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, venereal diseases, chronic diseases and other health fields will not dismantle these programs in order to embark on a new service such as family planning, nor should they. Only if the funds allocated are considerably higher than have previously been available is it possible to expect some development of new services. A further difficulty, however, is that new health services have rarely been initiated without the protection provided by special funds, at least for a limited period of time. It is very difficult for a new service to compete successfully with long-established programs for funds from a general budget. Thus I would urge you to consider both increasing the overall authorizations for the Partnership for Health Program and within this increase, allocating at least $20 million specifically for family planning services. This would permit the Public Health Service to become actively involved, as it should, in this field which is so vital to total family health and well-being, including the proper care of mothers and the reduction of infant mortality, prematurity and such associated problems as mental retardation. The delivery of family planning services at the local level must be accomplished through a variety of health resources: hospitals, health departments, voluntary health agencies, community action agencies and private physicians. State and local health departments have an important contribution to make to this total effort, as does the PHS. New York currently has one of the best developed networks of family planning facilities under both public and private auspices of any city in the country. The resources available to finance these services have come mostly from local tax funds and private contributions, augmented in the last two years by Office of Economic Opportunity and Children's Bureau grants. These services complement and reinforce each other, and we believe that about half the population in need is currently receiving family planning guidance. To complete the job-to make serv ices available to the other half-will require additional funds of between $1.5-3 million annually for the next several years until the programs are established enough to be integrated into the city's ongoing health services. We do not expect that sums of this magnitude will be available from our local budget-or from the funds that will come to us under current Federal health programs. The additional funds we are suggesting under the Partnership for Health program could be decisive in enabling us realistically to make competent family planning serv ices available to every low-income New Yorker who needs and wants them. Mr. ROGERS. Thank you very much. We appreciate your statement. Dr. Jessup, have you a statement to make? Dr. JESSUP. I am pleased, Mr. Chairman, to have this opportunity to present the needs of the people of California for essential Federal assistance in proceeding with the State's private-public partnership effort in relation to family planning. Our objectives in our California plan are to within 4 years, by 1971, make it possible for every newborn child in California to be wanted child and for families to really have the choice. I have been charged today with presenting the case for this additional Federal assistance by representatives of the State administration of government in Sacramento, by the California Legislature Public Health Committee and the Assembly Public Health Committee, and by the professional groups. Representatives of all these groups have joined together in a partnership interagency family planning council, which I have appended to my statement, the leaders, and so on, who back us in this effort. California's history in family planning has been one of concern and one of leadership in the Nation over the past decade. Important strides have been taken. The goal has always been, and is today, to make every child a wanted child and thus improve the health and strengthen the integrity of California families. Among the important steps that have been taken over the past 10 years are: Senate Concurrent Resolution Nos. 19 and 47, policy statements favoring family planning program extension by representatives of the executive branch of State government, the California Medical Association, County Boards of Supervisors, the California State Board of Public Health, and the California Congress of Parents and Teachers. Forty of California's fifty-eight counties now have publicly supported family planning services, woefully insufficient though they are. There are also 16 privately supported planned parenthood world population programs, and the important services provided by dedicated private physicians in their own offices. Today, despite California's leadership and the progress that private and public groups have made, there remain wide gaps in the availability of both family planning information and services. One conspicuous gap lies in the paucity of information available to young people. In California there is now general recognition of the fact that "we cannot ask or expect young people to exercise responsibility over procreative powers without information." Sixty percent of the population growth rate of California is the fact that 1,500 newcomers come from your State over the border into our State, at the rate of a half million new citizens every year. Mr. ROGERS. I might say that we in Florida are also getting some people from California. Dr. JESSUP. Yes, sir, we are trading off. The proposed extension of freedom of choice in family planning will have but a secondary effect on your State, Mr. Rogers, or our State population, where the growth rate is well recognized. The primary effect and essential purpose of the family planning program is to extend to all persons the option of planning their families and sharing the benefits of the latest scientific advances in the field. The advantages of such a recent information in family planning services is clearly not available to all Californians or available equally today. A canvass which I have included in my testimony shows that only one in about seven families in California, of low income, really have any chance or information or services to plan their families if they want to. There are some 350,000 medically indigent women of childbearing age in California who simply do not have the services available today. If you take $5,000, their annual family income, it goes up to 750,000 women. A recent canvass we did in just the last 2 months, in preparation for this testimony, indicated that we would need some $2 million of Federal funds in order to realistically get our California program underway. We have called on the Children's Bureau, the existing maternal and infant care funds, we have used all we can of our maternal and child health allotments from Public Health Service, we have four or five neighborhood health centers coming up, we hope. But we have exhausted these funds. Existing programs will simply not do the job. We have exhausted our State and local resources and our private funding. It comes down to the fact that unless we get some $1.8 to $2 million, about 100,000 mothers in California who would like this service are simply not going to get it in the next fiscal year. So we are appealing to the Congress this year, and we are supporting strongly 749. California took leadership in the idea of comprehensive planning. What we really feel is that unless we get adequate funding earmarked in some way out of one of the funds from the Congress this year, we will not be able to carry out the charge of the Congress and of the Secretary of Health, Education, and Welfare, and of the President, given on many occasions. Unless we get these funds we simply cannot carry out a plan which we have worked out. We don't need planning. We are ready to go. I have submitted the plan with my statement, the plan which all of us in California are in agreement upon. We in California agree that we need Federal funds at this time and we appeal to the committee to give an increased appropriation which will make possible appropriations to the State. Mr. ROGERS. Thank you very much. Are there any questions, Mr. Stuckey? Mr. STUCKEY. No questions, Mr. Chairman. Mr. ROGERS. Dr. Carter. Mr. CARTER. I have certainly enjoyed your presentation, and I thank you for the mention made of the bill which I introduced for family planning. I regret to say that when we mention these bills so many times, particularly in the full committee, there is a great silence that is almost palpable. I regret this. Certainly I would like to see that you get the money for family planning in California, and all the States of the United States. They need it very badly. It would result in the saving of dollars and in the health of mothers, improvement in the health and the lives of the children. I am very interested in this. I have visited birth control clinics as far away as India. I find that some of them are quite successful. Certainly I wonder about our different forms of foreign aid. It seems that we have supplied military aid in billions of dollars for some of these countries to fight among themselves, as they have just been doing with our material. I wonder what would have happened if we had used this money for family planning and birth control. There are not only the lives that we would save in that, but it would be a tremendous help to the countries, too. Thank you, Mr. Chairman. Mr. ROGERS. Mr. Kyros. Mr. KYROS. I have no questions, Mr. Chairman. Mr. ROGERS. Thank you very much. (Dr. Jessup's prepared statement follows:) STATEMENT OF DR. BRUCE JESSUP, BUREAU OF MATERNAL AND CHILD HEALTH, CALIFORNIA STATE DEPARTMENT OF PUBLIC HEALTH Mr. Chairman and Members of the Committee, I am pleased to have this opportunity to present the needs of the people of California for essential federal assistance in proceeding with the State's own private-public partnership plan in family planning. The objectives of the plan are to make it possible by 1971 for every newborn child in our State to be a wanted child; and to make freedom of choice in the number and spacing of children a reality for all California parents. I am today charged with presenting the case for additional federal funds by representatives of the Administration, the California Legislature's Senate and Assembly Public Health Committees, representatives of the California Medical Association, Nurses' Association, Hospital Association, County Supervisors Association, the Congress of Parents and Teachers, State Board of Education, the California State Departments of Public Health and Social Welfare, the California Conference of Local Health Officers, the leaders of religious groups, labor and California industry. Representatives of all of these groups have joined together in a partnership Interagency Family Planning Council to develop a California Family Planning Program which I have distributed with this statement. (List |