Let me further say that at this point there are many in the State, Federal, and local governments who have advocated the rapid expansion of such programs. In our opinion, the expansion is proceeding at a very, very reluctant pace. I think Dr. Jessup can testify to this. We have appended to my testimony an estimate of the unfilled need in various selected communities in the United States. I think this will be of particular interest to the members of the committee because it does indicate the numbers of low-income patients not now served in various communities represented by members of this committee. I think if the members of this committee can interpret the impact of providing services to these individuals in their communities, upon the well-being of their communities, they will see that the proposals we are talking about have considerable merit. Thank you, Mr. Chairman. (Mr. Todd's statement and appended material follow :) STATEMENT OF PAUL H. TODD, JR., CHIEF EXECUTIVE OFFICER, PLANNED PARENTHOOD-WORLD POPULATION Mr. Chairman, members of the Committee, I am delighted to be with you this morning and to see again the many friends with whom I spent some very happy days. I particularly appreciate the opportunity to present to you some thoughts of Planned Parenthood-World Population on a matter which may seem minor— and perhaps non-controversial-compared with such subjects as the railroad dispute which is under the jurisdiction of your Committee. I well identify with your problem of sifting from the many points of view and many needs those which are most appropriate for your time, attention, and action. Although the subject to which we devote our time and energies as an organization is now only a very small part of governmental concern, and especially support, I believe no subject is more fundamental to family health and wellbeing, and through these, to the well-being of the social fabric of our great nation. As most of you know, the organization I represent is a non-profit national organization which has during the past 50 years provided high quality medical service in the area of family planning to literally millions of American couples. Today our organization is providing family planning services to approximately 315,000 women a year through 450 clinics established in 150 communities throughout the United States. In spite of massive efforts in the past few years to expand our services in as many places as possible, we cannot-indeed, we should not-be expected to reach all medically indigent families with a service they cannot normally afford. It has become clear to most Americans, as many members of this Congress well known, that Federal, state and local health agencies must increasingly become involved in the provision of family planning services, with special emphasis on providing those services to families living in poverty. It is because Planned Parenthood-World Population shares with this Congress, this Administration and the vast majority of American people, concern for the extent and the quality of health services available to this nation's impoverished families, that I am here today. Family planning is a health service which has too long been denied to poor families. By making this service available to those who could not afford private medical care, our organization has for many years acted to make health care more comprehensive. We thus associate ourselves with the Public Health Service's concern to develop better and more comprehensive health services. At the community level, there are five major channels available for delivery of family planning services: local hospitals, health departments, community action organizations, private physicians and voluntary health agencies. Some of these resources exist in almost all communities, but the pattern varies widely from one community to the next, and these different agencies do not all reach the same patients. To deliver family planning services to all impoverished families who need and want them will require coordinated efforts to encourage each of these channels to undertake active programs in this field. We estimate that there are approximately 5 million medically dependent women in their childbearing years who are not seeking a desired pregnancy and are potential patients for subsidized family planning services. Of these, only about 700,000 are currently being served by all public and private agencies concerned. Thus, 85 percent of those who need these services do not currently have access to them. To extend family planning to the remaining 85 percent, greatly intensified short- and long-term efforts are required. Far from duplicating services at the local level, a flexible program involving all the relevant Federal agencies is essential in order to accomplish the job. For example, hospital services would be stimulated best through the Children's Bureau Maternity and Infant Care program, and would be geared mainly to helping pregnant and recently delivered mothers. Couples who are newly married and wish to space their children—or who have already had the number of children they want-would best be reached through health department services, assisted by grants from the Public Health Service, and through community action and voluntary agency programs, aided by Office of Economic Opportunity grants, which permit greater flexibility in bringing services close to the population in need. Private physicians are likely to become more involved, in the long run, through the development of the Medical Assistance Program. Not only are these varied programs not mutually exclusive, but they actually complement each other. Only through a multi-faceted program such as this will local communities receive the level of assistance they need. I would like to submit for your study a table representing preliminary estimates of the need for family planning services in 25 selected communities and states, many of which the members of this Committee represent. In these 25 areas alone, a minimum of 545,000 families are not currently receiving family planning services, out of an estimated total of 708,000 who need and want them. The financial requirements for these services are estimated at between $11 and $14 million. Most of you will concur with the repeated statements of local officials that these communities do not have surplus budget funds of this magnitude available to finance this new and vital field of health care. To reach the 4,300,000 medically indigent women throughout the country who are not now being served, we believe it is necessary for Congress to act simultaneously on several pending proposals. If enacted, these proposals would allocate funds to all relevant Federal agencies for expansion of family planning services. These proposals were endorsed by the Board of Directors of Planned Parenthood-World Population last month, and I would like to submit their resolution for the record. Briefly, these proposed complementary efforts include: 1. Dr. Alan Guttmacher, President of our organization, in testifying before the Ways and Means Committee last March 22, suggested that in view of the minimal increase in authorization requested for the Maternity and Infant Care program which would do no more than offset rising medical costs, the Committee should give serious consideration to earmarking additional funds for family planning services through this program. 2. Representative Scheuer has introduced a bill, now before the Committee on Education and Labor, that would earmark funds for family planning services through the OEO's War on Poverty. 3. Proposals to allocate funds for family planning to be administered by either the Public Health Service or the Children's Bureau, at the discretion of the Secretary, have been introduced in this Committee by Representative Carter (H.R. 355) by Representative Hawkins (H.R. 6858 and H.R. 9743); by Representative Friedel (H.R. 8461); and by Representative Moss (H.R. 9045). Our experience convinces us that for a limited period of time necessary to launch this new program, funds need to be allocated specifically, because: Family planning is a relatively new service to most Federal, state and local governmental health agencies; Family planning is an area unprotected by existing and entrenched professional staffs at all levels of government: Family planning has a long history of neglect by health agencies; and When many health programs must contend for appropriations from a very limited budget, the changes for expansion of family planning services are extremely remote. In our opinion this special allocation of family planning funds can be provided by this Committee in one of two ways: The bills introduced by Representatives Friedel, Carter, Hawkins and Moss could be reported out favorably, or the allocation of specific sums for family planning in the Partnership for Health Act could be considered. Let us look for one moment at H.R. 6418, the Partnership for Health Amendments of 1947. The emphasis of this legislation is on the development of a comprehensive approach to health needs on a state-wide basis. The states are encouraged to take stock and to determine what needs to be done and how to do it most expeditiously, using existing resources and, presumably, developing new ones. By establishing a system of block grants to the states, the legislation, at least formally, does away with the old categorical approach to illness and disease. I say at least formally, for this is more theoretical than real. In fact, the current bill calls for an increase of only $7.2 million each in state formula grants and in project grants over the present level of funding. We can only guess how much of this increase would be absorbed by the rising cost of health care, but certainly a substantial amount would be diverted in this manner. Under these conditions, it seems most likely that the states will continue, at perhaps a slightly expanded level, the programs of TB and venereal disease control, cancer control, etc., which they are now conducting. And this is probably as it should be, for these programs are needed and should not be terminated. Theoretically again, some reallocation of priorities and perhaps some economies can be realized under a comprehensive state program. It certainly cannot be expected, however, that the funds released in this fashion will be sufficient to finance new endeavors in anything but a minimal manner. We do not feel, therefore, that any sizable extension of family planning services can be realistically be expected through the proposed Partnership for Health bill. Should the sums authorized for the program be greatly increased as we believe they should be if the legislation is to fulfill its goal, we are still doubtful that funds in sufficient amounts would become available for broad extension of family planing programs. Considerable interest exists at the State and local level, as Dr. Venable of the Association of State and Territorial Health Offices noted in reporting to you the results of the survey undertaken by the Association which indicated that at least 30 states listed family planning among their first ten priorities. But state and local health departments must choose among many unmet health needs, and even several large states such as California, New York or Maryland, where sizable beginnings have already been made in the family planning field, indicated in response to this survey that they did not expect to be able to devote sizable funds to family planning under the Partnership for Health program. Dr. Venable indicated that the State of Georgia would need roughly $1.4 million to reach 70% of its potential case load. You will hear shortly from Dr. Jessup who will report on the level of accomplishment and the level of need in the State of California, and I call your attention to the testimony of Dr. O'Rourke, Health Commissioner for the City of New York, which we `would like to submit for the record. The State of Florida has a county-by-county plan and a specially trained staff of professional personnel at all levels ready to do the job-but there are no existing resources. The interest is there, the cost is relatively moderate, but we realize that as long as funds are limited, as they always are, programs which are older and better established, which have carefully cultivated administrative and political support, and which are "glamorous” I will fare better in the allocation of funds. To summarize, Mr. Chairman, family planning services are urgently needed. They are of high benefit to the individual, the family and the community at a relatively low cost. We urge that you and the Committee give consideration to providing financial support to initiate a broad program. The legislation introduced by four members of this Committee, Representatives Friedel. Carter, Hawkins and Moss, would provide the necessary funds. Alternatively, we submit that the authorization for Partnership for Health should be greatly increased if the legislation is to be effective, and that within this increase a sum of $20 million for Fiscal 1968 should be reserved for family planning services. Closing the gap in family planning services in selected counties, SM SA's, and States 1 Estimates of need for subsidized family planning services calculated by Nancy Van Vleck of PPWP Research Department, employing the Dryfoos-Polgar formula and Bureau of the Census Population Estimates, p. 25, No. 347, Aug. 31, 1966. Figure denotes minimum number of fertile, medically dependent women who are not pregnant or seeking a pregnancy at any given time. Low-income patients currently served by all public and private agencies are approximated on the basis of (where applicable) (a) patients with incomes below $75 weekly in 1966 at planned parenthood affiliated clinics; (b) patient loads reported in the 1966 American Public Health Association Survey of State and Local Health Department Family Planning Activities; (c) patient loads reported for 1966 by the California and Florida State Departments of Health. Estimated, based on an average of $20 to $25 per year per patient, including the cost of medical examination and prescription, Pap smear and continuing supplies. Boston service levels are estimated on basis of number of hospitals and clinics reporting current availability of services, since specific information is unavailable. RESOLUTION ADOPTED BY THE BOARD OF DIRECTORS OF PLANNED PARENTHOODWORLD POPULATION, DENVER, COLO., MAY 6, 1967 A year ago this Board stated its considered judgment that in the family planning field, "neither the problems of the developing areas overseas nor in poverty areas of our own country will be solved with timid, hesitating efforts. The time has come for our nation to move beyond token programs and to allocate resources to this field comensurate with its worldwide urgency." In the last year, there has been some progress in the programs of some Federal agencies, but, in others, the efforts thus far are still token, timid and unimaginative. We salute the increased vitality displayed in the last two months by the Office of Economic Opportunity and the Agency for International Development in the encouragement of voluntary family planning services. On March 20, following an extensive survey by PPWP of the funding status of anti-poverty family planning projects, the OEO announced that special emergency funds would be made available to insure the continuation of all existing family planning programs supported by the War on Poverty. This action-the first administrative allocation of high priority funds for family planning by a Federal agency-prevented a serious setback in approximately 25 communities where family planning services were threatened with closure or sharp reductions in funds. A major shift in U.S. foreign policy emerged on April 5 when AID announced that it would now entertain requests from developing nations for funds to purchase contraceptive supplies and equipment for their manufacture. This new policy removed a serious restriction that previously hampered AID officials and missions in helping other countries develop national voluntary family planning programs. We welcome these two developments and congratulate the agencies involved. They are indicative of the kind of administrative initiative which could bring about rapid progress in this field, if it were carried out energetically in all the relevant Federal agencies and adequately supported by the allocation of sufficient funds for family planning program development. We are encouraged, therefore, by the substantial efforts already under way in the 90th Congress to authorize and appropriate significantly larger earmarked funds for both domestic and overseas programs. Senator Tydings and 17 of his colleagues in the Senate, joined by Representatives Friedel, Moss, Hawkins, and Carter in the House, have introduced measures to provide specific funds, up to $75 million, for domestic family planning services to be provided by both public and voluntary agencies. Representative Scheuer has stated that he will shortly introduce a measure which would create a national emphasis program on family planning, similar to Operation Head Start, within the War on Poverty, and would also allocate up to $75 million for this effort. Senator Fulbright and 18 Senators have sponsored a bill to earmark $50 million annually for family planning programs as part of foreign aid to developing nations. The experience of the last two years has clearly demonstrated the need for these kinds of measures, as well as for Senator Gruening's bill to create an administrative framework in both the Departments of State and Health, Education and Welfare to provide the leadership and direction necessary. The assignment of top-level administrative responsibility, coupled with adequate financial resources and a flexible funding program, such as is envisioned in the above measures, will stimulate family planning efforts by a variety of public and private agencies, and will insure the rapid and orderly expansion of family planning services at home and abroad. STATEMENT OF DR. EDWARD O'ROURKE, COMMISSIONER OF HEALTH, Mr. Chairman, I am pleased to join with the representatives of Planned Parenthood-World Population to discuss with you the likely impact of the Partnership for Health Amendments of 1967, H.R. 6418, on the expansion of family planning services. My views have been shaped by my experiences both as Special Assistant to the Surgeon General in the family planning field, and more recently, as the Health Commissioner of a large metropolitan area. All of us in the health field are in basic agreement with the long-term purpose of this legislation which is to enable us to make our health services more comprehensive both in delivery and scope, and to use our limited health resources wisely in furthering this objective. We therefore supported PL 89-749 last year and we support H.R. 6418 this year. Yet I believe we must be clear as to what this program is likely to be able to accomplish in the near future. It is a step toward giving our state and local health agencies the capability to plan more effectively and to coordinate health resources. This is a very important step and should not be minimized. But it is only a first step on a course which will take many years. Certainly the funds requested for Fiscal 1968 are not sufficient to guarantee that the health services we can actually deliver can be greatly expanded. As Under Secretary Cohen stated in his testimony before you on May 2: "A large proportion of the funds authorized under the Partnership for Health Amendments for fiscal 1968 are likely to be committed by the States to programs approved and begun in earlier years. The $70 million authorization for fiscal 1968 will thus allow for only a modest expansion in these activities***.” This factor is especially important when it comes to a field like family planning which, as far as most health agencies are concerned, is essentially a new service. Agencies which have well-established programs in control of tuberculosis, |