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Senator HARKIN. Thank you very much, Marvin, for a fine statement.

One point here on the Older Workers Program. You mentioned it in your statement, but did you know the minimum wage has gone up?

Mr. WEBB. Yes.

Senator HARKIN. Will restoring the program to last year's level be good enough if we are going to meet the increase in minimum wage? It seems to me if we keep it at last year's level and minimum wage went from $3.80 to $4.25, we are still not going to be at the same level.

Mr. WEBB. Right. I would encourage an increase. We had a very successful program in our area especially combining the State match money for title V and also working with the 3-percent setaside under the Job Training Partnership Act program. Those three programs together have given us a lot of success. And as I mention in my written testimony, we have been identified by the Department of Labor as a national example of the pooling of those kinds of resources.

I think employment for older persons does get overlooked. We do serve persons in extreme situations. We may not think of divorce in later life, but that does occur at an alarming rate. We, I think, are aware of the health care needs of seniors, but we also serve especially older women that may have health problems themselves and need the income for medical expenses and so forth. So I think the Older Worker Program is one that tends to get pushed back. And we encourage this committee to bring that forward as much as possible.

Senator HARKIN. Well, thank you very much, Marvin. Congratulations on a fine job in Iowa.



Senator HARKIN. Next is Lynn Cooper Breckenmaker and Jill June on behalf of the National Family Planning and Reproductive Health Association.

Welcome to the subcommittee. Your statement will be made a part of the record in its entirety. Please proceed.

Ms. COOPER. Thank you.

Mr. Chairman, members of the subcommittee and staff, thank you very much for the opportunity to testify today. And as you have stated, my name is Lynn Cooper Breckenmaker. I am vice president for the Family Health Council of Central Pennsylvania. I am very proud to be here today to testify on behalf of the National Family Planning and Reproductive Health Association, of which I am a member.

Sitting with me today is Jill June, president of the Planned Parenthood of Greater Iowa and a member of the National Family Planning and Reproductive Health Association Board of Directors. The written testimony that you have received is full of important information. It describes NFPRHA and the services that family planning provides. It also contains some incredibly startling data.

But what I hear is that this subcommittee consists of bottom line Senators. So what I would like to do is tell you the bottom line. Title X saves money. Title X prevents abortion. Title X strengthens families. And title X prevents disease and saves lives.

I repeat, title X saves money. When a poor teenager becomes pregnant in this country today, she almost immediately goes on welfare. And unfortunately, she stays there often until her child becomes a teenager. And to make matters worse, that teen of that teen mother often becomes pregnant herself and the cycle goes on endlessly.

We have proven through a study done in central Pennsylvania that was funded by the Ford Foundation that tailoring family planning services to the needs of adolescence prevents unintended pregnancy. This funding results in enormous savings for this county.

Title X prevents abortion. A friend of mine who is in the Pennsylvania House of Representatives, whose name is Peck Foster, he is opposed to abortion. He stood on the floor of the house in 1981, 10 years ago, and asked a very simple question to my legislators: What is the No. 1 cause of abortion? And the answer is very simple. Pregnancy, he stated. What we have to do if we want to stop abortion is prevent the unintended pregnancy.

Title X strengthens families. The American family today needs as much help as they can get. An unintended pregnancy, an unwanted and undesired pregnancy can plunge a marginally poor family into poverty. And it can keep an already impoverished family there for many years to come.

Title X prevents disease and it saves lives. It is the only source of health care for many women. And many folks are really unaware of this important fact. In rural Pennsylvania counties like mine that I cover many of the women that receive service through our program have no other source of health care at all other than the family planning agency that they attend.

Title X prevents cancer. It prevents sexually transmitted diseases and it prevents AIDS.

We need six things and we ask that this subcommittee do the following.

One, support the reauthorization of title X as a categorical grant. Reject the idea of a block grant.

Two, appropriate at least $180 million to this program.

Three, appropriate funds for the administration of this program separate from those funds for family planning activities.

Four, reject again the idea of centralizing our regional offices.
Five, fund contraceptive research.

And, six, fund AIDS and HIV research and services and appropriate funding to the title X network for these critical care and services.

Despite continued struggles, subsidized family planning services have endured. Title X and the National Family Planning and Reproductive Health Association have had many successes. I am proud to have devoted a great deal of the last 15 years of my life to this program.


If you remember nothing else that I have said today, please remember the bottom line. Title X saves money. Title X prevents abortion. Title X strengthens. And title X prevents disease and saves lives.

Thank you.

[The statement follows:]


Mr. Chairman and Members of the Subcommittee:

I am Lynn Cooper Breckenmaker of the Family Health Council of Central Pennsylvania and a member of the National Family Planning and Reproductive Health Association (NFPRHA). I am testifying today on behalf of NFPRHA and in support of an increased appropriation for the Title X national family planning program.

NFPRHA is a non-profit membership organization, established to improve and expand the delivery of voluntary family planning and reproductive health care services nationwide. As the only national organization representing the entire family planning community, NFPRHA represents almost all agencies funded under the national Title X family planning program including: state-county-local health departments; hospital based clinics; Planned Parenthood Federation of America affiliates; family planning councils; independent freestanding clinics; and individual providers, researchers, and consumers. Our members provide reproductive health care services to nearly five million women, men, and adolescents.

Originally established in 1970, the Title X program provides access to contraceptive and reproductive health services to poor women and adolescents through a network of over 4,000 clinics. The average Title X client is young, female, and has a low or marginal income. For many, the Title X program is the only source of health care readily available. The network of Title X clinics reach a population of people whose only other access to health care is through the emergency room.

A typical visit to a Title X program offers an array of preventive and public health services including physical examinations, contraceptive information and services; pap smears; screening and treatment for sexually transmitted diseases; AIDS/HIV testing and counseling; breast and cervical cancer screening; hemoglobin tests; urinalysis; pregnancy and infertility testing; parent/teen communication; maternal and child health services; diagnosis of problem pregnancies; services for men such as counseling, education and the provision of condoms; special teen clinics; adolescent health education; and community education programs. Through these free services, Title X clinics are in a unique and vital position to reach a population of women who are at particular risk for AIDS and sexually transmitted diseases.

Currently 3.5 million low income women and 1.5 million adolescents depend on the Title X clinic services. However, it is estimated that an additional 5.3 million poor women and 3.4 million adolescents are in need of reproductive health care but cannot obtain services. Currently, the Title X clinics are overwhelmed with poor and low income clients. The Reagan and Bush administrations have eroded the family planning program over the past decade in an attempt to save money. We submit that this "savings" has been no savings whatsoever - instead there has been a tremendous cost. A cost both in dollar terms and in human terms.

I urge you to concentrate on the numbers that I have just quoted. 3.5 million low income women served - but 5.3 million poor women unserved. 1.5 million adolescents served but 3.4 million adolescents unserved and in need of reproductive health care. Although millions of unintended pregnancies are averted each year as a direct result of services provided by Title X clinics, the increase in the number of unintended pregnancies and abortions is staggering. Over 50 percent of the six million pregnancies yearly in this country are unintended, with 1.1 million of these pregnancies occurring to teenagers. Eighty percent of all teenage pregnancies are unintended and more than 400,000 of the 1.5 million abortions occur to teenagers. I repeat those numbers: 5.3 million low income women unserved and 3.4 teenagers unserved.

This nation will redeem true savings with full funding for family planning. The authorization of the Title X statute expired on September 30, 1985. The result of its unauthorized status has been a reduction in the funds appropriated despite the overwhelming evidence for the need to expand and to improve the delivery of family planning services. Funding for the Title X program has not increased in real dollars since 1973. Funding for family planning services under Title X have dropped from $162 million in FY81 to $144.4 million in FY91. Inflationary increases alone would have brought the current level of Title X funding to over $239 million this year.

Let's reflect a moment on what that would mean to those earlier figures - 3.5 million women and 3.4 million adolescents unserved. Full funding for Title X at $239 million

would mean that 8.4 million of a total population of 13.7 million women of all ages would be served! First and foremost this would result in a healthier population and healthier outcomes when a women would choose to become pregnant. And in very real dollars terms, full funding would result in enormous savings. In the Alan Guttmacher Institute's study Public Sector Savings Resulting from Expenditures for Contraceptive Services, researchers conclude that every $1 spent on contraceptive services saves an average of $4.40. The study also finds that through the expansion and improvement of the provision of contraceptive services, reproductive health care consumers could more effectively reduce the incidence of unintended pregnancies and abortions. That study does not address, nor add in, the savings of health care dollars accrued from the earlier detection and prevention of sexually transmitted diseases, AIDS and breast and cervical cancer.

Because each day 115 Americans are diagnosed with AIDS and 110 Americans become infected with HIV, support for AIDS prevention and services remains a high priority for reproductive health care providers. We are concerned with federal support for programs to provide successful interventions in the spread of AIDS and HIV infection, especially for adolescents at risk, pregnant women, children, and people of color. Provision of condoms and education, particularly to young women and adolescents is a vital service that family planning clinics provide to help stem the tide of AIDS. Further, poor women can seldom afford preventative health care. However, they can turn to family planning clinics for contraceptive services. Family planning clinics are often the only venue the health care community has to reach this at-risk population.

The United States also faces a serious crisis with the spread of sexually transmitted diseases (STDs). The number of cases of congenital syphilis has increased from fewer than 300 cases in the early 1980s to nearly 4,000 cases in 1990. If left untreated, this entirely preventable disease causes brain damage, blindness, bone deformities and death in newborns. Family planning and reproductive health care providers are increasingly screening and treating patients for STDs. Yet, federal support for these services has not increased.

We recommend the following: 1. Support the reauthorization of Title X as a categorical grant program, rejecting, once again, the administration's attempt to replace the national program with a block grant. Reauthorization of the categorical Title X program is essential to ensure long-term stability on the provision of an effective range of family planning methods and reproductive health care services for poor women, adolescents, and people of color. Although we strongly urge the full restoration of the program at the $239 million level, we urge the committee to appropriate at least $175 million for FY91 for programs under Title X. 2. Appropriate funds for the administration of the Title X program by the Office of Populations Affairs in addition to, and in a separate line item from, the appropriation for family planning activities, specifically services grants and contracts. Furthermore, we suggest that a clear delineation between funds for program management/program support and family planning services be included in future committee and conference reports. 3. Reject, again, in committee report language the proposal by the Administration to reorganize the PHS regional offices through centralization. We recommend that the Subcommittee include committee and conference report language in the FY92 appropriations bill to prohibit the Administration from centralizing the grantmaking authority for Title X through the reorganization of the ten regional offices. 4. Contraceptive Research should be funded. Norplant is the first new method of contraception to emerge in the last twenty five years. And yet, this method, which could be particularly useful in addressing the contraceptive needs of at-risk populations will be virtually unavailable to Title X programs because of its cost. 5. Appropriate $3 billion for FY92 for federal funding of AIDS/HIV research, prevention, and care related programs that provide services to women, adolescents and children with AIDS. Specifically, we recommend that the Subcommittee appropriate $10 million for grants to the network of Title X clinics for outreach, counseling and family planning services for women who are HIV positive or at risk of infection.

Despite administration attempts in the past decade to undermine it, the national Title X family planning program remains a program of many successes. These accomplishments are an endorsement for the reauthorization of Title X and for NFPRHA's request that this Congress approve an appropriation for Title X of $175 million for FY92.

Thank you.

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