% 5% 3% 3% 4%
BPHC 0%† 0%† 0%† 1% 1% 1% 1% 2% 1% 1% 2%
Other 7% 7% 8% 7% 7% 8% 9% 9% 7% 8% 7%
Subtotal 30% 29% 28% 29% 27% 26% 27% 27% 24% 26% 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-44 Family Planning Annual Report: 2020 National Summary
Exhibit A–16c. Amount (unadjusted) and distribution of total project revenue, by revenue source and year: 2010–2020
Note: The data in this graph are presented in tabular form in Exhibits A–16a and 16b.
Notes: 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.
Family Planning Annual Report: 2020 National Summary B-1
Appendix B
State Exhibits
B-2 Family Planning Annual Report: 2020 National Summary
Exhibit B–1. Number and distribution of all family planning users, by sex and state, and distribution of all
users, by state: 2020 (Source: FPAR Table 1)
State Female Male Total Female Male
State Users as %
of All Users
Alabama 45,396 101 45,497 100% 0%† 3%
Alaska 315 30 345 91% 9% 0%†
Arizona 12,287 3,334 15,621 79% 21% 1%
Arkansas 31,604 52 31,656 100% 0%† 2%
California 162,339 25,620 187,959 86% 14% 12%
Colorado 34,853 5,778 40,631 86% 14% 3%
Connecticut 5,345 2,550 7,895 68% 32% 1%
Delaware 8,488 1,584 10,072 84% 16% 1%
District of Columbia 33,477 15,322 48,799 69% 31% 3%
Florida 80,406 6,076 86,482 93% 7% 6%
Georgia 113,555 48,788 162,343 70% 30% 11%
Hawaii 0 0 0 — — 0%
Idaho 9,445 1,318 10,763 88% 12% 1%
Illinois 12,274 1,696 13,970 88% 12% 1%
Indiana 10,976 1,102 12,078 91% 9% 1%
Iowa 15,081 1,396 16,477 92% 8% 1%
Kansas 12,846 1,519 14,365 89% 11% 1%
Kentucky 24,173 4,229 28,402 85% 15% 2%
Louisiana 25,732 7,885 33,617 77% 23% 2%
Maine 0 0 0 — — 0%
Maryland 18,716 1,629 20,345 92% 8% 1%
Massachusetts 12,434 1,785 14,219 87% 13% 1%
Michigan 13,231 1,449 14,680 90% 10% 1%
Minnesota 953 1,333 2,286 42% 58% 0%†
Mississippi 30,068 823 30,891 97% 3% 2%
Missouri 24,772 3,849 28,621 87% 13% 2%
Montana 7,157 1,322 8,479 84% 16% 1%
Nebraska 16,479 3,296 19,775 83% 17% 1%
Nevada 11,190 1,737 12,927 87% 13% 1%
New Hampshire 463 20 483 96% 4% 0%†
New Jersey 26,236 2,413 28,649 92% 8% 2%
New Mexico 7,459 248 7,707 97% 3% 1%
New York 1,765 463 2,228 79% 21% 0%†
— Not applicable. (continued)
† Percentage is less than 0.5%.
Family Planning Annual Report: 2020 National Summary B-3
Exhibit B–1. Number and distribution of all family planning users, by sex and state, and distribution of all
users, by state: 2020 (Source: FPAR Table 1) (continued)
State Female Male Total Female Male
State Users as
% of All Users
North Carolina 61,091 104 61,195 100% 0%† 4%
North Dakota 3,829 954 4,783 80% 20% 0%†
Ohio 27,322 7,853 35,175 78% 22% 2%
Oklahoma 31,485 589 32,074 98% 2% 2%
Oregon 0 0 0 — — 0%
Pennsylvania 82,749 12,135 94,884 87% 13% 6%
Rhode Island 15,433 3,570 19,003 81% 19% 1%
South Carolina 30,395 6,398 36,793 83% 17% 2%
South Dakota 3,773 469 4,242 89% 11% 0%†
Tennessee 45,113 1,514 46,627 97% 3% 3%
Texas 134,468 18,297 152,765 88% 12% 10%
Utah 0 0 0 — — 0%
Vermont 0 0 0 — — 0%
Virginia 18,424 1,422 19,846 93% 7% 1%
Washington 0 0 0 — — 0%
West Virginia 30,921 2,942 33,863 91% 9% 2%
Wisconsin 6,830 1,405 8,235 83% 17% 1%
Wyoming 4,455 848 5,303 84% 16% 0%†
Territories & FAS
American Samoa
1,421 53 1,474 96% 4% 0%†
Comm. of the Northern
Mariana Islands
1,271 6 1,277 100% 0%† 0%†
Federated States of
Micronesia
2,803 620 3,423 82% 18% 0%†
Guam
235 25 260 90% 10% 0%†
Puerto Rico
9,763 1,593 11,356 86% 14% 1%
Republic of the
Marshall Islands
2,131 9 2,140 100% 0%† 0%†
Republic of Palau 847 93 940 90% 10% 0%†
U.S. Virgin Islands 2,720 103 2,823 96% 4% 0%†
Total All Users 1,326,994 209,749 1,536,743 86% 14% 100%
Range 42%–100% 0%†–58% 0%–12%
FAS=Freely Associated States.
— Not applicable.
† Percentage is less than 0.5%.
B-4 Family Planning Annual Report: 2020 National Summary
Exhibit B–2. Number and distribution of all family planning users, by user income level and state: 2020
(Source: FPAR Table 4)
State
Under
101%
101%
to 250%
Over
250% UK/NR Total
Under
101%
101%
to 250%
Over
250%
UK/NR
Alabama 23,120 8,440 1,129 12,808 45,497 51% 19% 2% 28%
Alaska 160 146 38 1 345 46% 42% 11% 0%†
Arizona 9,910 3,599 683 1,429 15,621 63% 23% 4% 9%
Arkansas 23,565 7,403 687 1 31,656 74% 23% 2% 0%†
California 124,177 33,859 3,096 26,827 187,959 66% 18% 2% 14%
Colorado 31,472 7,615 1,544 0 40,631 77% 19% 4% 0%
Connecticut 7,581 302 12 0 7,895 96% 4% 0%† 0%
Delaware 6,274 2,278 140 1,380 10,072 62% 23% 1% 14%
District of Columbia 31,931 10,282 2,173 4,413 48,799 65% 21% 4% 9%
Florida 66,299 17,605 2,039 539 86,482 77% 20% 2% 1%
Georgia 101,741 30,752 24,367 5,483 162,343 63% 19% 15% 3%
Hawaii 0 0 0 0 0 — — — —
Idaho 6,083 3,884 796 0 10,763 57% 36% 7% 0%
Illinois 11,136 2,573 251 10 13,970 80% 18% 2% 0%†
Indiana 8,263 3,254 561 0 12,078 68% 27% 5% 0%
Iowa 11,230 3,962 786 499 16,477 68% 24% 5% 3%
Kansas 8,793 4,098 1,011 463 14,365 61% 29% 7% 3%
Kentucky 19,421 5,618 1,033 2,330 28,402 68% 20% 4% 8%
Louisiana 21,959 7,118 815 3,725 33,617 65% 21% 2% 11%
Maine 0 0 0 0 0 — — — —
Maryland 12,368 3,768 589 3,620 20,345 61% 19% 3% 18%
Massachusetts 11,244 1,792 1,098 85 14,219 79% 13% 8% 1%
Michigan 8,898 4,290 975 517 14,680 61% 29% 7% 4%
Minnesota 1,740 355 151 40 2,286 76% 16% 7% 2%
Mississippi 17,210 3,151 286 10,244 30,891 56% 10% 1% 33%
Missouri 16,668 7,532 4,421 0 28,621 58% 26% 15% 0%
Montana 3,430 2,924 1,920 205 8,479 40% 34% 23% 2%
Nebraska 12,174 5,039 1,991 571 19,775 62% 25% 10% 3%
Nevada 6,451 4,311 924 1,241 12,927 50% 33% 7% 10%
New Hampshire 232 192 59 0 483 48% 40% 12% 0%
New Jersey 17,291 10,173 504 681 28,649 60% 36% 2% 2%
New Mexico 6,301 1,311 57 38 7,707 82% 17% 1% 0%†
New York 1,638 243 95 252 2,228 74% 11% 4% 11%
UK/NR=unknown or not reported. (continued)
— Not applicable.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2020 National Summary B-5
Exhibit B–2. Number and distribution of all family planning users, by user income level and state: 2020
(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 36,766 16,261 5,721 2,447 61,195 60% 27% 9% 4%
North Dakota 1,925 1,608 1,085 165 4,783 40% 34% 23% 3%
Ohio 22,006 10,490 2,484 195 35,175 63% 30% 7% 1%
Oklahoma 22,029 9,004 834 207 32,074 69% 28% 3% 1%
Oregon 0 0 0 0 0 — — — —
Pennsylvania 64,769 18,607 5,972 5,536 94,884 68% 20% 6% 6%
Rhode Island 8,499 3,023 3,427 4,054 19,003 45% 16% 18% 21%
South Carolina 23,183 9,310 4,300 0 36,793 63% 25% 12% 0%
South Dakota 2,441 1,062 675 64 4,242 58% 25% 16% 2%
Tennessee 34,709 10,319 1,549 50 46,627 74% 22% 3% 0%†
Texas 117,816 24,520 2,987 7,442 152,765 77% 16% 2% 5%
Utah 0 0 0 0 0 — — — —
Vermont 0 0 0 0 0 — — — —
Virginia 13,254 4,941 1,293 358 19,846 67% 25% 7% 2%
Washington 0 0 0 0 0 — — — —
West Virginia 18,264 7,803 2,269 5,527 33,863 54% 23% 7% 16%
Wisconsin 2,968 2,014 963 2,290 8,235 36% 24% 12% 28%
Wyoming 2,589 1,504 1,210 0 5,303 49% 28% 23% 0%
Territories & FAS
American Samoa
1,474 0 0 0 1,474 100% 0% 0% 0%
Comm. of the Northern
Mariana Islands
912 15 5 345 1,277 71% 1% 0%† 27%
Federated States of
Micronesia
3,423 0 0 0 3,423 100% 0% 0% 0%
Guam 251 2 1 6 260 97% 1% 0%† 2%
Puerto Rico 10,548 489 304 15 11,356 93% 4% 3% 0%†
Republic of the
Marshall Islands
2,140 0 0 0 2,140 100% 0% 0% 0%
Republic of Palau 528 199 19 194 940 56% 21% 2% 21%
U.S. Virgin Islands 1,745 1,078 0 0 2,823 62% 38% 0% 0%
Total All Users 1,020,999 320,118 89,329 106,297 1,536,743 66% 21% 6% 7%
Range 36%–100% 0%–42% 0%–23% 0%–33%
UK/NR=unknown or not reported. FAS=Freely Associated States.
Notes: 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 https://aspe.hhs.gov/poverty/
.
— Not applicable.
† Percentage is less than 0.5%.
B-6 Family Planning Annual Report: 2020 National Summary
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2020
(Source: FPAR Table 5)
State Public Private
Uninsured
UK/NR Total Public Private Uninsured UK/NR
Alabama 11,709 8,092 25,684 12 45,497 26% 18% 56% 0%†
Alaska 98 103 144 0 345 28% 30% 42% 0%
Arizona 3,887 2,685 9,049 0 15,621 25% 17% 58% 0%
Arkansas 13,395 10,709 7,552 0 31,656 42% 34% 24% 0%
California 110,239 9,013 59,804 8,903 187,959 59% 5% 32% 5%
Colorado 16,491 6,163 17,579 398 40,631 41% 15% 43% 1%
Connecticut 5,511 1,236 1,148 0 7,895 70% 16% 15% 0%
Delaware 4,112 2,304 3,009 647 10,072 41% 23% 30% 6%
District of Columbia 34,762 4,135 9,890 12 48,799 71% 8% 20% 0%†
Florida 44,393 18,090 23,632 367 86,482 51% 21% 27% 0%†
Georgia 49,473 52,648 57,924 2,298 162,343 30% 32% 36% 1%
Hawaii 0 0 0 0 0 — — — —
Idaho 2,754 1,065 4,693 2,251 10,763 26% 10% 44% 21%
Illinois 6,908 2,977 4,083 2 13,970 49% 21% 29% 0%†
Indiana 3,469 2,422 6,187 0 12,078 29% 20% 51% 0%
Iowa 6,162 5,832 4,295 188 16,477 37% 35% 26% 1%
Kansas 1,533 3,167 9,522 143 14,365 11% 22% 66% 1%
Kentucky 13,155 5,944 8,496 807 28,402 46% 21% 30% 3%
Louisiana 19,934 5,314 8,189 180 33,617 59% 16% 24% 1%
Maine 0 0 0 0 0 — — — —
Maryland 5,675 4,557 9,639 474 20,345 28% 22% 47% 2%
Massachusetts 8,318 4,463 1,388 50 14,219 58% 31% 10% 0%†
Michigan 6,413 3,989 4,173 105 14,680 44% 27% 28% 1%
Minnesota 466 159 1,661 0 2,286 20% 7% 73% 0%
Mississippi 11,178 2,876 16,721 116 30,891 36% 9% 54% 0%†
Missouri 5,176 7,519 15,926 0 28,621 18% 26% 56% 0%
Montana 1,962 3,784 2,575 158 8,479 23% 45% 30% 2%
Nebraska 2,921 4,533 12,320 1 19,775 15% 23% 62% 0%†
Nevada 3,934 2,749 6,063 181 12,927 30% 21% 47% 1%
New Hampshire 230 137 116 0 483 48% 28% 24% 0%
New Jersey 11,934 6,838 9,643 234 28,649 42% 24% 34% 1%
New Mexico 2,054 784 4,837 32 7,707 27% 10% 63% 0%†
New York 1,411 365 452 0 2,228 63% 16% 20% 0%
UK/NR=unknown or not reported. (continued)
— Not applicable.
† Percentage is less than 0.5%.
Family Planning Annual Report: 2020 National Summary B-7
Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2020
(Source: FPAR Table 5) (continued)
State Public Private Uninsured UK/NR Total Public Private Uninsured UK/NR
North Carolina 25,525 8,080 25,337 2,253 61,195 42% 13% 41% 4%
North Dakota 444 2,543 1,793 3 4,783 9% 53% 37% 0%†
Ohio 14,711 7,543 12,271 650 35,175 42% 21% 35% 2%
Oklahoma 5,876 4,800 21,398 0 32,074 18% 15% 67% 0%
Oregon 0 0 0 0 0 — — — —
Pennsylvania 47,381 25,132 19,202 3,169 94,884 50% 26% 20% 3%
Rhode Island 11,705 5,388 1,861 49 19,003 62% 28% 10% 0%†
South Carolina 16,455 14,610 5,728 0 36,793 45% 40% 16% 0%
South Dakota 527 1,314 2,401 0 4,242 12% 31% 57% 0%
Tennessee 15,124 5,467 26,026 10 46,627 32% 12% 56% 0%†
Texas 33,680 10,415 103,828 4,842 152,765 22% 7% 68% 3%
Utah 0 0 0 0 0 — — — —
Vermont 0 0 0 0 0 — — — —
Virginia 6,416 6,651 3,693 3,086 19,846 32% 34% 19% 16%
Washington 0 0 0 0 0 — — — —
West Virginia 12,524 10,868 10,332 139 33,863 37% 32% 31% 0%†
Wisconsin 4,347 779 1,658 1,451 8,235 53% 9% 20% 18%
Wyoming 368 1,554 3,345 36 5,303 7% 29% 63% 1%
Territories & FAS
American Samoa
0 0 1,474 0 1,474 0% 0% 100% 0%
Comm. of the Northern
Mariana Islands
706 237 314 20 1,277 55% 19% 25% 2%
Federated States of
Micronesia
586 12 2,567 258 3,423 17% 0%† 75% 8%
Guam 32 5 155 68 260 12% 2% 60% 26%
Puerto Rico 7,408 3,121 818 9 11,356 65% 27% 7% 0%†
Republic of the Marshall
Islands
0 0 2,140 0 2,140 0% 0% 100% 0%
Republic of Palau 893 8 29 10 940 95% 1% 3% 1%
U.S. Virgin Islands 1,647 378 798 0 2,823 58% 13% 28% 0%
Total Users 616,012 293,557 593,562 33,612 1,536,743 40% 19% 39% 2%
Range 0%–95% 0%–53% 3%–100% 0%–26%
UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: Due to rounding, the percentages may not sum to 100%.
— Not applicable.
† Percentage is less than 0.5%.
B-8 Family Planning Annual Report: 2020 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 status of the states’ Medicaid expansion under the
Affordable Care Act (ACA): 2020 (Source: FPAR Table 5)
State Public Private Uninsured UK/NR Total Public Private Uninsured UK/NR
Expansion States
Alaska
a
98 103 144 0 345 28% 30% 42% 0%
Arizona
b
3,887 2,685 9,049 0 15,621 25% 17% 58% 0%
Arkansas
b
13,395 10,709 7,552 0 31,656 42% 34% 24% 0%
California 110,239 9,013 59,804 8,903 187,959 59% 5% 32% 5%
Colorado 16,491 6,163 17,579 398 40,631 41% 15% 43% 1%
Connecticut 5,511 1,236 1,148 0 7,895 70% 16% 15% 0%
Delaware 4,112 2,304 3,009 647 10,072 41% 23% 30% 6%
District of Columbia 34,762 4,135 9,890 12 48,799 71% 8% 20% 0%
Hawaii 0 0 0 0 0 — — — —
Idaho
a,c
2,754 1,065 4,693 2,251 10,763 26% 10% 44% 21%
Illinois 6,908 2,977 4,083 2 13,970 49% 21% 29% 0%†
Indiana
a,b
3,469 2,422 6,187 0 12,078 29% 20% 51% 0%
Iowa
b
6,162 5,832 4,295 188 16,477 37% 35% 26% 1%
Kentucky 13,155 5,944 8,496 807 28,402 46% 21% 30% 3%
Louisiana
a
19,934 5,314 8,189 180 33,617 59% 16% 24% 1%
Maine
a
0 0 0 0 0 — — — —
Maryland 5,675 4,557 9,639 474 20,345 28% 22% 47% 2%
Massachusetts 8,318 4,463 1,388 50 14,219 58% 31% 10% 0%†
Michigan
a,b
6,413 3,989 4,173 105 14,680 44% 27% 28% 1%
Minnesota 466 159 1,661 0 2,286 20% 7% 73% 0%
Montana
a,b,c
1,962 3,784 2,575 158 8,479 23% 45% 30% 2%
Nebraska
a,c
2,921 4,533 12,320 1 19,775 15% 23% 62% 0%†
Nevada 3,934 2,749 6,063 181 12,927 30% 21% 47% 1%
New Hampshire
a,b
230 137 116 0 483 48% 28% 24% 0%
New Jersey 11,934 6,838 9,643 234 28,649 42% 24% 34% 1%
New Mexico
b
2,054 784 4,837 32 7,707 27% 10% 63% 0%†
New York 1,411 365 452 0 2,228 63% 16% 20% 0%
North Dakota 444 2,543 1,793 3 4,783 9% 53% 37% 0%†
Ohio
b
14,711 7,543 12,271 650 35,175 42% 21% 35% 2%
Oregon 0 0 0 0 0 — — — —
Pennsylvania
a
47,381 25,132 19,202 3,169 94,884 50% 26% 20% 3%
Rhode Island 11,705 5,388 1,861 49 19,003 62% 28% 10% 0%†
Utah
a,b,c
0 0 0 0 0 — — — —
Vermont 0 0 0 0 0 — — — —
Virginia
a
6,416 6,651 3,693 3,086 19,846 32% 34% 19% 16%
Washington 0 0 0 0 0 — — — —
West Virginia 12,524 10,868 10,332 139 33,863 37% 32% 31% 0%†
Expansion States
Subtotal
379,376 150,385 246,137 21,719 797,617 48% 19% 31% 3%
Range 9%–71% 5%–53% 10%–73% 0%–21%
UK/NR=unknown or not reported. — Not applicable. † Percentage is less than 0.5%. (continued)
a
Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted the Medicaid expansion
except for the following: Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska
(9/1/2015), Montana (1/1/2016), Louisiana (7/1/2016), Virginia (1/1/2019), Maine (1/10/2019 with coverage retroactive to 7/2/2018),
Idaho (1/1/2020), Utah (1/1/2020), and Nebraska (10/1/2020). The following states adopted Medicaid expansion after the 2020
reporting period: Oklahoma (implementation planned for 7/1/2021) and Missouri (implementation planned for 7/1/2021) [see
reference 38].
b
Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah have approved Section
1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law [see reference 38].
c
See reference 38 for updates on the status of Medicaid expansion in this state.
Family Planning Annual Report: 2020 National Summary B-9
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 status of the states’ Medicaid expansion under the
Affordable Care Act (ACA): 2020 (Source: FPAR Table 5) (continued)
State Public Private Uninsured UK/NR Total Public Private Uninsured UK/NR
Nonexpansion States
Alabama
11,709 8,092 25,684 12 45,497 26% 18% 56% 0%†
Florida
c
44,393 18,090 23,632 367 86,482 51% 21% 27% 0%†
Georgia
c
49,473 52,648 57,924 2,298 162,343 30% 32% 36% 1%
Kansas
c
1,533 3,167 9,522 143 14,365 11% 22% 66% 1%
Mississippi
c
11,178 2,876 16,721 116 30,891 36% 9% 54% 0%†
Missouri
a,c
5,176 7,519 15,926 0 28,621 18% 26% 56% 0%
North Carolina
c
25,525 8,080 25,337 2,253 61,195 42% 13% 41% 4%
Oklahoma
a,c
5,876 4,800 21,398 0 32,074 18% 15% 67% 0%
South Carolina
c
16,455 14,610 5,728 0 36,793 45% 40% 16% 0%
South Dakota
c
527 1,314 2,401 0 4,242 12% 31% 57% 0%
Tennessee 15,124 5,467 26,026 10 46,627 32% 12% 56% 0%†
Texas 33,680 10,415 103,828 4,842 152,765 22% 7% 68% 3%
Wisconsin
c
4,347 779 1,658 1,451 8,235 53% 9% 20% 18%
Wyoming 368 1,554 3,345 36 5,303 7% 29% 63% 1%
Nonexpansion States
Subtotal 225,364 139,411 339,130 11,528 715,433 32% 19% 47% 2%
Range
7%–53% 7%–40% 16%–68% 0%–18%
All States
Total
604,740 289,796 585,267 33,247 1,513,050 40% 19% 39% 2%
Range
7%–71% 5%–53% 10%–73% 0%–21%
UK/NR=unknown or not reported.
Note: Due to rounding, the percentages may not sum to 100%.
a
Coverage under the Medicaid expansion became effective January 1, 2014 in all states that have adopted the Medicaid expansion
except for the following: Michigan (4/1/2014), New Hampshire (8/15/2014), Pennsylvania (1/1/2015), Indiana (2/1/2015), Alaska
(9/1/2015), Montana (1/1/2016), Louisiana (7/1/2016), Virginia (1/1/2019), Maine (1/10/2019 with coverage retroactive to 7/2/2018),
Idaho (1/1/2020), Utah (1/1/2020), and Nebraska (10/1/2020). The following states adopted Medicaid expansion after the 2020
reporting period: Oklahoma (implementation planned for 7/1/2021) and Missouri (implementation planned for 7/1/2021) [see
reference 38].
b
Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah have approved Section
1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law [see reference 38].
c
See reference 38 for updates on the status of Medicaid expansion in this state.
† Percentage is less than 0.5%.
B-10 Family Planning Annual Report: 2020 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:
2020 (Source: FPAR Table 7)
State
Most
Effective
Permanent
Methods
a
Most
Effective
Reversible
Methods
a
Moderately
Effective
Methods
b
Less
Effective
Methods
c
Total
At Risk
d
Most
Effective
Methods
a
Moderately
Effective
Methods
b
Less
Effective
Methods
c
Alabama
95 2,473 20,602 4,505 42,264 6% 49% 11%
Alaska
5 123 99 34 272 47% 36% 13%
Arizona
119 2,613 4,594 1,634 10,817 25% 42% 15%
Arkansas
1,695 5,309 16,044 2,396 27,465 26% 58% 9%
California
9,306 29,209 41,168 32,811 145,782 26% 28% 23%
Colorado
353 11,084 14,235 3,430 31,849 36% 45% 11%
Connecticut
441 561 698 749 4,076 25% 17% 18%
Delaware
387 1,435 3,510 1,158 7,521 24% 47% 15%
District of Columbia
812 4,456 6,652 1,578 29,280 18% 23% 5%
Florida
1,062 9,972 41,642 8,767 66,655 17% 62% 13%
Georgia
14,581 10,344 17,418 28,004 90,803 27% 19% 31%
Hawaii
0 0 0 0 0 — — —
Idaho
391 1,669 3,677 1,122 7,753 27% 47% 14%
Illinois
158 1,221 3,512 2,317 10,506 13% 33% 22%
Indiana
387 2,162 5,897 1,319 9,985 26% 59% 13%
Iowa
618 3,649 6,187 1,469 12,839 33% 48% 11%
Kansas
466 1,479 7,255 1,386 12,015 16% 60% 12%
Kentucky
487 2,108 9,227 8,725 21,149 12% 44% 41%
Louisiana
1,909 2,452 11,466 3,585 22,412 19% 51% 16%
Maine
0 0 0 0 0 — — —
Maryland
380 3,023 7,182 2,578 17,411 20% 41% 15%
Massachusetts
147 2,077 3,938 1,406 10,459 21% 38% 13%
Michigan
285 1,348 8,610 1,300 12,129 13% 71% 11%
Minnesota
21 163 189 288 877 21% 22% 33%
Mississippi
2 167 12,835 160 29,963 1% 43% 1%
Missouri
1,271 3,951 12,185 3,526 21,754 24% 56% 16%
Montana
289 2,089 3,037 1,125 6,616 36% 46% 17%
Nebraska
1,078 4,940 3,862 2,780 14,471 42% 27% 19%
Nevada
205 1,957 4,268 1,265 10,389 21% 41% 12%
New Hampshire
29 92 263 31 432 28% 61% 7%
New Jersey
1,188 4,036 7,564 7,498 22,502 23% 34% 33%
New Mexico
95 2,129 3,864 240 6,567 34% 59% 4%
New York
32 130 209 234 1,484 11% 14% 16%
— Not applicable. (continued)
Family Planning Annual Report: 2020 National Summary B-11
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:
2020 (continued)
State
Most
Effective
Permanent
Methods
b
Most
Effective
Reversible
Methods
b
Moderately
Effective
Methods
c
Less
Effective
Methods
d
Total
At Risk
a
Most
Effective
Methods
b
Moderately
Effective
Methods
c
Less
Effective
Methods
d
North Carolina
488 11,047 31,229 7,695 55,019 21% 57% 14%
North Dakota
142 773 2,066 448 3,547 26% 58% 13%
Ohio
2,626 3,554 10,718 3,624 24,515 25% 44% 15%
Oklahoma
120 4,848 16,952 3,222 26,291 19% 64% 12%
Oregon
0 0 0 0 0 — — —
Pennsylvania
4,291 10,240 28,110 13,575 70,785 21% 40% 19%
Rhode Island
1,720 2,761 4,406 1,772 12,246 37% 36% 14%
South Carolina
258 3,621 18,643 4,894 27,416 14% 68% 18%
South Dakota
50 619 2,402 248 3,619 18% 66% 7%
Tennessee
156 4,773 24,105 4,534 33,915 15% 71% 13%
Texas
9,101 20,570 47,252 38,190 123,431 24% 38% 31%
Utah
0 0 0 0 0 — — —
Vermont
0 0 0 0 0 — — —
Virginia
570 3,505 9,752 1,863 16,682 24% 58% 11%
Washington
0 0 0 0 0 — — —
West Virginia
2,229 4,420 15,441 2,554 27,769 24% 56% 9%
Wisconsin
97 878 2,719 891 6,748 14% 40% 13%
Wyoming
228 722 2,255 605 4,237 22% 53% 14%
Territories & FAS
American Samoa
22 77 552 427 1,322 7% 42% 32%
Comm. of the Northern
Mariana Islands
4 245 850 37 1,191 21% 71% 3%
Federated States of
Micronesia
47 320 1,209 343 2,636 14% 46% 13%
Guam
0 0 99 33 153 0% 65% 22%
Puerto Rico
76 565 6,982 2,008 9,697 7% 72% 21%
Republic of the
Marshall Islands
95 469 805 7 1,622 35% 50% 0%†
Republic of Palau
6 7 622 117 843 2% 74% 14%
U.S. Virgin Islands
194 118 1,536 806 2,654 12% 58% 30%
Total Users 60,814 192,553 510,594 215,313 1,164,835 22% 44% 18%
Range 0%–47% 14%–74% 0%†–41%
FAS=Freely Associated States.
Notes: 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.
— Not applicable.
B-12 Family Planning Annual Report: 2020 National Summary
Exhibit B–5. Number and percentage of female family planning users under 25 years who were tested for
chlamydia, by state: 2020 (Source: FPAR Table 11)
State
Female Users
Under 25 Years
Tested for Chlamydia
Female Users
Under 25 Years
% of Female Users
Under 25 Years
Tested for Chlamydia
Alabama
12,537 19,996 63%
Alaska
82 125 66%
Arizona
3,466 5,155 67%
Arkansas
9,657 14,295 68%
California
26,716 48,418 55%
Colorado
6,160 16,403 38%
Connecticut
813 1,594 51%
Delaware
1,629 3,975 41%
District of Columbia
4,476 10,142 44%
Florida
12,721 31,880 40%
Georgia
13,607 33,299 41%
Hawaii
0 0 —
Idaho
1,270 3,801 33%
Illinois
2,789 4,086 68%
Indiana
3,360 4,217 80%
Iowa
3,839 5,898 65%
Kansas
2,550 4,992 51%
Kentucky
4,446 10,888 41%
Louisiana
6,011 9,369 64%
Maine
0 0 —
Maryland
2,284 5,918 39%
Massachusetts
2,534 5,576 45%
Michigan
4,069 6,285 65%
Minnesota
260 313 83%
Mississippi
5,862 13,719 43%
Missouri
6,923 12,052 57%
Montana
2,406 3,885 62%
Nebraska
4,649 6,641 70%
Nevada
2,423 4,018 60%
New Hampshire
74 197 38%
New Jersey
4,550 7,256 63%
New Mexico
2,330 3,582 65%
New York
238 408 58%
— Not applicable. (continued)
Family Planning Annual Report: 2020 National Summary B-13
Exhibit B–5. Number and percentage of female family planning users under 25 years who were tested for
chlamydia, by state: 2020 (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
11,133 20,580 54%
North Dakota
1,029 1,763 58%
Ohio
6,265 10,749 58%
Oklahoma
9,140 15,831 58%
Oregon
0 0 —
Pennsylvania
15,613 35,383 44%
Rhode Island
1,913 5,216 37%
South Carolina
8,578 12,547 68%
South Dakota
939 1,812 52%
Tennessee
14,757 21,401 69%
Texas
25,075 45,109 56%
Utah
0 0 —
Vermont
0 0 —
Virginia
4,653 6,325 74%
Washington
0 0 —
West Virginia
4,888 13,862 35%
Wisconsin
1,436 3,529 41%
Wyoming
1,199 2,212 54%
Territories & FAS
American Samoa
28 363 8%
Comm. of the Northern Mariana
Islands
116 522 22%
Federated States of Micronesia
483 1,036 47%
Guam
99 115 86%
Puerto Rico
1,730 4,762 36%
Republic of the Marshall Islands
14 908 2%
Republic of Palau 13 264 5%
U.S. Virgin Islands 268 788 34%
Total Users 264,100 503,460 52%
Range
2%–86%
FAS=Freely Associated States.
— Not applicable.
B-14 Family Planning Annual Report: 2020 National Summary
This page intentionally left blank.
Family Planning Annual Report: 2020 National Summary C-1
Appendix C
Field and Methodological Notes
C-2 Family Planning Annual Report: 2020 National Summary
INTRODUCTION
This appendix presents additional information about the 2020 Family Planning Annual Report
(FPAR), including issues identified during data validation and relevant table-specific notes
from grantees and Health and Human Services (HHS) Project Officers. The notes are
organized according to the FPAR reporting table to which they apply.
For purposes of describing grantee-level changes across various FPAR performance metrics,
we compare data for the 72 grantees that were active and reported family planning users in
both 2019 and 2020. In 2020, the Office of Population Affairs (OPA) awarded three new
grants, which are excluded from this comparison.
FPAR COVER SHEET: GRANTEE PROFILE
Grantees—In this report, the terms “grantee” and “grant” are synonymous. If an agency
receives multiple grants to support Title X services in different geographic areas (e.g.,
different states), OPA requires the agency to submit separate FPARs for each grant. In 2020,
70 agencies submitted one FPAR, one agency submitted two FPARs, and one agency
submitted three FPARs.
Subrecipients—Of the 72 grantees that were active in both 2019 and 2020, 42 reported no
change in the number of subrecipients, 15 reported a decrease, and 15 reported an increase.
Of the 15 grantees that reported a decrease, 10 mentioned the 2019 Final Rule as a reason for
the decrease in subrecipients.
Service Sites—Of the 72 grantees that were active in both 2019 and 2020, 28 reported no
change in the number of service sites, 26 reported a decrease, and 18 reported an increase.
Reasons given by several grantees for the change in the number of services sites included the
addition of subrecipients; withdrawal of subrecipients, including some withdrawals because
of the 2019 Final Rule; and service site closures.
Reporting Period—Two grantees reported data for a reporting period that was less than 12
months, and all others (N=73) reported data for the 12-month period from January 1, 2020,
through December 31, 2020.
FPAR TABLE 1: USERS BY AGE AND SEX
Of the 72 grantees that were active in both 2019 and 2020, 56 reported a decrease in the
number of family planning users, and 16 reported an increase.
Of the 56 grantees reporting a decrease in the number of users, 46 mentioned the COVID-19
pandemic as a reason for the decrease, while 10 mentioned subrecipient and site withdrawals
from Title X because of the 2019 Final Rule.
▪ Reasons given by grantees for the decrease in the number of users included site closures,
subrecipient (and site) withdrawals from Title X participation because of the 2019 Final
Family Planning Annual Report: 2020 National Summary C-3
Rule, issues related to data collection (e.g., implementation of new electronic health record
[EHR] systems and documentation issues); and decline in the number of encounters
because of increased use of long-acting reversible contraceptives (LARCs).
Pandemic‑related reasons. Pandemic-related reasons included the following: clinic closures
and delays in re-opening sites; reduced operating hours; scheduling adjustments to ensure
social distancing and infection control; efficiency losses during the transition to telehealth
visits; reduced staffing, such as because of staff absences, reassignment to work on
pandemic-related activities, and other reasons; challenges onboarding new subrecipients;
stay-at-home orders; and decreased willingness for users to attend in-person visits.
▪ Reasons given by grantees for the increase in the number of users included the addition
of new subrecipients and service sites, increased funding, increased outreach in
hard‑to‑reach areas or to hard-to-reach groups (e.g., males), and integration of family
planning services into primary care, behavioral health, and sexually transmitted disease
(STD) clinics.
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 9% of total female users for whom race was unknown or not
reported in 2020, 68% 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 race categories or
refusal to report race data, other data collection issues (e.g., errors collecting/documenting
race or ethnicity, challenges compiling data from multiple subrecipient data systems
challenges of implementing the EHR system, or the inclusion of an “other” race field), and
pandemic-related disruptions in operations that affected data collection (e.g., failure to
record race/ethnicity for telehealth encounters, reassignment of staff to pandemic-related
activities, changes in clinic flow, shift to telehealth, and delays orienting new
subrecipients).
▪ Reasons given by grantees for a decrease in the percentage of female users with
unknown race or ethnicity included staff training and improved capture of ethnicity and
race data by staff or within the EHR systems.
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 8% of total male users for whom race was unknown or not reported in
2020, 57% 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 race categories or refusal
to report race data, other data collection issues (e.g., errors collecting/documenting race or
ethnicity, challenges of implementing the EHR system, or the inclusion of an “other” race
C-4 Family Planning Annual Report: 2020 National Summary
field), pandemic-related disruptions in operations that affected data collection (e.g.,
reassignment of staff to pandemic-related activities, failure to record race/ethnicity for
telehealth encounters, changes in clinic flow, shift to telehealth, and delays orienting new
subrecipients), and challenges compiling data from multiple subrecipient data systems.
▪ Reasons given by grantees for a decrease in the percentage of male users with unknown
race or ethnicity included staff training and improved capture of ethnicity and race data by
staff or within the EHR systems.
FPAR TABLE 4: USERS BY INCOME LEVEL
Of the 72 grantees operating in both 2019 and 2020, 40 reported an increase in the percentage
of users with incomes at or below 100% of poverty, 31 reported a decrease, and 1 reported no
change.
▪ Grantees attributed the high or increased percentage of family planning users with
incomes at or below 100% of poverty to pandemic-related losses in income or loss of
employment, natural disasters (e.g., earthquakes) that had a negative economic effect on
the community, and changes in the composition of the Title X service network (e.g.,
Planned Parenthood withdrawal, addition of federally qualified health centers [FQHCs] or
community health centers [CHCs]) that altered the profile of clients served.
▪ Grantees attributed the decreased percentage of family planning users with incomes at
or below 100% of poverty to changes in network composition (e.g., increase in number of
subrecipients that serve clients with higher incomes) and pandemic-related changes in the
income composition of clients who were served.
Of the 72 grantees operating in both 2019 and 2020, 31 reported an increase in the percentage
of users with unknown or not reported income, 30 reported a decrease, and 11 reported no
change.
▪ Grantees attributed an increased percentage of family planning users with unknown or
not reported income to pandemic-related issues affecting data collection (e.g.,
reassignment of staff to pandemic-related activities, changes in clinic flow, shift to
telehealth), refusal by some clients (e.g., full-fee, adolescent, or insured clients) to report
income data, other data collection issues (e.g., failure to collect or record income data for
different types of encounters [telehealth] or in different settings [schools], income as an
optional field in the EHR systems, and data loss occurring during implementation of new
EHR systems), staff turnover, and lack of quality control checks for data submitted by
subrecipients.
▪ Grantees attributed a decrease in percentage 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: 2020 National Summary C-5
FPAR TABLE 5: USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE STATUS
Of the 72 grantees operating in both 2019 and 2020, 49 reported an increase in the percentage
of users with health insurance, 21 reported a decrease, and 2 reported no change.
▪ Reasons grantees gave for an increase in the percentage of users with health insurance
included changes in the composition of the subrecipient network (e.g., Planned Parenthood
withdrawal or addition of FQHCs or CHCs) and the clients served, an increase in clients
qualifying for public insurance because of pandemic-related job loss, health insurance
enrollment campaigns, an increase in clients newly insured through the Affordable Care
Act and state Medicaid expansion, and improvements in data collection (e.g., dedicated
template in the EHR, new methodology for reporting user payer data, or quality
improvement efforts).
▪ Reasons grantees gave for a decrease in the percentage of users with health insurance
included changes in the composition of the subrecipient network (e.g., Planned Parenthood
withdrawal or addition of FQHCs or CHCs) and clientele and data collection issues (e.g.,
challenges training staff on the implementation of new EHR systems and changes to the
reporting system).
Unknown/not reported health insurance status—Grantees attributed the high or increased
number of family planning users with unknown or not reported health insurance coverage
status to reporting errors and pandemic-related issues that included the reassignment of staff
to assist with pandemic-related activities and changes in clinical operations and routines (e.g.,
shift to telehealth visits), which affected data collection and documentation.
FPAR TABLE 6: USERS WITH LIMITED ENGLISH PROFICIENCY (LEP)
Of the 72 grantees operating in both 2019 and 2020, 37 reported a decrease in the percentage
of users who are LEP, 34 reported an increase, and 1 reported no change.
▪ Reasons given by grantees for a decrease in the percentage of users with LEP included
changes in the composition of the subrecipient network and clientele, pandemic-related
issues affecting data collection (e.g., clinic closures, low staffing levels due to staff
absences or reassignment to work on pandemic-related activities, a shift to telehealth visits
that may have disadvantaged LEP clients, and difficulties documenting LEP status for
telehealth visits), and other data collection issues (e.g., difficulty extracting from
subrecipient systems, reporting errors, and challenges associated with EHR
implementation).
▪ Reasons given by grantees for an increase in the percentage of users with LEP included
improved data collection, change in network composition (e.g., loss of sites that served a
large percentage of non-LEP users), and errors in reporting 2019 LEP data.
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 errors in
documenting LEP status or failure to collect or document LEP status, especially during
telehealth visits.
C-6 Family Planning Annual Report: 2020 National Summary
FPAR TABLE 7: FEMALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Pandemic-specific actions to support effective contraceptive use—Several grantees noted
various strategies implemented in Title X service sites to support clients’ contraceptive use
while protecting client and staff health during the pandemic, including providing an advanced
supply of emergency contraception to clients using less or moderately effective methods,
offering self-administered injectable contraception, telehealth consultations, increasing
method pickup at local pharmacies, extending prescriptions, sending method supplies by mail,
and offering curbside services for method supply pickup, Depo-Provera shots, and other
services.
Of the 72 grantees operating in both 2019 and 2020, 41 reported an increase in the percentage
of female users using a most or moderately effective method and 31 reported a decrease.
Of the 72 grantees operating in both 2019 and 2020, 30 reported a decrease in the percentage
of female users with an unknown primary contraceptive method, 24 reported an increase, and
18 reported no change.
▪ Grantees attributed the high or increased number of female users with an unknown
primary method to pandemic-related issues that affected data collection or reporting,
including low staffing levels due to staff absences or reassignment to work on
pandemic‑related activities, changes in clinic routines or documentation practices, a shift to
telehealth visits, orientation of new subrecipients in the network (e.g., addition of FQHCs
or CHCs), and staff capacity (e.g., inadequate training and turnover). Other data collection
problems included inconsistent or incomplete documentation of primary method overall or
data entry or extraction problems, EHR system issues (e.g., implementation or transition,
lacking a “no method” option, and EHR data mapping issues), and client refusal to report
method.
▪ Grantees attributed a decrease in the number of female users with an unknown
primary method to improved data collection, targeted efforts to improve data quality, and
staff training.
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 method effectiveness categories
align with the OPA-developed and National Quality Forum-endorsed contraceptive care
performance measures.
26
The contraceptive care measures are based on the following method
groups or tiers defined by Trussell (2011):
27
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®), 0.05%
▪ Intrauterine device (Mirena®), 0.2%
Family Planning Annual Report: 2020 National Summary C-7
▪ Intrauterine device (Skyla®), 0.4%
39
▪ Intrauterine device (Kyleena®), 0.2%
40
▪ Intrauterine device (Liletta®), 0.2%
41
▪ 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 (Xulane®), 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 or lactational amenorrhea method, diaphragm or 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 because a limited
number of Title X clients report using the methods in these combined categories.
Please note that the methods listed under each tier and their corresponding failure rate were
updated in the 2018 publication of Contraceptive Technology (21
st
edition).
42
In this update,
the diaphragm was the only method that changed tiers, moving from Tier 2 to Tier 3. The
diaphragm’s failure rate increased from 12% to 17%. Failure rates for other methods changed
as well. For purposes of maintaining alignment with the OPA contraceptive care performance
measures, the diaphragm was retained as a Tier 2 method based on the 2011 classification.
27
C-8 Family Planning Annual Report: 2020 National Summary
Hormonal injection users—Eighteen grantees in eight regions (I, III, IV, V, VI, VII, VIII,
and IX) reported a total of 93 female users who relied on 1-month hormonal injections as
their primary method. One-month hormonal injection users accounted for 0.04% of the
213,854 hormonal injection users reported in 2020.
Sterilization among users under 20—No grantees reported female users under 20 relying on
female sterilization as a primary contraceptive method.
Vasectomy among users under 18—Three grantees reported three female users under 18
relying on vasectomy as their primary contraceptive method; all three grantees confirmed that
these users received noncoercion counseling.
FPAR TABLE 8: MALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Pandemic-specific actions to support effective contraceptive use—Several grantees noted
the various strategies implemented in Title X service sites to support contraceptive use and
protection for male clients during the pandemic, including placing condoms in convenient
pickup locations to allow for social distancing and curbside services.
Primary method category definitions—See note for FPAR Table 7 in the above section.
Sterilization among users under 20—No grantees reported male users under 20 relying on
vasectomy as their primary contraceptive method.
Of the 72 grantees operating in both 2019 and 2020, 38 reported a decrease in the percentage
of male users relying on most, moderately, or less effective methods, 31 reported an increase,
and 2 reported no change. One of the 72 grantees reported no male users in 2020.
Of the 72 grantees operating in both 2019 and 2020, 29 reported an increase in the percentage
of male users with an unknown primary contraceptive method, 25 reported a decrease, and 17
reported no change. One of the 72 grantees reported no male users in 2020.
▪ Grantees attributed the high or increased number of male users with an unknown
primary method to pandemic-related issues (e.g., low staffing levels due to staff absences,
turnover, or reassignment to work on pandemic-related activities, changes in clinic routines
or documentation practices, and a shift to telehealth visits), orientation of new
subrecipients in the network, staff capacity (e.g., inadequate training and turnover), data
collection or system problems (e.g., inconsistent or incomplete documentation of primary
method overall or for a specific types of visits [telehealth, infectious disease, or pediatric
visits]), EHR-related issues (e.g., no structured data field in the EHR for recording primary
method data retrieval and transition to a new EHR), and refusal by clients to disclose their
primary method.
▪ Grantees attributed a decrease in the number of male users with an unknown primary
method to improved data collection, staff training, continuous quality improvement
efforts, and technical assistance.
Family Planning Annual Report: 2020 National Summary C-9
FPAR TABLE 9: CERVICAL CANCER SCREENING ACTIVITIES
Of the 72 grantees that submitted an FPAR in both 2019 and 2020, 45 reported a decrease in
the percentage of female users who received a Pap test, and 27 reported an increase.
▪ Reasons given by grantees for a decrease in the percentage of female users screened for
cervical cancer included pandemic-related issues (e.g., postponement of screening visits
and prioritization of women at high risk during the emergency response, clinic closures,
low staffing levels due to staff absences or reassignment to work on pandemic-related
activities, change in clinic routines, inability to obtain testing supplies, and a shift to
telehealth visits), the withdrawal from Title X participation (2019 Final Rule) of
subrecipients that offered screening, adherence to cervical cancer screening guidelines,
data collection/reporting issues (e.g., difficulty extracting data, data entry errors, and EHR
system implementation), and loss of Title X funding.
▪ Reasons given by grantees for an increase in the percentage of female users screened
for cervical cancer included a quality initiative aimed at increasing adherence to screening
guidelines, prioritization of in-person visits for those with indications for a physical exam,
and increased clinical services provider (CSP) staffing.
FPAR TABLE 10: CLINICAL BREAST EXAMS (CBES) AND REFERRALS
CBEs—Of the 72 grantees that were active in both 2019 and 2020, 46 reported a decrease in
the percentage of female users who received a CBE, and 26 reported an increase.
▪ Reasons given by grantees for a decrease in the percentage of female users who
received a CBE included loss of subrecipients and service sites that performed CBEs,
pandemic-related factors (e.g., postponement of preventive screenings/exams, focus on
women who were at high risk, clinic closures, low staffing levels due to staff absences or
reassignment to work on pandemic-related activities, change in clinic routines, changes in
documentation procedures, and shift to telehealth visits), adherence to breast cancer
screening guidelines, and challenges associated with implementing new EHR systems.
▪ Reasons given by grantees for an increase in the percentage of female users who
received a CBE included training of providers to document screening, improved data
reporting (e.g., addition of a code for CBE and improved documentation), adherence to
guidelines, improved ability to identify clients needing a CBE, and an increase in clients
needing a CBE.
CBE-related referrals—Of the 72 grantees that submitted an FPAR in both 2019 and 2020,
40 reported an increase in the percentage of female users referred for further evaluation based
on CBE findings, 25 reported a decrease, and 6 reported no change.
▪ Reasons given by grantees for an increase in the percentage of CBE-related referrals
included prioritization of in-person visits for women with indications or identified issues
and errors in reporting 2019 data.
C-10 Family Planning Annual Report: 2020 National Summary
▪ Reasons given by grantees for a decrease in the percentage of CBE-related referrals
included pandemic-related issues (e.g., delays in annual exam visits, the switch from
in‑person to telehealth visits, and a drop in the number clients served) and the loss of
subrecipients that screened and referred higher percentages of clients.
FPAR TABLE 11: USERS TESTED FOR CHLAMYDIA BY AGE AND SEX
Of the 72 grantees that submitted an FPAR in both 2019 and 2020, 51 reported a decrease in
the percentage of female users under 25 tested for chlamydia, and 21 reported an increase. In
addition, 45 reported a decrease in the percentage of male users tested, 23 reported an
increase, and 3 reported no change. One of the 72 grantees that was active in both years
reported no male users in 2019.
▪ Reasons given by grantees for a decrease in the chlamydia testing rate included a
decrease in the number of service sites, pandemic-related issues (e.g., postponement of
preventive health visits, prioritization of clients at high risk, clinic closures, low staffing
levels due to staff absences or reassignment to work on pandemic-related activities, change
in clinic routines, lack of supplies and testing kits, and shift to telehealth visits), issues
related to data quality or reporting (e.g., changes in documentation procedures, difficulty
extracting data, coding errors, limited training for new subrecipients or subrecipients’
inability to report test data, and challenges of transitioning to new EHRs), and adherence to
guidelines.
▪ Reasons given by grantees for an increase in the chlamydia testing rate included the
addition of clinic sites, collaboration with other entities to expand testing capacity and
coverage, improved data collection and documentation, adherence to screening guidelines,
increased outreach to and education of at-risk populations, increase in at-risk clients
requiring testing, and increased staff training and awareness.
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 an increase in STD testing included an increase in testing sites,
outreach efforts coordinated with other entities, adherence to guidelines, improved data
quality/reporting, use of opt-out language, mandated testing of postpartum women,
encouragement of staff to offer/perform STD/HIV testing, and provision of technical
assistance to subrecipients to improve their STD services.
▪ Reasons given for a decrease in STD testing included the decrease in the number of
clients, pandemic-related issues (e.g., postponement of preventive health visits,
prioritization of individuals at high risk of infection or complications, clinic closures,
reduced staffing levels due to staff absences or reassignment to work on pandemic-related
activities, change in clinic routines, changes in documentation procedures, lack of supplies
and testing kits, and shift to telehealth visits), change in the composition of the Title X
Family Planning Annual Report: 2020 National Summary C-11
service network (e.g., Planned Parenthood withdrawal or addition of FQHCs or CHCs),
and other data quality/reporting issues (e.g., not all subrecipients reporting, data entry
errors, challenges mapping lab data to EHR data, and implementation of new EHRs).
Gonorrhea testing rate—Of the 72 grantees that submitted an FPAR in both 2019 and 2020,
45 grantees reported a decrease in the number of gonorrhea tests per female user, and 27
reported an increase. In addition, 42 grantees reported a decrease in the number of gonorrhea
tests per male user, 27 reported an increase, and 2 reported no change. One grantee was
excluded from this comparison because they served no male users in 2019.
▪ Reasons given by grantees for a decrease in gonorrhea testing included the decrease in
number of clients; prioritization of individuals at high risk of infection or complications,
lack of testing supplies, and reporting (e.g., data mapping) issues.
▪ Reasons given by grantees for an increase in gonorrhea testing included improved data
collection/reporting; outreach and education to promote awareness; the addition of new
subrecipients; active populations of men who have sex with men and HIV pre-exposure
prophylaxis programs, resulting in more frequent testing; an increase in male clients; and
increased gonorrhea prevalence in the service area.
Syphilis testing rate—Of the 72 grantees that submitted an FPAR in both 2019 and 2020, 34
reported a decrease in the number of syphilis tests per female user, 32 reported an increase,
and 1 reported no change. In addition, 34 grantees reported a decrease in the number of
syphilis tests per male user, 33 reported an increase, and 4 reported no change. One grantee is
excluded from this comparison because they served no male users in 2019.
▪ Reasons given for a decrease in syphilis testing were related to data reporting and
mapping issues.
▪ Reasons given for an increase in syphilis testing included improved data collection,
education and outreach, the addition of new subrecipients/service sites, an increase in male
clients, testing of all pregnant clients, and heightened awareness of syphilis screening
guidelines.
Confidential HIV testing rate—Of the 72 grantees that submitted an FPAR in both 2019
and 2020, 47 grantees reported a decrease in the number of confidential HIV tests per female
user, and 25 reported an increase. In addition, 36 grantees reported a decrease in the number
of confidential HIV tests per male user, 34 reported an increase, and 1 reported no change.
One grantee is excluded from this comparison because they served no male users in 2019.
▪ Reasons given by grantees for an decrease in confidential HIV testing included
withdrawal of subrecipients that performed higher testing levels, change in data reporting,
decrease in demand for testing, and decreased in-person visits.
▪ Reasons given by grantees for an increase in confidential HIV testing included agency
efforts to increase HIV screening rates, outreach and education, implementation of
universal screening, and improved data collection/reporting by subrecipients.
Positive confidential HIV tests—Of the 72 grantees that submitted an FPAR in both 2019
and 2020, 28 reported an increase in the number of positive confidential HIV tests per 1,000
C-12 Family Planning Annual Report: 2020 National Summary
tests performed, 21 reported a decrease, and 23 reported no change (ratio was zero in both
years).
▪ Reasons cited by grantees for an increase in positive confidential HIV tests included an
increased demand for testing because other community testing sites had closed, social
media marketing to promote testing, implementation of routine (opt-out) HIV screening,
outbreak of HIV in the community, and increased testing of higher-risk individuals.
FPAR TABLE 13: FAMILY PLANNING ENCOUNTERS AND STAFFING
CSP full-time equivalent (FTE)—Of the 72 grantees that submitted an FPAR in both 2019
and 2020, 37 reported a decrease in the total number of CSP FTEs delivering Title X-funded
services, 24 reported an increase, and 11 reported no change.
▪ Reasons given for a decrease in CSP FTEs included pandemic-related issues (e.g., clinic
closures, low staffing levels due to staff absences or reassignment to pandemic-related
activities, changes in clinic routines, shift to telehealth visits, and changes in
documentation procedures), changes in the composition of the service network (e.g.,
Planned Parenthood or other subrecipient withdrawals) and staffing, inability of
subrecipients to report FTE information, difficulties onboarding new subrecipients, and
staff turnover and difficulty retaining or recruiting staff.
▪ Reasons given for an increase in CSP FTEs included a change in the staffing mix to cover
telehealth visits, prior-year reporting error by a subrecipient, the addition of new
subrecipients and service sites, success in filling vacant CSP positions, and more accurate
reporting of CSP FTEs.
Physician FTEs—Of the 72 grantees that submitted an FPAR in both 2019 and 2020, 31
reported a decrease in physician FTEs, 27 reported an increase, and 14 reported no change. A
reason cited for the increase in physician FTEs was the addition of subrecipients (e.g.,
FQHCs) that rely more heavily on physician providers. A reason for the decrease in physician
FTEs was improved reporting of FTE data.
Midlevel clinician FTEs—Of the 72 grantees that submitted an FPAR in both 2019 and
2020, 36 reported a decrease in midlevel clinician FTEs, 22 grantees reported an increase, 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 clinician FTEs.
Other CSP FTEs—Of the 72 grantees that submitted an FPAR in both 2019 and 2020, 45
reported zero other CSP FTEs in both years, 11 reported a decrease, 9 reported an increase,
and 7 reported no change. One reason for the decrease in reporting other CSP FTEs was
recognition that staff previously reported as other CSPs should not be classified as such.
Family planning encounters—Of the 72 grantees that submitted an FPAR in both 2019 and
2020, 56 reported a decrease in the number of total encounters, and 16 reported an increase.
▪ Reasons given for a decrease in encounters included pandemic-related issues (e.g.,
decrease in users, clinic closures, low staffing levels due to staff absences or reassignment
to pandemic-related activities, change in clinic routines, changes in documentation
Family Planning Annual Report: 2020 National Summary C-13
procedures, and shift to telehealth visits), change in network composition (e.g., Planned
Parenthood withdrawal), limited appointment times due to the implementation of an EHR
transition, and inability of some subrecipients to report information.
▪ Reasons given for an increase in encounters included increased hours of operation at
some sites and the addition of new subrecipients and service sites.
Virtual/Telehealth Encounters—In January 2021, OPA updated the family planning
encounter and family planning user definitions in the Title X Family Planning Annual Report
(FPAR): Forms and Instructions to allow grantees to report virtual/telehealth family planning
encounters and the family planning users resulting from such encounters in Table 13 of the
FPAR. Because the Table 13 form on the FPAR 1.0 Data System was not updated to collect
virtual/telehealth encounters for the 2020 FPAR reporting period, OPA instructed grantees to
report both in-person and virtual/telehealth family planning encounters in Table 13 and to use
the Table 13 Note field to provide (1) the number of total family planning encounters with
CSP staff that were virtual/telehealth encounters and (2) the number of total family planning
encounters with non-CSP staff that were virtual/telehealth encounters. If grantee or
subrecipient data systems prevented grantees from reporting virtual/telehealth encounters by
type of staff (CSP vs. non-CSP), grantees were instructed to provide a total number.
Of the 75 Title X services grantees in 2020:
▪ 51 provided virtual/telehealth encounter data by type of staff, including 14 that reported
0 virtual/telehealth encounters with CSP and non-CSP staff
▪ 11 provided data on the total number of virtual/telehealth encounters because they were
unable to report virtual/telehealth encounters by type of staff
▪ 13 were unable to report virtual/telehealth encounter data.
Finally, several grantees noted that their own or their subrecipients’ data systems were not
configured to capture virtual/telehealth encounters and that they were unable to modify their
systems to collect and report the data for the 2020 FPAR.
FPAR TABLE 14: REVENUE REPORT
Total revenue (row 18)—All Regions—Of the 72 grantees that submitted an FPAR in both
2019 and 2020, 38 reported an increase in total revenue, and 34 reported a decrease.
Title X revenue (row 1)—All Regions—Title X revenue includes 2020 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 20 states:
▪ Region I—New Hampshire and Rhode Island
▪ Region II—New Jersey
▪ Region III—Maryland, Pennsylvania, and Virginia
C-14 Family Planning Annual Report: 2020 National Summary
▪ Region IV—Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina
▪ Region V—Indiana, Minnesota, and Wisconsin
▪ Region VI—New Mexico and Oklahoma
▪ Region VII—None
▪ Region VIII—Montana and Wyoming
▪ Region IX—California
▪ Region X—None.
Four states (Iowa, Missouri, Texas, and Vermont) operated entirely state-funded programs to
provide family planning services, but the sole grantee in Vermont discontinued Title X
participation because of the 2019 Final Rule.
No revenue from Medicaid eligibility expansions was reported for Connecticut, Maine, New
York, Oregon, or Washington as grantees that had reported this revenue in prior years
discontinued Title X participation because of the 2019 Final Rule.
Other revenue (rows 12 through 16)—All Regions—An illustrative list of “other” revenue
sources reported in rows 12 through 16 includes the following: agency contributions; Arizona
Department of Health Services STD Control; Breast & Cervical Cancer Early Detection
Programs; carry-over funds; Centers for Disease Control and Prevention Infertility Prevention
Program; class action lawsuit funds; client and other donations; Early Detection Works
Program; earned and special income revenue; fundraising revenue; grants received by county
health departments; Healthy Women Healthy Babies program; HIV and STD funds; human
papillomavirus funds; Health Resources and Services Administration (HRSA) Paycheck
Protection Program (PPP) loan; HRSA Ryan White program; interest income; Kansas Setoff
Program; Kentucky Office of Refugees funds; LARC (Medicaid) funding; medical records
revenue; miscellaneous other revenue; Montana Cancer Screening Program; Montana
STD/HIV Program; pandemic-related COVID-19 (H8C) and Coronavirus Aid, Relief, and
Economic Security (CARES) Act (H8D) awards funding; PPP loan; Pennsylvania
Department of Health STD Project; Personal Responsibility Education Program (PREP)
grant; Pregnancy Prevention Grant; Preventive Health and Health Services Block grant;
Prime Education grant; private and client donations; private foundation and other grant
revenues; program income; refund for lab expenses; refund for medical supplies; revenue
recovery; Sexual Risk Avoidance Education (Title V grant); Small Business Administration
Payroll Protection Program loan forgiveness; State Farmworker Voucher Program; State
STD/HIV voucher program; STD grant; subrecipient contributions; subrecipient funding;
Teen Pregnancy Prevention grant; The 20/22 Act Society (Puerto Rico); Tobacco Settlement;
United Nations Population Fund (UNFPA); United Way; University of Wisconsin; Worker's
compensation; and Wyoming Cancer Program.
Family Planning Annual Report: 2020 National Summary
D-1
Appendix D
Preliminary Analysis:
Estimated Effects of the
2019 Final Rule and COVID-19 Pandemic
on Title X User Counts and Total Revenue
2018 to 2020
D-2 Family Planning Annual Report: 2020 National Summary
INTRODUCTION
The purpose of this analysis is to estimate the impact of the 2019 Final Rule and coronavirus
disease 2019 (COVID-19) pandemic on changes in the number of Title X family planning
users and total revenue between 2018 and 2019, 2018 and 2020, and 2019 and 2020. Grantees
are classified into four groups, as described below. We use information for one group of 40
grantees, which reported no losses due to the 2019 Final Rule, to help estimate
pandemic‑related losses experienced by other grantee groups.
METHOD
We used data for 106 grantees that were active for all or part of the study period (2018–2020).
We categorized these grantees into four groups:
▪
D
iscontinued, Final Rule [DFR]: 19 grantees that discontinued Title X participation in
2019 because of the Final Rule. All DFR grantees were active during 2018 and part of
2019. As a condition of their continued funding and pursuant to court orders, grantees
choosing to stay in the Title X program were required to comply with all requirements of
the Final Rule by July 15, 2019.
▪
Continued, Final Rule [CFR]: 18 grantees that continued Title X participation but
reported losses of subrecipients/sites/users because of the Final Rule. All CFR grantees
were active during 2018, 2019, and 2020.
▪
No Change, Unaffected by Final Rule [NCFR]: 40 grantees reported no network changes
or impact because of the Final Rule. All NCFR grantees were active during 2018, 2019,
and 2020.
▪
O
ther: The 29 Other grantees include 20 grantees that participated in Title X for only 1 or
2 years of the 3-year study period (nine of these 20 grantees left the program in 2019 for
reasons not related to the Final Rule) and nine U.S. Territories and Freely Associated
States (TFAS) grantees. Of the 20 Other grantees that had partial participation across the
3‑year study period, 10 grantees participated in 2018–2019, four grantees participated in
2019–2020, three grantees participated in 2018 only, and three grantees participated in
2020 only. The grantees in this group that were not TFAS grantees did not have the
complete 3‑year history of users and revenue needed to provide sufficient information to
contribute to the estimate of pandemic-related losses. We included the TFAS grantees in
this group because they are unique in terms of the setting and contextual factors affecting
the implementation and performance of their Title X projects. By year, the number of
Other grantees is as follows: 22 in 2018, 23 in 2019, and 16 in 2020.
The group classification for one grantee changed from DFR in 2018 and 2019 to Other in
2020. This grantee withdrew from the program in 2019 because of the Final Rule but then
returned to the program in the last quarter of 2020.
Family Planning Annual Report: 2020 National Summary D-3
ASSUMPTIONS
For the 19 DFR grantees that discontinued Title X participation because of the Final Rule,
we assumed the following:
▪
I
n the absence of the Final Rule, the 19 DFR grantees and their service networks would
have remained in the program and reported data for all of 2019 and 2020.
– In 2019, the DFR grantees would have performed at the same level (i.e., achieved the
same number of users served and total revenue) as in 2018.
– In 2020, the DFR grantees would performed at the same level as in 2018, but their 2020
user count and total revenue would have been subject to pandemic-related losses similar
to those experienced by the NCFR grantees.
▪
One hundred percent of losses (i.e., users, revenue) in 2019 are attributable to the Final
Rule.
▪
Lo
sses in 2020 (i.e., users, revenue) are attributable to either the Final Rule or the
pandemic.
▪
I
f DFR grantees had remained in the Title X program in 2020, the percentage decreases in
users and total revenue attributable to the COVID-19 pandemic would be the same as the
percentage decreases reported by the 40 NCFR grantees that experienced no Final Rule
effects.
▪
T
he 2019 user counts and total revenue for DFR grantees reflect between 3 and 8 months
of Title X participation. Comparisons using 2019 data reflect a partial impact of the Final
Rule.
For the 18 CFR grantees that continued Title X participation but experienced a decrease in
the size or capacity of their service network because of the Final Rule, we assumed the
following:
▪ All losses (i.e., users, revenue) in 2019 are attributable to the Final Rule.
▪ Losses (i.e., users, revenue) in 2020 are attributable to either the Final Rule or the
pandemic.
▪ For CFR grantees, the percentage decreases in users and total revenue attributable to the
COVID-19 pandemic are the same as the percentage decreases reported by the 40 NCFR
grantees that experienced no Final Rule effects.
For the 40 NCFR grantees that reported no network changes or impact because of the Final
Rule, we assumed the following:
▪ All losses (i.e., users, revenue) in 2019 are not attributable to the Final Rule.
▪ All losses (i.e., users, revenue) in 2020 are attributable to the pandemic.
▪
T
he percentage changes in users and revenue for 2018 vs. 2020 and 2019 vs. 2020 reported
by NCFR grantees can be applied to the user and revenue decreases of DFR and CFR
grantees to estimate pandemic-related losses. These percentage changes are as follows:
D-4 Family Planning Annual Report: 2020 National Summary
– User Losses: Among NCFR grantees, the total number of users in 2020 (965,510) was
21% lower (by 253,655) than in 2018 and 21% lower (by 257,458) than in 2019. The
total number of users served by NCFR grantees in 2018 and 2019 was 1.2 million users.
– Revenue Losses: Among NCFR grantees, total revenue in 2020 ($346.1 million) was
6% lower (by $22.3 million) than in 2018 ($368.4 million) and 10% lower
(by $36.7 million) than in 2019 ($382.8 million).
For the 29 Other grantees, we assumed the following:
▪ All losses (i.e., users, revenue) in 2019 are not attributable to the Final Rule.
▪ All losses (i.e., users, revenue) in 2020 are attributable to the pandemic.
Finally, apart from the Final Rule and the pandemic, we expect that other factors may have
influenced both increases and decreases in the number of users. For the purposes of this
analysis, we assume that the effects of these other factors are negligible.
FINDINGS | FINAL RULE IMPACT: 2019 VS. 2018
Title X Users: 2019 vs. 2018
▪ Between 2018 and 2019, there was a decrease of 844,083 Title X users. The Final Rule
accounted for an estimated 94% (or 789,960 users) of the decrease in Title X users.
▪ For each grantee group, the estimated losses in users between 2018 and 2019 that are
attributed to the Final Rule are as follows:
– 19 DFR grantees reported decrease of 310,756 users, of which 100% is attributed to the
Final Rule.
– 18 CFR grantees reported a decrease of 479,204 users, of which 100% is attributed to
the Final Rule.
– 40 NCFR grantees reported a small increase of 3,803 users, of which 0% is attributed
to the Final Rule.
– 29 Other grantees reported a decrease of 57,926 users, of which 0% is attributed to the
Final Rule.
Title X Project Revenue: 2019 vs. 2018
▪ Between 2018 and 2019, there was a decrease of $335.5 million in total Title X project
revenue from all sources (“total revenue”). The Final Rule accounted for 98%
(or $327.2 million) of the decrease in total revenue.
▪ For each grantee group, the estimated losses in total revenue between 2018 and 2019 that
are attributed to the Final Rule are as follows:
– 19 DFR grantees reported a decrease of $168.4 million, of which 100% is attributed to
the Final Rule.
– 18 CFR grantees reported a decrease of $158.7 million, of which 100% is attributed to
the Final Rule.
Family Planning Annual Report: 2020 National Summary D-5
– 40 NCFR grantees reported an increase of $14.5 million, of which 0% is attributed to
the Final Rule.
– 29 Other grantees reported a decrease of $22.8 million, of which 0% is attributed to the
Final Rule.
FINDINGS | IMPACT OF FINAL RULE AND COVID-19 PANDEMIC: 2020 VS. 2018
Title X Users: 2020 vs. 2018
▪ Between 2018 and 2020, there was a decrease of 2.4 million Title X users. The Final Rule
accounted for 63% (or 1.5 million users) of the decrease in Title X users, and the pandemic
accounted for 37% (or 877,354 users) of this decrease.
▪ For each grantee group, the projected or estimated losses in users between 2018 and 2020
that are attributed to either the Final Rule or the pandemic are as follows:
– 19 DFR grantees had a projected decrease of 895,536 users, of which 79% (or 707,473)
is attributed to the Final Rule and 21% (or 188,063) is attributed to the pandemic.
– 18 CFR grantees reported a decrease of about 1.2 million users, of which 70% (or
818,178) is attributed to the Final Rule and 30% (or 353,466) is attributed to the
pandemic.
– 40 CFR grantees reported a decrease of 253,655 users, of which 100% is attributed to
the pandemic.
– 29 Other grantees reported a decrease of 82,171 users, of which 100% is attributed to
the pandemic.
Title X Project Revenue: 2020 vs. 2018
▪ Between 2018 and 2020, there was a decrease of $809.4 million in total revenue. The Final
Rule accounted for 86% (or $698.5 million) of the decrease in total revenue, and the
pandemic accounted for 14% (or $110.8 million).
▪ For each grantee group, the projected or estimated losses in total revenue between 2018
and 2020 that are attributed to either the Final Rule or the pandemic are as follows:
– 19 DFR grantees had a projected decrease of $406.8 million, of which 94%
(or $382.4 million) is attributed to the Final Rule and 6% (or $24.4 million) is attributed
to the pandemic.
– 18 CFR grantees reported a decrease of $351.3 million, of which 90%
(or $316.1 million) is attributed to the Final Rule and 10% (or $35.2 million) is
attributed to the pandemic.
– 40 NCFR grantees reported a decrease of $22.3 million, of which 100% is attributed to
the pandemic.
– 29 Other grantees reported a decrease of $29.0 million, of which 100% is attributed to
the pandemic.
D-6 Family Planning Annual Report: 2020 National Summary
FINDINGS | IMPACT OF FINAL AND COVID-19 PANDEMIC: 2020 VS. 2019
Title X Users: 2020 vs. 2019
▪ Between 2019 and 2020, there was a decrease of 1.6 million in the number of Title X
users. The Final Rule accounted for an estimated 58% (or 901,583 users) of the decrease in
Title X users, and the pandemic accounted for 42% (or 657,340 users).
▪ For each grantee group, the projected or estimated losses in users between 2019 and 2020
that are attributed to either the Final Rule or the pandemic are as follows:
– 19 DFR grantees had a projected decrease of 584,780 users, of which 79% (or 461,976)
is attributed to the Final Rule and 21% (or 122,804) is attributed to the pandemic.
– 18 CFR grantees reported a decrease of 692,440 users, of which 63% (or 439,607) is
attributed to the Final Rule and 37% (or 252,833) is attributed to the pandemic.
– 40 NCFR grantees reported a decrease of 257,458 users, of which 100% is attributed to
the pandemic.
– 29 Other grantees reported a decrease of 24,245 users of which 100% is attributed to
the pandemic.
Title X Project Revenue: 2020 vs. 2019
▪ Between 2019 and 2020, there was a decrease of $473.8 million in total revenue. The Final
Rule accounted for an estimated 77% (or $364.4 million) of the decrease in total revenue,
and the pandemic accounted for 23% (or $109.5 million).
▪ For each grantee group, the projected or estimated losses in total revenue between 2019
and 2020 that are attributed to the Final Rule or the pandemic are as follows:
– 19 DFR grantees had a projected decrease of $238.4 million, of which 90%
(or $214.5 million) is attributed to the Final Rule and 10% (or $23.8 million) is
attributed to the pandemic.
– 18 CFR grantees reported a decrease of $192.6 million, of which 78%
(or $149.8 million) is attributed to the Final Rule and 22% (or $42.8 million) is
attributed to the pandemic.
– 40 NCFR grantees reported a decrease of $36.7 million, of which 100% is attributed to
the pandemic.
– 29 Other grantees reported a decrease of $6.1 million, of which 100% is attributed to
the pandemic.
See Exhibits D-1 and D-2 for the impact of the Final Rule and COVID-19 pandemic on
Title X family planning user counts and project revenue, respectively.
Family Planning Annual Report: 2020 National Summary D-7
LIMITATIONS
▪ The analysis does not identify other factors, in addition to the Final Rule and the pandemic,
that may have affected the number of users or total project revenue in 2019 or 2020.
▪ The average percentage decrease in users or revenue experienced by the NCFR grantees
may not be an accurate reflection of the effects of the pandemic on the DFR and CFR
grantees. Grantees vary by type (i.e., public health department, private family planning or
primary health agency) and in their size, composition, and capacity to provide Title X
services. This preliminary analysis does not account for these grantee-level differences.
D-8 Family Planning Annual Report: 2020 National Summary
Exhibit D–1. Preliminary analysis of the impact of the 2019 Final Rule and COVID-19 pandemic on Title X family planning user counts: 2018–2020
Group
User Counts 2018 vs. 2019 2018 vs. 2020 2019 vs. 2020
2018 2019 2020
Total
Difference
Difference
Attributed to
Final Rule
Total
Difference
Difference
Attributed to
Final Rule
a
Difference
Attributed to
Pandemic
Total
Difference
Difference
Attributed to
Final Rule
b
Difference
Attributed to
Pandemic
DFR grantees
[N=19]
895,536 584,780 0 –310,756 –310,756
[Assumption:
Loss is 100% of
total difference]
–895,536 –707,473
a
–188,063
[Assumption:
Loss equal to
21% of 2018
total users]
–584,780 –461,976
b
–122,804
[Assumption:
Loss equal to
21% of 2019
total users]
CFR grantees
[N=18]
1,683,170 1,203,966 511,526 –479,204 –479,204
[Assumption:
Loss is 100% of
total difference]
–1,171,644 –818,178
a
–353,466
[Assumption:
Loss equal to
21% of 2018
total users]
–692,440 –439,607
b
–252,833
[Assumption:
Loss equal to
21% of 2019
total users]
NCFR grantees
[N=40]
[Note: Actual % losses
are the basis for
assumptions about DFR
and CFR pandemic-
related losses]
1,219,165 1,222,968 965,510 3,803 0 –253,655 0 –253,655
c
[Actual:
Loss equal to
21% of 2018
total users]
–257,458 0 –257,458
c
[Actual:
Loss equal to
21% of 2019
total users]
Other grantees
[N=29]
d
141,878 83,952 59,707 –57,926 0 –82,171 0 –82,171 –24,245 0 –24,245
Total
[N=106]
3,939,749 3,095,666 1,536,743 –844,083 –789,960 –2,403,006 –1,525,652 –877,354 –1,558,923 –901,583 –657,340
% Attributed to
Final Rule or pandemic
— — — — 94% — 63% 37% — 58% 42%
CFR=Continued, Final Rule; DFR=Discontinued, Final Rule; FR=Final Rule; NCFR=No Change, Unaffected by Final Rule.
a
For DFR and CFR grantees, the 2018 vs. 2020 difference (loss in users) attributed to the Final Rule is equal to the total 2018 vs. 2020 difference minus the difference attributed to the
pandemic.
b
For DFR and CFR grantees, the 2019 vs. 2020 difference (loss in users) attributed to the Final Rule is equal to the total 2019 vs. 2020 difference minus the difference attributed to the
pandemic.
c
The percentage change in number of users for the NCFR grantees is −21% for both 2018 vs. 2020 and 2019 vs. 2020.
d
Other grantees include all TFAS grantees in and grantees that participated in Title X for only 1 or 2 years of the 3-year study period. By year, the number of Other grantees is as follows: 22 in
2018, 23 in 2019, and 16 in 2020.
— Not applicable.
Family Planning Annual Report: 2020 National Summary D-9
Exhibit D–2. Preliminary analysis of the impact of the 2019 Final Rule and COVID-19 pandemic on Title X project revenue: 2018–2020
Group
Total Revenue (in $2020s) 2018 vs. 2019 (in $2020s) 2018 vs. 2020 (in $2020s) 2019 vs. 2020 (in $2020s)
2018 2019 2020
Total
Difference
Difference
Attributed to
Final Rule
Total
Difference
Difference
Attributed to
Final Rule
a
Difference
Attributed to
Pandemic
Total
Difference
Difference
Attributed to
Final Rule
b
Difference
Attributed to
Pandemic
DFR grantees
[N=19]
406,802,819 238,377,440 0 –168,425,379 –168,425,379
[Assumption:
100% of total
difference]
–406,802,819 –382,394,650
a
–24,408,169
[Assumption:
Loss equal to 6%
of 2018
total revenue]
–238,377,440 –214,539,696
b
–23,837,744
[Assumption:
Loss equal to
10% of 2019
total revenue]
CFR grantees
[N=18]
586,564,106 427,823,742 235,221,658 –158,740,364 –158,740,364
[Assumption:
100% of total
difference]
–351,342,448 –316,148,602
a
–35,193,846
[Assumption:
Loss equal to 6%
of 2018
total revenue]
–192,602,084 –149,819,710
b
–42,782,374
[Assumption:
Loss equal to
10% of 2019
total revenue]
NCFR grantees
[N=40]
[Note: Actual %
losses are the basis
for assumptions
about DFR and
CFR pandemic-
related losses]
368,366,046 382,843,412 346,110,824 14,477,366 0 –22,255,222 0 –22,255,222
c
[Actual: Loss
equal to 6%
of 2018 total
revenue]
–36,732,588 0 –36,732,588
c
[Actual: Loss
equal to 10% of
2019 total
revenue]
Other grantees
d
[N=29]
52,631,173 29,802,323 23,675,376 –22,828,850 0 –28,955,797 0 –28,955,797 –6,126,947
–6,126,947
Total
[N=106]
1,414,364,144 1,078,846,917 605,007,858 –335,517,227 –327,165,743 –809,356,286 –698,543,252 –110,813,035 –473,839,059 –364,359,406 –109,479,653
% Attributed to
Final Rule or
pandemic
— — — — 98% — 86% 14% — 77% 23%
CFR=Continued, Final Rule; DFR=Discontinued, Final Rule; FR=Final Rule; NCFR=No Change, Unaffected by Final Rule.
Note: All revenue is presented as adjusted $2020s.
a
For DFR and CFR grantees, the 2018 vs. 2020 difference (loss in revenue) attributed to the Final Rule is equal to the total 2018 vs. 2020 difference minus the difference attributed to the
pandemic.
b
For DFR and CFR grantees, the 2019 vs. 2020 difference (loss in revenue) attributed to the Final Rule is equal to the total 2019 vs. 2020 difference minus the difference attributed to the
pandemic
.
c
The percentage change in total revenue for the NCFR grantees is −6% for 2018 vs. 2020 and −10% for 2019 vs. 2020.
d
Other grantees include all TFAS grantees and grantees that participated in Title X for only 1 or 2 years of the 3-year study period. By year, the number of Other grantees is as follows: 22 in
2018, 23 in 2019, and 16 in 2020.
— Not applicable.
Office of Population Affairs
Office of the Assistant Secretary for Health
U.S. Department of Health and Human Services
1101 Wootton Parkway, Suite 200
Rockville, MD 20852
opa.hhs.gov
