2017 FPAR National Summary

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2017 FPAR National Summary

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August 2018

Title X
Family Planning
Annual Report
2017 National Summary

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Family Planning Annual Report: 2017 National Summary

August 2018

Family Planning Annual Report:
2017 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 700
Rockville, MD 20852

Prepared by
RTI International

3040 East Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709

_________________________________
RTI International is a registered trademark and a trade name of Research Triangle Institute.

SUGGESTED CITATION
Fowler, C. I., Gable, J., Wang, J., & Lasater, B. (2018, August). Family Planning Annual
Report: 2017 national summary. Research Triangle Park, NC: RTI International.

ADDITIONAL COPIES
This report can be viewed, downloaded, and printed from the Office of Population Affairs
Website at https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html.

ACKNOWLEDGMENTS
This report was prepared by RTI International under OPA contract number
HHSP23320095651WC/HHSP23337041T. RTI staff who prepared the report include
Christina Fowler (Project Director and Health Scientist), Julia Gable (Statistician), Jiantong
Wang (Statistician), and Beth Lasater (Information Systems Analyst). The conclusions
expressed in this report are those of the authors and do not necessarily represent the views of
HHS or OPA. Sharon Barrell and Margaret Johnson (Editors); Roxanne Snaauw (Document
Preparation Specialist); and Kimberly Cone, Pam Tuck, Teresa Bass, and Danny Occoquan
(Web Conversion Team) provided publications assistance. Nathan Sikes, Yuying Zhang, AlNisa Berry, and Vesselina Bakalov provided support for web-based data collection.
For their help resolving data validation issues and reviewing the final report, the authors
thank U.S. Department of Health and Human Services (HHS) Office of Population Affairs
(OPA) staff Emily Decker (FPAR Data Coordinator) and Ana Carolina Loyola Briceño and
HHS/OPA Regional Project Officers.
Finally, publication of this report would not have been possible without the contributions of
Title X services grantees and subrecipients that collect, compile, and submit FPAR data to
OPA.

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Family Planning Annual Report: 2017 National Summary

CONTENTS
Executive Summary ....................................................................... ES-1
1

Introduction ........................................................................................ 1

Title X National Family Planning Program ........................................................................... 1
Family Planning Annual Report............................................................................................. 1
Report Structure ..................................................................................................................... 3
2

FPAR Methodology .............................................................................. 5

Data Collection ...................................................................................................................... 5
Data Validation ...................................................................................................................... 5
3

Findings .............................................................................................. 7

Title X Service Network Profile ............................................................................................ 7
Family Planning User Demographic Profile .......................................................................... 8
Total Users (Exhibit 3) .................................................................................................... 8
Users by Sex (Exhibits 4 and 5) ...................................................................................... 9
Users by Age (Exhibits 4 and 5) ..................................................................................... 9
Users by Race (Exhibits 6 through 14) ......................................................................... 12
Users by Ethnicity (Exhibits 6 through 14) ................................................................... 12
Family Planning User Social and Economic Profile ............................................................ 21
Users by Income Level (Exhibit 15) ............................................................................. 21
Users by Insurance Coverage Status (Exhibit 16) ......................................................... 21
Limited English Proficient Users (Exhibit 17) .............................................................. 22
Primary Contraceptive Method Use ..................................................................................... 27
Female Users by Primary Contraceptive Method (Exhibits 18 through 21) ................. 27
Trends in Female Primary Contraceptive Method Use ................................................. 29
Male Users by Primary Contraceptive Method (Exhibits 22 through 25) ..................... 35
Cervical and Breast Cancer Screening ................................................................................. 41
Cervical Cancer Screening (Exhibit 26)........................................................................ 41
Breast Cancer Screening (Exhibit 26) ........................................................................... 41
Sexually Transmitted Disease Testing ................................................................................. 43
Chlamydia Testing (Exhibits 27 and 28)....................................................................... 43
Gonorrhea Testing (Exhibit 29) .................................................................................... 44
Syphilis Testing (Exhibit 29) ........................................................................................ 44
Human Immunodeficiency Virus Testing (Exhibit 29) ................................................. 44
Staffing and Family Planning Encounters............................................................................ 49

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Clinical Services Provider Staffing (Exhibit 30) ........................................................... 49
Family Planning Encounters (Exhibit 30) ..................................................................... 49
Revenue................................................................................................................................ 53
Title X Services Grant ................................................................................................... 53
Payment for Services: Client Fees ................................................................................ 53
Payment for Services: Third-Party Payers .................................................................... 53
Other Revenue............................................................................................................... 54
Revenue per User and Encounter .................................................................................. 55
Revenue Trends: 2007 vs. 2017 .................................................................................... 58
4

References ........................................................................................ 59

Appendixes

A National Trend Exhibits .............................................................................................. A-1
B State Exhibits............................................................................................................... B-1
C Field and Methodological Notes ................................................................................. C-1
Exhibits

1. U.S. Department of Health and Human Services regions ............................................... 2
2. Number of and percentage change in grantees, subrecipients, and service sites,
by year and region: 2016–2017 (Source: FPAR Grantee Profile Cover Sheet) .............. 7
3. Number, distribution, and percentage change in number of all family planning
users, by year and region: 2016–2017 (Source: FPAR Table 1) ..................................... 8
4. Number of all family planning users, by sex, age, and region: 2017
(Source: FPAR Table 1) ................................................................................................ 10
5. Distribution of all family planning users, by sex, age, and region: 2017
(Source: FPAR Table 1) ................................................................................................ 11
6. Number and distribution of all family planning users, by race and ethnicity:
2017 (Source: FPAR Tables 2 and 3) ............................................................................ 13
7. Number and distribution of female family planning users, by race and
ethnicity: 2017 (Source: FPAR Table 2) ....................................................................... 13
8. Number and distribution of male family planning users, by race and ethnicity:
2017 (Source: FPAR Table 3) ....................................................................................... 13
9. Number of all family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Tables 2 and 3) ..................................................................................... 14
10. Distribution of all family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Tables 2 and 3) ..................................................................................... 15
11. Number of female family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Table 2) ................................................................................................ 16

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Family Planning Annual Report: 2017 National Summary

12. Distribution of female family planning users, by race, ethnicity, and region:
2017 (Source: FPAR Table 2) ....................................................................................... 17
13. Number of male family planning users, by race, ethnicity, and region: 2017
(Source: FPAR Table 3) ................................................................................................ 18
14. Distribution of male family planning users, by race, ethnicity, and region:
2017 (Source: FPAR Table 3) ....................................................................................... 19
15. Number and distribution of all family planning users, by income level and
region: 2017 (Source: FPAR Table 4) ........................................................................... 23
16. Number and distribution of all family planning users, by principal health
insurance coverage status and region: 2017 (Source: FPAR Table 5) .......................... 24
17. Number and distribution of all family planning users, by limited English
proficiency (LEP) status and region: 2017 (Source: FPAR Table 6) ............................ 25
18. Number of female family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 7)......................................................................... 30
19. Distribution of female family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 7)......................................................................... 31
20. Number of female family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 7) .................................................................... 32
21. Distribution of female family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 7) .................................................................... 33
22. Number of male family planning users, by primary contraceptive method and
age: 2017 (Source: FPAR Table 8) ............................................................................... 36
23. Distribution of male family planning users, by primary contraceptive method
and age: 2017 (Source: FPAR Table 8)......................................................................... 37
24. Number of male family planning users, by primary contraceptive method and
region: 2017 (Source: FPAR Table 8) ........................................................................... 38
25. Distribution of male family planning users, by primary contraceptive method
and region: 2017 (Source: FPAR Table 8) .................................................................... 39
26. Cervical and breast cancer screening activities, by screening test or exam and
region: 2017 (Source: FPAR Tables 9 and 10) ............................................................. 42
27. Number of family planning users tested for chlamydia, by sex, age, and region:
2017 (Source: FPAR Table 11) ..................................................................................... 46
28. Percentage of family planning users in each age group tested for chlamydia, by
sex, age, and region: 2017 (Source: FPAR Table 11) ................................................... 47
29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and
region, and number of positive HIV tests, by region: 2017
(Source: FPAR Table 12) .............................................................................................. 48
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:
2017 (Source: FPAR Table 13) ..................................................................................... 51

Family Planning Annual Report: 2017 National Summary

v

31. Amount and distribution of Title X project revenues, by revenue source: 2017
(Source: FPAR Table 14) .............................................................................................. 55
32. Amount of Title X project revenues, by revenue source and region: 2017
(Source: FPAR Table 14) .............................................................................................. 56
33. Distribution of Title X project revenues, by revenue source and region: 2017
(Source: FPAR Table 14) .............................................................................................. 57
A–1a. Number of Title X-funded grantees, subrecipients, and service sites, by region
and year: 2007–2017 ................................................................................................... A-2
A–1b. Distribution of Title X-funded grantees, subrecipients, and service sites, by
region and year: 2007–2017 ........................................................................................ A-3
A–1c. Number of Title X-funded service sites and users per service site, by year:
2007–2017 ................................................................................................................... A-4
A–2a. Number and distribution of all family planning users, by region and year:
2007–2017 ................................................................................................................... A-6
A–2b. Number and distribution of all family planning users, by region and year:
2007–2017 ................................................................................................................... A-7
A–3a. Number and distribution of all family planning users, by age and year:
2007–2017 ................................................................................................................... A-8
A–3b. Number and distribution of all family planning users, by age and year:
2007–2017 ................................................................................................................... A-9
A–4a. Number and distribution of all family planning users, by race and year:
2007–2017 ................................................................................................................. A-10
A–4b. Number and distribution of all family planning users, by race and year:
2007–2017 ................................................................................................................. A-11
A–5a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2007–2017 ................................................................. A-12
A–5b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity (all races) and year: 2007–2017 ................................................................. A-13
A–6a. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2007–2017......................................................................... A-14
A–6b. Number and distribution of all family planning users, by Hispanic or Latino
ethnicity, race, and year: 2007–2017......................................................................... A-15
A–7a. Number and distribution of all family planning users, by income level and
year: 2007–2017 ........................................................................................................ A-16
A–7b. Number and distribution of all family planning users, by income level and
year: 2007–2017 ........................................................................................................ A-17
A–8a. Number and distribution of all family planning users, by primary health
insurance status and year: 2007–2017 ....................................................................... A-18
A–8b. Number and distribution of all family planning users, by primary health
insurance status and year: 2007–2017 ....................................................................... A-19

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Family Planning Annual Report: 2017 National Summary

A–9a. Number of all female family planning users, by primary contraceptive method
and year: 2007–2017 ................................................................................................. A-20
A–9b. Distribution of all female family planning users, by primary contraceptive
method and year: 2007–2017 .................................................................................... A-21
A–9c. Number and distribution of all female family planning users, by type of
primary contraceptive method and year: 2007–2017 ................................................ A-22
A–10a. 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: 2007–2017 ............................................................................. A-23
A–10b. Number and percentage of female users who received a Pap test, by year:
2007–2017 ................................................................................................................. A-23
A–11a. Number and percentage of female users under 25 tested for chlamydia, by
year: 2007–2017 ........................................................................................................ A-24
A–11b. Number and percentage of female users under 25 tested for chlamydia, by
year: 2007–2017 ........................................................................................................ A-24
A-12a. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2007–2017 ............................................................. A-25
A-12b. Number of confidential HIV tests performed and number of tests per 10 users
(all, female, and male), by year: 2007–2017 ............................................................. A-25
A–13a. Actual and adjusted (constant 2017$ and 2007$) total, Title X, and Medicaid
revenue, by year: 2007–2017 .................................................................................... A-26
A–13b. Total, Title X, and Medicaid adjusted (constant 2017$) revenue (in millions),
by year: 2007–2017 ................................................................................................... A-27
A–13c. Total actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in
millions), by year: 2007–2017................................................................................... A-28
A–13d. Title X actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue
(in millions), by year: 2007–2017 ............................................................................. A-29
A–13e. Medicaid actual (unadjusted) and adjusted (constant 2017$ and 2007$)
revenue (in millions), by year: 2007–2017................................................................ A-30
A–14a. Amount of Title X project revenue, by revenue source and year: 2007–2017 .......... A-32
A–14b. Distribution of Title X project revenue, by revenue source and year: 2007–
2017 ........................................................................................................................... A-33
A–14c. Amount (unadjusted) and distribution of Title X project revenue, by revenue
source and year: 2007–2017 ...................................................................................... A-34
B–1. Number and distribution of all family planning users, by sex and state, and
distribution of all users, by state: 2017 (Source: FPAR Table 1) ................................ B-2
B–2. Number and distribution of all family planning users, by user income level and
state: 2017 (Source: FPAR Table 4)............................................................................ B-4
B–3a. Number and distribution of all family planning users, by insurance status and
state: 2017 (Source: FPAR Table 5)............................................................................ B-6

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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 states’
Medicaid expansion status: 2017 (Source: FPAR Table 5) ......................................... B-8
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: 2017 (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: 2017 (Source: FPAR Table 11) ....................... B-12

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Executive Summary
The Title X National Family Planning Program, administered by the U.S. Department of
Health and Human Services, 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 program is designed to provide contraceptive supplies and information to all who
want and need them, with priority given to persons from low-income families. In addition to
offering a broad range of effective and acceptable contraceptive methods 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.1,2 The program is implemented through competitively
awarded grants to state and local public health departments and community health, family
planning, and other private nonprofit agencies. For many clients, Title X providers are their
only ongoing source of health care and health education.3 In fiscal year 2017, 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
service 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 and
Congress 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: 2017 National Summary is to present the
national-, regional-, and state-level findings for the 2017 reporting period (calendar year) and
trends for selected measures. Below we highlight key findings.

KEY 2017 FPAR FINDINGS
A diverse network of public and private nonprofit health and community service
agencies delivers Title X services. In 2017, Title X-funded services were implemented
through grants to 89 agencies: 47 (53%) state and local health departments and 42 (47%)
nonprofit family planning and community health agencies. Title X funds supported a network
of 3,858 service sites operated either by grantees or 1,091 subrecipients in the 50 United
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 2017, Title X-funded providers served
approximately 4.0 million family planning users (i.e., clients) through 6.6 million family
planning encounters. A family planning user is an individual who has at least one family
planning encounter at a Title X service site during the reporting period. A family planning
encounter is a documented, face-to-face interaction between an individual and a family

Family Planning Annual Report: 2017 National Summary

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planning provider that includes the delivery of family planning services (alone or in
conjunction with related preventive health services) to avoid unintended pregnancies or
achieve intended pregnancies. About 9 of every 10 users (88%) were female, 65% were under
30 years of age, and 67% had family incomes at or below the poverty level ($24,600 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 2017, the
percentage of users who were insured (57%) exceeded the percentage who were uninsured
(42%). This is the third consecutive year, since OPA began collecting insurance data in 2005,
that the percentage insured has exceeded the percentage uninsured. Although the increase in
health insurance coverage signals greater access to health care for Title X clients, the
percentage of Title X users who were uninsured (42%) in 2017 is more than triple the national
rate for adults (13%).8 Among insured users, 67% had coverage through Medicaid or other
public sources and 33% had private coverage.
Title X providers serve a racially and ethnically diverse population. Of the 4.0 million
family planning users served in 2017, 31% self-identified with at least one of the nonwhite
Office of Management and Budget9 race categories (black or African American, Asian,
Native Hawaiian or Pacific Islander, American Indian or Alaska Native, or more than one
race), 33% self-identified as Hispanic or Latino, and 14% were limited English proficient.
Title X providers offer clients a broad range of effective, medically safe contraceptive
methods approved by the U.S. Food and Drug Administration. In 2017, 80% (2.8 million)
of all female users exited their last encounter in the reporting period with a most effective
(vasectomy, female sterilization, implant, or IUD), moderately effective (injectable
contraception, vaginal ring, contraceptive patch, pills, diaphragm, or cervical cap), or less
effective (male condom, female condom, sponge, withdrawal, a fertility awareness-based
method [FAM], lactational amenorrhea method [LAM], or spermicide used alone)
contraceptive method.10 Nine percent (313,802) of all female users exited their last encounter
with no primary method because they were either pregnant or seeking pregnancy. Among the
3.1 million female clients at risk of unintended pregnancy (not pregnant, not seeking
pregnancy, or abstinent), 70% (2.2 million) exited their last encounter with either a most
(21%) or moderately effective (49%) contraceptive method.
Title X-funded cervical and breast cancer screening services are necessary for early
detection and treatment. In 2017, Title X providers conducted Papanicolaou (Pap) testing
on 18% (649,266) of female users. Fourteen percent of the 683,247 Pap tests performed had
an indeterminate or abnormal result requiring further evaluation and possible treatment. In
addition, providers performed clinical breast exams on 25% (878,491) of female users and
referred 5% 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 2017, Title X providers tested 61%
(939,250) of female users under 25 for chlamydia. Providers also performed 2.4 million
gonorrhea tests (6.1 tests per 10 users), 1.2 million confidential HIV tests (3.0 tests per 10
users), and 709,161 syphilis tests (1.8 tests per 10 users). Of the confidential HIV tests
performed, 2,195 (1.8 per 1,000 tests performed) were positive for HIV.

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Family Planning Annual Report: 2017 National Summary

Title X providers deliver male-focused family planning and reproductive health services
to a growing number of male clients. In 2017, 12% (463,011) of all Title X users were men,
a number that has grown by 57% since 2007. Most male users were in their 20s (44%) or 30s
(22%), and 76% (353,287) adopted or continued use of condoms or another contraceptive
method at exit from their last encounter. In addition, Title X providers tested 69% (321,280)
of all male users for chlamydia and provided testing for several other STDs, including
gonorrhea (7.6 tests per 10 male users), HIV (5.9 tests per 10 male users), and syphilis (3.6
tests per 10 male users).
A variety of qualified health providers deliver Title X-funded clinical services. In 2017,
3,525 full-time equivalent (FTE) clinical services providers (CSPs) delivered Title X-funded
care. Nurse practitioners, certified nurse midwives, and physician assistants accounted for
70% of total CSP FTEs, followed by physicians (23%) and registered nurses with an
expanded scope of practice (7%). A CSP attended 78% of the 6.6 million family planning
encounters in 2017.
Title X projects rely on revenue from a variety of public and private sources. In 2017,
Title X grantees reported total project revenue of almost $1.3 billion to support their approved
Title X services projects. Five sources accounted for 86% of total revenue: Medicaid (38%, or
$495.2 million), Title X (19%, or $244.6 million), state and local governments (15%, or
$188.2 million), private third-party payers (11%, or $140.1 million), and client service fees
(4%, or $52.4 million). In 2017, Title X projects reported a net decrease of 3% ($40.3 million
in constant 2017 dollars) in total revenue compared with 2016.
Summary. The FPAR data for 2017, and over time, show that Title X providers continue to
deliver family planning and related preventive care to a socioeconomically disadvantaged
population. Despite the recent decline in revenue, the number of clients served has remained
almost level since 2015, and the delivery of recommended preventive health care remains
high, both of which attest to the network’s efforts to deliver care meeting the highest national
standards.

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Introduction

TITLE X NATIONAL FAMILY PLANNING PROGRAM
The National Family Planning Program, created in 1970 and authorized under Title X of the
Public Health Service Act,11 is administered by the Office of Population Affairs (OPA),
Office of the Assistant Secretary for Health (OASH), 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. The program is
designed to provide contraceptive supplies and information to all who want and need them,
with priority given to persons from low-income families. In addition to offering a broad range
of effective and acceptable contraceptive methods 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.1,2 By
law, Title X funds cannot be used in programs where abortion is a method of family
planning.1,2 The program is implemented through grants to approximately 90 public health
departments and community health, family planning, and other private nonprofit agencies.
These grants support delivery of Title X services in approximately 4,000 sites. For many
clients, Title X providers are their only ongoing source of health care and health education.3
In fiscal year 2017, the Title X program received approximately $286.5 million in federal
Title X funding.4
The HHS Regional Offices monitor the performance of the Title X grantees in their respective
regions (see Exhibit 1), with overall program oversight from OPA.

FAMILY PLANNING ANNUAL REPORT
The Family Planning Annual Report (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 and
Congress about the program; and

Family Planning Annual Report: 2017 National Summary

1

▪ estimate the impact of Title X-funded activities on key reproductive health outcomes,

including prevention of unintended pregnancy, infertility, and invasive cervical cancer.5

Exhibit 1.

U.S. Department of Health and Human Services regions

The 10 HHS regions (and regional office locations) are as follows:

▪ Region I (Boston, MA)—Connecticut, Maine, Massachusetts, New Hampshire, Rhode
Island, and Vermont

▪ Region II (New York, NY)—New Jersey, New York, Puerto Rico, and the U.S. Virgin
Islands

▪ Region III (Philadelphia, PA)—Delaware; Maryland; Pennsylvania; Virginia;
Washington, DC; and West Virginia

▪ Region IV (Atlanta, GA)—Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, and Tennessee

▪ Region V (Chicago, IL)—Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin
▪ Region VI (Dallas, TX)—Arkansas, Louisiana, New Mexico, Oklahoma, and Texas
▪ Region VII (Kansas City, MO)—Iowa, Kansas, Missouri, and Nebraska
▪ Region VIII (Denver, CO)—Colorado, Montana, North Dakota, South Dakota, Utah, and
Wyoming

▪ Region IX (San Francisco, CA)—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

▪ Region X (Seattle, WA)—Alaska, Idaho, Oregon, and Washington
2

Family Planning Annual Report: 2017 National Summary

REPORT STRUCTURE
The Family Planning Annual Report: 2017 National Summary presents data for the
89 Title X services grantees that submitted an FPAR report for the 2017 reporting period
(January 1, 2017, through December 31, 2017). The National Summary has four 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.

▪ Section 3—Findings—presents the results for each FPAR table and includes a discussion

of national and regional patterns and trends for selected indicators. Section 3 also includes
definitions for table-specific FPAR terms and reporting guidance.

▪ Section 4—References—is a list of National Summary references.
Additional data for the National Summary are included in three appendices: Appendix A
presents trend data for selected indicators for 2007 through 2017. Appendix B presents 2017
data for selected indicators by state, which includes the 50 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 the U.S. Virgin Islands). The
Appendix B exhibits present information on the number and distribution of Title X family
planning users served by sex, income level, health insurance coverage status (overall and by
Medicaid expansion status), contraceptive use, and chlamydia testing. Appendix C presents
general and table-specific notes about the data presented in this report.
Throughout this report, we present the instructions for preparing each FPAR table alongside
the table-specific findings. In addition, 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 2017 or trend data. Each exhibit identifies the FPAR table that is the source for the data
presented.

Note:
Due to rounding, percentages cited in text may not match summed percentages from the
exhibits.

Family Planning Annual Report: 2017 National Summary

3

Key Terms and Definitions for FPAR Reporting
Family Planning User—A family planning user is an individual who has at least one family planning encounter at a
Title X service site during the reporting period. The same individual may be counted as a family planning user only
once during a reporting period.
Family Planning Provider—A family planning provider is the individual who assumes primary responsibility for
assessing a client and documenting services in the client record. Providers include those agency staff who exercise
independent judgment as to the services rendered to the client during an encounter. Two general types of providers
deliver Title X family planning services: Clinical Services Providers and Other Services Providers.
CLINICAL SERVICES PROVIDERS—Include physicians (family and general practitioners, specialists), 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. Clinical
Services Providers are able to offer client education, counseling, referral, follow-up, and clinical services (physical
assessment, treatment, and management) relating to a client’s proposed or adopted method of contraception,
general reproductive health, or infertility treatment, in accordance with the Program Guidelines.12
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 Program
Guidelines.12 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 the Program Guidelines.12
Family Planning Encounter—A family planning encounter is a documented, face-to-face contact between an
individual and a family planning provider that takes place in a Title X service site. The purpose of a family planning
encounter—whether clinical or nonclinical—is to provide family planning and related preventive health services to
female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies. To be counted
for purposes of the FPAR, a written record of the services provided during the family planning encounter must be
documented in the client record. Laboratory tests and related counseling and education, in and of themselves, do not
constitute a family planning encounter unless there is face-to-face contact between the client and provider, the provider
documents the encounter in the client’s record, and the tests are accompanied by family planning counseling or
education.
There are two types of family planning encounters at Title X service sites: (1) family planning encounters with a Clinical
Services Provider and (2) family planning encounters with an Other Services Provider. The type of family planning
provider who renders the care, regardless of the services rendered, determines the type of family planning encounter.
Although a client may meet with both Clinical and Other Services Providers during an encounter, the provider with the
highest level of training who takes ultimate responsibility for the client’s clinical or nonclinical assessment and care
during the visit is credited with the encounter.
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) that comply with Title X
Program Guidelines12 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 (e.g., blood
pressure check, urine-based pregnancy, or STD test). 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.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 7–10.

4

Family Planning Annual Report: 2017 National Summary

2

FPAR Methodology

DATA COLLECTION
The Title X Family Planning Annual Report (FPAR): Forms and Instructions (Reissued
October 2016)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 family planning and related preventive health services at Title X-funded
service sites, the range and scope of the services provided, and the family planning providers
that render care.
Title X services grantees are required to submit the FPAR by February 15 for the recently
completed reporting period (January 1 to December 31). In February 2018, 89 grantees
submitted FPARs for the 2017 reporting period. Almost all (99%) FPARs were submitted by
the due date, and all were submitted using the web-based FPAR 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 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,
HHS regional staff review the FPAR and either accept it or return it to the grantee for
correction or clarification. Once the HHS regional staff accept the FPAR, the FPAR Data
Coordinator performs a second and final review, either accepting the FPAR or returning it to
the HHS regional staff 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 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 HHS staff and grantees address all outstanding validation issues in the
FPAR Data System, RTI extracts the final data file for tabulation and analysis.

Family Planning Annual Report: 2017 National Summary

5

Guidance for Reporting User Demographic Profile Data in FPAR Tables 1 through 3
In FPAR Tables 1, 2, and 3, grantees report information on the demographic profile of family planning users,
including age and sex (Table 1) and race and ethnicity (Tables 2 and 3).
In FPAR Table 1, grantees report the unduplicated number of family planning users by age group and sex,
categorizing the users based on their age as of June 30 of the reporting period.
In FPAR Tables 2 and 3, grantees report the unduplicated number of female (Table 2) and male (Table 3) family
planning users by race and ethnicity. The FPAR instructions provide the following guidance for reporting this
information:
Race and Ethnicity—The categories for reporting ethnicity and race in the FPAR conform to the Office of
Management and Budget (OMB) 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity9 and are used by other HHS programs and compilers of such national data sets as the National
Survey of Family Growth. If an agency wants to collect data for ethnicity or race subcategories, the agency must be
able to aggregate the data reported into the OMB minimum standard set of ethnicity and race categories. OMB
encourages self-identification of race. When respondents are allowed to self-identify or self-report their race,
agencies should adopt a method that allows respondents to mark or select more than one of the five minimum race
categories.
The two minimum OMB categories for reporting ethnicity are as follows:
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 as follows:
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.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 15–17, A-1–A-2.

6

Family Planning Annual Report: 2017 National Summary

3

Findings

TITLE X SERVICE NETWORK PROFILE
In 2017, Title X-funded services were implemented through grants to 89 agencies: 47 (53%)
state and local health departments and 42 (47%) nonprofit family planning and community
health agencies. This funding supported a service network that included 1,091 subrecipients
(subcontractors) and 3,858 service sites in the 50 United States, the District of Columbia, and
the eight U.S. territories and Freely Associated States (Exhibit 2).
Compared with 2016, in 2017, the Title X program had two fewer grantees (89 vs. 91), 26
fewer subrecipients (1,091 vs. 1,117), and 40 fewer service sites (3,858 vs. 3,898). All but
three regions (II, III, and VIII) reported a decrease in subrecipients, while seven regions (I,
IV, V, VI, VII, VIII, and IX) reported a decrease in service sites (Exhibit 2).

Exhibit 2.

Number of and percentage change in grantees, subrecipients, and service sites, by year
and region: 2016–2017 (Source: FPAR Grantee Profile Cover Sheet)

Network
Feature

All
Region
Regions
I

Region
II

Region
III

Region
IV

Region
V

Region
VI

Region
VII

Region
VIII

Region
IX

Region
X

Grantees
2017

89

11

6

10

9

11

6

5

6

17

8

2016

91

11

6

10

9

11

7

5

6

18

8

Difference

−2

0

0

0

0

0

−1

0

0

−1

0

% Change

−2%

0%

0%

0%

0%

0%

−14%

0%

0%

−6%

0%

Subrecipients
2017

1,091

68

68

225

277

113

39

91

69

85

56

1,117

69

68

223

281

118

41

92

68

99

58

Difference

−26

−1

0

2

−4

−5

−2

−1

1

−14

−2

% Change

−2%

−1%

0%

1%

−1%

−4%

−5%

−1%

1%

−14%

−3%

Service Sites
2017

3,858

221

244

653

912

365

415

210

162

465

211

3,898

225

244

640

914

374

425

221

180

469

206

Difference

−40

−4

0

13

−2

−9

−10

−11

−18

−4

5

% Change

−1%

−2%

0%

2%

0%†

−2%

−2%

−5%

−10%

−1%

2%

2016

2016

†

Percentage change is greater than –0.5% and less than 0.5%.

Family Planning Annual Report: 2017 National Summary

7

Since 2007, the change in the number of grantees and subrecipients has been smaller than the
change in the number of service sites. Compared with 2007, in 2017, there was no change in
the number of grantees (89 in 2017 and 2007), a 7% decrease in the number of subrecipients
(1,091 vs. 1,176), and a 15% decrease in the number of service sites (3,858 vs. 4,542).
Exhibits A–1a and A–1b in Appendix A present trends (2007–2017) in the number of
grantees, subrecipients, and service sites by region.

FAMILY PLANNING USER DEMOGRAPHIC PROFILE
Total Users (Exhibit 3)

In 2017, Title X-funded sites served over 4.0 million family planning users. Grantees in
Region IX served 27% of Title X users; those in Regions II, III, IV, V, and VI each served
between 9% and 17%; and those in Regions I, VII, VIII, and X served between 3% and 5%.
The number of users served in 2017 was 0.1% (or 3,306 users) lower than in 2016. Region
VII reported the largest numeric decline in users (by 15,148 users). Three other regions
reported client losses ranging from 5,671 (X) to 13,369 (III), and six others reported gains of
between 945 (II) and 15,713 (VI) (Exhibit 3). On average, the number of users per service
site increased by 10, from 1,028 in 2016 to 1,038 in 2017 (Exhibit A–1c).
In 2017, the number of family planning users served (4.0 million) was 20% (or 982,992
users) lower than the number served in 2007 (5.0 million) and 23% (or 1.2 million) lower
than the highest number of users (5.2 million) ever served by the program in a single year
(2010) (Exhibits A–2a and A–2b).

Exhibit 3.

Users
Number
2017
2016
Difference
% Change
Distribution
2017
2016

Number, distribution, and percentage change in number of all family planning users, by
year and region: 2016–2017 (Source: FPAR Table 1)
All
Regions

Region
I

Region
II

Region
III

Region
IV

Region
V

Region
VI

Region
VII

Region
VIII

4,004,246 194,952

429,091

464,216

677,146

391,901

350,646

120,759

126,922

1,093,827 154,786

4,007,552 183,383

428,146

477,585

669,743

390,541

334,933

135,907

124,021

1,102,836 160,457

945

−13,369

7,403

1,360

15,713 −15,148

2,901

−9,009

−5,671

−3%

1%

−3,306
0%†

11,569
6%

0%†

0%†

Region
IX

Region
X

5%

−11%

2%

−1%

−4%

100%

5%

11%

12%

17%

10%

9%

3%

3%

27%

4%

100%

5%

11%

12%

17%

10%

8%

3%

3%

28%

4%

Note: Due to rounding, percentages may not sum to 100%.
†

8

Percentage change is greater than –0.5% and less than 0.5%.

Family Planning Annual Report: 2017 National Summary

Users by Sex (Exhibits 4 and 5)

Of the 4.0 million family planning users served in 2017, 88% (3.5 million) were female and
12% (463,011) were male (Exhibits 4 and 5).

▪ By region, 84% (VIII) to 92% (X) of total users were female (Exhibit 5).
▪ By state, the percentage of total users who were female ranged from 73% to 100%
(Exhibit B–1 in Appendix B).

From 2007 through 2017, the percentage of users who were female declined from 94% to
88%, while the percentage of users who were male increased from 6% to 12%. Numerically,
the number of female users decreased 25%, from 4.7 million in 2007 to 3.5 million in 2017,
while the number of male users increased 57%, from 295,381 in 2007 to 463,011 in 2017
(Exhibits A–2a and A–2b).
Users by Age (Exhibits 4 and 5)

In 2017, 17% (693,724) of family planning users were under 20, 47% (1.9 million) were 20 to
29, and 35% (1.4 million) were 30 or older. Approximately the same percentages of female
and male users were in their teens (17% females and 16% males). A higher percentage of
female (48%) than male (44%) users was in their 20s, while a higher percentage of male
(40%) than female (35%) users was 30 or over (Exhibits 4 and 5).

▪ Across regions, there was higher variation in the age distribution of male and female users.
– Among female users, 15% (II) to 22% (VIII and X) were in their teens, 44% (I, III, and
VI) to 51% (V and IX) were in their 20s, and 29% (VIII) to 39% (VI) were 30 or over.
– Among male users, 11% (IX) to 24% (III) of male users were in their teens, 30% (IV) to
54% (V) were in their 20s, and 32% (II) to 51% (IV) were 30 or over.
See Exhibits A–3a and A–3b for trends (2007–2017) in the distribution of all family planning
users by age group.

▪ Numerically, the number of teenage users decreased 45%, from 1.3 million (2007) to
693,724 (2017), while the number of users 20 to 24 decreased 35%, from 1.6 million
(2007) to 1.0 million (2017).

▪ In contrast, the percentage of users 25 or over increased from 44% (2007) to 57% (2017).
Numerically, this represents a 6% increase, from 2.2 million users (2007) to 2.3 million
(2017).

Family Planning Annual Report: 2017 National Summary

9

Exhibit 4.

Number of all family planning users, by sex, age, and region: 2017 (Source: FPAR Table 1)

10

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

36,621

2,636

3,019

6,809

9,006

3,132

3,357

1,120

1,208

4,865

1,469

15 to 17

242,464

13,871

22,133

31,489

42,709

25,672

21,586

8,858

9,165

53,493

13,488

18 to 19

340,340

15,772

33,212

37,365

55,963

36,615

29,621

11,432

13,369

90,840

16,151

20 to 24

908,324

38,380

98,668

92,192

144,018

97,164

74,454

26,942

31,005

266,945

38,556

25 to 29

777,777

35,234

89,661

84,371

129,370

76,656

65,315

21,453

20,493

224,591

30,633

30 to 34

517,460

24,669

60,814

60,240

93,320

46,271

49,753

15,317

13,382

134,319

19,375

35 to 39

334,384

16,375

38,140

40,680

61,927

28,342

35,248

10,677

8,625

82,584

11,786

40 to 44

195,225

10,252

21,626

24,830

34,599

14,891

19,893

6,209

4,867

51,495

6,563

Over 44

Family Planning Annual Report: 2017 National Summary

188,640

9,590

19,287

26,057

38,863

13,233

16,799

6,556

3,914

49,343

4,998

Subtotal

3,541,235

166,779

386,560

404,033

609,775

341,976

316,026

108,564

106,028

958,475

143,019

Male Users
Under 15

12,439

1,191

1,245

2,983

4,137

535

795

103

378

1,018

54

28,965

3,281

2,958

6,433

4,618

1,775

2,108

545

1,036

5,594

617

18 to 19

32,895

2,090

3,474

4,874

3,864

3,520

2,931

1,075

1,446

8,795

826

20 to 24

105,619

5,500

11,239

11,973

10,351

14,170

7,520

3,430

5,324

33,260

2,852

25 to 29

99,811

5,677

9,972

10,302

10,090

12,688

6,849

2,765

4,926

33,758

2,784

30 to 34

63,373

3,713

6,055

6,758

7,690

7,161

4,663

1,740

3,023

20,627

1,943

35 to 39

40,372

2,342

3,201

4,767

6,200

4,098

3,304

1,041

1,836

12,402

1,181

40 to 44

25,523

1,414

1,708

3,172

5,268

2,237

2,189

612

1,126

7,126

671

Over 44

54,014

2,965

2,679

8,921

15,153

3,741

4,261

884

1,799

12,772

839

Subtotal

463,011

28,173

42,531

60,183

67,371

49,925

34,620

12,195

20,894

135,352

11,767

15 to 17

All Users
Under 15

49,060

3,827

4,264

9,792

13,143

3,667

4,152

1,223

1,586

5,883

1,523

15 to 17

271,429

17,152

25,091

37,922

47,327

27,447

23,694

9,403

10,201

59,087

14,105

18 to 19

373,235

17,862

36,686

42,239

59,827

40,135

32,552

12,507

14,815

99,635

16,977

20 to 24

1,013,943

43,880

109,907

104,165

154,369

111,334

81,974

30,372

36,329

300,205

41,408

25 to 29

877,588

40,911

99,633

94,673

139,460

89,344

72,164

24,218

25,419

258,349

33,417

30 to 34

580,833

28,382

66,869

66,998

101,010

53,432

54,416

17,057

16,405

154,946

21,318

35 to 39

374,756

18,717

41,341

45,447

68,127

32,440

38,552

11,718

10,461

94,986

12,967

40 to 44

220,748

11,666

23,334

28,002

39,867

17,128

22,082

6,821

5,993

58,621

7,234

Over 44

242,654

12,555

21,966

34,978

54,016

16,974

21,060

7,440

5,713

62,115

5,837

4,004,246

194,952

429,091

464,216

677,146

391,901

350,646

120,759

126,922

1,093,827

154,786

Total All Users

Family Planning Annual Report: 2017 National Summary

Exhibit 5.

Distribution of all family planning users, by sex, age, and region: 2017 (Source: FPAR Table 1)

Age Group (Years)

11

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
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal

1%
7%
10%
26%
22%
15%
9%
6%
5%
100%

2%
8%
9%
23%
21%
15%
10%
6%
6%
100%

1%
6%
9%
26%
23%
16%
10%
6%
5%
100%

2%
8%
9%
23%
21%
15%
10%
6%
6%
100%

1%
7%
9%
24%
21%
15%
10%
6%
6%
100%

1%
8%
11%
28%
22%
14%
8%
4%
4%
100%

1%
7%
9%
24%
21%
16%
11%
6%
5%
100%

1%
8%
11%
25%
20%
14%
10%
6%
6%
100%

1%
9%
13%
29%
19%
13%
8%
5%
4%
100%

1%
6%
9%
28%
23%
14%
9%
5%
5%
100%

1%
9%
11%
27%
21%
14%
8%
5%
3%
100%

Male Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Subtotal

3%
6%
7%
23%
22%
14%
9%
6%
12%
100%

4%
12%
7%
20%
20%
13%
8%
5%
11%
100%

3%
7%
8%
26%
23%
14%
8%
4%
6%
100%

5%
11%
8%
20%
17%
11%
8%
5%
15%
100%

6%
7%
6%
15%
15%
11%
9%
8%
22%
100%

1%
4%
7%
28%
25%
14%
8%
4%
7%
100%

2%
6%
8%
22%
20%
13%
10%
6%
12%
100%

1%
4%
9%
28%
23%
14%
9%
5%
7%
100%

2%
5%
7%
25%
24%
14%
9%
5%
9%
100%

1%
4%
6%
25%
25%
15%
9%
5%
9%
100%

0%†
5%
7%
24%
24%
17%
10%
6%
7%
100%

All Users
Under 15
15 to 17
18 to 19
20 to 24
25 to 29
30 to 34
35 to 39
40 to 44
Over 44
Total All Users

1%
7%
9%
25%
22%
15%
9%
6%
6%
100%

2%
9%
9%
23%
21%
15%
10%
6%
6%
100%

1%
6%
9%
26%
23%
16%
10%
5%
5%
100%

2%
8%
9%
22%
20%
14%
10%
6%
8%
100%

2%
7%
9%
23%
21%
15%
10%
6%
8%
100%

1%
7%
10%
28%
23%
14%
8%
4%
4%
100%

1%
7%
9%
23%
21%
16%
11%
6%
6%
100%

1%
8%
10%
25%
20%
14%
10%
6%
6%
100%

1%
8%
12%
29%
20%
13%
8%
5%
5%
100%

1%
5%
9%
27%
24%
14%
9%
5%
6%
100%

1%
9%
11%
27%
22%
14%
8%
5%
4%
100%

90%
10%

87%
13%

90%
10%

87%
13%

90%
10%

90%
10%

84%
16%

88%
12%

92%
8%

Female Users
88%
86%
Male Users
12%
14%
Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.

Users by Race (Exhibits 6 through 14)

In 2017, 54% (approximately 2.2 million) of all family planning users identified themselves
as white, 22% (869,574) as black or African American, 4% (143,215) as Asian, and 1% as
either American Indian or Alaska Native (35,587) or Native Hawaiian or Other Pacific
Islander (31,019). Four percent (144,397) 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 16% (629,974) (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 (54% of female users vs. 50% of male users) and black or African
American (21% of female users vs. 27% of male users). The distribution of users across the
remaining race categories and for whom race was unknown was within one percentage
point for female and 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 44% (IX) to 75% (VII and
VIII), 5% (X) to 38% (IV) self-identified as black or African American, 1% (IV and VI) to
7% (IX) self-identified as Asian, and 2% (III, IV, VI, and VIII) to 8% (I) self-identified
with two or more race categories.

▪ Of the 629,974 users with an unknown race, 75% self-identified as Hispanic or Latino
ethnicity (Exhibit 6).

See Exhibits A–4a and A–4b for trends (2007–2017) in the distribution of all family planning
users by self-identified race.
Users by Ethnicity (Exhibits 6 through 14)

In 2017, 33% (1.3 million) of users self-identified as Hispanic or Latino ethnicity (Exhibit 6).

▪ By sex, 34% (1.2 million) of female users and 28% (130,066) 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 and 8).

▪ By region, grantees in Regions II, VI, and IX reported the highest percentages of female
(39% to 52%) and male (33% to 44%) users who self-identified as Hispanic or Latino
(Exhibits 11, 12, 13, and 14).

See Exhibits A–5a and A–5b for trends (2007–2017) in the distribution of all family planning
users by self-identified Hispanic or Latino ethnicity. See Exhibits A–6a and A–6b for trends
(2007–2017) in the distributions of all family planning users by self-identified race and
ethnicity.

12

Family Planning Annual Report: 2017 National Summary

Exhibit 6.

Number and distribution of all family planning users, by race and ethnicity: 2017
(Source: FPAR Tables 2 and 3)
Hispanic
or Latino

Race
Am Indian/Alaska Native

Not
Hispanic or
Latino

Ethnicity
UK/NR

Total

%
Hispanic
or Latino

%
Not Hispanic
or Latino

%
Ethnicity
UK/NR

%
Total

13,463

21,103

1,021

35,587

0%†

1%

0%†

1%

5,256

130,688

7,271

143,215

0%†

3%

0%†

4%

Black/African American

40,452

806,970

22,152

869,574

1%

20%

1%

22%

Nat Hawaiian/Pac Island

5,453

24,508

1,058

31,019

0%†

1%

0%†

1%

706,762

1,394,432

49,286

2,150,480

18%

35%

1%

54%

Asian

White
More than one race
Unknown/not reported
Total All Users

79,973

58,948

5,476

144,397

2%

1%

0%†

4%

473,458

116,767

39,749

629,974

12%

3%

1%

16%

1,324,817

2,553,416

126,013

4,004,246

33%

64%

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 7.

Number and distribution of female family planning users, by race and ethnicity: 2017
(Source: FPAR Table 2)
Hispanic
or Latino

Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total Female Users

12,346

Not
Hispanic or
Latino
18,960

Ethnicity
UK/NR
833

Total
32,139

%
Hispanic
or Latino
0%†

%
Not Hispanic
or Latino
1%

%
Ethnicity
UK/NR
0%†

%
Total
1%

4,758

119,071

6,569

130,398

0%†

3%

0%†

4%

34,613

690,969

18,149

743,731

1%

20%

1%

21%

4,893

22,794

965

28,652

1%

0%†

1%

642,470

1,233,668

42,916

1,919,054

18%

0%†

35%

1%

54%

70,839

52,005

4,534

127,378

2%

1%

0%†

4%

424,832

101,168

33,883

559,883

12%

3%

1%

16%

1,194,751

2,238,635

107,849

3,541,235

34%

63%

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: 2017
(Source: FPAR Table 3)

Race
Am Indian/Alaska Native
Asian
Black/African American
Nat Hawaiian/Pac Island
White
More than one race
Unknown/not reported
Total Male Users

Hispanic
or Latino

Not
Hispanic or
Latino

Ethnicity
UK/NR

Total

%
Hispanic
or Latino

%
Not Hispanic
or Latino

%
Ethnicity
UK/NR

%
Total

1,117

2,143

188

3,448

0%†

0%†

0%†

1%

498

11,617

702

12,817

0%†

3%

0%†

3%

5,839

116,001

4,003

125,843

1%

25%

560

1,714

93

2,367

64,292

160,764

6,370

231,426

14%

9,134

6,943

942

17,019

2%

48,626

15,599

5,866

70,091

130,066

314,781

18,164

463,011

1%

27%

0%†

1%

35%

1%

50%

1%

0%†

4%

11%

3%

1%

15%

28%

68%

4%

100%

0%†

0%†

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%.

Family Planning Annual Report: 2017 National Summary

13

Exhibit 9.

Number of all family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Tables 2 and 3)

14

Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

Region I

Region II

Region III

Region IV

Region V

Region VI

13,463
21,103
1,021
35,587

284
645
40
969

2,705
1,133
56
3,894

903
4,087
131
5,121

2,204
1,738
37
3,979

1,149
1,677
101
2,927

581
3,423
31
4,035

335
949
33
1,317

5,256
130,688
7,271
143,215

168
10,118
108
10,394

442
14,570
110
15,122

511
8,816
396
9,723

460
6,601
99
7,160

183
8,471
433
9,087

153
3,594
61
3,808

40,452
806,970
22,152
869,574

4,181
28,250
330
32,761

15,632
100,494
589
116,715

3,747
142,660
5,041
151,448

6,819
250,061
2,183
259,063

1,867
98,709
2,352
102,928

5,453
24,508
1,058
31,019

581
237
16
834

928
569
22
1,519

489
417
39
945

746
599
90
1,435

White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

706,762
1,394,432
49,286
2,150,480

21,986
90,949
3,231
116,166

61,403
126,789
3,175
191,367

37,537
178,384
9,456
225,377

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

79,973
58,948
5,476
144,397

9,740
5,915
449
16,104

16,504
2,400
68
18,972

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

473,458
116,767
39,749
629,974

12,975
3,682
1,067
17,724

1,324,817
2,553,416
126,013
4,004,246

49,915
139,796
5,241
194,952

Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

Family Planning Annual Report: 2017 National Summary

Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

All Regions

Region VII Region VIII

Region IX

Region X

556
1,409
60
2,025

4,287
4,740
455
9,482

459
1,302
77
1,838

280
2,082
107
2,469

69
2,477
133
2,679

2,834
67,023
5,593
75,450

156
6,936
231
7,323

1,378
79,134
345
80,857

1,888
16,487
473
18,848

297
6,540
329
7,166

4,232
77,834
10,204
92,270

411
6,801
306
7,518

309
434
37
780

321
592
12
925

57
198
5
260

86
544
39
669

1,628
19,789
767
22,184

308
1,129
31
1,468

109,228
253,661
2,767
365,656

34,916
193,774
4,711
233,401

149,684
91,120
742
241,546

23,504
64,789
1,841
90,134

21,747
70,993
2,144
94,884

230,580
235,164
18,644
484,388

16,177
88,809
2,575
107,561

5,553
3,019
351
8,923

3,632
7,406
156
11,194

3,259
9,795
492
13,546

2,610
4,893
35
7,538

1,400
1,743
156
3,299

930
1,379
159
2,468

35,216
18,006
3,596
56,818

1,129
4,392
14
5,535

65,648
15,451
403
81,502

39,942
17,479
5,258
62,679

19,695
7,493
1,471
28,659

21,657
5,663
1,912
29,232

5,947
5,713
277
11,937

2,518
924
990
4,432

13,047
2,350
1,634
17,031

275,582
51,648
26,005
353,235

16,447
6,364
732
23,543

163,262
261,406
4,423
429,091

88,682
354,862
20,672
464,216

142,784
527,559
6,803
677,146

63,340
318,523
10,038
391,901

160,674
188,469
1,503
350,646

29,982
87,172
3,605
120,759

36,732
85,692
4,498
126,922

554,359
474,204
65,264
1,093,827

35,087
115,733
3,966
154,786

Family Planning Annual Report: 2017 National Summary

Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Tables 2 and 3)
Race and Ethnicity

All Regions

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

1%
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
0%†
0%†
1%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
2%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

0%†
3%
0%†
4%

0%†
5%
0%†
5%

0%†
3%
0%†
4%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
2%
0%†
2%

0%†
2%
0%†
2%

0%†
6%
1%
7%

0%†
4%
0%†
5%

2%
14%
0%†
17%

4%
23%
0%†
27%

1%
37%
0%†
38%

0%†
25%
1%
26%

0%†
23%
0%†
23%

2%
14%
0%†
16%

0%†
5%
0%†
6%

0%†
7%
1%
8%

0%†
4%
0%†
5%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
1%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

1%
20%
1%
22%
0%†
1%
0%†
1%
18%
35%
1%
54%
2%
1%
0%†
4%

15

Percentage is less than 0.5%.

11%
47%
2%
60%

14%
30%
1%
45%

5%
3%
0%†
8%

4%
1%
0%†
4%

12%
3%
1%
16%

7%
2%
1%
9%

15%
4%
0%†
19%

33%
64%
3%
100%

26%
72%
3%
100%

Note: Due to rounding, percentages may not sum to 100%.
†

Region I

American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

38%
61%
1%
100%

1%
31%
1%
33%
0%†
0%†
0%†
0%†
8%
38%
2%
49%
1%
1%
0%†
2%
9%
4%
1%
14%
19%
76%
4%
100%

16%
37%
0%†
54%

9%
49%
1%
60%

43%
26%
0%†
69%

19%
54%
2%
75%

17%
56%
2%
75%

1%
1%
0%†
2%

1%
2%
0%†
3%

1%
1%
0%†
2%

1%
1%
0%†
3%

3%
1%
0%†
4%

6%
1%
0%†
7%

2%
2%
0%†
3%

2%
1%
1%
4%

10%
2%
1%
13%

25%
5%
2%
32%

46%
54%
0%†
100%

25%
72%
3%
100%

29%
68%
4%
100%

51%
43%
6%
100%

21%
78%
1%
100%

16%
81%
3%
100%

1%
1%
0%†
2%

21%
21%
2%
44%
3%
2%
0%†
5%

10%
57%
2%
69%
1%
3%
0%†
4%
11%
4%
0%†
15%
23%
75%
3%
100%

Exhibit 11. Number of female family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 2)

16

Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

12,346
18,960
833
32,139

253
525
26
804

2,623
1,013
56
3,692

844
3,644
102
4,590

2,171
1,639
33
3,843

992
1,424
78
2,494

535
3,274
21
3,830

317
818
21
1,156

428
1,229
50
1,707

3,750
4,172
373
8,295

433
1,222
73
1,728

4,758
119,071
6,569
130,398

154
9,450
91
9,695

378
13,357
107
13,842

461
8,005
351
8,817

433
5,835
82
6,350

169
7,484
392
8,045

143
3,254
46
3,443

274
1,937
95
2,306

64
2,186
116
2,366

2,534
60,914
5,065
68,513

148
6,649
224
7,021

34,613
690,969
18,149
743,731

3,490
23,426
262
27,178

14,177
89,433
568
104,178

3,037
118,921
3,932
125,890

5,163
221,411
1,890
228,464

1,591
83,784
1,903
87,278

1,180
66,174
216
67,570

1,777
13,699
339
15,815

242
4,512
250
5,004

3,588
63,558
8,517
75,663

368
6,051
272
6,691

4,893
22,794
965
28,652

485
203
16
704

800
489
22
1,311

425
372
36
833

707
557
89
1,353

269
387
31
687

298
560
10
868

51
177
4
232

65
442
30
537

1,503
18,548
699
20,750

290
1,059
28
1,377

White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

642,470
1,233,668
42,916
1,919,054

19,332
77,021
2,749
99,102

57,081
112,919
3,117
173,117

33,792
159,996
8,679
202,467

101,016
231,071
2,340
334,427

31,674
169,340
4,005
205,019

137,730
84,023
665
222,418

22,072
58,621
1,504
82,197

18,746
58,888
1,770
79,404

205,685
200,028
15,713
421,426

15,342
81,761
2,374
99,477

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

70,839
52,005
4,534
127,378

8,444
5,025
369
13,838

15,514
2,178
64
17,756

4,244
2,571
296
7,111

3,436
6,447
122
10,005

2,865
8,621
421
11,907

2,475
4,665
33
7,173

1,281
1,535
112
2,928

794
1,186
139
2,119

30,734
15,626
2,969
49,329

1,052
4,151
9
5,212

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

424,832
101,168
33,883
559,883

11,478
3,121
859
15,458

58,560
13,736
368
72,664

35,194
14,783
4,348
54,325

17,563
6,566
1,204
25,333

19,933
5,031
1,582
26,546

5,421
5,090
213
10,724

2,257
820
853
3,930

11,561
1,990
1,340
14,891

247,628
44,430
22,441
314,499

15,237
5,601
675
21,513

1,194,751
2,238,635
107,849
3,541,235

43,636
118,771
4,372
166,779

149,133
233,125
4,302
386,560

77,997
308,292
17,744
404,033

130,489
473,526
5,760
609,775

57,493
276,071
8,412
341,976

147,782
167,040
1,204
316,026

28,029
77,607
2,928
108,564

31,900
70,433
3,695
106,028

495,422
407,276
55,777
958,475

32,870
106,494
3,655
143,019

Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

Family Planning Annual Report: 2017 National Summary

Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

Family Planning Annual Report: 2017 National Summary

Exhibit 12. Distribution of female family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 2)
Race and Ethnicity

All Regions

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

1%
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
0%†
0%†
1%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
2%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

0%†
3%
0%†
4%

0%†
6%
0%†
6%

0%†
3%
0%†
4%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
2%
0%†
2%

0%†
2%
0%†
2%

0%†
6%
1%
7%

0%†
5%
0%†
5%

2%
14%
0%†
16%

4%
23%
0%†
27%

1%
36%
0%†
37%

0%†
24%
1%
26%

0%†
21%
0%†
21%

2%
13%
0%†
15%

0%†
4%
0%†
5%

0%†
7%
1%
8%

0%†
4%
0%†
5%

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
0%†

0%†
0%†
0%†
1%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

1%
20%
1%
21%
0%†
1%
0%†
1%
18%
35%
1%
54%
2%
1%
0%†
4%

17

Percentage is less than 0.5%.

12%
46%
2%
59%

15%
29%
1%
45%

5%
3%
0%†
8%

4%
1%
0%†
5%

12%
3%
1%
16%

7%
2%
1%
9%

15%
4%
0%†
19%

34%
63%
3%
100%

26%
71%
3%
100%

Note: Due to rounding, percentages may not sum to 100%.
†

Region I

American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

39%
60%
1%
100%

1%
29%
1%
31%
0%†
0%†
0%†
0%†
8%
40%
2%
50%
1%
1%
0%†
2%
9%
4%
1%
13%
19%
76%
4%
100%

17%
38%
0%†
55%

9%
50%
1%
60%

44%
27%
0%†
70%

20%
54%
1%
76%

18%
56%
2%
75%

1%
1%
0%†
2%

1%
3%
0%†
3%

1%
1%
0%†
2%

1%
1%
0%†
3%

3%
1%
0%†
4%

6%
1%
0%†
8%

2%
2%
0%†
3%

2%
1%
1%
4%

11%
2%
1%
14%

26%
5%
2%
33%

47%
53%
0%†
100%

26%
71%
3%
100%

30%
66%
3%
100%

52%
42%
6%
100%

21%
78%
1%
100%

17%
81%
2%
100%

1%
1%
0%†
2%

21%
21%
2%
44%
3%
2%
0%†
5%

11%
57%
2%
70%
1%
3%
0%†
4%
11%
4%
0%†
15%
23%
74%
3%
100%

Exhibit 13. Number of male family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 3)

18

Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

Region I

Region II

1,117
2,143
188
3,448

31
120
14
165

82
120
0
202

59
443
29
531

33
99
4
136

157
253
23
433

46
149
10
205

18
131
12
161

128
180
10
318

537
568
82
1,187

26
80
4
110

498
11,617
702
12,817

14
668
17
699

64
1,213
3
1,280

50
811
45
906

27
766
17
810

14
987
41
1,042

10
340
15
365

6
145
12
163

5
291
17
313

300
6,109
528
6,937

8
287
7
302

5,839
116,001
4,003
125,843

691
4,824
68
5,583

1,455
11,061
21
12,537

710
23,739
1,109
25,558

1,656
28,650
293
30,599

276
14,925
449
15,650

198
12,960
129
13,287

111
2,788
134
3,033

55
2,028
79
2,162

644
14,276
1,687
16,607

43
750
34
827

560
1,714
93
2,367

96
34
0
130

128
80
0
208

64
45
3
112

39
42
1
82

40
47
6
93

23
32
2
57

6
21
1
28

21
102
9
132

125
1,241
68
1,434

18
70
3
91

White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

64,292
160,764
6,370
231,426

2,654
13,928
482
17,064

4,322
13,870
58
18,250

3,745
18,388
777
22,910

8,212
22,590
427
31,229

3,242
24,434
706
28,382

11,954
7,097
77
19,128

1,432
6,168
337
7,937

3,001
12,105
374
15,480

24,895
35,136
2,931
62,962

835
7,048
201
8,084

More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

9,134
6,943
942
17,019

1,296
890
80
2,266

990
222
4
1,216

1,309
448
55
1,812

196
959
34
1,189

394
1,174
71
1,639

135
228
2
365

119
208
44
371

136
193
20
349

4,482
2,380
627
7,489

77
241
5
323

Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

48,626
15,599
5,866
70,091

1,497
561
208
2,266

7,088
1,715
35
8,838

4,748
2,696
910
8,354

2,132
927
267
3,326

1,724
632
330
2,686

526
623
64
1,213

261
104
137
502

1,486
360
294
2,140

27,954
7,218
3,564
38,736

1,210
763
57
2,030

130,066
314,781
18,164
463,011

6,279
21,025
869
28,173

14,129
28,281
121
42,531

10,685
46,570
2,928
60,183

12,295
54,033
1,043
67,371

5,847
42,452
1,626
49,925

12,892
21,429
299
34,620

1,953
9,565
677
12,195

4,832
15,259
803
20,894

58,937
66,928
9,487
135,352

2,217
9,239
311
11,767

Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

Family Planning Annual Report: 2017 National Summary

Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal

All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

All Regions

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Family Planning Annual Report: 2017 National Summary

Exhibit 14. Distribution of male family planning users, by race, ethnicity, and region: 2017 (Source: FPAR Table 3)
Race and Ethnicity
American Indian or Alaska Native
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Asian
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Black or African American
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Native Hawaiian or Other Pacific Islander
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
White
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
More Than One Race
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
Race Unknown or Not Reported
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Subtotal
All Races
Hispanic or Latino
Not Hispanic or Latino
Unknown/not reported
Total All Users

All Regions

19

Percentage is less than 0.5%.

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

0%†
0%†
0%†
1%

0%†
0%†
0%†
1%

0%†
0%†
0%
0%†

0%†
1%
0%†
1%

0%†
0%†
0%†
0%†

0%†
1%
0%†
1%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

1%
1%
0%†
2%

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
3%
0%†
3%

0%†
2%
0%†
2%

0%†
3%
0%†
3%

0%†
1%
0%†
2%

0%†
1%
0%†
1%

0%†
2%
0%†
2%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

0%†
5%
0%†
5%

0%†
2%
0%†
3%

2%
17%
0%†
20%

3%
26%
0%†
29%

0%†
10%
0%†
10%

0%†
11%
1%
12%

0%†
6%
0%†
7%

0%†
0%†
0%
0%†

0%†
0%†
0%
0%†

0%†
0%†
0%†
1%

0%†
1%
0%†
1%

0%†
1%
0%†
1%

1%
25%
1%
27%
0%†
0%†
0%†
1%
14%
35%
1%
50%
2%
1%
0%†
4%

9%
49%
2%
61%

10%
33%
0%†
43%

1%
39%
2%
42%
0%†
0%†
0%†
0%†
6%
31%
1%
38%

5%
3%
0%†
8%

2%
1%
0%†
3%

11%
3%
1%
15%

5%
2%
1%
8%

17%
4%
0%†
21%

8%
4%
2%
14%

28%
68%
4%
100%

22%
75%
3%
100%

33%
66%
0%†
100%

18%
77%
5%
100%

Note: Due to rounding, percentages may not sum to 100%.
†

Region I

2%
1%
0%†
3%

2%
43%
0%†
45%
0%†
0%†
0%†
0%†
12%
34%
1%
46%

1%
30%
1%
31%
0%†
0%†
0%†
0%†
6%
49%
1%
57%

1%
37%
0%†
38%
0%†
0%†
0%†
0%†
35%
20%
0%†
55%

1%
23%
1%
25%
0%†
0%†
0%†
0%†
12%
51%
3%
65%

14%
58%
2%
74%

0%†
1%
0%†
2%

1%
2%
0%†
3%

0%†
1%
0%†
1%

1%
2%
0%†
3%

3%
1%
0%†
5%

3%
1%
1%
5%

2%
2%
0%†
4%

2%
1%
1%
4%

7%
2%
1%
10%

21%
5%
3%
29%

16%
78%
6%
100%

23%
73%
4%
100%

44%
49%
7%
100%

18%
80%
2%
100%

12%
85%
3%
100%

37%
62%
1%
100%

1%
1%
0%†
2%

18%
26%
2%
47%
3%
2%
0%†
6%

7%
60%
2%
69%
1%
2%
0%†
3%
10%
6%
0%†
17%
19%
79%
3%
100%

Guidance for Reporting User Social and Economic Profile Data in FPAR Tables 4 through 6
In FPAR Tables 4, 5, and 6, grantees report information on the social and economic profile of family planning users,
including income level (Table 4), health insurance coverage (Table 5), and English proficiency (Table 6).
In FPAR Table 4, grantees report the unduplicated number of family planning users by income level, using the
following instructions:
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.1,2 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 Report the unduplicated number of users by income level, using the most current
income information available. For additional guidance, see Program Requirements for Title X Funded Family
Planning Projects (Version 1.0).1
In FPAR Table 5, grantees report the unduplicated number of users by their principal insurance coverage status,
using the following instructions:
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. Report the most current
health insurance coverage information available for the client even though he or she may not have used this health
insurance to pay for family planning services received during his or her 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 health insurance covering primary medical
care include public and private sources of coverage.
Public Health Insurance Covering Primary Medical Care—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 Covering Primary Medical Care—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 CHAMPVA).
Uninsured—Refers to clients 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
(LEP), using the following instructions:
Limited English Proficient (LEP) Users—Refers to 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.
In Table 6, report the unduplicated number of family planning users who required language assistance services
(interpretation or translation) to optimize their use of Title X services. Include as LEP any user who received Title X
services from bilingual staff in the user’s preferred non-English language, who was assisted by a competent agency
or contracted interpreter, or who opted to use a family member or friend as an interpreter after refusing the
provider’s offer of free language assistance services. Service providers should consult the Revised HHS LEP
Guidance13 for further information about identifying LEP individuals and complying with language assistance
requirements. Unless they are also LEP, do not include users who are visually or hearing impaired or have other
disabilities.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 21–23.

20

Family Planning Annual Report: 2017 National Summary

FAMILY PLANNING USER SOCIAL AND ECONOMIC PROFILE
Users by Income Level (Exhibit 15)

Federal regulations1,2 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 2017 ($24,600 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.
In 2017, 90% (3.6 million) of users had family incomes that qualified them for either
subsidized or no-charge services. Sixty-seven percent (2.7 million) of users had family
incomes at or below 100% of poverty, 23% (931,795) had incomes ranging from 101% to
250% of poverty, and 7% (277,975) had incomes over 250% of poverty. Family income data
were unknown or not reported for 3% (128,565) of users (Exhibit 15).

▪ By region, from 82% (I and III) to 95% (VI) of users had family incomes qualifying them

for either no-charge (from 49% to 77% of users) or subsidized (from 19% to 34% of users)
services. In Regions IV, VI, and IX, the percentage of users with incomes at or below
poverty exceeded the national average of 67% (Exhibit 15).

▪ By state, the percentages of users with incomes at or below poverty ranged from 36% to

100%, from 0% to 47% for users with incomes between 101% and 250% of poverty, and
from 0% to 26% for users over 250% of poverty (Exhibit B–2).

See Exhibits A–7a and A–7b for trends (2007–2017) in the distribution of family planning
users by income level.
Users by Insurance Coverage Status (Exhibit 16)

Title X regulations1,2 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.
In 2017, 57% (2.3 million) of family planning users had either public (38%, 1.5 million) or
private (19%, 760,051) insurance covering broad primary medical care benefits; 42% (1.7
million) were uninsured. Health insurance coverage status was unknown or not reported for
1% (56,837) of users (Exhibit 16).

Family Planning Annual Report: 2017 National Summary

21

▪ By region, from 20% (VIII) to 47% (II) of family planning users had public coverage, and
from 7% (IX) to 31% (I) had private coverage. The percentage of uninsured users ranged
from 26% (I) to 58% (VI), with the number of uninsured exceeding the number of insured
in three regions (VI, VIII, and IX) (Exhibit 16).

▪ By state, there was wide variation in the percentage of users who were publicly insured

(0% to 99%), privately insured (0% to 57%), and uninsured (1% to 100%) (Exhibit B–3a).

Among users in the 50 states and the District of Columbia, 72% (2.8 million) received Title
X services in 1 of 32 states (includes the District of Columbia) that expanded Medicaid
under the Affordable Care Act (ACA), and 28% (1.1 million users) received Title X care in
1 of 19 states that did not. Compared with users in “nonexpansion” states, on average,
users in “expansion” states were more likely to be publicly insured (42% vs. 26%), about
as likely to be privately insured (18% vs. 22%), and less likely to be uninsured (38% vs.
51%) (Exhibit B–3b).
See Exhibits A–8a and A–8b for trends (2007–2017) in the distribution of family planning
users by primary health insurance status.
Limited English Proficient Users (Exhibit 17)

As recipients of HHS assistance, 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.13 In 2017, 14% (553,241) of family planning users
were LEP. By region, the percentage of users who were LEP ranged from 6% (V) to 22%
(VI), with three regions (II, IV, and VI) exceeding the national LEP average of 14%
(Exhibit 17).
The percentage of family planning users who were LEP was 13% in 2007 vs. 14% in 2017.
During this period, the number of LEP users decreased 17%, from 662,714 (2007) to 553,241
(2017) (not shown).

22

Family Planning Annual Report: 2016 National Summary

Family Planning Annual Report: 2017 National Summary

Exhibit 15. Number and distribution of all family planning users, by income level and region: 2017 (Source: FPAR Table 4)
All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

2,665,911

94,737

276,750

274,896

479,362

231,030

268,722

68,933

83,456

797,477

90,548

101% to 150%

551,163

34,607

67,974

62,297

82,793

60,192

42,431

19,978

15,682

140,889

24,320

151% to 200%

257,155

20,392

29,209

26,831

34,039

32,608

16,268

9,598

9,314

64,202

14,694

201% to 250%

123,477

11,033

15,118

18,109

17,371

17,917

7,426

5,958

5,577

17,096

7,872

Over 250%

277,975

22,936

38,948

33,981

48,386

46,404

10,471

12,268

9,828

40,132

14,621

Unknown/not reported

128,565

11,247

1,092

48,102

15,195

3,750

5,328

4,024

3,065

34,031

2,731

4,004,246

194,952

429,091

464,216

677,146

391,901

350,646

120,759

126,922

1,093,827

154,786

Under 101%

67%

49%

64%

59%

71%

59%

77%

57%

66%

73%

58%

101% to 150%

14%

18%

16%

13%

12%

15%

12%

17%

12%

13%

16%

151% to 200%

6%

10%

7%

6%

5%

8%

5%

8%

7%

6%

9%

201% to 250%

3%

6%

4%

4%

3%

5%

2%

5%

4%

2%

5%

Over 250%

7%

12%

9%

7%

7%

12%

3%

10%

8%

4%

9%

Unknown/not reported

3%

6%

0%†

10%

2%

1%

2%

3%

2%

3%

2%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Income Levela
Under 101%

Total All Users

Total All Users

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/poverty/.
† Percentage is less than 0.5%.

23

24

Exhibit 16. Number and distribution of all family planning users, by principal health insurance coverage status and region: 2017
(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

1,511,533

83,747

200,603

191,879

230,236

143,335

85,864

26,009

25,554

463,495

60,811

760,051

59,643

69,491

115,338

149,948

108,441

60,323

36,181

34,214

79,883

46,589

1,675,825

50,650

144,045

137,058

289,591

137,408

202,255

57,686

62,357

549,626

45,149

56,837

912

14,952

19,941

7,371

2,717

2,204

883

4,797

823

2,237

4,004,246

194,952

429,091

464,216

677,146

391,901

350,646

120,759

126,922

1,093,827

154,786

Public health insurance

38%

43%

47%

41%

34%

37%

24%

22%

20%

42%

39%

Private health insurance

19%

31%

16%

25%

22%

28%

17%

30%

27%

7%

30%

Uninsured

42%

26%

34%

30%

43%

35%

58%

48%

49%

50%

29%

3%

4%

1%

1%

1%

1%

4%

100%

100%

100%

100%

100%

100%

100%

Public health insurance
Private health insurance
Uninsured
Unknown/not reported
Total All Users

Unknown/not reported

Family Planning Annual Report: 2017 National Summary

Total All Users

1%
100%

0%†
100%

Note: Due to rounding, percentages may not sum to 100%.
† Percentage is less than 0.5%.

0%†
100%

1%
100%

Family Planning Annual Report: 2017 National Summary

Exhibit 17. Number and distribution of all family planning users, by limited English proficiency (LEP) status and region: 2017
(Source: FPAR Table 6)
All Regions

Region I

Region IIa

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IXb

Region X

553,241

27,980

79,899

54,515

102,189

23,471

75,997

14,505

13,494

148,618

12,573

3,418,253

156,702

348,551

391,337

573,944

367,691

274,638

104,693

113,380

945,114

142,203

32,752

10,270

641

18,364

1,013

739

11

1,561

48

95

10

4,004,246

194,952

429,091

464,216

677,146

391,901

350,646

120,759

126,922

1,093,827

154,786

LEP

14%

14%

19%

12%

15%

6%

22%

12%

11%

14%

8%

Not LEP

85%

80%

81%

84%

85%

94%

78%

87%

89%

86%

92%

1%

5%

100%

100%

LEP Status
LEP
Not LEP
Unknown/not reported
Total All Users

Unknown/not reported
Total All Users

0%†
100%

4%
100%

0%†
100%

0%†
100%

0%†
100%

1%
100%

0%†
100%

0%†
100%

0%†
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%.

25

Guidance for Reporting Primary Contraceptive Use Data in FPAR Tables 7 and 8
In FPAR Table 7, grantees report the unduplicated number of female family planning users by primary method and
age, and in FPAR Table 8, grantees report the unduplicated number of male family planning users by primary
method and age. The FPAR instructions provide the following guidance for reporting this information:
Age—Use the client’s age as of June 30 of the reporting period.
Primary Method of Family Planning—The primary method of family planning is the user’s method—adopted or
continued—at the time of exit from his or her last encounter in the reporting period. If the user reports that he or she
is using more than one family planning method, report the most effective one as the primary method. Family planning
methods include the following:
Female Sterilization—In Table 7, report the number of female users who rely on female sterilization as their
primary family planning method. 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)—In Table 7, report the number of female users who use a long-term
hormonal or other type of intrauterine device (IUD) or system (IUS) as their primary family planning method.
Hormonal Implant—In Table 7, report the number of female users who use a long-term, subdermal hormonal
implant as their primary family planning method.
1-Month Hormonal Injection—In Table 7, report the number of female users who use 1-month injectable
hormonal contraception as their primary family planning method.
3-Month Hormonal Injection—In Table 7, report the number of female users who use 3-month injectable
hormonal contraception as their primary family planning method.
Oral Contraceptive—In Table 7, report the number of female users who use any oral contraceptive, including
combination and progestin-only (“mini-pills”) formulations, as their primary family planning method.
Contraceptive Patch—In Table 7, report the number of female users who use a transdermal contraceptive patch
as their primary family planning method.
Vaginal Ring—In Table 7, report the number of female users who use a hormonal vaginal ring as their primary
family planning method.
Cervical Cap or Diaphragm—In Table 7, report the number of female users who use a cervical cap or diaphragm
(with or without spermicidal jelly or cream) as their primary family planning method.
Contraceptive Sponge—In Table 7, report the number of female users who use a contraceptive sponge as their
primary family planning method.
Female Condom—In Table 7, report the number of female users who use female condoms (with or without
spermicidal foam or film) as their primary family planning method.
Spermicide (used alone)—In Table 7, report the number of female users who use only spermicidal jelly, cream,
foam, or film (i.e., not in conjunction with another method of contraception) as their primary family planning method.
Fertility Awareness Method (FAM) or Lactational Amenorrhea Method (LAM)—FAMs refer to family planning
methods that rely on identifying the fertile days in each menstrual cycle when intercourse is most likely to result in a
pregnancy. FAMs include Standard Days®, Calendar Rhythm, TwoDay, Billings Ovulation, and SymptoThermal
methods. The LAM is the proactive application of exclusive breastfeeding during lactational amenorrhea for the first
6 months after delivery. To be effective, LAM requires 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) breastfeeding.14 In Table 7, report the number
of female users who use one or a combination of the FAMs listed above or who rely on LAM as their primary family
planning method. In Table 8, Row 3, report male users who rely on a FAM as their primary method. Report male
users who rely on LAM as their primary method in Table 8, Row 6, “Rely on female method(s).”
Abstinence—In Tables 7 and 8, report the number of female and male users, respectively, who rely on abstinence
as their primary family planning method or who are not currently sexually active and therefore not using
contraception. For purposes of FPAR reporting, abstinence is defined as refraining from oral, vaginal, and anal
intercourse.15
Withdrawal and Other Methods—In Tables 7 and 8, report the number of female and male users, respectively,
who use withdrawal or other methods not listed in the tables as their primary family planning method.
(continued)

26

Family Planning Annual Report: 2017 National Summary

PRIMARY CONTRACEPTIVE METHOD USE
Federal regulations1,2 specify that Title X projects are required to provide a broad range of
acceptable and effective medically approved family planning methods, including natural
family planning methods. In addition to offering a full range of methods for clients to
consider, the Quality Family Planning (QFP) Recommendations16 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.
Female Users by Primary Contraceptive Method (Exhibits 18 through
21)

In 2017, 80% (2.8 million) of all female users adopted or continued use of a most,
moderately, or less effective contraceptive method at their last encounter in the reporting
period. Nine percent (313,802) of females exited the encounter with no primary method
because they were pregnant or seeking pregnancy, and another 5% (190,518) exited with no
method for other reasons. Three percent (92,385) of female users reported that they were
abstinent, and the type of primary method used was unknown or not reported for the
remaining 3% (116,331) (Exhibits 18 and 19).

Guidance for Reporting Primary Contraceptive Use Data in FPAR Tables 7 and 8 (continued)
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. In Table 7, report the number of female
users who rely on vasectomy as their (partner’s) primary family planning method. In Table 8, report the number of
male users on whom a vasectomy was performed in the current or any previous reporting period.
Male condom—In Table 7, report the number of female users who rely on their sexual partner to use male
condoms (with or without spermicidal foam or film) as their primary family planning method. In Table 8, report the
number of male users who use male condoms (with or without spermicidal foam or film) as their primary family
planning method.
Rely on Female Method(s)—In Table 8, report the number of male family planning users who rely on their female
partner’s family planning methods as their primary method. “Female” contraceptive 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.
No Method–[Partner] Pregnant or Seeking Pregnancy—In Tables 7 and 8, report the number of female and
male users, respectively, who are not using any family planning method because they (Table 7) or their partners
(Table 8) are pregnant or seeking pregnancy.
No Method–Other Reason—In Tables 7 and 8, report the number of female and male users who are not using
any family planning method to avoid pregnancy due to reasons other than pregnancy or seeking pregnancy,
including if either partner is sterile without having been sterilized surgically, if either partner has had a
noncontraceptive surgical procedure that has rendered him or her unable to conceive or impregnate, or if the user
has a sexual partner of the same sex.
Method Unknown or Not Reported—In Tables 7 and 8, report the number of female and male users,
respectively, for whom the primary family planning method at exit from the last family planning encounter is
unknown or not reported.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 27–30.

Family Planning Annual Report: 2017 National Summary

27

Additional results include the following:

▪ By level of effectiveness10 in preventing pregnancy, 19% of all female users relied on a

most effective contraceptive method (vasectomy, female sterilization, implant, or IUD),
43% used a moderately effective method (injectable contraception, vaginal ring,
contraceptive patch, pills, diaphragm, or cervical cap), and 18% used a less effective
method (male condom, female condom, sponge, withdrawal, a fertility awareness-based
method [FAM] or LAM, or spermicide used alone) (Exhibits 18 and 19). See Table 7
comments in the Field and Methodological Notes (Appendix C) for information about the
three method-effectiveness categories.

▪ By type of method, the contraceptive pill was used by 25% of all female users, followed

by male condoms (15%), injectable contraception (14%), IUDs (9%), hormonal implants
(7%), female sterilization (3%), the vaginal ring (2%), and the contraceptive patch (1%).
Two 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:
a FAM or LAM, vasectomy, female condom, cervical cap or diaphragm, spermicide (used
alone), or contraceptive sponge (Exhibits 18 and 19).

▪ By age group, from 56% (under 15) to 84% (18 to 19) of female users relied on a most,

moderately, or less effective method (Exhibits 18 and 19). The three leading methods by
age group were as follows:
– Females under 15: Abstinence (29%), pills (20%), and injectables (14%)
– Females 15 to 19: Pills (30% to 32%), injectables (18% to 23%), and male condoms
(12% to 14%)
– Females 20 to 39: Pills (20% to 29%), male condoms (16%), and injectables (12% to
14%)
– Females 40 to 44: Male condoms (18%), pills (18%), and injectables (13%)
– Females over 44: Male condoms (18%), female sterilization (16%), and pills (12%)

▪ Nonuse of contraception because of pregnancy or the desire for pregnancy was highest

among females 18 to 39 (8% to 11%) and was 5% or less among females in the younger
(under 18) and older (over 39) age groups.

▪ By region, from 72% (III) to 87% (VIII) of female users exited the encounter with a most,
moderately, or less effective contraceptive method (Exhibits 20 and 21).

– Most effective method use ranged from 13% (IV) to 26% (I). Among all methods,
IUDs were the second most common in Region I and the third most common in four
others (II, VIII, IX, and X).
– Moderately effective method use ranged from 37% (I) to 53% (X). Among all
methods, pills were the most common in all regions, with use ranging from 23% to 32%
of female users in each region. Injectable contraception was the second most common in
six regions (IV, V, VI, VII, VIII, and X) and the third most common in Region III.
– Less effective method use ranged from 11% (VIII) to 25% (IX). Among all methods,
male condoms were the second most common in three regions (II, III, and IX) and the
third most common in five others (I, IV, V, VI, and VII).

28

Family Planning Annual Report: 2017 National Summary

– Nonuse of contraception because of pregnancy or the desire for pregnancy ranged from
6% (III) to 12% (IV).

▪ By state, there was wide variation in the percentage of female users at risk of unintended

pregnancy who relied on most effective (0% to 37%), moderately effective (18% to 91%),
and less effective (1% to 42%) contraceptive methods (Exhibit B–4). Female users at risk
of unintended pregnancy were not pregnant, seeking pregnancy, or abstinent.

Trends in Female Primary Contraceptive Method Use

From 2007 through 2017, the percentage of all female users relying on most, moderately, or
less effective methods ranged from 79% to 84%; 13% to 15% used no method because they
were either pregnant, seeking pregnancy, or for other reasons; and 1% to 3% were abstinent
(Exhibits A–9a, A–9b, and A–9c).
Use of most effective methods: Among all female users, the percentage relying on the most
effective methods increased from 5% in 2007 to 19% in 2017 (Exhibits A–9a, A–9b, and
A–9c).

▪ IUD use among female users increased from 3% in 2007 to 9% in 2017. Numerically, the
number of IUD users more than doubled, from 138,714 in 2007 to 324,174 in 2017.

▪ Implant use increased from less than 0.5% of female users in 2007 to 7% in 2017.

Numerically, the number of implant users increased 32-fold, from 7,300 in 2007 to
239,029 in 2017.

Use of moderately effective methods: The percentage of all female users relying on
moderately effective methods decreased from 57% in 2007 to 43% in 2017 (Exhibits A–9a,
A–9b, and A–9c).

▪ The pill, used by 39% of female users in 2007 and 25% in 2017, was the preferred method
among female users in all years.

▪ Injectable contraception, used by 13% of female users in 2007 and 14% in 2017, was the
third most common method, except in 2014 and 2015 when it was the second most used
method.

▪ Use of the vaginal ring decreased from 3% of female users in 2007 to 2% in 2017, while

the percentage using the contraceptive patch decreased from 3% in 2007 to 1% in 2017. In
all years, less than 0.5% of female users relied on the cervical cap or diaphragm.

Use of less effective methods: The percentage of all female users relying on less effective
methods was 19% in 2007 and 18% in 2017 (Exhibits A–9a, A–9b, and A–9c). Across the
different methods in this category, there were small or no changes in the percentage of female
users who relied on male condoms (15% in 2007 and 2017); withdrawal or other methods not
listed in FPAR Table 7 (3% in 2007 vs. 2% in 2017); and all other less effective methods
(less than 0.5% for each method in 2007 and 2017), including FAM or LAM, female
condoms, contraceptive sponge, or spermicide.

Family Planning Annual Report: 2017 National Summary

29

Exhibit 18. Number of female family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 7)

30

Primary Method

Family Planning Annual Report: 2017 National Summary

Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode

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

94,173
324,174
239,029
500,960a
894,128
48,256
76,252
2,219
169
2,537
1,991
15,287
92,385
73,047

0
406
2,723
6,610a
7,219
471
167
22
1
14
34
73
10,616
350

0
9,013
25,546
55,400a
73,193
4,015
2,967
159
5
133
205
482
13,668
2,472

1
19,744
33,224
61,489a
107,263
5,401
5,575
203
11
151
153
812
6,901
4,507

1,377
76,865
75,270
125,331a
267,725
14,574
21,974
381
32
517
384
3,056
13,633
15,600

7,510
83,158
51,951
97,026a
199,608
11,173
23,498
447
36
469
374
3,557
12,531
15,778

15,289
60,377
27,849
67,654a
116,559
6,808
14,097
384
25
345
309
2,729
9,527
11,723

20,770
39,824
14,224
46,032a
65,409
3,646
5,313
308
22
290
224
1,921
7,749
8,086

19,432
22,016
5,775
25,075a
34,323
1,556
1,895
158
16
231
152
1,320
5,943
5,596

29,794
12,771
2,467
16,343a
22,829
612
766
157
21
387
156
1,337
11,817
8,935

8,848
547,129

0
2,518

4
28,472

108
47,724

405
141,902

963
123,381

1,575
80,314

1,996
53,725

1,822
34,833

1,975
34,260

313,802
190,518
116,331
3,541,235

607
1,859
2,931
36,621

10,272
7,972
8,486
242,464

25,710
12,491
8,872
340,340

90,488
36,999
21,811
908,324

87,183
37,363
21,771
777,777

56,680
28,123
17,093
517,460

29,938
21,707
13,200
334,384

9,878
15,274
9,930
195,225

3,046
28,730
12,237
188,640

2,828,199

20,608

202,066

286,366

745,393

618,929

406,037

261,790

154,200

132,810

Most effectivee
666,224
3,129
34,563
53,077
153,917
143,582
105,090
76,814
49,045
47,007
Moderately effectivee
1,521,815
14,489
135,734
179,931
429,985
331,752
205,502
120,708
63,007
40,707
Less effectivee
640,160
2,990
31,769
53,358
161,491
143,595
95,445
64,268
42,148
45,096
Abstinence
92,385
10,616
13,668
6,901
13,633
12,531
9,527
7,749
5,943
11,817
Not Using a Method
504,320
2,466
18,244
38,201
127,487
124,546
84,803
51,645
25,152
31,776
Method Unknown
116,331
2,931
8,486
8,872
21,811
21,771
17,093
13,200
9,930
12,237
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: 2017 National Summary

Exhibit 19. Distribution of female family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown

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

3%
9%
7%
14%a
25%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
2%

0%
1%
7%
18%a
20%
1%
0%†
0%†
0%†
0%†
0%†
0%†
29%
1%

0%
4%
11%
23%a
30%
2%
1%
0%†
0%†
0%†
0%†
0%†
6%
1%

0%†
6%
10%
18%a
32%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
1%

0%†
8%
8%
14%a
29%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
2%

1%
11%
7%
12%a
26%
1%
3%
0%†
0%†
0%†
0%†
0%†
2%
2%

3%
12%
5%
13%a
23%
1%
3%
0%†
0%†
0%†
0%†
1%
2%
2%

6%
12%
4%
14%a
20%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
2%

10%
11%
3%
13%a
18%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
3%

16%
7%
1%
9%a
12%
0%†
0%†
0%†
0%†
0%†
0%†
1%
6%
5%

0%†
15%

0%
7%

0%†
12%

0%†
14%

0%†
16%

0%†
16%

0%†
16%

1%
16%

1%
18%

1%
18%

9%
5%
3%
100%

2%
5%
8%
100%

4%
3%
3%
100%

8%
4%
3%
100%

10%
4%
2%
100%

11%
5%
3%
100%

11%
5%
3%
100%

9%
6%
4%
100%

5%
8%
5%
100%

2%
15%
6%
100%

80%

56%

83%

84%

82%

80%

78%

78%

79%

70%

19%
43%
18%
3%
14%
3%

9%
40%
8%
29%
7%
8%

14%
56%
13%
6%
8%
3%

16%
53%
16%
2%
11%
3%

17%
47%
18%
2%
14%
2%

18%
43%
18%
2%
16%
3%

20%
40%
18%
2%
16%
3%

23%
36%
19%
2%
15%
4%

25%
32%
22%
3%
13%
5%

25%
22%
24%
6%
17%
6%

31

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%.

Exhibit 20. Number of female family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 7)

32

Primary Method

Family Planning Annual Report: 2017 National Summary

Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Methode
Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown

All Regions

Region I

Region IV

Region V

Region VII

Region VIII

94,173
324,174
239,029
500,960a
894,128
48,256
76,252
2,219
169
2,537
1,991
15,287
92,385
73,047

6,930
21,400
13,626
17,157a
39,276
1,880
3,513
131
8
80
36
389
8,484
3,339

Region II
7,415
43,631
20,559
42,450
101,921
7,723
9,937
173
31
186
51
1,087
6,585
10,111

Region III
13,858
30,436
24,512
53,887a
91,582
2,915
7,944
509
9
886
874
848
11,467
6,046

16,064
30,381
33,778
124,175
141,353
6,252
6,961
108
26
354
307
5,783
20,236
20,705

8,419
32,252
21,168
55,382
99,044
4,252
9,064
168
5
169
68
403
6,430
4,111

Region VI
12,909
22,440
21,374
52,598a
71,675
2,490
4,793
139
23
184
459
2,201
11,971
8,496

4,773
11,063
6,992
20,725
29,377
688
1,787
36
3
84
29
544
1,989
1,367

1,419
15,360
9,432
16,776
32,937
504
3,988
43
11
49
18
179
2,623
1,262

Region IX
19,734
99,563
76,702
96,573a
241,731
18,117
22,995
807
47
517
104
3,591
19,617
15,249

Region X
2,652
17,648
10,886
21,237
45,232
3,435
5,270
105
6
28
45
262
2,983
2,361

8,848
547,129

580
20,358

639
66,057

1,381
56,355

929
61,104

794
44,740

1,266
42,131

437
11,925

428
9,921

1,771
220,691

623
13,847

313,802
190,518
116,331
3,541,235

11,879
10,583
7,130
166,779

37,796
28,004
2,204
386,560

23,226
24,749
52,549
404,033

75,504
45,422
20,333
609,775

29,546
14,662
11,299
341,976

32,419
26,420
2,038
316,026

10,310
4,113
2,322
108,564

7,181
3,195
702
106,028

73,707
29,370
17,589
958,475

12,234
4,000
165
143,019

2,828,199

128,703

311,971

292,042

448,280

280,039

243,178

89,830

92,327

818,192

123,637

666,224
1,521,815
640,160
92,385
504,320
116,331

42,536
61,957
24,210
8,484
22,462
7,130

72,244
162,204
77,523
6,585
65,800
2,204

70,187
156,837
65,018
11,467
47,975
52,549

81,152
278,849
88,279
20,236
120,926
20,333

62,633
167,910
49,496
6,430
44,208
11,299

57,989
131,695
53,494
11,971
58,839
2,038

23,265
52,613
13,952
1,989
14,423
2,322

26,639
54,248
11,440
2,623
10,376
702

197,770
380,223
240,199
19,617
103,077
17,589

31,809
75,279
16,549
2,983
16,234
165

FAM=fertility awareness-based method. LAM=lactational amenorrhea method.
a
b
c
d
e

Includes both 3-month and 1-month hormonal injection users.
FAMs include Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
User refrained from oral, vaginal, and anal intercourse.
Includes withdrawal or any other method not listed in FPAR Table 7.
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: 2017 National Summary

Exhibit 21. Distribution of female family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 7)
Primary Method
Female sterilization
Intrauterine device
Hormonal implant
Hormonal injection
Oral contraceptive
Contraceptive patch
Vaginal ring
Cervical cap or diaphragm
Contraceptive sponge
Female condom
Spermicide (used alone)
FAM or LAMb
Abstinencec
Withdrawal or other methodd
Rely on Male Method
Vasectomy
Male condom
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users

All Regions

Region I

Region II

3%
9%
7%
14%a
25%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
2%

4%
13%
8%
10%a
24%
1%
2%
0%†
0%†
0%†
0%†
0%†
5%
2%

2%
11%
5%
11%
26%
2%
3%
0%†
0%†
0%†
0%†
0%†
2%
3%

Region III
3%
8%
6%
13%a
23%
1%
2%
0%†
0%†
0%†
0%†
0%†
3%
1%

Region IV
3%
5%
6%
20%
23%
1%
1%
0%†
0%†
0%†
0%†
1%
3%
3%

Region V
2%
9%
6%
16%
29%
1%
3%
0%†
0%†
0%†
0%†
0%†
2%
1%

Region VI
4%
7%
7%
17%a
23%
1%
2%
0%†
0%†
0%†
0%†
1%
4%
3%

Region VII
4%
10%
6%
19%
27%
1%
2%
0%†
0%†
0%†
0%†
1%
2%
1%

Region VIII
1%
14%
9%
16%
31%
0%†
4%
0%†
0%†
0%†
0%†
0%†
2%
1%

Region IX
2%
10%
8%
10%a
25%
2%
2%
0%†
0%†
0%†
0%†
0%†
2%
2%

Region X
2%
12%
8%
15%
32%
2%
4%
0%†
0%†
0%†
0%†
0%†
2%
2%

0%†
15%

0%†
12%

0%†
17%

0%†
14%

0%†
10%

0%†
13%

0%†
13%

0%†
11%

0%†
9%

0%†
23%

0%†
10%

9%
5%
3%
100%

7%
6%
4%
100%

10%
7%
1%
100%

6%
6%
13%
100%

12%
7%
3%
100%

9%
4%
3%
100%

10%
8%
1%
100%

9%
4%
2%
100%

7%
3%
1%
100%

8%
3%
2%
100%

9%
3%
0%†
100%

Using Most, Moderately, or Less
Effective Methode

80%

77%

81%

72%

74%

82%

77%

83%

87%

85%

86%

Most effectivee
Moderately effectivee
Less effectivee
Abstinence
Not Using a Method
Method Unknown

19%
43%
18%
3%
14%
3%

26%
37%
15%
5%
13%
4%

19%
42%
20%
2%
17%
1%

17%
39%
16%
3%
12%
13%

13%
46%
14%
3%
20%
3%

18%
49%
14%
2%
13%
3%

18%
42%
17%
4%
19%
1%

21%
48%
13%
2%
13%
2%

25%
51%
11%
2%
10%
1%

21%
40%
25%
2%
11%
2%

22%
53%
12%
2%
11%
0%†

33

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%.

This page intentionally left blank.

34

Family Planning Annual Report: 2017 National Summary

Male Users by Primary Contraceptive Method (Exhibits 22 through 25)

In 2017, grantees reported that 76% (353,287) 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. Nine percent (42,327) of males used no primary method, either because their partners
were pregnant or seeking pregnancy (1%) or for other reasons (8%), and another 7% (33,275)
reported that they were abstinent. The type of primary contraceptive method used was
unknown or not reported for 7% (34,122) of male users (Exhibits 22 and 23).

▪ By type of method, two-thirds (65%) of all male users relied on male condoms, followed
by reliance on a female method (7%), withdrawal (3%), vasectomy (1%), and a FAM or
LAM (1%) (Exhibits 22 and 23).

▪ By age group, from 15% (under 15) to 84% (20 to 24) of male users relied on a most,

moderately, or less effective method. Across all age groups, the two leading contraceptive
methods were male condoms, which were the primary method for 11% to 76% of male
users, and reliance on a female method, a choice for 3% to 11% of male users (Exhibits 22
and 23). Other findings by age group were as follows:
– Vasectomy prevalence was 1% to 3% among males 30 or over and less than 0.5%
among males 20 to 29.
– Nonuse of contraception because a partner was pregnant or seeking pregnancy was less
than 0.5% among males under 18 and from 1% to 2% of males in all other age groups.

▪ By region, the percentage of males who exited the encounter with a most, moderately, or
less effective method ranged from 60% (IV) to 89% (IX) (Exhibits 24 and 25).

– Male condoms, the leading primary method for males in all regions, were used by 40%
(IV) to 81% (IX) of male users. The percentage of males relying on a female method, the
second most common primary method for males in four regions (III, V, VII, and VIII),
ranged from 3% (II and IX) to 17% (VIII).
– Nonuse of contraception because a partner was pregnant or seeking pregnancy ranged
from less than 0.5% (II) to 2% (V, VI, and IX).

Family Planning Annual Report: 2017 National Summary

35

Exhibit 22. Number of male family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 8)

36

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

3,402

0

0

0

57

280

604

717

686

1,058

299,268

1,420

14,880

23,632

79,995

73,477

43,768

25,278

13,987

22,831

2,585

8

52

102

493

606

374

307

261

382

Abstinence

33,275

8,001

7,927

2,593

2,982

2,411

1,786

1,442

1,172

4,961

Withdrawal or other methodc

14,407

130

431

668

2,216

2,390

1,982

1,573

1,252

3,765

Rely on female methodd

33,625

314

1,548

1,814

6,211

6,466

4,841

3,595

2,747

6,089

5,997

4

82

237

1,179

1,371

1,075

758

523

768

Other reason

36,330

905

1,620

2,092

7,342

7,060

4,824

3,421

2,433

6,633

Method Unknown

34,122

1,657

2,425

1,757

5,144

5,750

4,119

3,281

2,462

7,527

Total Male Users

463,011

12,439

28,965

32,895

105,619

99,811

63,373

40,372

25,523

54,014

Using most, moderately, or less
effective methode

353,287

1,872

16,911

26,216

88,972

83,219

51,569

31,470

18,933

34,125

Abstinence

33,275

8,001

7,927

2,593

2,982

2,411

1,786

1,442

1,172

4,961

Not using a method

42,327

909

1,702

2,329

8,521

8,431

5,899

4,179

2,956

7,401

Method unknown

34,122

1,657

2,425

1,757

5,144

5,750

4,119

3,281

2,462

7,527

Primary Method
Vasectomy
Male condom
FAM or LAM

a

b

No Method
Partner pregnant/seeking pregnancy

Family Planning Annual Report: 2017 National Summary

b

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: 2017 National Summary

Exhibit 23. Distribution of male family planning users, by primary contraceptive method and age: 2017 (Source: FPAR Table 8)
All Age
Groups

Under 15
Years

15 to 17
Years

18 to 19
Years

1%

0%

0%

0%

Male condom

65%

11%

51%

72%

FAM or LAM

1%

Abstinence

7%

64%

Withdrawal or other methodc

3%

Rely on female methodd

Primary Method
Vasectomy

76%

30 to 34
Years

35 to 39
Years

40 to 44
Years

Over 44
Years

1%

2%

3%

2%

74%

69%

63%

55%

42%

0%†

0%†

1%

1%

1%

1%

1%

27%

8%

3%

2%

3%

4%

5%

9%

1%

1%

2%

2%

2%

3%

4%

5%

7%

7%

3%

5%

6%

6%

6%

8%

9%

11%

11%

Partner pregnant/seeking pregnancy

1%

0%†

0%†

1%

1%

1%

2%

2%

2%

1%

Other reason

8%

7%

6%

6%

7%

7%

8%

8%

10%

12%

Method Unknown

7%

13%

8%

5%

5%

6%

6%

8%

10%

14%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

76%

15%

58%

80%

84%

83%

81%

78%

74%

63%

Abstinence

7%

64%

27%

8%

3%

2%

3%

4%

5%

9%

Not using a method

9%

7%

6%

7%

8%

8%

9%

10%

12%

14%

Method unknown

7%

13%

8%

5%

5%

6%

6%

8%

10%

14%

b

0%†

0%†

25 to 29
Years

0%†

a

0%†

20 to 24
Years

No Method

Total Male Users
Using most, moderately, or less
effective methode
b

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%.

37

Exhibit 24. Number of male family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 8)

38
Primary Method
Vasectomy

All
Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII Region VIII Region IX

Region X

3,402

219

151

356

674

441

206

86

327

692

250

299,268

15,897

31,299

29,694

26,968

35,645

20,860

8,222

13,053

110,006

7,624

2,585

22

29

169

1,079

10

905

45

13

307

6

Abstinence

33,275

4,033

1,580

3,459

12,661

1,942

3,874

263

1,254

3,730

479

Withdrawal or other methodc

14,407

766

1,551

1,122

3,175

361

332

231

357

5,238

1,274

Rely on female methodd

33,625

2,166

1,305

5,170

8,242

3,704

3,093

1,226

3,632

4,384

703

5,997

271

188

409

774

1,018

851

69

255

2,077

85

Other reason

36,330

3,306

5,552

4,031

6,786

3,788

3,762

787

1,929

5,092

1,297

Method Unknown

34,122

1,493

876

15,773

7,012

3,016

737

1,266

74

3,826

49

Total Male Users

463,011

28,173

42,531

60,183

67,371

49,925

34,620

12,195

20,894

135,352

11,767

Using most, moderately, or less
effective methode

353,287

19,070

34,335

36,511

40,138

40,161

25,396

9,810

17,382

120,627

9,857

Abstinence

33,275

4,033

1,580

3,459

12,661

1,942

3,874

263

1,254

3,730

479

Not using a method

42,327

3,577

5,740

4,440

7,560

4,806

4,613

856

2,184

7,169

1,382

Method unknown

34,122

1,493

876

15,773

7,012

3,016

737

1,266

74

3,826

49

Male condom
FAM or LAM

a

b

No Method
Partner pregnant/seeking pregnancy

Family Planning Annual Report: 2017 National Summary

b

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: 2017 National Summary

Exhibit 25. Distribution of male family planning users, by primary contraceptive method and region: 2017 (Source: FPAR Table 8)
Primary Method
Vasectomy

All
Regions

Region I

1%

1%

Male condom

65%

56%

FAM or LAM

1%

Abstinence

7%

Withdrawal or other methodc
Rely on female methodd

0%†
74%

Region III

Region IV

Region V

Region VI

Region VII Region VIII Region IX

Region X

1%

1%

1%

1%

1%

2%

1%

2%

49%

40%

71%

60%

67%

62%

81%

65%

0%†

0%†

2%

0%†

3%

0%†

0%†

0%†

0%†

14%

4%

6%

19%

4%

11%

2%

6%

3%

4%

3%

3%

4%

2%

5%

1%

1%

2%

2%

4%

11%

7%

8%

3%

9%

12%

7%

9%

10%

17%

3%

6%

Partner pregnant/seeking pregnancy

1%

1%

0%†

1%

1%

2%

2%

1%

1%

2%

1%

Other reason

8%

12%

13%

7%

10%

8%

11%

6%

9%

4%

11%

Method Unknown

7%

5%

2%

26%

10%

6%

2%

10%

0%†

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

76%

68%

81%

61%

60%

80%

73%

80%

83%

89%

84%

Abstinence

7%

14%

4%

6%

19%

4%

11%

2%

6%

3%

4%

Not using a method

9%

13%

13%

7%

11%

10%

13%

7%

10%

5%

12%

Method unknown

7%

5%

2%

26%

10%

6%

2%

10%

a

b

0%†

Region II

No Method

Total Male Users
Using most, moderately, or less
effective methode
b

0%†

3%

0%†

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%.

39

Guidance for Reporting Cervical and Breast Cancer Screening Activities in FPAR Tables 9 and 10
In FPAR Table 9, grantees report the following information on cervical cancer screening activities:

▪ Unduplicated number of female users who obtained a Pap test;
▪ Number of Pap tests performed;
▪ Number of Pap tests with an ASC or higher result according to the 2014 Bethesda System.17 ASC or higher

results include ASC-US; ASC-H; LSIL; HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical
AIS; adenocarcinoma; or other malignant neoplasms; and

▪ Number of Pap tests with an HSIL or higher result according to the 2014 Bethesda System.17 HSIL or higher

results include HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical AIS; adenocarcinoma;
or other malignant neoplasms.

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.
The FPAR instructions provide the following guidance for reporting this information:
Tests—Report Pap tests and CBEs performed during the reporting period that are provided within the scope of the
agency’s Title X project.
Squamous Cell Abnormalities—The 2014 Bethesda System17 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)—ASC 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.18

▪ 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.18

▪ 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).18

▪ Squamous cell carcinoma is a finding of cancer in the squamous cells of the cervix.18
Glandular Cell Abnormalities—The 2014 Bethesda System17 classifies glandular cell abnormalities into the
following categories:

▪ Atypical glandular cells (AGCs) 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.18 The 2014 Bethesda
System17 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.18

▪ Adenocarcinoma is a finding of cancer in endocervical, endometrial, extrauterine, or not otherwise specified
glandular tissue.18

Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 33–35.

40

Family Planning Annual Report: 2017 National Summary

CERVICAL AND BREAST CANCER SCREENING
According to the QFP Recommendations,16 providers should assess clients’ need for related
preventive health services (e.g., cervical and breast cancer screening) 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.
Cervical Cancer Screening (Exhibit 26)

In 2017, Title X service sites provided Papanicolaou (Pap) testing to 18% (649,266) of female
family planning users and performed 683,247 Pap tests (1.1 tests per female tested). Of the
Pap tests performed, 14% had an indeterminate or abnormal result (i.e., atypical squamous
cell [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 14% (V)
to 25% (VII). From 12% (III and IV) to 20% (II) of Pap tests had an ASC or higher result,
and 1% of Pap tests in all regions except for Region I (2%) had an HSIL or higher result.
See Exhibits A–10a and A–10b for trends (2007–2017) in cervical cancer screening.
Breast Cancer Screening (Exhibit 26)

In 2017, Title X service sites provided clinical breast exams (CBEs) to 25% (878,491) of
female users and referred 5% (41,766) of those examined for further evaluation based on
CBE results.
By region, from 14% (IX) to 37% (IV, VII, and VIII) of female users received a CBE, and
from 1% (VIII and X) to 11% (IX) of those examined were referred for further evaluation
(Exhibit 26).

Family Planning Annual Report: 2017 National Summary

41

Exhibit 26. Cervical and breast cancer screening activities, by screening test or exam and region: 2017 (Source: FPAR Tables 9 and 10)

42

Tests/Exams
Pap Tests
Female users tested
Numbera
Percentage

b

Tests performed
Number
Tests per female tested
Tests with ASC or higher result
Number
Percentage

c

Tests with HSIL or higher result
Number

Family Planning Annual Report: 2017 National Summary

Percentagec
Clinical Breast Exams
Female users examined
Numbera
Percentage

b

Female users referred based on
exam
Number
Percentage

d

All Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region IX

Region X

649,266

24,468

72,940

77,007

135,660

47,176

75,466

27,009

18,913

145,880

24,747

18%

15%

19%

19%

22%

14%

24%

25%

18%

15%

17%

683,247

24,670

74,531

81,732

144,500

48,971

76,819

27,454

19,330

160,340

24,900

1.1

1.0

1.0

1.1

1.1

1.0

1.0

1.0

1.0

1.1

1.0

95,678

3,854

14,826

9,766

16,834

7,200

10,257

3,690

3,530

20,912

4,809

14%

16%

20%

12%

12%

15%

13%

13%

18%

13%

19%

7,304

404

1%

2%

798

772

1,480

518

931

323

217

1,576

285

1%

1%

1%

1%

1%

1%

1%

1%

1%

878,491

36,396

106,611

102,348

224,527

56,605

114,232

40,305

39,466

132,635

25,366

25%

22%

28%

25%

37%

17%

36%

37%

37%

14%

18%

41,766

2,348

2,959

6,645

3,968

2,705

5,938

2,074

370

14,394

365

5%

6%

3%

6%

2%

5%

5%

5%

1%

11%

1%

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.

Region VII Region VIII

SEXUALLY TRANSMITTED DISEASE TESTING
Sexually transmitted diseases (STDs) are a concern for clients served by Title X services
grantees, particularly young (15 to 24) sexually active women, a population that typically has
the highest reported rates of chlamydia and gonorrhea.19 According to the QFP
Recommendations,16 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 the Centers for Disease Control and
Prevention’s (CDC’s) Sexually Transmitted Diseases Treatment Guidelines, 2015.20
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 sexual 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.20
In 2017, Title X service sites tested 52% (1.8 million) of all female users for chlamydia and
61% (939,250) of females under 25 (Exhibits 27 and 28).

▪ By age group, chlamydia testing rates were higher among females 15 to 24 (61% to 63%)
than those under 15 (39%) or over 24 (45%) (Exhibits 27 and 28).

▪ By region, the chlamydia testing rate for females under 25 ranged from 49% (III) to 71%
(IX) (Exhibits 27 and 28).

▪ By state, chlamydia testing rates for females under 25 ranged from less than 0.5% to 83%
(Exhibit B–5).

See Exhibits A–11a and A–11b for trends (2007–2017) in chlamydia testing.
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) at least annually or
more frequently (every 3 to 6 months) if at increased risk and sexually active men with HIV
at the first HIV evaluation and at least annually thereafter unless risk behaviors and the local
epidemiology warrant more frequent screening.20
In 2017, Title X service sites tested 69% (321,280) of all male users for chlamydia
(Exhibits 27 and 28).

▪ By age group, rates of chlamydia testing were higher for males 18 to 19 (73%) and 20 to
24 (82%) and lower for males 15 to 17 (50%) and under 15 (16%).

Family Planning Annual Report: 2017 National Summary

43

▪ By region, Title X service sites tested between 42% (IV) and 85% (V) of all male users for
chlamydia.

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, and exchanging sex for drugs or money). CDC also
recommends screening sexually active MSM at anatomic sites of contact (urethra, rectum,
and pharynx) at least annually or more frequently (every 3 to 6 months) if at increased risk.
Finally, CDC 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.20
In 2017, Title X service sites performed just over 2.4 million gonorrhea tests, or an average of
5.9 gonorrhea tests for every 10 female users and 7.6 tests for every 10 male users. By region,
the rate of gonorrhea testing ranged from 4.8 (I) to 6.5 (V and IX) tests for every 10 female
users and from 3.6 (IV) to 9.6 (V) tests for every 10 male users (Exhibit 29).
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.20
In 2017, Title X service sites performed 709,161 syphilis tests, or an average of 1.5 syphilis
tests for every 10 female users and 3.6 tests for every 10 male users. By region, the rate of
syphilis testing ranged from 0.3 tests (VIII and X) to 2.7 tests (IV) for every 10 female users
and from 1.6 tests (VIII) to 5.4 tests (VI) for every 10 male users (Exhibit 29).
Human Immunodeficiency Virus 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 the client or their partner(s) has
had more than one sex partner since their most recent HIV test.20
In 2017, Title X service sites performed approximately 1.2 million confidential HIV tests, or
an average of 2.6 confidential HIV tests for every 10 female users and 5.9 tests for every 10
male users. Of the confidential HIV tests performed, 2,195, or 1.8 tests per 1,000 tests
performed, were positive for HIV. In addition, Title X sites performed 2,083 anonymous HIV
tests. By region, the rate of HIV testing ranged from 1.1 test (X) to 3.3 tests (VI) for every 10
female users and from 2.6 tests (IV) to 7.2 tests (VIII and IX) for every 10 male users
(Exhibit 29).
See Exhibits A–12a and A–12b for trends (2007–2017) in confidential HIV testing among
female and male users.

44

Family Planning Annual Report: 2017 National Summary

Guidance for Reporting STD Testing Activities in FPAR Tables 11 and 12
In FPAR Tables 11 and 12, grantees report testing information for chlamydia (Table 11), gonorrhea (Table 12),
syphilis (Table 12), and HIV (Table 12).
In FPAR Table 11, grantees report the unduplicated number of family planning users tested for chlamydia, by age
group (<15, 15–17, 18–19, 20–24, and 25 or over) and sex.
In FPAR Table 12, grantees report the following information on gonorrhea, syphilis, and HIV testing:

▪
▪
▪
▪
▪

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; and
Number of anonymous HIV tests performed.

The FPAR instructions provide the following guidance for reporting this information:
Age Group—Use the client’s age as of June 30 of the reporting period.
Tests—Report STD (chlamydia, gonorrhea, and syphilis) and HIV (confidential and anonymous) tests performed
during the reporting period that are provided within the scope of the grantee’s Title X project. Do not report tests
performed in an STD clinic operated by the Title X-funded agency, unless the activities of the STD clinic are within
the defined scope of the agency’s Title X project.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), p. 39–40.

Family Planning Annual Report: 2017 National Summary

45

Exhibit 27. Number of family planning users tested for chlamydia, by sex, age, and region: 2017 (Source: FPAR Table 11)

46

Age Group (Years)

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

Female Users
Under 15

14,129

766

1,100

2,077

3,325

1,296

1,425

428

446

2,568

698

15 to 17

146,839

7,062

13,617

15,345

23,590

15,545

13,088

5,681

5,661

38,669

8,581

18 to 19

215,830

8,908

21,418

18,830

33,619

23,172

17,713

7,096

8,557

65,933

10,584

20 to 24

562,452

21,747

59,157

46,002

86,110

59,694

44,006

16,357

18,200

186,999

24,180

Over 24

906,644

40,928

112,495

85,096

159,439

83,703

80,969

24,148

15,511

273,882

30,473

1,845,894

79,411

207,787

167,350

306,083

183,410

157,201

53,710

48,375

568,051

74,516

Under 25

939,250

38,483

95,292

82,254

146,644

99,707

76,232

29,562

32,864

294,169

44,043

Male Users
Under 15

1,976

249

93

654

527

73

32

28

27

267

26

15 to 17

14,434

1,348

1,436

2,786

1,444

1,274

646

432

499

4,045

524

18 to 19

24,104

1,462

2,509

3,024

2,080

3,091

1,561

904

1,089

7,643

741

20 to 24

86,537

4,513

9,349

8,307

6,543

12,829

5,308

2,854

4,302

29,990

2,542

Over 24

194,229

10,440

18,133

19,843

17,390

25,264

13,466

5,162

9,466

69,216

5,849

Subtotal

321,280

18,012

31,520

34,614

27,984

42,531

21,013

9,380

15,383

111,161

9,682

Subtotal
a

Family Planning Annual Report: 2017 National Summary

All Users
Under 15

a

All Regions

16,105

1,015

1,193

2,731

3,852

1,369

1,457

456

473

2,835

724

15 to 17

161,273

8,410

15,053

18,131

25,034

16,819

13,734

6,113

6,160

42,714

9,105

18 to 19

239,934

10,370

23,927

21,854

35,699

26,263

19,274

8,000

9,646

73,576

11,325

20 to 24

648,989

26,260

68,506

54,309

92,653

72,523

49,314

19,211

22,502

216,989

26,722

Over 24

1,100,873

51,368

130,628

104,939

176,829

108,967

94,435

29,310

24,977

343,098

36,322

Total All Users

2,167,174

97,423

239,307

201,964

334,067

225,941

178,214

63,090

63,758

679,212

84,198

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 20] and USPSTF
[2014, September]. Gonorrhea and chlamydia: Screening [see reference 21].)

Family Planning Annual Report: 2017 National Summary

Exhibit 28. Percentage of family planning users in each age group tested for chlamydia, by sex, age, and region: 2017 (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

39%

29%

36%

31%

37%

41%

42%

38%

37%

53%

48%

15 to 17

61%

51%

62%

49%

55%

61%

61%

64%

62%

72%

64%

18 to 19

63%

56%

64%

50%

60%

63%

60%

62%

64%

73%

66%

20 to 24

62%

57%

60%

50%

60%

61%

59%

61%

59%

70%

63%

Over 24

45%

43%

49%

36%

45%

47%

43%

40%

30%

51%

42%

52%

48%

54%

41%

50%

54%

50%

49%

46%

59%

52%

Under 25

61%

54%

61%

49%

58%

61%

59%

61%

60%

71%

63%

Male Users
Under 15

16%

21%

7%

22%

13%

14%

4%

27%

7%

26%

48%

15 to 17

50%

41%

49%

43%

31%

72%

31%

79%

48%

72%

85%

18 to 19

73%

70%

72%

62%

54%

88%

53%

84%

75%

87%

90%

20 to 24

82%

82%

83%

69%

63%

91%

71%

83%

81%

90%

89%

Over 24

69%

65%

77%

58%

39%

84%

63%

73%

74%

80%

79%

Subtotal

69%

64%

74%

58%

42%

85%

61%

77%

74%

82%

82%

All Users
Under 15

Subtotal
a

a

33%

27%

28%

28%

29%

37%

35%

37%

30%

48%

48%

15 to 17

59%

49%

60%

48%

53%

61%

58%

65%

60%

72%

65%

18 to 19

64%

58%

65%

52%

60%

65%

59%

64%

65%

74%

67%

20 to 24

64%

60%

62%

52%

60%

65%

60%

63%

62%

72%

65%

Over 24

48%

46%

52%

39%

44%

52%

45%

44%

39%

55%

45%

Total All Users

54%

50%

56%

44%

49%

58%

51%

52%

50%

62%

54%

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 20] and USPSTF
[2014, September]. Gonorrhea and chlamydia: Screening [see reference 21].)

47

48

Exhibit 29. Number of gonorrhea, syphilis, and HIV tests performed, by test type and region, and number of positive HIV tests, by region:
2017 (Source: FPAR Table 12)
STD Tests

Region I

Region II

Region III

Region IV

Region V

Region VI

2,073,331

80,664

236,791

222,594

321,372

223,648

171,406

58,454

53,821

624,259

80,322

Male

351,585

18,453

34,100

45,009

24,137

48,037

22,267

9,959

17,308

121,763

10,552

Total

2,424,916

99,117

270,891

267,603

345,509

271,685

193,673

68,413

71,129

746,022

90,874

5.9

4.8

6.1

5.5

5.3

6.5

5.4

5.4

5.1

6.5

5.6

Male

7.6

6.5

8.0

7.5

3.6

9.6

6.4

8.2

8.3

9.0

9.0

Total

6.1

5.1

6.3

5.8

5.1

6.9

5.5

5.7

5.6

6.8

5.9

Gonorrhea Tests
Female

Tests per 10 Users
Female

Syphilis Tests
Female

All Regions

Region VII

Region VIII

Region IX

Region X

Family Planning Annual Report: 2017 National Summary

540,346

18,975

30,476

69,434

167,342

34,878

81,828

14,989

3,292

114,488

4,644

Male

168,815

8,259

11,881

25,517

18,650

15,807

18,859

4,099

3,390

59,240

3,113

Total

709,161

27,234

42,357

94,951

185,992

50,685

100,687

19,088

6,682

173,728

7,757

Tests per 10 Users
Female

1.5

1.1

0.8

1.7

2.7

1.0

2.6

1.4

0.3

1.2

0.3

Male

3.6

2.9

2.8

4.2

2.8

3.2

5.4

3.4

1.6

4.4

2.6

Total

1.8

1.4

1.0

2.0

2.7

1.3

2.9

1.6

0.5

1.6

0.5

Confidential HIV Tests
Female

917,623

36,485

116,670

106,972

155,190

84,706

105,566

20,292

14,299

261,042

16,401

Male

274,496

16,636

28,045

36,491

17,662

29,942

20,326

6,397

15,081

97,661

6,255

Total

1,192,119

53,121

144,715

143,463

172,852

114,648

125,892

26,689

29,380

358,703

22,656

Tests per 10 Users
Female

2.6

2.2

3.0

2.6

2.5

2.5

3.3

1.9

1.3

2.7

1.1

Male

5.9

5.9

6.6

6.1

2.6

6.0

5.9

5.2

7.2

7.2

5.3

Total

3.0

2.7

3.4

3.1

2.6

2.9

3.6

2.2

2.3

3.3

1.5

Positive Test Results

2,195

98

265

402

212

126

307

31

74

610

70

Anonymous HIV Tests

2,083

0

0

209

0

634

0

921

0

274

45

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 exams
and medical procedures, as described in the Program Requirements for Title X Funded
Family Planning Projects1 and the QFP Recommendations.16
In 2017, 3,525 full-time equivalent (FTE) CSPs delivered medical family planning and
related preventive health services in Title X service sites (Exhibit 30).

▪ By CSP type, midlevel clinicians (i.e., PAs, NPs, and CNMs) accounted for 70% of total
FTEs, followed by physicians (23%) and other CSPs (7%). On average, there were 3.0
midlevel clinician FTEs for every 1.0 physician FTE.

▪ By region, from 7% (V) to 36% (I) of total FTEs were physician FTEs, 59% (III) to 86%

(VIII) were midlevel clinician FTEs, and 0% (VI, VII, VIII, and X) to 26% (V) were other
CSP FTEs. There were from 1.8 (I and III) to 9.1 (V) midlevel clinician FTEs for every 1.0
physician FTE.

Family Planning Encounters (Exhibit 30)

In 2017, Title X service sites reported a total of 6.6 million family planning encounters, or an
average of 1.7 encounters per user (Exhibit 30).

▪ By type, most family planning encounters (78%, or 5.2 million) were attended by a CSP,

resulting in an average of 1.3 CSP encounters per user and 1,465 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 (X) to
1.8 (VII).
– CSP encounters: The percentage of encounters that were attended by a CSP ranged
from 56% (VI) to 91% (I). The number of CSP encounters per user ranged from 1.0 (VI)
to 1.4 (I, II, III, and IX), and the number of CSP encounters per CSP FTE ranged from
897 (X) to 2,208 (II).
– Non-CSP encounters: The percentage of encounters that were attended by non-CSP
staff ranged from 9% (I) to 44% (VI). The number of non-CSP encounters per user
ranged from 0.1 (I and II) to 0.7 (VI).

Family Planning Annual Report: 2017 National Summary

49

Guidance for Reporting Encounter and Staffing Data in FPAR Table 13
In FPAR Table 13, grantees report information on the number and type of family planning encounters and the use of
Clinical Services Providers to deliver Title X-funded family planning and related preventive health services. Table 13
reports the following provider staffing and encounter data:

▪ 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.
The FPAR instructions provide the following guidance for reporting this information:
Family Planning Provider—A family planning provider is the individual who assumes primary responsibility for
assessing a client and documenting services in the client record. Providers include those agency staff who exercise
independent judgment as to the services rendered to the client during an encounter. Two general types of providers
deliver Title X family planning services: Clinical Services Providers and Other Services Providers.
Clinical Services Providers—Include physicians (family and general practitioners, specialists), 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. Clinical
Services Providers are able to offer client education, counseling, referral, follow-up, and clinical services (physical
assessment, treatment, and management) relating to a client’s proposed or adopted method of contraception,
general reproductive health, or infertility treatment, in accordance with the Program Guidelines.12
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)
who 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 Program
Guidelines.12 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 the Program Guidelines.12
Family Planning Encounter—A family planning encounter is a documented, face-to-face contact between an
individual and a family planning provider that takes place in a Title X service site. The purpose of a family planning
encounter—whether clinical or nonclinical—is to provide family planning and related preventive health services to
female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies. To be
counted for purposes of the FPAR, a written record of the services provided during the family planning encounter
must be documented in the client record. Laboratory tests and related counseling and education, in and of
themselves, do not constitute a family planning encounter unless there is face-to-face contact between the client
and provider, the provider documents the encounter in the client’s record, and the tests are accompanied by family
planning counseling or education.
There are two types of family planning encounters at Title X service sites: (1) family planning encounters with a
Clinical Services Provider and (2) family planning encounters with an Other Services Provider. The type of family
planning provider who renders the care, regardless of the services rendered, determines the type of family planning
encounter. Although a client may meet with both Clinical and Other Services Providers during an encounter, the
provider with the highest level of training who takes ultimate responsibility for the client’s clinical or nonclinical
assessment and care during the visit is credited with the encounter.
Full-Time Equivalent (FTE)—For each type of Clinical Services Provider, report the time in FTEs that these
providers are involved in the direct provision of Title X-funded services (i.e., engaged in a family planning encounter).
A full-time equivalent (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.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 43–45.

50

Family Planning Annual Report: 2017 National Summary

Family Planning Annual Report: 2017 National Summary

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: 2017 (Source: FPAR Table 13)
FTEs and FP Encounters
Number of CSP FTEs
Physician

All
Regions

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

819.9

57.3

71.6

218.5

209.4

22.0

40.9

14.9

11.2

133.7

40.4

2,465.7

102.7

194.6

393.1

547.4

200.1

149.0

72.2

69.7

578.7

158.3

239.4

1.4

9.0

58.0

80.5

79.7

0.0

0.0

0.0

10.8

0.0

3,525.0

161.4

275.2

669.7

837.4

301.7

189.9

87.1

80.9

723.2

198.6

23%

36%

26%

33%

25%

7%

22%

17%

14%

18%

20%

70%

64%

71%

59%

65%

66%

78%

83%

86%

80%

80%

7%

1%

3%

9%

10%

26%

0%

0%

0%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

3.0

1.8

2.7

1.8

2.6

9.1

3.6

4.9

6.2

4.3

3.9

5,162,855

274,191

607,590

632,593

761,690

511,560

338,400

145,326

137,585

1,575,771

178,149

With other

1,477,446

25,725

64,135

178,002

407,402

167,470

262,048

76,734

62,229

190,180

43,521

Total

6,640,301

299,916

671,725

810,595

1,169,092

679,030

600,448

222,060

199,814

1,765,951

221,670

78%

91%

90%

78%

65%

75%

56%

65%

69%

89%

80%

22%

9%

10%

22%

35%

25%

44%

35%

31%

11%

20%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

1.3

1.4

1.4

1.4

1.1

1.3

1.0

1.2

1.1

1.4

1.2

With other

0.4

0.1

0.1

0.4

0.6

0.4

0.7

0.6

0.5

0.2

0.3

Total

1.7

1.5

1.6

1.7

1.7

1.7

1.7

1.8

1.6

1.6

1.4

1,465

1,699

2,208

945

910

1,695

1,782

1,669

1,700

2,179

897

PA/NP/CNM
Other CSPa
Total
Distribution of CSP FTEs
Physician
PA/NP/CNM
Other CSP

a

Total
Midlevel to Physician FTEb
Number of FP Encounters
With CSP

Distribution of FP Encounters
With CSP
With other
Total
FP Encounters per User
With CSP

CSP Encounters per CSP FTE

1%

0%

51

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.

Guidance for Reporting Project Revenue in FPAR Table 14
In FPAR Table 14, grantees report the revenues (i.e., actual cash receipts or drawdown amounts) received during
the reporting period from each funding source to support activities within the scope of the grantee’s Title X services
grant (Section 1001), even if the funds were not expended during the reporting period. Grantees are instructed not to
report the monetary value of in-kind contributions as revenue in Table 14. The FPAR instructions provide the
following guidance for reporting this information:
Title X Grant—Refers to funds received from the Title X Section 1001 family planning services grant. Report the
amount received (cash receipts or drawdown amounts) during the reporting period from the Title X services grant.
Include base Title X grant funding and other Title X funding for special initiatives (e.g., HIV integration and male
involvement). Do not report the amount of grant funds awarded unless this figure is the same as the actual cash
receipts or drawdown amounts.
Payment for Services—Refers to funds collected directly from clients and revenues received from public and private
third-party payers (capitated or fee-for-service) for services provided within the scope of the grantee’s Title X project.
Total Client Collections/Self-Pay (“Client Fees”)—Report the amount collected directly from clients during the
reporting period for services provided within the scope of the grantee’s Title X project.
Third-Party Payers—For each third-party source listed, report the amount received (i.e., reimbursed) during the
reporting period for services provided within the scope of the grantee’s Title X project. Only revenue from prepaid
(capitated) managed care arrangements (e.g., capitated Medicare, Medicaid, and private managed care contracts)
should be reported as prepaid. Revenues received after the date of service, even under managed care
arrangements, should be reported as not prepaid.
Medicaid/Title XIX—Report the amount received from Medicaid (federal and state shares) during the reporting
period for services provided within the scope of the grantee’s Title X project, regardless of whether the
reimbursement was paid directly by Medicaid or through a fiscal intermediary or a health maintenance
organization (HMO). For example, in states with a capitated Medicaid program (i.e., the grantee has a contract
with a private plan like Blue Cross), the payer is Medicaid, even though the actual payment may come from Blue
Cross. Include revenue from family planning waivers (both federal and state shares) in Row 3a, Column B. If the
amount reported in Row 3a, Column B includes family planning waiver revenue, indicate this in the Table 14
“Note” field.
Medicare/Title XVIII—Report the amount received from Medicare during the reporting period for services
provided within the scope of the grantee’s Title X project, 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)—Report the amount of funds received during the reporting period
from CHIP for services provided within the scope of the grantee’s Title X project. If the grantee is unable to report
CHIP revenue separately from Medicaid (Row 3a), indicate this in the Table 14 “Note” field.
Other Public Health Insurance—Report the amount reimbursed by other federal, state, or local government
health insurance programs during the reporting period for services provided within the scope of the grantee’s Title
X project. 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—Report the amount of funds received from private third-party health insurance plans
during the reporting period for services provided within the scope of the grantee’s Title X project. Private health
insurance include plans obtained through an employer, union, or direct purchase, including insurance purchased
for public employees or retirees or military personnel and their dependents (e.g., TRICARE or CHAMPVA) that
provide a broad set of primary medical care benefits for the enrolled individual (beneficiary or dependent).
Other Revenue—Refers to revenue received from other sources during the reporting period that supported services
provided within the scope of the grantee’s Title X project. Other revenue sources include block grants, TANF, state
and local governments (e.g., contracts, state and local indigent care programs), the Bureau of Primary Health Care,
private and client donations, or other public or private revenues.
Maternal and Child Health (MCH) Block Grant/Title V—Report the amount of Title V funds received during the
reporting period that supported services provided within the scope of the grantee’s Title X project.
Social Services Block Grant/Title XX—Report the amount of Title XX funds received in the reporting period that
supported services provided within the scope of the grantee’s Title X project.
(continued)

52

Family Planning Annual Report: 2017 National Summary

REVENUE
In 2017, Title X grantees reported total program revenue of $1.3 billion to support the
delivery of Title X-funded family planning and related preventive health care. The major
sources of revenue—Medicaid (including Children’s Health Insurance Program [CHIP])
($496.5 million) and Title X ($244.6 million)—accounted for 38% and 19%, respectively, of
total revenue. Revenue from state governments ($119.0 million), private third-party payers
($140.1 million), local governments ($69.2 million), and client service fees ($52.4 million)
each accounted for 4% to 11% of total revenue, while all other sources each contributed 2%
or less (Exhibit 31).
Title X Services Grant

Revenue from Title X accounted for 19% ($244.6 million) of total national revenue and
between 9% (IX) and 32% (VII) of total regional revenue. Title X was the largest source of
revenue in three regions (VI, VII, and VIII) and the second largest source after Medicaid in
three others (III, IV, and V) (Exhibits 32 and 33).
Payment for Services: Client Fees

Revenue from client service fees accounted for 4% ($52.4 million) of total revenue and
between 2% (VI) and 9% (VII) of total regional revenue (Exhibits 32 and 33).
Payment for Services: Third-Party Payers

In 2017, revenue from third-party payers was 50% ($655.3 million) of total revenue, with
Medicaid/CHIP accounting for most (76%) of this amount.
Medicaid and CHIP. Medicaid revenue (federal and state shares) accounted for 38%
($495.2 million) of total revenue, and separately reported CHIP revenue accounted for less
than 0.5% ($1.3 million) of total revenue. Together, these two sources totaled $496.5 million,
or 38% of total 2017 revenue.
Guidance for Reporting Project Revenue in FPAR Table 14 (continued)
Temporary Assistance for Needy Families (TANF)—Report the amount of TANF funds received in the reporting
period that supported services provided within the scope of the grantee’s Title X project.
Local Government Revenue—Report the amount of funds from local government sources (including county and
city grants or contracts) that were received during the reporting period and that supported services provided within
the scope of the grantee’s Title X project.
State Government Revenue—Report the amount of funds from state government sources (including grants or
contracts) that were received during the reporting period and that supported services provided within the scope of
the grantee’s Title X project. Do not report as “state government revenue” funding from sources like the Centers for
Disease Control and Prevention (CDC) or block grant funds that are awarded to and distributed by the state. Report
these revenues as “Other revenue” and specify their sources.
Bureau of Primary Health Care (BPHC)—Report the amount of revenue received from BPHC grants
(e.g., Section 330) during the reporting period that supported services provided within the scope of the grantee’s
Title X project.
Other Revenue—Report the amount and specify the source of funds received during the reporting period from
other sources that supported services provided within the scope of the grantee’s Title X project. This may include
revenue from such sources as CDC (infertility, STD, or HIV prevention; breast and cervical cancer detection),
private grants and donations, fundraising, interest income, or other sources.
Source: Title X Family Planning Annual Report: Forms and Instructions (Reissued October 2016), pp. 47–49.

Family Planning Annual Report: 2017 National Summary

53

By region, Medicaid (including CHIP) accounted for 11% (VII) to 63% (IX) of total regional
revenue. Medicaid was the largest source (29% to 63%) of regional revenue in six regions (II,
III, IV, V, IX, and X) and the second largest source (25%) in Region I (Exhibits 32 and 33).
Medicaid revenue reported by grantees in 26 states included revenue from state Medicaid
family planning eligibility expansions. (See the FPAR Table 14 notes in Appendix C: Field
and Methodological Notes for a list of states.)
Medicare and Other Public. Revenue from Medicare ($7.2 million) and other public thirdparty payers ($11.4 million) together accounted for 1% of total national revenue. By region,
the share of revenue from Medicare and other public third-party payers ranged from less than
0.5% (IV, VIII, IX, and X) to 6% (VI) (Exhibits 32 and 33).
Private. Revenue from private third-party payers ($140.1 million) accounted for 11% of total
national revenue and between 5% (IV) and 26% (I) of total regional revenue. Private thirdparty payer revenue was the most important source of revenue in Region I, the second most
important source in Regions VII, VIII, and X, and the third most important source in Regions
III, V, and IX (Exhibits 32 and 33).
Other Revenue

Block Grants and Temporary Assistance for Needy Families (TANF). Revenue from the
Title V Maternal and Child Health (MCH) block grant ($13.0 million), the Title XX Social
Services block grant ($4.5 million), and TANF ($6.4 million) each accounted for 1% or less
of total national revenue. By region, the share of total regional revenue from block grants
(MCH or Social Services) or TANF ranged from 0% to 3% of total regional revenues. While
all regions reported some revenue from the MCH block grant, only five reported revenue
from the Social Services block grant (I, III, V, VIII, and IX) or TANF (I, IV, V, VII, and
VIII) (Exhibits 32 and 33).
State Governments. State government revenue accounted for 9% ($119.0 million) of total
national revenue and from less than 0.5% (VII) to 26% (VI) of total regional revenue. State
government revenue was the second largest source of regional revenue in Regions II and VI
(Exhibits 32 and 33).
Local Governments. Local government revenue accounted for 5% ($69.2 million) of total
national revenue and from less than 0.5% (I) to 22% (IV) of total regional revenue. Local
government revenue was the third largest source of regional revenue in Regions IV and VIII
(Exhibits 32 and 33).
Bureau of Primary Health Care. Revenue from the Health Resources Services
Administration Bureau of Primary Health Care (BPHC) accounted for 2% ($21.4 million) of
total national revenue. Two regions (III and VIII) reported no BPHC revenue, while eight
others reported BPHC revenue ranging from less than 0.5% (I, II, IV, VI, and X) to 11% (VII)
of total regional revenue (Exhibits 32 and 33).

54

Family Planning Annual Report: 2017 National Summary

Exhibit 31. Amount and distribution of Title X project revenues, by revenue source: 2017
(Source: FPAR Table 14)
Revenue Source

Amount

Distribution

$244,563,111

19%

$52,367,880

4%

Medicaidb

$495,245,884

38%

Medicare

$7,169,121

1%

Title X
Payment for Services
Client fees
Third-party payers

a

Children’s Health Insurance Program

$1,256,008

0%†

$11,445,695

1%

Private

$140,145,229

11%

Subtotal

$707,629,817

55%

$12,960,533

1%

$4,547,979

0%†

$6,385,879

0%†

Other public

Other Revenue
Maternal and Child Health block grant
Social Services block grant
Temporary Assistance for Needy Families
State government

$119,036,286

9%

Local government

$69,199,630

5%

Bureau of Primary Health Care

$21,389,246

2%

Other

$111,905,640

9%

Subtotal

$345,425,193

27%

$1,297,618,121

100%

c

Total Revenue
Total Revenue per User

$324

—

Total Revenue per Encounter

$195

—

— Not applicable.
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 Medicaid family planning eligibility expansions in 26 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.”
† Percentage is less than 0.5%.

All Other Revenue. Finally, 9% ($111.9 million) of total revenue came from a combination
of all other public and private sources not listed separately in Table 14. Revenue from other
sources ranged from 2% (III and IV) to 17% (IX) of total regional revenue (Exhibits 32 and
33). See the notes for FPAR Table 14 in Appendix C: Field and Methodological Notes for a
list of other revenue sources.
Revenue per User and Encounter

On average, in 2017 grantees reported $324 in program revenue per family planning user
served or $195 per family planning encounter. By region, revenue per user ranged from $202
(III) to $454 (X), and revenue per encounter ranged from $116 (III) to $317 (X) (Exhibit 32).

Family Planning Annual Report: 2017 National Summary

55

Exhibit 32. Amount of Title X project revenues, by revenue source and region: 2017 (Source: FPAR Table 14)

56
Revenue Source
Title X

Region I
($)

Region II
($)

Region III
($)

Region IV
($)

Region V
($)

Region VI
($)

Region VII
($)

Region VIII
($)

Region IX
($)

Region X
($)

$25,895,531

$25,955,568

$50,096,697

$34,593,256

$29,647,951

$12,992,294

$10,411,761

$32,151,760

$9,825,069

$1,927,062

$8,224,845

$4,652,730

$6,523,021

$8,613,543

$2,205,405

$3,071,392

$3,626,520

$9,828,614

$3,694,748

$495,245,884 $13,214,930

$5,197,845 $229,908,942

$25,683,078

$244,563,111 $12,993,224

Payment for Services
Client fees
Third-party payersa
Medicaidb
Medicare
CHIP
Other public

All Regions
($)

c

$52,367,880

$62,470,700

$29,541,633

$58,275,198

$49,556,691

$16,875,782

$4,521,085

$7,169,121

$435,380

$1,958,623

$1,115,643

$506,261

$2,282,515

$64,915

$188,159

$46,400

$414,663

$156,562

$1,256,008

$20,730

$232,921

$43,676

$205,835

$516,288

$87,660

$81,899

$66,999

$0

$0

$11,445,695

$6,025,266

$263,201

$24,111

$351,641

$10,575

$7,029,482

$23,242,334

$14,402,876

$15,991,357 $263,746,194

$43,947,839

Family Planning Annual Report: 2017 National Summary

$1,731,986

$0

$1,768,371

$17,289

$1,253,255

Private

$140,145,229 $13,755,113

$20,925,515

$12,038,084

$10,254,322

$23,822,984

$7,543,839

$7,130,680

Subtotal

$707,629,817 $31,085,201

$93,812,604

$49,160,137

$75,781,926

$86,045,276

$32,802,867

$15,256,416

$2,579,856

$2,236,738

$1,463,738

$307,777

$359,505

$1,139,606

Other Revenue
MCH block grant

$12,960,533

$22,000

$2,614,678

$1,646,959

SS block grant

$4,547,979

$911,968

$0

$2,490,289

$0

$1,088,595

$0

$0

$34,825

$22,302

$0

TANF

$6,385,879

$76,928

$0

$0

$3,406,536

$2,475,168

$0

$424,059

$3,188

$0

$0

State government

$119,036,286

$5,967,060

$38,687,725

$11,030,307

$19,409,178

$4,285,935

$26,694,359

$155,337

$802,261

$2,241,976

$9,762,148

Local government

$69,199,630

$5,747

$2,867,008

$1,345,265

$43,179,062

$3,762,450

$5,024,775

$238,946

$6,590,523

$2,318,992

$3,866,862

$589,676

BPHC

$21,389,246

$88,923

$242,500

$0

$96,839

$13,053,310

$176,184

$4,580,207

$0

$3,107,672

$43,611

Otherd

$111,905,640

$1,342,597

$13,143,301

$2,182,252

$4,769,234

$9,248,677

$5,497,838

$6,506,429

$4,268,589

$62,748,549

$2,198,174

Subtotal

$345,425,193

$8,415,223

$57,555,212

$18,695,072

$73,440,705

$36,150,873

$38,856,894

$12,212,755

$12,058,891

$71,579,097

$16,460,471

$93,810,777 $199,319,328 $156,789,405 $101,307,712

$40,461,465

$38,462,009 $367,477,051

$70,233,379

Total Revenue

$1,297,618,121 $52,493,648 $177,263,347

Total Revenue per User

$324

$269

$413

$202

$294

$400

$289

$335

$303

$336

$454

Total Revenue per
Encounter

$195

$175

$264

$116

$170

$231

$169

$182

$192

$208

$317

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 Medicaid family planning eligibility expansions in 26 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: 2017 National Summary

Exhibit 33. Distribution of Title X project revenues, by revenue source and region: 2017 (Source: FPAR Table 14)
Revenue Source

All Regions

Title X

Region I

Region II

Region III

Region IV

Region V

Region VI

Region VII

Region VIII

Region IX

Region X

19%

25%

15%

28%

25%

22%

29%

32%

27%

9%

14%

Payment for Services
Client fees

4%

4%

5%

5%

3%

5%

2%

8%

9%

3%

5%

Third-party payers
Medicaidb

38%

25%

35%

31%

29%

32%

17%

11%

14%

63%

37%

1%

1%

1%

1%

0%†

1%

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%

0%

Medicare
CHIP
Other public

c

a

1%

3%

0%

2%

0%†

1%

6%

1%

Private

11%

26%

12%

13%

5%

15%

7%

18%

18%

6%

21%

Subtotal

55%

59%

53%

52%

38%

55%

32%

38%

42%

72%

63%

1%

2%

1%

1%

1%

1%

1%

Other Revenue
MCH block grant

1%

0%†

0%†

0%†

0%†

0%†

1%

SS block grant

0%†

2%

0%

3%

0%

1%

0%

0%

0%†

0%†

0%

TANF

0%†

0%†

0%

0%

2%

2%

0%

1%

0%†

0%

0%

State government

9%

22%

12%

10%

3%

26%

0%†

2%

1%

14%

Local government

5%

0%†

2%

1%

22%

2%

5%

1%

17%

1%

6%

BPHC

2%

0%†

0%†

0%

8%

0%†

11%

0%

1%

0%†

Other

d

11%

0%†

9%

3%

7%

2%

2%

6%

5%

16%

11%

17%

3%

Subtotal

27%

16%

32%

20%

37%

23%

38%

30%

31%

19%

23%

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 Medicaid family planning eligibility expansions in 26 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%.

57

Revenue Trends: 2007 vs. 2017

Compared with 2007, in 2017, inflation-adjusted (constant 2017 dollars)22 total revenue
decreased 16% (by $246.6 million), from $1.5 billion in 2007 to $1.3 billion in 2017
(Exhibit A–13a). During this period, increases in revenue from third-party and “other”
revenue sources totaled $142.6 million. Medicaid (including CHIP) increased 5%, from
$473.8 million (2007) to $496.5 million (2017). In addition, private third-party payer revenue
increased 158% ($62.8 million in 2007 vs. $140.1 million in 2017), Medicare and other nonMedicaid public third-party payer revenue increased 286% ($4.8 million in 2007 vs.
$18.6 million in 2017), and “other” revenue sources combined increased 28% ($104.5 million
in 2007 vs. $133.3 million in 2017) (not shown).
The increase in revenue from these four sources, however, was too low to offset losses
totaling $389.2 million from Title X, client service fees, state and local governments, block
grants, and TANF. For each source, the decline in revenue between 2007 and 2017 was as
follows:

▪ Title X revenue decreased 29%, or by $101.2 million, between 2007 ($345.7 million) and
2017 ($244.6 million) (Exhibit A–13a).

▪ Client service fees revenue decreased 59%, or by $75.3 million, between 2007
($127.6 million) and 2017 ($52.4 million) (not shown).

▪ State government revenue decreased 37%, or by $68.8 million, between 2007
($187.9 million) and 2017 ($119.0 million) (not shown).

▪ Local government revenue decreased 49%, or by $65.5 million, between 2007
($134.7 million) and 2017 ($69.2 million) (not shown).

▪ Block grant revenue decreased 75%, or by $53.0 million, between 2007 ($70.5 million)
and 2017 ($17.5 million) (not shown).

▪ TANF revenue decreased 80%, or by $25.4 million, between 2007 ($31.8 million) and
2017 ($6.4 million) (not shown).

Since 2007, the composition of total revenue across major sources has changed. As a
percentage of total revenue, Medicaid (including CHIP) revenue grew from 31% (2007) to
38% (2017), Title X revenue decreased from 22% to 19%, and state and local government
revenue decreased from 21% to 15%. The share of total revenue from all other sources
combined fluctuated between 22% and 28% (Exhibit A–14c).
See Exhibits A–13a through A–13e for trends (2007–2017) in actual and inflation-adjusted
(constant 2017 dollars)22 total, Title X, and Medicaid revenue.

58

Family Planning Annual Report: 2017 National Summary

4

References
1. Office of Population Affairs. (2014). Program requirements for Title X funded
family planning projects (Version 1.0). Retrieved from
https://www.hhs.gov/opa/sites/default/files/ogc-cleared-final-april.pdf
2. 42 Code of Federal Regulations (CFR) Part 59 Subpart A. (2000, July 3).
Project grants for family planning services. Retrieved from
https://www.ecfr.gov/cgi-bin/textidx?SID=c1cbd72e13f7230f1e8328fa52b57899&mc=true&node=sp42.1.59.a
&rgn=div6
3. Frost, J. J. (2013). U.S. women’s use of sexual and reproductive health
services: Trends, sources of care and factors associated with use, 1995–2010.
New York: Guttmacher Institute. Retrieved from
https://www.guttmacher.org/pubs/sources-of-care-2013.pdf
4. Office of Population Affairs. (2018). Title X funding history. Retrieved from
https://www.hhs.gov/opa/about-opa-and-initiatives/funding-history/
5. Office of Population Affairs. (2016). Family planning annual report: Forms
and instructions (Reissued October 2016). 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://www.hhs.gov/opa/sites/default/files/fpar-forms-instructions-reissuedoct-2016.pdf
6. 45 Code of Federal Regulations (CFR) Part 75. (2016, October 1). Uniform
administrative requirements, cost principles, and audit requirements for HHS
awards. Retrieved from https://www.ecfr.gov/cgibin/retrieveECFR?gp=&SID=88c2f29440664f74c9444e7ff44bab5a&mc=true
&n=pt45.1.75&r=PART&ty=HTML
7. U.S. Department of Health and Human Services. (2016). 2017 poverty
guidelines, U.S. federal poverty guidelines used to determine financial
eligibility for certain federal programs. Retrieved from
https://aspe.hhs.gov/2017-poverty-guidelines
8. Cohen, R. A. Zammitti, E. P., & Martinez, M.E. (2018). Health insurance
coverage: Early release of estimates from the National Health Interview
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https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf

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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-1997-1030/pdf/97-28653.pdf
10. 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.
11. Title X of the Public Health Service Act, 42 U.S. Code 300 et seq. (1970).
Retrieved from https://www.hhs.gov/opa/sites/default/files/title-x-statuteattachment-a_0.pdf
12. The Title X Family Planning Program Guidelines consist of two documents:
(1) Program requirements for Title X funded family planning projects
(“Program Requirements”) and (2) clinical recommendations as outlined in
Providing quality family planning services: Recommendations of CDC and the
U.S. Office of Population Affairs (“QFP”), and in updates (2015 and 2017) to
the Recommendations. Retrieved from
https://www.hhs.gov/opa/guidelines/program-guidelines/index.html
13. 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
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https://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/policyguidance
document.html
14. Kennedy, K. I., & Trussell, J. (2011). Postpartum contraception and lactation.
In R. A. Hatcher, J. Trussell, A. L. Nelson, W. Cates, D. Kowal, & M. S.
Policar (Eds.), Contraceptive technology (20th ed., pp. 483–511). New York,
NY: Ardent Media.
15. U.S. Centers for Disease Control and Prevention. (2017). Sexual risk
behaviors: HIV, STD & teen pregnancy prevention. Retrieved from
https://www.cdc.gov/healthyyouth/sexualbehaviors/
16. U.S. 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

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from CDC and the U.S. Office of Population Affairs, 2017. MMWR, 66(50),
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Cytologica 29, 121–132.
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considerations referenced in treatment guidelines and original sources.
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Retrieved from https://www.allergan.com/assets/pdf/lilettashi_pi

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62

Family Planning Annual Report: 2017 National Summary

Appendix A
National Trend Exhibits

A-2

Exhibit A–1a.
Region
Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

Family Planning Annual Report: 2017 National Summary

Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

Number of Title X-funded grantees, subrecipients, and service sites, by region and year: 2007–2017
2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

10
7
9
10
11
8
5
6
15
8
89

10
7
9
10
11
8
5
6
15
7
88

10
7
9
10
11
8
5
6
16
7
89

10
7
9
10
12
6
5
6
16
8
89

11
7
9
10
12
6
5
6
17
8
91

11
7
9
13
11
6
5
6
17
8
93

11
6
10
13
11
7
5
6
18
8
95

12
6
10
14
10
6
5
6
17
8
94

11
6
10
10
12
6
5
6
17
8
91

11
6
10
9
11
7
5
6
18
8
91

11
6
10
9
11
6
5
6
17
8
89

70
91
226
187
158
93
107
73
107
64
1,176

70
91
222
185
146
95
107
78
112
64
1,170

69
89
222
190
136
94
107
73
116
61
1,157

71
82
218
188
130
90
105
74
104
60
1,122

72
80
230
183
135
79
106
74
121
62
1,142

67
75
265
184
129
78
101
75
113
61
1,148

66
71
271
214
133
90
97
74
105
60
1,181

67
70
258
253
120
45
93
74
95
59
1,134

71
70
316
226
122
47
94
74
102
59
1,181

69
68
223
281
118
41
92
68
99
58
1,117

68
68
225
277
113
39
91
69
85
56
1,091

240
293
662
1,117
428
573
286
187
479
277
4,542

233
292
651
1,093
410
571
294
190
508
280
4,522

230
296
656
1,104
373
588
296
185
501
286
4,515

221
272
641
1,091
371
580
289
184
495
245
4,389

228
263
639
1,076
392
553
267
179
539
246
4,382

238
253
633
1,044
364
521
251
185
474
226
4,189

225
256
627
1,019
362
571
242
182
460
224
4,168

233
251
615
1,183
340
442
223
182
441
217
4,127

224
247
648
936
383
457
218
177
461
200
3,951

225
244
640
914
374
425
221
180
469
206
3,898

221
244
653
912
365
415
210
162
465
211
3,858

Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

Family Planning Annual Report: 2017 National Summary

Exhibit A–1b.
Region

Distribution of Title X-funded grantees, subrecipients, and service sites, by region and year: 2007–2017
2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Grantees
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

11%
8%
10%
11%
12%
9%
6%
7%
17%
9%
100%

11%
8%
10%
11%
13%
9%
6%
7%
17%
8%
100%

11%
8%
10%
11%
12%
9%
6%
7%
18%
8%
100%

11%
8%
10%
11%
13%
7%
6%
7%
18%
9%
100%

12%
8%
10%
11%
13%
7%
5%
7%
19%
9%
100%

12%
8%
10%
14%
12%
6%
5%
6%
18%
9%
100%

12%
6%
11%
14%
12%
7%
5%
6%
19%
8%
100%

13%
6%
11%
15%
11%
6%
5%
6%
18%
9%
100%

12%
7%
11%
11%
13%
7%
5%
7%
19%
9%
100%

12%
7%
11%
10%
12%
8%
5%
7%
20%
9%
100%

12%
7%
11%
10%
12%
7%
6%
7%
19%
9%
100%

Subrecipients
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

6%
8%
19%
16%
13%
8%
9%
6%
9%
5%
100%

6%
8%
19%
16%
12%
8%
9%
7%
10%
5%
100%

6%
8%
19%
16%
12%
8%
9%
6%
10%
5%
100%

6%
7%
19%
17%
12%
8%
9%
7%
9%
5%
100%

6%
7%
20%
16%
12%
7%
9%
6%
11%
5%
100%

6%
7%
23%
16%
11%
7%
9%
7%
10%
5%
100%

6%
6%
23%
18%
11%
8%
8%
6%
9%
5%
100%

6%
6%
23%
22%
11%
4%
8%
7%
8%
5%
100%

6%
6%
27%
19%
10%
4%
8%
6%
9%
5%
100%

6%
6%
20%
25%
11%
4%
8%
6%
9%
5%
100%

6%
6%
21%
25%
10%
4%
8%
6%
8%
5%
100%

Service Sites
I
II
III
IV
V
VI
VII
VIII
IX
X
Total

5%
6%
15%
25%
9%
13%
6%
4%
11%
6%
100%

5%
6%
14%
24%
9%
13%
7%
4%
11%
6%
100%

5%
7%
15%
24%
8%
13%
7%
4%
11%
6%
100%

5%
6%
15%
25%
8%
13%
7%
4%
11%
6%
100%

5%
6%
15%
25%
9%
13%
6%
4%
12%
6%
100%

6%
6%
15%
25%
9%
12%
6%
4%
11%
5%
100%

5%
6%
15%
24%
9%
14%
6%
4%
11%
5%
100%

6%
6%
15%
29%
8%
11%
5%
4%
11%
5%
100%

6%
6%
16%
24%
10%
12%
6%
4%
12%
5%
100%

6%
6%
16%
23%
10%
11%
6%
5%
12%
5%
100%

6%
6%
17%
24%
9%
11%
5%
4%
12%
5%
100%

A-3

Note: Due to rounding, percentages in each year may not sum to 100%.

A-4

Exhibit A–1c.

Number of Title X-funded service sites and users per service site, by year: 2007–2017

5,000

2,000
4,542

4,522

4,515

4,389

4,382

4,189

4,168

4,127

4,000

3,951

3,898

3,858

3,000

1,098

1,117

1,149

1,190

1,146

1,137

1,094

1,001

1,017

1,028

1,038
1,000

2,000

500
1,000

0

2007

2008

2009

2010

2011

Number of service sites

2012

2013

2014

2015

Number of users per site

2016

2017

0

Number of users per site

Family Planning Annual Report: 2017 National Summary

Number of service sites

1,500

This page intentionally left blank.

Family Planning Annual Report: 2017 National Summary

A-5

A-6

Exhibit A–2a.
Region

Number and distribution of all family planning users, by region and year: 2007–2017

Family Planning Annual Report: 2017 National Summary

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

I

199,010

197,165

199,779

198,962

192,252

195,264

182,684

184,005

184,389

183,383

194,952

II

479,572

483,928

497,614

499,231

493,369

488,872

470,836

429,409

431,060

428,146

429,091

III

557,031

564,138

592,475

584,167

564,163

550,051

520,403

468,157

432,418

477,585

464,216

IV

1,018,656

1,019,264

1,010,012

989,770

940,931

907,020

852,400

770,501

660,156

669,743

677,146

V

531,679

507,431

492,741

492,359

472,062

434,587

401,935

377,552

390,446

390,541

391,901

VI

486,378

491,406

512,019

512,868

475,863

350,164

372,296

298,294

346,670

334,933

350,646

VII

234,592

210,012

209,350

214,032

205,167

186,716

167,286

148,405

140,055

135,907

120,759

VIII

149,395

151,261

160,919

176,892

169,311

163,068

152,248

137,509

131,031

124,021

126,922

IX

1,102,718

1,209,114

1,294,974

1,352,569

1,314,270

1,309,439

1,269,252

1,149,781

1,146,183

1,102,836

1,093,827

X

228,207

217,786

216,384

204,012

194,323

178,616

168,484

165,670

155,607

160,457

154,786

Total

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

Female

4,691,857

4,723,662

4,811,691

4,822,570

4,635,195

4,378,744

4,184,587

3,764,622

3,607,353

3,553,018

3,541,235

295,381

327,843

374,576

402,292

386,516

385,053

373,237

364,661

410,662

454,534

463,011

I

4%

4%

4%

4%

4%

4%

4%

4%

5%

5%

5%

II

10%

10%

10%

10%

10%

10%

10%

10%

11%

11%

11%

III

11%

11%

11%

11%

11%

12%

11%

11%

11%

12%

12%

IV

20%

20%

19%

19%

19%

19%

19%

19%

16%

17%

17%

V

11%

10%

10%

9%

9%

9%

9%

9%

10%

10%

10%

VI

10%

10%

10%

10%

9%

7%

8%

7%

9%

8%

9%

VII

5%

4%

4%

4%

4%

4%

4%

4%

3%

3%

3%

VIII

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

IX

22%

24%

25%

26%

26%

27%

28%

28%

29%

28%

27%

X

5%

4%

4%

4%

4%

4%

4%

4%

4%

4%

4%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

94%

94%

93%

92%

92%

92%

92%

91%

90%

89%

88%

6%

6%

7%

8%

8%

8%

8%

9%

10%

11%

12%

Male

Total
Female
Male

Note: Due to rounding, percentages in each year may not sum to 100%.

Family Planning Annual Report: 2017 National Summary

Exhibit A–2b.

Number and distribution of all family planning users, by region and year: 2007–2017

2017

5%

11%

12%

17%

10%

9%

3% 3%

27%

4%

4.00 million

2016

5%

11%

12%

17%

10%

8%

3% 3%

28%

4%

4.01 million

2015

5%

11%

11%

3% 3%

29%

4%

4.02 million

2014

4%

10%

11%

19%

9%

7%

4% 3%

28%

4%

4.13 million

2013

4%

10%

11%

19%

9%

8%

4% 3%

28%

4%

4.56 million

2012

4%

10%

12%

19%

7%

4% 3%

27%

4%

4.76 million

2011

4%

10%

11%

19%

9%

9%

4% 3%

26%

4%

5.02 million

2010

4%

10%

11%

19%

9%

10%

4% 3%

26%

4%

5.22 million

2009

4%

10%

11%

19%

25%

4%

5.19 million

2008

4%

10%

11%

20%

24%

4%

5.05 million

2007

4%

10%

11%

20%

5%

4.99 million

16%

10%

9%

9%

10%

10%

10%

4% 3%

10%

11%

4% 3%

10%

5% 3%

22%

0%

100%

I

II

III

IV

Note: Due to rounding, percentages in each year may not sum to 100%.

V

VI

VII

VIII

IX

X

A-7

A-8

Exhibit A–3a.

Number and distribution of all family planning users, by age and year: 2007–2017

Age Group (Years)

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Under 15

68,918

71,738

74,287

73,383

59,351

53,012

45,633

45,863

46,045

58,649

49,060

15 to 17

534,054

521,202

502,226

466,284

423,702

368,965

327,152

298,839

280,785

275,499

271,429

18 to 19

651,784

652,059

647,432

616,709

560,848

505,356

454,044

404,197

379,710

373,253

373,235

20 to 24

1,556,670

1,553,469

1,577,051

1,600,833

1,508,215

1,405,487

1,320,188

1,169,948

1,091,549

1,043,071

1,013,943

25 to 29

967,409

996,754

1,037,776

1,071,999

1,058,256

1,023,503

999,476

912,130

887,225

876,921

877,588

30 to 34

522,673

539,998

578,031

607,257

621,119

616,259

622,258

573,010

570,708

572,573

580,833

35 to 39

323,885

332,854

353,712

359,749

358,400

351,820

355,877

331,439

344,385

359,108

374,756

40 to 44

191,503

195,582

209,292

215,914

222,429

222,621

220,836

200,955

204,360

211,324

220,748

Over 44

170,342

187,849

206,460

212,734

209,391

216,774

212,360

192,902

213,248

237,154

242,654

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

Under 15

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

15 to 17

11%

10%

10%

9%

8%

8%

7%

7%

7%

7%

7%

18 to 19

13%

13%

12%

12%

11%

11%

10%

10%

9%

9%

9%

20 to 24

31%

31%

30%

31%

30%

30%

29%

28%

27%

26%

25%

25 to 29

19%

20%

20%

21%

21%

21%

22%

22%

22%

22%

22%

30 to 34

10%

11%

11%

12%

12%

13%

14%

14%

14%

14%

15%

35 to 39

6%

7%

7%

7%

7%

7%

8%

8%

9%

9%

9%

40 to 44

4%

4%

4%

4%

4%

5%

5%

5%

5%

5%

6%

Over 44

3%

4%

4%

4%

4%

5%

5%

5%

5%

6%

6%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Total

Family Planning Annual Report: 2017 National Summary

Total

Note: Due to rounding, percentages in each year may not sum to 100%.

Family Planning Annual Report: 2017 National Summary

Exhibit A–3b.

Number and distribution of all family planning users, by age and year: 2007–2017

30–44, 29%

25–29, 22%

20–24, 25%

15–17, 7% 18–19, 9%

2017

29%

22%

6%

4.00 million

6%

4.01 million

5%

4.02 million

2016

7%

9%

26%

2015

7%

9%

27%

2014

7%

10%

28%

22%

27%

5%

4.13 million

2013

7%

10%

29%

22%

26%

5%

4.56 million

2012

8%

5%

4.76 million

2011

8%

4%

5.02 million

2010

9%

23%

4%

5.22 million

2009

10%

22%

4%

5.19 million

2008

10%

13%

21%

4%

5.05 million

2007

11%

13%

21%

3%

4.99 million

21%

31%

12%

20%

30%

12%

24%

21%

30%

11%

25%

21%

30%

11%

28%

22%

20%

31%

19%

31%

0%

100%

<15

15–17

18–19

20–24

25–29

30–44

>44

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 the individual percentages
that are included in the aggregated categories. The percentage of users under 15 is 1% each year from 2007 through 2017.

A-9

A-10

Exhibit A–4a.

Number and distribution of all family planning users, by race and year: 2007–2017

Race

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

American Indian/Alaska Native

38,080

36,974

39,220

44,899

43,204

45,785

34,051

29,327

30,526

33,467

35,587

Asian

131,735

137,747

150,847

136,958

134,345

136,412

135,567

128,797

131,676

135,555

143,215

Black/African American

958,241

996,093

1,015,013

1,028,991

986,803

969,776

939,941

863,136

857,659

859,886

869,574

43,360

45,693

73,559

65,662

70,929

70,519

52,263

39,266

40,941

35,479

31,019

3,125,435

3,007,568

3,054,226

3,015,861

2,864,253

2,664,736

2,530,204

2,238,847

2,142,835

2,174,833

2,150,480

More than one race

132,911

151,535

169,044

261,397

250,825

248,590

191,871

153,907

136,043

142,564

144,397

Unknown/not reported

557,476

675,895

684,358

671,094

671,352

627,979

673,927

676,003

678,335

625,768

629,974

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

American Indian/Alaska Native

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

Asian

3%

3%

3%

3%

3%

3%

3%

3%

3%

3%

4%

19%

20%

20%

20%

20%

20%

21%

21%

21%

21%

22%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

1%

63%

60%

59%

58%

57%

56%

56%

54%

53%

54%

54%

3%

3%

3%

5%

5%

5%

4%

4%

3%

4%

4%

11%

13%

13%

13%

13%

13%

15%

16%

17%

16%

16%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Native Hawaiian/Pacific Islander
White

Total All Users

Family Planning Annual Report: 2017 National Summary

Black/African American
Native Hawaiian/Pacific Islander
White
More than one race
Unknown/not reported
Total All Users

Note: Due to rounding, percentages in each year may not sum to 100%.

Family Planning Annual Report: 2017 National Summary

Exhibit A–4b.

Number and distribution of all family planning users, by race and year: 2007–2017

2017

White, 54%

Black, 22%

Other, 9%

Unknown, 16%

4.00 million

2016

54%

21%

9%

16%

4.01 million

2015

53%

2014

54%

21%
21%

8%

17%

4.02 million

9%

16%

4.13 million

2013

56%

21%

9%

2012

56%

20%

11%

13%

4.76 million

2011

57%

10%

13%

5.02 million

2010

58%

10%

13%

5.22 million

2009

59%

8%

13%

5.19 million

2008

60%

7%

13%

5.05 million

20%
20%
20%
20%

63%

2007
0%

White

19%

Black

Other

Unknown

15%

7%

11%

4.56 million

4.99 million
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 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-11

A-12

Exhibit A–5a.

Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2007–2017

Ethnicity

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Hispanic or Latino

1,303,402

1,391,523

1,447,422

1,493,007

1,451,215

1,349,528

1,344,601

1,237,652

1,276,765

1,269,988

1,324,817

Not Hispanic or Latino

3,611,497

3,534,915

3,618,344

3,618,285

3,416,314

3,277,828

3,093,545

2,786,005

2,617,597

2,600,742

2,553,416

Unknown/not reported

72,339

125,067

120,501

113,570

154,182

136,441

119,678

105,626

123,653

136,822

126,013

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

Hispanic or Latino

26%

28%

28%

29%

29%

28%

30%

30%

32%

32%

33%

Not Hispanic or Latino

72%

70%

70%

69%

68%

69%

68%

67%

65%

65%

64%

Unknown/not reported

1%

2%

2%

2%

3%

3%

3%

3%

3%

3%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Total All Users

Total All Users

Note: Due to rounding, percentages in each year may not sum to 100%.

Family Planning Annual Report: 2017 National Summary

Family Planning Annual Report: 2017 National Summary

Exhibit A–5b.

Number and distribution of all family planning users, by Hispanic or Latino ethnicity (all races) and year: 2007–2017

2017

Not Hispanic/Latino, 64%

Hispanic/Latino, 33%

4.00 million

2016

65%

32%

4.01 million

2015

65%

32%

4.02 million

2014

67%

30%

4.13 million

2013

68%

30%

4.56 million

2012

69%

28%

4.76 million

2011

68%

29%

5.02 million

2010

69%

29%

5.22 million

2009

70%

28%

5.19 million

2008

70%

28%

5.05 million

26%

72%

2007
0%

4.99 million
100%

Not Hispanic/Latino
Note: Due to rounding, percentages in each year may not sum to 100%.

Hispanic/Latino

Unknown

A-13

A-14

Exhibit A–6a.

Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2007–2017

Ethnicity and Race

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Not Hispanic or Latino
Asian

126,320

127,850

139,831

126,413

121,777

124,790

128,015

119,454

122,310

124,233

130,688

926,564

956,741

969,690

986,409

939,143

917,539

890,133

816,061

811,244

806,815

806,970

2,324,430

2,232,893

2,227,867

2,214,680

2,060,244

1,951,410

1,812,924

1,583,629

1,439,284

1,445,887

1,394,432

234,183

217,431

280,956

290,783

295,150

284,089

262,473

266,861

244,759

223,807

221,326

1,303,402

1,391,523

1,447,422

1,493,007

1,451,215

1,349,528

1,344,601

1,237,652

1,276,765

1,269,988

1,324,817

72,339

125,067

120,501

113,570

154,182

136,441

119,678

105,626

123,653

136,822

126,013

4,987,238

5,051,505

5,186,267

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%

3%

3%

2%

2%

3%

3%

3%

3%

3%

3%

Black or African American

19%

19%

19%

19%

19%

19%

20%

20%

20%

20%

20%

White

47%

44%

43%

42%

41%

41%

40%

38%

36%

36%

35%

Other/unknown

5%

4%

5%

6%

6%

6%

6%

6%

6%

6%

6%

Hispanic or Latino
All races

26%

28%

28%

29%

29%

28%

30%

30%

32%

32%

33%

1%

2%

2%

2%

3%

3%

3%

3%

3%

3%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Black or African American
White
Other/unknown
Hispanic or Latino
All races
Unknown/Not Reported
Total All Users

Family Planning Annual Report: 2017 National Summary

Not Hispanic or Latino
Asian

Unknown/Not Reported
Total All Users

Note: 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: 2017 National Summary

Exhibit A–6b.

Number and distribution of all family planning users, by Hispanic or Latino ethnicity, race, and year: 2007–2017

NH White, 35%

2017

NH Black, 20%

9%

Hispanic (all races), 33%

4.00 million

2016

36%

20%

9%

32%

4.01 million

2015

36%

20%

9%

32%

4.02 million

38%

2014

20%

40%

2013

9%

20%

9%

2012

41%

19%

2011

41%

19%

9%
8%

30%

4.13 million

30%

4.56 million

28%

4.76 million

29%

5.02 million

2010

42%

19%

8%

29%

5.22 million

2009

43%

19%

8%

28%

5.19 million

28%

5.05 million

44%

2008

47%

2007

19%
19%

7%
7%

0%

26%

4.99 million
100%

NH White

NH Black

NH Other/Unkown

Hispanic (all races)

Unknown

A-15

NH=Not Hispanic or Latino.
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 the individual percentages
that are included in the aggregated categories. The “NH Other” 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

Exhibit A–7a.

Number and distribution of all family planning users, by income level and year: 2007–2017
2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

3,455,335

3,553,222

3,632,506

3,618,813

3,466,912

3,382,089

3,211,380

2,840,650

2,653,841

2,564,992

2,665,911

101% to 150%

820,870

781,113

785,090

795,065

731,410

649,462

636,484

572,948

556,141

575,420

551,163

151% to 200%

303,992

278,881

277,103

281,294

269,478

247,490

245,805

234,425

238,420

252,273

257,155

201% to 250%

121,473

119,181

119,768

125,298

116,188

103,061

103,246

100,402

105,975

128,874

123,477

Over 250%

212,849

224,603

207,484

250,440

250,829

230,947

222,718

226,918

255,093

297,988

277,975

72,719

94,505

164,316

153,952

186,894

150,748

138,191

153,940

208,545

188,005

128,565

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

Under 101%

69%

70%

70%

69%

69%

71%

70%

69%

66%

64%

67%

101% to 150%

16%

15%

15%

15%

15%

14%

14%

14%

14%

14%

14%

151% to 200%

6%

6%

5%

5%

5%

5%

5%

6%

6%

6%

6%

201% to 250%

2%

2%

2%

2%

2%

2%

2%

2%

3%

3%

3%

Over 250%

4%

4%

4%

5%

5%

5%

5%

5%

6%

7%

7%

Unknown/not reported

1%

2%

3%

3%

4%

3%

3%

4%

5%

5%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Income Level

a

Under 101%

Unknown/not reported
Total All Users

Family Planning Annual Report: 2017 National Summary

Total All Users

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 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 http://aspe.hhs.gov/poverty/.

Family Planning Annual Report: 2017 National Summary

Exhibit A–7b.

Number and distribution of all family planning users, by income level and year: 2007–2017

≤100%, 67%

2017

101%–150%, 14%

14%

69%

2014

6%

14%

66%

2015

6%

14%

64%

2016

7%

6%

4.00 million

7%

4.01 million

6%

4.02 million

5%

6%

4.13 million

2013

70%

14%

5%

5%

4.56 million

2012

71%

14%

5%

5%

4.76 million

5%

5%

2011

69%

15%

2010

69%

15%

2009

70%

15%

2008

70%

15%

6%

4%

5.05 million

2007

69%

16%

6%

4%

4.99 million

5%
5%

5.02 million

5%

5.22 million

4%

5.19 million

0%

100%

≤100%

101%–150%

151%–200%

201% – 250%

>250%

Unknown

Note: Title X-funded grantees and subrecipients 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 http://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-17

A-18

Exhibit A–8a.

Number and distribution of all family planning users, by primary health insurance status and year: 2007–2017

Primary Insurance

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

1,036,976

1,063,937

1,021,164

1,184,795

1,236,343

1,121,372

1,131,406

1,215,648

1,395,201

1,499,672

1,511,533

433,058

460,969

426,308

438,042

429,919

447,341

453,535

559,845

621,066

715,090

760,051

3,202,642

3,305,185

3,419,915

3,483,360

3,230,784

3,050,415

2,865,672

2,239,377

1,934,154

1,737,488

1,675,825

314,562

221,414

318,880

118,665

124,665

144,669

107,211

114,413

67,594

55,302

56,837

4,987,238

5,051,505

5,186,267

5,224,862

5,021,711

4,763,797

4,557,824

4,129,283

4,018,015

4,007,552

4,004,246

Public insurance

21%

21%

20%

23%

25%

24%

25%

29%

35%

37%

38%

Private insurance

9%

9%

8%

8%

9%

9%

10%

14%

15%

18%

19%

64%

65%

66%

67%

64%

64%

63%

54%

48%

43%

42%

6%

4%

6%

2%

2%

3%

2%

3%

2%

1%

1%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Public insurance
Private insurance
Uninsured
Unknown/not reported
Total All Users

Uninsured

Family Planning Annual Report: 2017 National Summary

Unknown/not reported
Total All Users

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.

Family Planning Annual Report: 2017 National Summary

Exhibit A–8b.

Number and distribution of all family planning users, by primary health insurance status and year: 2007–2017

2017

Public insurance, 38%

2016

37%

2012

24%

2011

25%

20%

2009

9%

2007

21%

9%

5.02 million

67%

5.22 million

66%

8%
9%

4.76 million
64%

8%

21%

4.56 million

64%

9%

2008

4.13 million

63%

10%

23%

2010

4.02 million

54%

14%

25%

2013

4.01 million

48%

15%

29%

2014

4.00 million

43%

18%

35%

2015

Uninsured, 42%

Private insurance, 19%

5.19 million
65%

5.05 million

64%

0%

4.99 million
100%

Public insurance

Private insurance

Note: Due to rounding, percentages in each year may not sum to 100%.

Uninsured

Unknown/Not reported

A-19

A-20

Exhibit A–9a.

Number of all female family planning users, by primary contraceptive method and year: 2007–2017

Primary Method

2007

Most Effectivea
Vasectomy
Sterilization

6,546

6,312

6,905

8,683

8,632

8,540

8,175

7,582

6,879

8,178

8,848

89,447

87,167

92,616

92,652

90,438

86,854

82,067

74,748

84,108

86,112

94,173

Hormonal implant

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

7,300

18,738

30,135

48,015

65,673

82,642

108,586

139,799

177,975

209,014

239,029

Intrauterine device

138,714

179,876

216,390

252,121

272,683

284,461

279,289

265,511

273,650

288,939

324,174

Moderately Effectivea
Hormonal injectionb
Vaginal ring

591,861

597,572

615,188

643,682

645,351

645,136

635,093

611,619

574,476

519,841

500,960

139,656

149,627

165,121

186,238

183,182

164,693

142,292

115,230

95,186

83,473

76,252

Contraceptive patch

128,324

101,763

106,266

93,499

89,795

83,145

78,547

69,469

49,010

47,030

48,256

1,826,518

1,734,786

1,696,319

1,684,201

1,534,684

1,409,300

1,316,671

1,135,950

1,000,062

946,383

894,128

4,087

3,612

12,278

4,402

3,390

4,116

8,245

2,379

1,660

2,130

2,219

716,646

727,440

737,991

787,329

838,131

745,265

692,678

578,139

572,607

559,356

547,129

3,925

4,753

4,635

5,944

5,939

3,722

3,914

3,308

3,558

2,929

2,537

1,827

1,337

991

1,581

921

765

541

651

660

138

169

123,844

111,160

105,705

116,635

115,002

113,016

95,798

70,982

61,504

75,191

73,047

Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom
Contraceptive sponge

Family Planning Annual Report: 2017 National Summary

Withdrawal or otherc
FAMd or LAM

8,784

10,409

12,633

14,379

17,105

12,676

11,753

12,648

13,503

14,392

15,287

16,882

13,627

15,598

8,346

7,061

4,926

4,028

2,911

1,873

1,848

1,991

53,987

61,329

62,380

75,534

69,924

71,737

72,486

70,098

73,896

89,102

92,385

383,303

381,848

395,633

400,194

361,056

377,547

356,750

330,279

321,229

321,706

313,802

308,061

283,848

260,946

238,347

229,541

183,613

181,657

175,111

171,068

175,371

190,518

142,145

248,458

273,961

160,788

96,687

96,590

106,017

98,208

124,449

121,885

116,331

Total Female Users

4,691,857

4,723,662

4,811,691

4,822,570

4,635,195

4,378,744

4,184,587

3,764,622

3,607,353

3,553,018

3,541,235

Using Most, Moderately, or Less
Effective Method

3,804,361

3,748,179

3,818,771

3,947,707

3,877,987

3,649,257

3,467,677

3,090,926

2,916,711

2,844,954

2,828,199

242,007

292,093

346,046

401,471

437,426

462,497

478,117

487,640

542,612

592,243

666,224

2,690,446

2,587,360

2,595,172

2,612,022

2,456,402

2,306,390

2,180,848

1,934,647

1,720,394

1,598,857

1,521,815

871,908

868,726

877,553

934,214

984,159

880,370

808,712

668,639

653,705

653,854

640,160

53,987

61,329

62,380

75,534

69,924

71,737

72,486

70,098

73,896

89,102

92,385

691,364

665,696

656,579

638,541

590,597

561,160

538,407

505,390

492,297

497,077

504,320

Spermicide
Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown

Most effectivea
Moderately effectivea
Less effectivea
Abstinent
Not Using a Method

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 2007–2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2017, the FAM
category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.

Family Planning Annual Report: 2017 National Summary

Exhibit A–9b.

Distribution of all female family planning users, by primary contraceptive method and year: 2007–2017

Primary Method

2007

Most Effectivea
Vasectomy
Sterilization

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

2%

2%

2%

2%

2%

2%

2%

2%

2%

2%

3%

Hormonal implant

0%†

0%†

1%

1%

1%

2%

3%

4%

5%

6%

7%

0%†

Intrauterine device

3%

4%

4%

5%

6%

6%

7%

7%

8%

8%

9%

Moderately Effectivea
Hormonal injectionb
Vaginal ring

13%

13%

13%

13%

14%

15%

15%

16%

16%

15%

14%

3%

3%

3%

4%

4%

4%

3%

3%

3%

2%

2%

Contraceptive patch

3%

2%

2%

2%

2%

2%

2%

2%

1%

1%

1%

39%

37%

35%

35%

33%

32%

31%

30%

28%

27%

25%

Oral contraceptive
Cervical cap/diaphragm
Less Effectivea
Male condom
Female condom

0%†
15%

0%†
15%

0%†
15%

0%†
16%

0%†
18%

0%†
17%

0%†
17%

0%†
15%

0%†
16%

0%†
16%

0%†
15%

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 otherc

3%

2%

2%

2%

2%

3%

2%

2%

2%

2%

2%

FAMd or LAM

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Spermicide

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

2%

2%

2%

2%

2%

2%

3%

3%

Other
Abstinence
No Method
Pregnant/seeking pregnancy
Other reason
Method Unknown
Total Female Users
Using Most, Moderately, or Less
Effective Method
Most effectivea
Moderately effectivea
Less effectivea
Abstinent
Not Using a Method

8%

8%

8%

8%

8%

9%

9%

9%

9%

9%

9%

7%

6%

5%

5%

5%

4%

4%

5%

5%

5%

5%

3%

5%

6%

3%

2%

2%

3%

3%

3%

3%

3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

81%
5%
57%
19%

79%
6%
55%
18%

79%
7%
54%
18%

82%
8%
54%
19%

84%
9%
53%
21%

83%
11%
53%
20%

83%
11%
52%
19%

82%
13%
51%
18%

81%
15%
48%
18%

80%
17%
45%
18%

80%
19%
43%
18%

1%

1%

1%

2%

2%

2%

2%

2%

2%

3%

3%

15%

14%

14%

13%

13%

13%

13%

13%

14%

14%

14%

A-21

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 2007–2010, the FAM category includes Calendar Rhythm, Standard Days®, Basal Body Temperature, Cervical Mucus, and SymptoThermal methods. For 2011–2017, the FAM
category includes Calendar Rhythm, Standard Days®, TwoDay, Billings Ovulation, and SymptoThermal methods.
† Percentage is less than 0.5%.

A-22

Exhibit A–9c.

Number and distribution of all female family planning users, by type of primary contraceptive method and year: 2007–2017

Most effective, 19%

2017

Moderately effective, 43%

17%

2016

45%

15%

2015

48%

13%

2014

Family Planning Annual Report: 2017 National Summary

11%

2012

11%

2011

9%

53%

2010

8%

54%

52%

3.54 million

18%

14%

3.55 million

14%

3.61 million

18%

13%

3.76 million

19%

13%

4.18 million

20%

13%

4.38 million

21%

13%

4.64 million

53%

2009

7%

2008

6%

55%

2007

5%

57%

0%

No method, 14%

18%

51%

2013

Less effective, 18%

19%

54%

13%

18%

14%

18%

14%

19%

15%

Most effective

Moderately effective

Less effective

Abstinence

No method

Method unknown

4.82 million
,

4.81 million
4.72 million
4.69 million
100%

Note: 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).

Screening Measures

2007

Female Users Screened
Number
Pap Tests Performed
Number

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2,272,571

2,088,218

2,035,017

1,727,251

1,444,418

1,237,328

988,114

785,540

743,683

687,373

649,266

48%

44%

42%

36%

31%

28%

24%

21%

21%

19%

18%

2,470,674

2,209,087

2,190,127

1,810,620

1,522,777

1,308,667

1,043,671

813,858

769,807

720,215

683,247

10%

11%

12%

13%

15%

14%

14%

14%

14%

14%

14%

Percentage

Percentage with an ASC or
higher result
ASC=atypical squamous cells.

Exhibit A–10b. Number and percentage of female users who received a Pap test, by year: 2007–2017

2.27

2.09

2.0

2.04
1.73

60%
1.44

48%

1.0

0.0

80%

2007

1.24
44%

2008

42%

2009

40%

0.99
36%

2010

31%

2011

28%

2012

A-23

Number of female users screened (in millions)

24%

2013

0.79

0.74

21%

21%

19%

18%

2014

2015

2016

2017

0.69

0.65
20%

Percentage of female users screened

0%

Percentage of female users screened

100%

3.0

Number of female users screened (in
millions)

Family Planning Annual Report: 2017 National Summary

Exhibit A–10a. 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: 2007–2017

A-24

Exhibit A–11a. Number and percentage of female users under 25 tested for chlamydia, by year: 2007–2017
Chlamydia Testing Measures
Number tested

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

1,385,623

1,435,430

1,433,829

1,442,176

1,357,231

1,268,269

1,181,534

1,011,474

955,775

953,273

939,250

52%

55%

55%

57%

58%

59%

60%

58%

59%

61%

61%

Percentage tested

1.5

1.39

1.44

1.43

1.44

1.36

100%
1.27

1.18

80%
1.01

1.0

52%

55%

55%

57%

58%

59%

60%

58%

0.96

0.95

0.94

59%

61%

61%

60%

40%

0.5

20%

0.0

2007

2008

2009

2010

2011

2012

Number of female users <25 years tested (in millions)

2013

2014

2015

2016

2017

0%

Percentage of female users <25 years tested

Percentage of female users <25 years
tested

Family Planning Annual Report: 2017 National Summary

Number of female users <25 years tested
(in millions)

Exhibit A–11b. Number and percentage of female users under 25 tested for chlamydia, by year: 2007–2017

Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2007–2017

HIV Testing Measures

2007

2008

2009

Tests performed

764,126

833,105

Tests per 10 users

1.5

Tests per 10 female users

1.4

Tests per 10 male users

4.1

2010

2011

2012

2013

2014

2015

2016

2017

997,765

1,101,665

1,283,375

1,249,867

1,187,631

1,031,624

1,113,635

1,163,883

1,192,119

1.6

1.9

2.1

2.6

2.6

2.6

2.5

2.8

2.9

3.0

1.5

1.8

1.9

2.3

2.4

2.4

2.2

2.4

2.5

2.6

3.9

4.1

4.3

5.2

5.5

5.3

5.7

5.9

5.7

5.9

Exhibit A-12b. Number of confidential HIV tests performed and number of tests per 10 users (all, female, and male), by year: 2007–2017

1.5

10.0
1.28

1.25

1.10

1.03

1.00

1.0
0.76

4.1
1.4

1.11

1.16

1.19

3.9
1.5

9.0
8.0
7.0

0.83

6.0
5.2

0.5

1.19

4.1
1.8

4.3
1.9

2.3

5.5
2.4

5.3
2.4

5.7

5.9

5.7

5.9

5.0
4.0

2.2

2.4

2.5

2.6

3.0
2.0
1.0

0.0

2007

2008

2009

2010

Number of tests performed (in millions)

2011

2012

2013

2014

Tests per 10 female users

2015

2016

2017

0.0

Tests per 10 male users

Tests per 10 users

Number of tests performed (in millions)

Family Planning Annual Report: 2017 National Summary

Exhibit A-12a.

A-25

A-26

Exhibit A–13a. Actual and adjusted (constant 2017$ and 2007$) total, Title X, and Medicaid revenue, by year: 2007–2017
Change
Revenue

2007
($)

2008
($)

2009
($)

2010
($)

2011
($)

2012
($)

2013
($)

2014
($)

2015
($)

2016
($)

2017
($)

2007–
2017

2016–
2017

Total
Actuala

1,140,511,162 1,211,489,469 1,231,311,085 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

14%

−1%

2017$b

1,544,235,493 1,581,716,444 1,558,170,903 1,583,243,242 1,527,857,574 1,443,647,706 1,436,378,602 1,358,292,735 1,323,597,898 1,337,923,305 1,297,618,121

−16%

−3%

2007$b

1,140,511,162 1,168,193,108 1,150,803,305 1,169,320,741 1,128,415,080 1,066,221,008 1,060,852,336 1,003,181,207

−3%

977,556,975

988,137,153

958,369,341

−16%

Title X

Family Planning Annual Report: 2017 National Summary

Actuala

255,337,864

259,743,981

266,393,881

279,295,186

276,002,719

267,095,215

253,655,493

249,517,445

242,576,878

245,066,054

244,563,111

−4%

0%†

2017$b

345,723,747

339,120,840

337,109,930

341,768,390

327,764,003

305,974,665

283,600,080

272,463,383

258,089,783

251,221,841

244,563,111

−29%

−3%

2007$b

255,337,864

250,461,218

248,976,041

252,416,594

242,073,509

225,980,767

209,455,784

201,230,662

190,614,890

185,542,500

180,624,626

−29%

−3%

Actuala

349,919,735

407,561,796

450,028,613

482,175,678

506,887,574

499,181,475

508,494,458

493,061,463

503,186,368

505,508,702

496,501,892

42%

−2%

2017$b

473,786,222

532,111,266

569,491,739

590,029,523

601,948,782

571,844,331

568,523,343

538,404,016

535,365,372

518,206,518

496,501,892

5%

−4%

2007$b

349,919,735

392,996,302

420,604,038

435,772,432

444,575,525

422,341,570

419,888,820

397,643,878

395,399,656

382,726,806

366,696,629

5%

−4%

Medicaidc

a

Revenue is shown in actual dollars (unadjusted) for each year.

b

Revenue is shown in constant 2017 dollars (2017$) and 2007 dollars (2007$), 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, http://data.bls.gov/cgi-bin/srgate).

c

Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.

†

Percentage is less than 0.5%.

$1,800
$1,600

Total revenue (in millions)

Family Planning Annual Report: 2017 National Summary

Exhibit A–13b. Total, Title X, and Medicaid adjusted (constant 2017$) revenue (in millions), by year: 2007–2017

$1,544

$1,400

$1,298

$1,200
$1,000
$800
$600

$497

$474

$400
$200
$0

$346
$245
2007

2008

2009

2010

2011

Total revenue

2012

Medicaid

Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.

2013

2014

Title X

2015

2016

2017

A-27

A-28

Exhibit A–13c. Total actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017

$1,800

Family Planning Annual Report: 2017 National Summary

Total revenue (in millions)

$1,600

$1,544

$1,400
$1,200
$1,000

$1,298
$1,141

$1,298

$1,141
$958

$800
$600
$400
$200
$0

2007

2008

2009

2010

Actual (unadjusted)

2011

2012

2013

Adjusted (2017$)

2014

2015

2016

Adjusted (2007$)

2017

$700
$600

Title X revenue (in millions)

Family Planning Annual Report: 2017 National Summary

Exhibit A–13d. Title X actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017

$500
$400
$300
$200

$346
$255

$245

$255

$245
$181

$100
$0

2007

2008

2009

2010

Actual (unadjusted)

2011

2012

2013

Adjusted (2017$)

2014

2015

2016

Adjusted (2007$)

2017

A-29

A-30

Exhibit A–13e. Medicaid actual (unadjusted) and adjusted (constant 2017$ and 2007$) revenue (in millions), by year: 2007–2017

$700

Family Planning Annual Report: 2017 National Summary

Medicaid revenue (in millions)

$600

$500

$497

$474

$497
$400

$300

$350
$367

$350

$200

$100

$0

2007

2008

2009

2010

Actual (unadjusted)

2011

2012

2013

Adjusted (2017$)

Note: Medicaid revenue includes separately reported Children’s Health Insurance Program revenue.

2014

2015

2016

Adjusted (2007$)

2017

This page intentionally left blank.

Family Planning Annual Report: 2017 National Summary

A-31

A-32

Exhibit A–14a. Amount of Title X project revenue, by revenue source and year: 2007–2017
Revenue Sources
Title X

2007
($)

2008
($)

2009
($)

2010
($)

2011
($)

2012
($)

2013
($)

2014
($)

2015
($)

2016
($)

2017
($)

255,337,864

259,743,981

266,393,881

279,295,186

276,002,719

267,095,215

253,655,493

249,517,445

242,576,878

245,066,054

244,563,111

Payment for Services
Client fees

94,273,992

94,531,003

80,940,857

84,540,815

72,156,363

70,400,120

69,425,823

53,170,034

47,872,483

52,876,599

52,367,880

Third-party payers
Medicaid

349,672,196

407,349,628

449,834,131

481,262,633

506,608,330

498,739,261

505,709,855

490,470,842

501,418,354

504,313,859

495,245,884

Medicare

523,170

826,424

843,164

1,913,519

2,002,181

1,173,110

1,864,987

3,083,719

4,731,999

3,945,295

7,169,121

CHIP

247,539

212,168

194,482

913,045

279,244

442,214

2,784,603

2,590,621

1,768,014

1,194,843

1,256,008

Other

3,042,991

3,855,406

4,903,482

2,466,949

4,088,072

3,743,183

10,848,382

10,202,966

14,230,460

10,540,646

11,445,695

46,403,049

45,067,919

48,445,935

50,409,637

51,655,083

63,955,467

69,210,207

95,138,355

104,000,648

132,617,104

140,145,229

494,162,937

551,842,548

585,162,051

621,506,598

636,789,273

638,453,355

659,843,857

654,656,537

674,021,958

705,488,346

707,629,817

Other Revenue
MCH block grant

23,484,206

23,058,822

21,044,962

21,205,336

25,512,030

24,439,148

19,852,391

23,095,828

18,485,003

16,526,644

12,960,533

SS block grant

28,593,275

27,333,993

30,841,136

34,001,848

23,736,983

11,229,640

8,805,626

5,601,590

4,711,602

4,285,521

4,547,979

TANF

23,460,554

22,325,121

15,580,002

14,475,023

14,517,155

13,548,818

13,268,175

10,570,729

5,347,682

7,797,115

6,385,879

State government

138,760,608

147,447,953

153,830,395

135,464,470

125,392,165

117,468,476

131,054,838

120,974,720

119,983,576

133,484,660

119,036,286

Local government

99,510,026

101,295,242

84,666,243

91,289,586

84,214,372

87,010,991

93,770,370

80,388,864

73,018,511

66,637,455

69,199,630

BPHC

7,177,359

9,531,860

4,965,372

4,090,546

5,289,075

4,625,737

11,461,645

10,080,722

12,468,766

14,319,221

21,389,246

Other

70,024,333

68,909,949

68,827,043

92,507,316

95,120,838

96,335,555

93,002,768

89,015,512

93,426,923

111,534,633

111,905,640

391,010,361

399,902,940

379,755,153

393,034,125

373,782,618

354,658,365

371,215,813

339,727,965

327,442,063

354,585,249

345,425,193

Private
Subtotal

Family Planning Annual Report: 2017 National Summary

Subtotal
Total Revenue
Actual

1,140,511,162 1,211,489,469 1,231,311,085 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

2017$a

1,544,235,493 1,581,716,444 1,558,170,903 1,583,243,242 1,527,857,574 1,443,647,706 1,436,378,602 1,358,292,735 1,323,597,898 1,337,923,305 1,297,618,121

2007$a

1,140,511,162 1,168,193,108 1,150,803,305 1,169,320,741 1,128,415,080 1,066,221,008 1,060,852,336 1,003,181,207

977,556,975

988,137,153

958,369,341

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 2017 dollars (2017$) and 2007 dollars (2007$), 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, http://data.bls.gov/cgi-bin/srgate).

Family Planning Annual Report: 2017 National Summary

Exhibit A–14b. Distribution of Title X project revenue, by revenue source and year: 2007–2017
Revenue Sources

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Title X

22%

21%

22%

22%

21%

21%

20%

20%

19%

19%

19%

Payment for Services
Client fees

8%

8%

7%

7%

6%

6%

5%

4%

4%

4%

4%

Third-party payers
Medicaid

31%

34%

37%

37%

39%

40%

39%

39%

40%

39%

38%

Medicare

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

1%

CHIP

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

0%†

Other

0%†

0%†

0%†

0%†

0%†

0%†

1%

1%

1%

1%

1%

Private

4%

4%

4%

4%

4%

5%

5%

8%

8%

10%

11%

Subtotal

43%

46%

48%

48%

49%

51%

51%

53%

54%

54%

55%

Other Revenue
MCH block grant

2%

2%

2%

2%

2%

2%

2%

2%

1%

1%

1%

SS block grant

3%

2%

3%

3%

2%

1%

1%

0%†

0%†

0%†

0%†

TANF

2%

2%

1%

1%

1%

1%

1%

1%

0%†

1%

0%†

State government

12%

12%

12%

10%

10%

9%

10%

10%

10%

10%

9%

Local government

9%

8%

7%

7%

7%

7%

7%

6%

6%

5%

5%

BPHC

1%

1%

0%†

0%†

0%†

0%†

1%

1%

1%

1%

2%

Other

6%

6%

6%

7%

7%

8%

7%

7%

8%

9%

9%

Subtotal

34%

33%

31%

30%

29%

28%

29%

27%

26%

27%

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-33

A-34

Exhibit A–14c. Amount (unadjusted) and distribution of Title X project revenue, by revenue source and year: 2007–2017

2017

Medicaid, 38%

Title X, 19%

2016

39%

19%

State/Local Govt,
15%

Other, 28%
27%

15%

$1.30 billion
$1.31 billion

Family Planning Annual Report: 2017 National Summary

2015

40%

19%

16%

25%

$1.24 billion

2014

40%

20%

16%

24%

$1.24 billion

2013

40%

20%

18%

23%

$1.28 billion

2012

40%

21%

16%

23%

$1.26 billion

2011

39%

21%

16%

23%

$1.29 billion

18%

24%

$1.29 billion

19%

22%

$1.23 billion

2010

37%

2009

37%

22%
22%

34%

2008

21%

31%

2007

22%

21%
21%

24%
26%

0%

$1.21 billion
$1.14 billion
100%

Medicaid

Title X

State/local government

Other

Note: 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.

Appendix B
State Exhibits

Exhibit B–1.

Number and distribution of all family planning users, by sex and state, and distribution of
all users, by state: 2017 (Source: FPAR Table 1)

State

Male

Total

Female

Male

State Users as %
of All Users

81,989

764

82,753

99%

1%

2%

Alaska

7,176

1,416

8,592

84%

16%

0%†

Arizona

30,405

5,997

36,402

84%

16%

1%

Arkansas

46,280

221

46,501

100%

California

891,739

127,239

1,018,978

88%

12%

25%

Colorado

44,143

9,075

53,218

83%

17%

1%

Connecticut

37,910

5,925

43,835

86%

14%

1%

Delaware

15,891

3,241

19,132

83%

17%

0%†

District of Columbia

39,984

14,570

54,554

73%

27%

1%

Florida

113,929

3,352

117,281

97%

3%

3%

Georgia

104,290

39,503

143,793

73%

27%

4%

Hawaii

15,954

961

16,915

94%

6%

0%†

Idaho

9,355

695

10,050

93%

7%

0%†

Illinois

101,619

10,807

112,426

90%

10%

3%

Indiana

21,793

2,094

23,887

91%

9%

1%

Iowa

28,322

2,514

30,836

92%

8%

1%

Kansas

19,688

2,729

22,417

88%

12%

1%

Kentucky

42,197

8,215

50,412

84%

16%

1%

Louisiana

37,808

10,647

48,455

78%

22%

1%

Maine

19,712

3,715

23,427

84%

16%

1%

Maryland

64,937

8,081

73,018

89%

11%

2%

Massachusetts

64,732

10,543

75,275

86%

14%

2%

Michigan

59,204

6,384

65,588

90%

10%

2%

Minnesota

46,318

9,082

55,400

84%

16%

1%

Mississippi

26,507

231

26,738

99%

1%

1%

Missouri

35,043

2,889

37,932

92%

8%

1%

Montana

15,508

2,601

18,109

86%

14%

0%†

Nebraska

25,511

4,063

29,574

86%

14%

1%

Nevada

10,179

608

10,787

94%

6%

0%†

New Hampshire

14,545

1,868

16,413

89%

11%

0%†

New Jersey

89,945

9,899

99,844

90%

10%

2%

New Mexico

13,154

1,881

15,035

87%

13%

0%†

279,688

31,673

311,361

90%

10%

8%

Alabama

New York
†

Female

Percentage is less than 0.5%.

B-2

0%†

1%

(continued)

Family Planning Annual Report: 2017 National Summary

Exhibit B–1.

Number and distribution of all family planning users, by sex and state, and distribution of
all users, by state: 2017 (Source: FPAR Table 1) (continued)
Total

Female

Male

State Users as
% of All Users

1,004

110,059

99%

1%

3%

5,736

1,291

7,027

82%

18%

0%†

Ohio

82,643

16,036

98,679

84%

16%

2%

Oklahoma

46,915

715

47,630

98%

2%

1%

Oregon

41,952

2,863

44,815

94%

6%

1%

Pennsylvania

175,295

25,267

200,562

87%

13%

5%

Rhode Island

21,198

4,901

26,099

81%

19%

1%

South Carolina

58,520

13,956

72,476

81%

19%

2%

South Dakota

4,707

348

5,055

93%

7%

0%†

73,288

346

73,634

100%

0%†

2%

Texas

171,869

21,156

193,025

89%

11%

5%

Utah

30,388

6,701

37,089

82%

18%

1%

Vermont

8,682

1,221

9,903

88%

12%

0%†

Virginia

47,374

3,201

50,575

94%

6%

1%

Washington

84,536

6,793

91,329

93%

7%

2%

West Virginia

60,552

5,823

66,375

91%

9%

2%

Wisconsin

30,399

5,522

35,921

85%

15%

1%

Wyoming

5,546

878

6,424

86%

14%

0%†

American Samoa

2,331

44

2,375

98%

2%

0%†

Comm. of the Northern
Mariana Islands

1,049

8

1,057

99%

1%

0%†

Federated States of
Micronesia

3,275

425

3,700

89%

11%

0%†

289

12

301

96%

4%

0%†

14,411

761

15,172

95%

5%

0%†

2,605

9

2,614

100%

0%†

0%†

649

49

698

93%

7%

0%†

2,516

198

2,714

93%

7%

0%†

3,541,235

463,011

4,004,246

88%

12%

73%–100%

0%†–27%

State

Female

North Carolina

109,055

North Dakota

Tennessee

Male

Territories & FAS

Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range

100%
0%†–25%

FAS=Freely Associated States.
† Percentage is less than 0.5%.

Family Planning Annual Report: 2017 National Summary

B-3

Exhibit B–2.

Number and distribution of all family planning users, by user income level and state:
2017 (Source: FPAR Table 4)

State
Alabama

Under
101%

101%
to 250%

Over
250%

UK/NR

Total

Under
101%

101%
to 250%

Over
250%

UK/NR

59,236

21,250

2,222

45

82,753

72%

26%

3%

0%†

Alaska

4,230

2,903

1,144

315

8,592

49%

34%

13%

4%

Arizona

23,628

9,450

3,025

299

36,402

65%

26%

8%

1%

Arkansas

35,832

9,639

1,030

0

46,501

77%

21%

2%

0%

California

745,570

205,748

35,475

32,185

1,018,978

73%

20%

3%

3%

Colorado

41,134

9,810

2,274

0

53,218

77%

18%

4%

0%

Connecticut

16,323

20,618

6,720

174

43,835

37%

47%

15%

0%†

Delaware

12,326

4,640

1,111

1,055

19,132

64%

24%

6%

6%

District of Columbia

31,832

14,337

2,361

6,024

54,554

58%

26%

4%

11%

Florida

68,469

26,020

19,963

2,829

117,281

58%

22%

17%

2%

Georgia

100,035

25,813

11,394

6,551

143,793

70%

18%

8%

5%

Hawaii

11,842

3,369

982

722

16,915

70%

20%

6%

4%

Idaho

6,002

3,422

610

16

10,050

60%

34%

6%

0%†

Illinois

78,293

23,125

10,649

359

112,426

70%

21%

9%

0%†

Indiana

14,761

7,609

1,517

0

23,887

62%

32%

6%

0%

Iowa

18,358

8,622

3,720

136

30,836

60%

28%

12%

0%†

Kansas

13,089

6,587

1,345

1,396

22,417

58%

29%

6%

6%

Kentucky

36,348

9,151

2,739

2,174

50,412

72%

18%

5%

4%

Louisiana

36,647

8,572

1,689

1,547

48,455

76%

18%

3%

3%

8,424

10,302

4,132

569

23,427

36%

44%

18%

2%

Maryland

61,093

7,788

1,560

2,577

73,018

84%

11%

2%

4%

Massachusetts

46,314

21,590

5,197

2,174

75,275

62%

29%

7%

3%

Michigan

35,671

22,634

7,223

60

65,588

54%

35%

11%

0%†

Minnesota

29,288

16,783

8,817

512

55,400

53%

30%

16%

1%

Mississippi

23,594

2,902

102

140

26,738

88%

11%

Missouri

20,071

12,460

5,401

0

37,932

53%

33%

14%

0%

Montana

8,333

5,155

1,766

2,855

18,109

46%

28%

10%

16%

Nebraska

17,415

7,865

1,802

2,492

29,574

59%

27%

6%

8%

Nevada

6,060

3,454

634

639

10,787

56%

32%

6%

6%

New Hampshire

7,506

5,765

2,470

672

16,413

46%

35%

15%

4%

New Jersey

53,374

43,304

2,867

299

99,844

53%

43%

3%

0%†

New Mexico

12,608

1,679

149

599

15,035

84%

11%

1%

4%

208,650

66,527

35,532

652

311,361

67%

21%

11%

0%†

Maine

New York

UK/NR=unknown or not reported.
† Percentage is less than 0.5%.

B-4

0%†

1%

(continued)

Family Planning Annual Report: 2017 National Summary

Exhibit B–2.

Number and distribution of all family planning users, by user income level and state:
2017 (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

73,095

26,490

7,203

3,271

110,059

66%

24%

7%

3%

North Dakota

2,608

2,384

1,862

173

7,027

37%

34%

26%

2%

Ohio

52,187

29,177

14,700

2,615

98,679

53%

30%

15%

3%

Oklahoma

33,781

12,767

1,022

60

47,630

71%

27%

2%

0%†

Oregon

29,028

12,996

2,652

139

44,815

65%

29%

6%

0%†

Pennsylvania

112,013

56,212

25,889

6,448

200,562

56%

28%

13%

3%

Rhode Island

12,103

4,176

2,597

7,223

26,099

46%

16%

10%

28%

South Carolina

62,050

8,192

2,234

0

72,476

86%

11%

3%

0%

South Dakota

3,162

1,330

526

37

5,055

63%

26%

10%

1%

56,535

14,385

2,529

185

73,634

77%

20%

3%

0%†

Texas

149,854

33,468

6,581

3,122

193,025

78%

17%

3%

2%

Utah

24,524

9,992

2,573

0

37,089

66%

27%

7%

0%

Vermont

4,067

3,581

1,820

435

9,903

41%

36%

18%

4%

Virginia

28,197

13,427

2,068

6,883

50,575

56%

27%

4%

14%

Washington

51,288

27,565

10,215

2,261

91,329

56%

30%

11%

2%

West Virginia

29,435

10,833

992

25,115

66,375

44%

16%

1%

38%

Wisconsin

20,830

11,389

3,498

204

35,921

58%

32%

10%

1%

Wyoming

3,695

1,902

827

0

6,424

58%

30%

13%

0%

American Samoa

2,365

0

4

6

2,375

100%

0%

0%†

0%†

Comm. of the Northern
Mariana Islands

1,008

38

5

6

1,057

95%

4%

0%†

1%

Federated States of
Micronesia

3,685

1

0

14

3,700

100%

0%†

0%

0%†

295

5

1

0

301

98%

2%

0%†

0%

12,175

2,310

546

141

15,172

80%

15%

4%

1%

2,454

0

0

160

2,614

94%

0%

0%

6%

570

122

6

0

698

82%

17%

1%

0%

2,551

160

3

0

2,714

94%

6%

0%†

0%

2,665,911

931,795

277,975

128,565

4,004,246

67%

23%

7%

3%

Tennessee

Territories & FAS

Guam
Puerto Rico
Republic of the
Marshall Islands
Republic of Palau
U.S. Virgin Islands
Total All Users
Range

36%–100% 0%–47% 0%–26% 0%–38%

UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: 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 http://aspe.hhs.gov/poverty/.
† Percentage is less than 0.5%.

Family Planning Annual Report: 2017 National Summary

B-5

Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2017
(Source: FPAR Table 5)
State
Alabama

Public

Private

Uninsured

UK/NR

Total

Public

Private

Uninsured

UK/NR

25,162

12,647

44,803

141

82,753

30%

15%

54%

0%†

Alaska

2,337

3,588

2,645

22

8,592

27%

42%

31%

0%†

Arizona

5,451

8,480

22,471

0

36,402

15%

23%

62%

0%

Arkansas

16,904

18,836

10,761

0

46,501

36%

41%

23%

0%

California

445,304

65,679

507,387

608

1,018,978

44%

6%

50%

0%†

Colorado

18,826

7,542

22,855

3,995

53,218

35%

14%

43%

8%

Connecticut

12,166

11,731

19,570

368

43,835

28%

27%

45%

1%

6,273

5,041

7,019

799

19,132

33%

26%

37%

4%

District of Columbia

41,888

4,641

8,018

7

54,554

77%

9%

15%

0%†

Florida

47,030

31,197

36,123

2,931

117,281

40%

27%

31%

2%

Georgia

42,128

45,797

55,699

169

143,793

29%

32%

39%

0%†

Hawaii

8,214

3,730

4,823

148

16,915

49%

22%

29%

1%

Idaho

964

2,673

6,117

296

10,050

10%

27%

61%

3%

Illinois

42,298

31,415

37,416

1,297

112,426

38%

28%

33%

1%

Indiana

5,592

5,433

12,768

94

23,887

23%

23%

53%

0%†

10,602

12,442

7,233

559

30,836

34%

40%

23%

2%

2,748

4,593

14,768

308

22,417

12%

20%

66%

1%

Kentucky

23,342

7,091

17,998

1,981

50,412

46%

14%

36%

4%

Louisiana

27,731

5,560

15,156

8

48,455

57%

11%

31%

0%†

5,112

11,038

7,236

41

23,427

22%

47%

31%

0%†

Maryland

26,600

17,091

25,790

3,537

73,018

36%

23%

35%

5%

Massachusetts

41,821

18,388

14,637

429

75,275

56%

24%

19%

1%

Michigan

22,368

18,225

24,832

163

65,588

34%

28%

38%

0%†

Minnesota

12,314

21,535

21,277

274

55,400

22%

39%

38%

0%†

Mississippi

7,403

508

18,730

97

26,738

28%

2%

70%

0%†

Missouri

9,706

11,016

17,210

0

37,932

26%

29%

45%

0%

Montana

4,322

8,199

5,463

125

18,109

24%

45%

30%

1%

Nebraska

2,953

8,130

18,475

16

29,574

10%

27%

62%

0%†

Nevada

2,804

1,829

6,129

25

10,787

26%

17%

57%

0%†

New Hampshire

4,911

7,720

3,738

44

16,413

30%

47%

23%

0%†

New Jersey

35,458

16,396

47,635

355

99,844

36%

16%

48%

0%†

New Mexico

4,476

1,207

9,346

6

15,035

30%

8%

62%

0%†

149,923

52,244

94,607

14,587

311,361

48%

17%

30%

5%

Delaware

Iowa
Kansas

Maine

New York

UK/NR=unknown or not reported.
† Percentage is less than 0.5%.

B-6

(continued)

Family Planning Annual Report: 2017 National Summary

Exhibit B–3a. Number and distribution of all family planning users, by insurance status and state: 2017
(Source: FPAR Table 5) (continued)
State
North Carolina

Public

Private

Uninsured

UK/NR

Total

Public

Private

Uninsured

UK/NR

31,740

17,409

58,866

2,044

110,059

29%

16%

53%

2%

493

3,992

2,435

107

7,027

7%

57%

35%

2%

38,704

26,507

32,579

889

98,679

39%

27%

33%

1%

8,942

7,584

31,104

0

47,630

19%

16%

65%

0%

Oregon

16,764

8,085

18,515

1,451

44,815

37%

18%

41%

3%

Pennsylvania

91,233

58,500

45,876

4,953

200,562

45%

29%

23%

2%

Rhode Island

16,528

6,232

3,309

30

26,099

63%

24%

13%

0%†

South Carolina

26,386

26,237

19,853

0

72,476

36%

36%

27%

0%

312

2,349

1,966

428

5,055

6%

46%

39%

8%

Tennessee

27,045

9,062

37,519

8

73,634

37%

12%

51%

0%†

Texas

27,811

27,136

135,888

2,190

193,025

14%

14%

70%

1%

Utah

1,182

10,148

25,759

0

37,089

3%

27%

69%

0%

Vermont

3,209

4,534

2,160

0

9,903

32%

46%

22%

0%

Virginia

8,096

8,099

32,959

1,421

50,575

16%

16%

65%

3%

Washington

40,746

32,243

17,872

468

91,329

45%

35%

20%

1%

West Virginia

17,789

21,966

17,396

9,224

66,375

27%

33%

26%

14%

Wisconsin

22,059

5,326

8,536

0

35,921

61%

15%

24%

0%

419

1,984

3,879

142

6,424

7%

31%

60%

2%

0

0

2,371

4

2,375

0%

0%

100%

0%†

Comm. of the Northern
Mariana Islands

532

156

364

5

1,057

50%

15%

34%

0%†

Federated States of
Micronesia

479

6

3,182

33

3,700

13%

0%†

86%

1%

18

2

281

0

301

6%

1%

93%

0%

14,040

649

473

10

15,172

93%

4%

3%

0%†

0

0

2,614

0

2,614

0%

0%

100%

0%

693

1

4

0

698

99%

0%†

1%

0%

1,182

202

1,330

0

2,714

44%

7%

49%

0%

1,511,533

760,051

1,675,825

56,837

4,004,246

38%

19%

42%

1%

0%–99%

0%–57%

North Dakota
Ohio
Oklahoma

South Dakota

Wyoming
Territories & FAS
American Samoa

Guam
Puerto Rico
Republic of the Marshall
Islands
Republic of Palau
U.S. Virgin Islands
Total Users
Range

1%–100% 0%–14%

UK/NR=unknown or not reported. FAS=Freely Associated States.
Note: Due to rounding, the percentages may not sum to 100%.
† Percentage is less than 0.5%.

Family Planning Annual Report: 2017 National Summary

B-7

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 states’ Medicaid expansion status:
2017 (Source: FPAR Table 5)
State

Public

Private

Uninsured UK/NR

Total

Public

Private

Uninsured

UK/NR

Expansion States
Alaska
Arizona

a

Arkansas

2,337

3,588

2,645

22

8,592

27%

42%

31%

0%†

5,451

8,480

22,471

0

36,402

15%

23%

62%

0%

16,904

18,836

10,761

0

46,501

36%

41%

23%

0%

California

445,304

65,679

507,387

608

1,018,978

44%

6%

50%

0%†

Colorado

18,826

7,542

22,855

3,995

53,218

35%

14%

43%

8%

Connecticut

12,166

11,731

19,570

368

43,835

28%

27%

45%

1%

a

Delaware
District of Columbia
Hawaii
Illinois
Indiana

6,273

5,041

7,019

799

19,132

33%

26%

37%

4%

41,888

4,641

8,018

7

54,554

77%

9%

15%

0%†

8,214

3,730

4,823

148

16,915

49%

22%

29%

1%

42,298

31,415

37,416

1,297

112,426

38%

28%

33%

1%

5,592

5,433

12,768

94

23,887

23%

23%

53%

0%†

Iowaa

10,602

12,442

7,233

559

30,836

34%

40%

23%

2%

Kentucky

23,342

7,091

17,998

1,981

50,412

46%

14%

36%

4%

Louisiana

27,731

5,560

15,156

8

48,455

57%

11%

31%

0%†

Maryland

26,600

17,091

25,790

3,537

73,018

36%

23%

35%

5%

Massachusetts

41,821

18,388

14,637

429

75,275

56%

24%

19%

1%

Michigan

22,368

18,225

24,832

163

65,588

34%

28%

38%

0%†

Minnesota

12,314

21,535

21,277

274

55,400

22%

39%

38%

0%†

Montana

4,322

8,199

5,463

125

18,109

24%

45%

30%

1%

Nevada

2,804

1,829

6,129

25

10,787

26%

17%

57%

0%†

4,911

7,720

3,738

44

16,413

30%

47%

23%

0%†

35,458

16,396

47,635

355

99,844

36%

16%

48%

0%†

a

a

a

New Hampshire

a

New Jersey
New Mexico

4,476

1,207

9,346

6

15,035

30%

8%

62%

0%†

149,923

52,244

94,607

14,587

311,361

48%

17%

30%

5%

493

3,992

2,435

107

7,027

7%

57%

35%

2%

Ohio

38,704

26,507

32,579

889

98,679

39%

27%

33%

1%

Oregon

16,764

8,085

18,515

1,451

44,815

37%

18%

41%

3%

Pennsylvania

91,233

58,500

45,876

4,953

200,562

45%

29%

23%

2%

Rhode Island

16,528

6,232

3,309

30

26,099

63%

24%

13%

0%†

3,209

4,534

2,160

0

9,903

32%

46%

22%

0%

Washington

40,746

32,243

17,872

468

91,329

45%

35%

20%

1%

West Virginia

17,789

21,966

17,396

9,224

66,375

27%

33%

26%

14%

516,102 1,089,716

46,553

2,849,762

42%

18%

38%

2%

New York
North Dakota

Vermont

Expansion States
Subtotal
Range

1,197,391

7%–77% 6%–57%

13%–62% 0%–14%

UK/NR=unknown or not reported.
a
Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire have approved Section 1115 waivers.
† Percentage is less than 0.5%.

B-8

(continued)

Family Planning Annual Report: 2017 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 states’ Medicaid expansion
status: 2017 (Source: FPAR Table 5) (continued)
State

Public

Private

Uninsured

UK/NR

Total

Public

Private

Uninsured

UK/NR

Nonexpansion States
Alabama

25,162

12,647

44,803

141

82,753

30%

15%

54%

0%†

Florida

47,030

31,197

36,123

2,931

117,281

40%

27%

31%

2%

Georgia

42,128

45,797

55,699

169

143,793

29%

32%

39%

0%†

964

2,673

6,117

296

10,050

10%

27%

61%

3%

Kansas

2,748

4,593

14,768

308

22,417

12%

20%

66%

1%

Maine

5,112

11,038

7,236

41

23,427

22%

47%

31%

0%†

Mississippi

7,403

508

18,730

97

26,738

28%

2%

70%

0%†

Missouri

9,706

11,016

17,210

0

37,932

26%

29%

45%

0%

Nebraska

2,953

8,130

18,475

16

29,574

10%

27%

62%

0%†

31,740

17,409

58,866

2,044

110,059

29%

16%

53%

2%

8,942

7,584

31,104

0

47,630

19%

16%

65%

0%

26,386

26,237

19,853

0

72,476

36%

36%

27%

0%

312

2,349

1,966

428

5,055

6%

46%

39%

8%

Tennessee

27,045

9,062

37,519

8

73,634

37%

12%

51%

0%†

Texas

27,811

27,136

135,888

2,190

193,025

14%

14%

70%

1%

Utah

1,182

10,148

25,759

0

37,089

3%

27%

69%

0%

Virginia

8,096

8,099

32,959

1,421

50,575

16%

16%

65%

3%

22,059

5,326

8,536

0

35,921

61%

15%

24%

0%

419

1,984

3,879

142

6,424

7%

31%

60%

2%

297,198

242,933

575,490

10,232

1,125,853

26%

22%

51%

1%

Idaho

North Carolina
Oklahoma
South Carolina
South Dakota

Wisconsin
Wyoming
Nonexpansion States
Subtotal
Range

3%–61% 2%–47%

24%–70%

0%–8%

All States
Total

1,494,589

759,035

1,665,206

56,785

Range

3,975,615

38%

19%

3%–77% 2%–57%

42%
13%–70%

1%
0%–14%

UK/NR=unknown or not reported.
Note: Due to rounding, the percentages may not sum to 100%. The exhibit excludes the eight U.S. Territories and Freely Associated
States.
† Percentage is less than 0.5%.

Family Planning Annual Report: 2017 National Summary

B-9

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: 2017 (Source: FPAR Table 7)

State
Alabama

Most
Effective
Permanent
Methodsb

Most
Effective
Reversible
Methodsb

Moderately
Effective
Methodsc

Less
Effective
Methodsd

Total
At Riska

Most
Moderately
Effective
Effective
Methodsb Methodsc

Less
Effective
Methodsd

22

4,328

47,348

14,898

68,802

6%

69%

22%

Alaska

186

2,068

2,895

915

6,439

35%

45%

14%

Arizona

205

5,202

15,848

4,001

27,654

20%

57%

14%

Arkansas

2,422

5,935

22,045

5,796

40,085

21%

55%

14%

California

20,332

164,856

347,805

232,195

807,484

23%

43%

29%

Colorado

660

13,522

17,310

4,646

38,614

37%

45%

12%

2,006

7,393

15,755

7,103

35,559

26%

44%

20%

Delaware

445

3,051

5,330

2,137

14,680

24%

36%

15%

District of Columbia

875

6,047

9,356

1,387

35,206

20%

27%

4%

Florida

1,470

13,239

56,034

11,756

93,003

16%

60%

13%

Georgia

11,321

8,671

15,924

16,971

86,433

23%

18%

20%

Hawaii

595

2,919

5,722

1,894

12,570

28%

46%

15%

Idaho

366

1,536

5,279

860

8,190

23%

64%

11%

Illinois

2,607

17,703

44,764

14,843

90,373

22%

50%

16%

404

2,771

13,559

2,178

19,688

16%

69%

11%

1,130

5,820

13,956

3,106

25,868

27%

54%

12%

889

1,829

10,962

1,913

17,224

16%

64%

11%

Kentucky

1,436

2,553

16,700

13,934

37,379

11%

45%

37%

Louisiana

2,665

4,272

19,539

4,774

32,559

21%

60%

15%

745

4,807

8,317

1,927

17,814

31%

47%

11%

Maryland

1,789

12,225

26,870

12,763

58,246

24%

46%

22%

Massachusetts

1,767

13,628

21,756

9,796

56,468

27%

39%

17%

Michigan

794

7,328

35,181

9,311

53,966

15%

65%

17%

Minnesota

464

10,069

24,332

7,053

42,824

25%

57%

16%

Mississippi

676

1,581

20,633

1,207

25,757

9%

80%

5%

Missouri

1,467

4,144

19,210

4,497

30,116

19%

64%

15%

Montana

483

2,840

8,588

2,224

14,560

23%

59%

15%

1,724

6,262

8,485

4,436

23,057

35%

37%

19%

Nevada

236

1,962

5,710

879

9,131

24%

63%

10%

New Hampshire

658

3,431

6,341

1,269

12,645

32%

50%

10%

New Jersey

1,459

10,353

42,965

20,693

80,739

15%

53%

26%

New Mexico

29

3,469

5,575

2,004

11,818

30%

47%

17%

6,414

53,443

108,254

52,574

244,695

24%

44%

Connecticut

Indiana
Iowa
Kansas

Maine

Nebraska

New York

21%
(continued)

B-10

Family Planning Annual Report: 2017 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: 2017 (continued)

State

Most
Most
Effective
Effective
Permanent Reversible
Methodsb
Methodsb

Moderately
Effective
Methodsc

Less
Effective
Methodsd

Total
At Riska

Most
Effective
Methodsb

Moderately
Effective
Methodsc

Less
Effective
Methodsd

North Carolina

637

19,600

57,438

11,762

101,604

20%

57%

12%

North Dakota

166

772

3,672

475

5,337

18%

69%

9%

4,170

10,683

35,432

10,080

71,651

21%

49%

14%

4,454

38,341

17%

65%

12%

Ohio
Oklahoma

314

6,306

24,983

Oregon

1,333

10,598

19,958

4,523

37,763

32%

53%

12%

Pennsylvania

7,409

20,167

71,383

35,943

160,275

17%

45%

22%

Rhode Island

2,087

3,265

6,103

3,324

16,065

33%

38%

21%

South Carolina

1,149

6,964

31,145

10,933

50,191

16%

62%

22%

South Dakota
Tennessee
Texas
Utah
Vermont

50

417

3,706

274

4,526

10%

82%

6%

282

7,223

33,627

6,818

50,866

15%

66%

13%

8,745

23,832

59,553

36,466

148,833

22%

40%

25%

260

6,577

17,609

3,088

27,948

24%

63%

11%

247

2,502

3,685

791

7,865

35%

47%

10%

Virginia

1,028

9,426

24,247

7,799

44,455

24%

55%

18%

Washington

1,390

14,332

47,147

10,251

75,410

21%

63%

14%

West Virginia

14%

35%

9%

3,693

4,032

19,651

4,989

56,478

Wisconsin

774

4,866

14,642

6,031

27,498

21%

53%

22%

Wyoming

228

664

3,363

733

5,239

17%

64%

14%

31

74

1,519

450

2,225

5%

68%

20%

0

187

689

79

971

19%

71%

8%

61

644

1,486

665

2,881

24%

52%

23%

Territories & FAS
American Samoa
Comm. of the Northern
Mariana Islands
Federated States of
Micronesia

0

0

106

8

116

0%

91%

7%

Puerto Rico

46

306

10,049

3,227

14,303

2%

70%

23%

Republic of the
Marshall Islands

39

403

845

12

1,553

28%

54%

1%

Guam

Republic of Palau
U.S. Virgin Islands
Total Users

6

18

493

16

566

4%

87%

3%

135

88

936

1,029

2,442

9%

38%

42%

103,021

563,203

1,521,815

640,160

3,135,048

21%

49%

20%

0%–37%

18%–91%

1%–42%

Range

FAS=Freely Associated States.
Note: 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.

Family Planning Annual Report: 2017 National Summary

B-11

Exhibit B–5.

Number and percentage of female family planning users under 25 years who were tested
for chlamydia, by state: 2017 (Source: FPAR Table 11)

State
Alabama

Female Users
Under 25 Years
Tested for Chlamydia

Female Users
Under 25 Years

% of Female Users
Under 25 Years
Tested for Chlamydia

30,982

39,759

78%

Alaska

2,362

3,298

72%

Arizona

11,142

14,572

76%

Arkansas

15,019

21,068

71%

California

275,725

387,415

71%

Colorado

14,063

20,564

68%

Connecticut

8,238

15,039

55%

Delaware

5,999

7,198

83%

District of Columbia

8,311

13,339

62%

Florida

18,513

45,645

41%

Georgia

13,915

31,123

45%

Hawaii

3,819

6,742

57%

Idaho

2,207

4,165

53%

Illinois

21,102

43,720

48%

Indiana

6,157

9,018

68%

Iowa

7,695

13,196

58%

Kansas

4,568

7,797

59%

Kentucky

7,014

18,718

37%

Louisiana

11,719

15,418

76%

4,727

8,983

53%

Maryland

12,681

25,479

50%

Massachusetts

15,469

27,391

56%

Michigan

16,916

29,726

57%

Minnesota

18,939

25,833

73%

Mississippi

10,122

13,455

75%

Missouri

9,447

17,369

54%

Montana

5,489

8,645

63%

Nebraska

7,852

9,990

79%

Nevada

3,047

3,880

79%

New Hampshire

3,775

6,355

59%

New Jersey

21,732

32,606

67%

New Mexico

4,139

6,429

64%

71,647

116,344

62%

Maine

New York

(continued)

B-12

Family Planning Annual Report: 2017 National Summary

Exhibit B–5.

Number and percentage of female family planning users under 25 years who were tested
for chlamydia, by state: 2017 (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

22,249

41,317

54%

North Dakota

1,626

2,730

60%

Ohio

26,755

39,970

67%

Oklahoma

15,033

24,629

61%

Oregon

10,129

18,552

55%

Pennsylvania

39,457

78,885

50%

Rhode Island

3,560

8,779

41%

South Carolina

18,998

25,969

73%

South Dakota

1,372

2,657

52%

Tennessee

24,851

35,710

70%

Texas

30,322

61,474

49%

Utah

8,980

17,437

51%

Vermont

2,714

4,112

66%

Virginia

7,630

17,187

44%

29,345

43,649

67%

West Virginia

8,176

25,767

32%

Wisconsin

9,838

14,316

69%

Wyoming

1,334

2,714

49%

Washington

Territories & FAS
American Samoa

45

578

8%

Comm. of the Northern Mariana
Islands

88

527

17%

Federated States of Micronesia

141

1,082

13%

97

150

65%

1,185

7,090

17%

1

976

Republic of Palau

64

221

29%

U.S. Virgin Islands

728

992

73%

939,250

1,527,749

61%

Guam
Puerto Rico
Republic of the Marshall Islands

Total Users
Range

0%†

0%†–83%

FAS=Freely Associated States.
†

Percentage is less than 0.5%.

Family Planning Annual Report: 2017 National Summary

B-13

This page intentionally left blank.

B-14

Family Planning Annual Report: 2017 National Summary

Appendix C
Field and Methodological Notes

INTRODUCTION
This appendix presents additional information about the 2017 FPAR, including issues RTI
identified during data validation and relevant table-specific notes from grantees and Health
and Human Services (HHS) Regional Project Officers. The notes are organized according to
the FPAR reporting table to which they apply.

FPAR COVER SHEET: GRANTEE PROFILE
Subrecipients—Of the 88 grantees that were active in both 2016 and 2017, 56 reported no
change in the number of subrecipients, 22 reported a decrease, and 10 reported an increase.
Some reasons given by several grantees for the decrease in subrecipients were because they
withdrew from Title X participation, agency mergers, and agency closures.
Service Sites—Of the 88 grantees active in both 2016 and 2017, 43 reported no change in the
number of service sites, 15 reported an increase, and 30 reported a decrease. Reasons given
by several grantees for the change in number of sites included subrecipient additions and
withdrawals and site closures or consolidations.
Reporting Period—Five grantees reported data for a reporting period that was less than 12
months, one grantee reported data for a different 12-month period, and all others (N=82)
reported data for the period from January 1, 2017, through December 31, 2017.

FPAR TABLE 1: USERS BY AGE AND SEX
Of the 88 grantees operating in both 2016 and 2017, 48 reported a decrease and 40 reported
an increase in the number of family planning users.

▪ Reasons given by grantees for the decrease in number of users included expiration of

state family planning waivers, site closures, site or subrecipient withdrawal from Title X
participation, reduced clinic hours, electronic health record (EHR) implementation or
transition, staffing shortages (e.g., furlough, medical leave, military leave, and clinical
services provider recruitment or retention), increased use of long-acting reversible
contraception (LARC) or adherence to screening guidelines resulting in a decline in
encounters, increased ability of newly insured clients to seek care from other providers,
delays and other challenges in executing contracts with new subrecipients and service sites,
various reporting issues, changes in contractors, data system issues and coding errors,
errors in reporting 2016 data, changes in payment policies for clinical services, and
weather-related disruptions in care delivery (e.g., hurricanes).

▪ Reasons given by grantees for the increase in the number of users included the following

reasons: new online scheduling systems, increase in providers, the addition of new
subrecipients, increase in state funding, improvement (e.g., standardization) in data
collection, integration of family planning services with sports health clearance visits,
increased or improved marketing efforts, increased outreach to males and teens, partnership

C-2

Family Planning Annual Report: 2017 National Summary

with university on research project, implementation of “One Key Question,” expanded
clinic hours, and improved data collection and reporting.

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 16% of total female users for whom race was unknown or not
reported in 2017, 76% 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 or refusal to report
race, loss of data during EHR implementation or transition, errors in the EHR system (e.g.,
reporting more than one race, refusing to report race, or reporting race as “Other”), coding
errors, staff failure to collect data, and not requiring clinic staff to collect and record
ethnicity information.

▪ Reasons given by grantees for a decrease in the percentage of female users with

unknown race or ethnicity included improvements in the collection, storage, and retrieval
of race and ethnicity data.

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 15% of total male users for whom race was unknown or not reported in
2017, 69% 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 or refusal to report race
information, failure of the EHR system to capture the data, difficulty with a new or
changing EHR system, coding errors, precoding client race to “unknown” when the
appointment was scheduled, and staff failure to collect data.

▪ Reasons given for a decrease in the percentage of male users with unknown race or

ethnicity included an improved workflow resulting in better capture of ethnicity and race
data, validation of EHR values, staff training, and improved data collection.

FPAR TABLE 4: USERS BY INCOME LEVEL
Unknown/not reported income status—Several grantees attributed the high or increased
number of family planning users with unknown or not reported income to problems with data
collection, including client (e.g., full-fee or insured clients) refusal to report income data,
difficulty retrieving information from EHR systems, EHR-related data collection issues,
problems entering data into regional data system, failure of sites to collect income data, and
system-related processing errors. Several other grantees attributed the decrease in number 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: 2017 National Summary

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FPAR TABLE 5: USERS BY PRINCIPAL HEALTH INSURANCE COVERAGE STATUS
Of the 88 grantees operating in both 2016 and 2017, 55 reported an increase in the percentage
of users with health insurance, 31 reported a decrease, and 2 reported no change.

▪ Reasons grantees gave for an increase in the percentage of users with health insurance
included an increase in newly insured clients because of the Affordable Care Act (ACA)
and Medicaid expansion, improved data collection, onsite health insurance enrollment
assistance, training to improve the collection of health insurance data, use of an EHR
template to capture insurance status information, and increased capacity and effort to bill
private insurance.

▪ Reasons grantees gave for a decrease in the percentage of users with health insurance
included targeted outreach to populations that are typically uninsured, an increase in the
number of uninsured clients, and loss of insured clients to private providers.

Unknown/not reported health insurance status—Several grantees attributed the high or
increased number of family planning users with unknown or not reported health insurance
coverage status to staff turnover, an inadequate health insurance field in EHRs, problems
extracting accurate data from EHRs, clients not wanting to report their insurance status for
fear of denial of care or loss of confidentiality, and teens not knowing their insurance status.

FPAR TABLE 6: USERS WITH LIMITED ENGLISH PROFICIENCY (LEP)
Of the 88 grantees operating in both 2016 and 2017, 45 reported a decrease and 43 reported
an increase in the percentage of users who are LEP.

▪ Reasons given by grantees for the decrease in percentage of users who are LEP included
changing demographic characteristics of clients (i.e., fewer LEP users) and improved data
collection.

▪ Reasons given by grantees for the increase in percentage of users who are LEP included
changing demographic characteristics of clients, staff training on creating a welcoming
environment, increased capacity to service LEP population, and increased outreach to
minority communities.

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 data system
limitations, including extracting LEP status data from EHRs and changes in EHR systems.

FPAR TABLE 7: FEMALE USERS BY PRIMARY CONTRACEPTIVE METHOD
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 categories correspond to the
three groups or tiers defined by Trussell (2011).10

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Family Planning Annual Report: 2017 National Summary

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/Implanon), 0.05%
▪ Intrauterine device (Mirena), 0.2%
▪ Intrauterine device (Skyla), 0.4%23
▪ Intrauterine device (Kyleena), 0.2%24
▪ Intrauterine device (Liletta), 0.2%25
▪ 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 (Evra), 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 [FAM] and lactational amenorrhea method [LAM], diaphragm and
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

Family Planning Annual Report: 2017 National Summary

C-5

because a limited number of Title X clients report using the methods in these combined
categories.
Hormonal injection users—Nine grantees in four regions (I, III, VI, and IX) reported a total
of 98 female users who relied on 1-month hormonal injections as their primary method. Onemonth hormonal injection users accounted for 0.02% of the 500,960 hormonal injection users
reported in 2017.
Sterilization among users under 20—One grantee reported a single female user under 20
relying on female sterilization as her primary contraceptive method. The grantee confirmed
that this female was sterilized prior to coming to the Title X site and that no Title X funding
was used for the sterilization.
Vasectomy among users under 18—Four grantees reported four female users under 18
relying on vasectomy as their primary contraceptive method. The grantees confirmed that
each of these females received noncoercion counseling.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of female users with an unknown primary method to one or more of
the following reasons: data collection/system problems (e.g., data entry errors, data
transfer/upload problems, and EHR issues related to implementation or transitions, missing
data fields, or data extraction), lack of staff training, staff turnover, outdated or inadequate
encounter forms, and failure to document primary method data for specific user subgroups
(e.g., users relying on third-party payer source) or encounters (e.g., nonclinical).
Grantees attributed the decrease in female users with an unknown primary method to
improved data collection, change in subrecipient reporting methodology, subrecipient
monitoring, and staff training.

FPAR TABLE 8: MALE USERS BY PRIMARY CONTRACEPTIVE METHOD
Primary method category definitions—See note for FPAR Table 7 in above section.
Sterilization among users under 20—No grantees reported male users under 20 relying on
vasectomy as their primary contraceptive method.
Unknown/not reported primary contraceptive method—Several grantees attributed the
high or increased number of male users with an unknown primary method to one or more of
the following reasons: failure to record primary method for some, all, or certain subgroups of
users (e.g., adolescent and insured) or encounters (e.g., non-clinical or and STD-only
encounters); problems extracting data from electronic systems (practice management or
EHR); failure to collect data for “no method, other reason” category; outdated encounter
forms; lack of staff training; staff turnover; challenges transitioning to new EHR; and client
refusal. Several other grantees attributed a decrease in the number of male users with an
unknown primary method to improved data collection, staff training, and technical assistance.

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Family Planning Annual Report: 2017 National Summary

FPAR TABLE 9: CERVICAL CANCER SCREENING ACTIVITIES
Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 58 reported a decrease in
the percentage of female users who received a Papanicolaou (Pap) test, and 30 reported an
increase.

▪ Reasons given by grantees for a decrease in the percentage of females screened for

cervical cancer included adherence to cervical cancer screening guidelines, EHR-related
issues (e.g., loss of data or difficulty extracting data), decreased opportunities to screen
because of a decline in visits among some users (e.g., LARC users), newly insured clients
seeking screening elsewhere, and weather-related disruptions in care delivery (e.g.,
hurricanes).

▪ Reasons given by grantees for an increase in the percentage of females screened for

cervical cancer included improved data collection and reporting, increase in new patients
who are in need of screening, and underreporting in 2016.

FPAR TABLE 10: CLINICAL BREAST EXAMS (CBEs) AND REFERRALS
CBEs—Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 59 reported a
decrease in the percentage of female users who received a CBE, and 29 reported an increase.

▪ Reasons given by grantees for a decrease in the percentage of females that received a

CBE included adherence to breast cancer screening guidelines, a decrease in the frequency
of clients receiving other physical exams or tests during which a CBE might be performed
(e.g., Pap tests or physical exam), lack of qualified staff to perform CBEs, overreporting of
CBEs in 2016, and EHR-related issues (e.g., transition, mapping and location of CBE
reporting field).

▪ Reasons given by grantees for an increase in the percentage of females that received a
CBE included greater attention to this area of clinical care, adherence to guidelines, and
improved data collection.

CBE-Related Referrals—Of the 88 grantees that submitted an FPAR in both 2016 and 2017,
43 reported a decrease in the percentage of female users referred for further evaluation
following a CBE, 41 reported an increase, and 4 reported no change.

▪ Reasons given by grantees for a decrease in the percentage of CBE-related referrals

were related to their EHR systems (e.g., transition, mapping, and location of CBE reporting
fields).

▪ Reasons given by grantees for an increase in the percentage of CBE-related referrals
included an increase in the number of older clients screened, improved data collection,
adherence to protocols, and better documentation of referrals in the EHRs.

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FPAR TABLE 11: USERS TESTED FOR CHLAMYDIA BY AGE AND SEX
Of the 88 grantees that submitted an FPAR in both 2016 and 2017, 50 reported an increase in
the percentage of female users under 25 tested for chlamydia, and 38 reported a decrease. In
addition, 61 grantees reported an increase in the percentage of male users tested, 26 reported a
decrease, and 1 reported no change.

▪ Reasons given for an increase in the chlamydia testing rate included high chlamydia

prevalence in the state or service area, improved data collection, increased staff training
and awareness, increased adherence to screening guidelines, greater availability of tests,
use of opt-out testing, chlamydia-focused quality improvement initiative, local and
statewide marketing of testing services, an increased number of male users at risk for
chlamydia, and increased outreach to males.

▪ Reasons given for a decrease in the chlamydia testing rate included a decrease in clients
who qualify for testing, inability to test in nontraditional encounter settings, decreased
funding or loss of dedicated funding, EHR-related issues (e.g., difficulty with data
extraction, problems with the lab–EHR interface, and challenges transitioning to a new
EHR), lab unable to process specimens, inconsistent data collection, clients tested at nonTitle X sites, and weather-related disruptions in care delivery.

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 the increase in STD testing included improved data collection,

implementation of opt-out testing, increased initiatives with staff to screen for STDs, an
increase in the availability of testing reagents, efforts to increase awareness and encourage
STD/HIV testing, an increase in users at high risk, an increase in male clients, improved
integration of STD with family planning services, increased marketing, initiation of
Personal Responsibility Education Program and Teens Pregnancy Prevention programs,
introduction of well-person services that include preventive and preconception health care
for men, and underreporting of 2016 STD testing data.

▪ Reasons given for the decrease in STD testing included difficulty with mapping lab data

to EHR data, reporting errors, inconsistent reporting, staff turnover, improved compliance
with STD testing guidelines, and weather-related disruptions in care delivery.

Gonorrhea Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016 and
2017, 53 reported an increase and 35 reported a decrease in the number of gonorrhea tests per
female user. In addition, 61 grantees reported an increase, 26 reported a decrease, and 1
reported no change in the number of tests per male user.

▪ Reasons given by grantees for the increase in gonorrhea testing included an increase in
gonorrhea prevalence in the service area, increased use of the combined chlamydia and
gonorrhea test, an increased number of users at high risk, and increase in multisite
specimens.

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Family Planning Annual Report: 2017 National Summary

▪ Reasons given by grantees for the decrease in gonorrhea testing included reporting issues
with subrecipient, loss of data from EHR, weather-related disruptions in care delivery, and
mechanical problems with testing equipment.

Syphilis Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016 and 2017,
53 reported an increase, 34 reported a decrease, and 1 reported no change in the number of
syphilis tests per female user. In addition, 58 grantees reported an increase, 25 reported a
decrease, and 5 reported no change in the number of syphilis tests per male user.

▪ Reasons given for the increase in syphilis testing included high prevalence or an outbreak
in the service area, better reporting, combined HIV and syphilis testing, an increase in
high-risk clients, and repeat testing of pregnant women in high-prevalence settings.

▪ A reason given for the decrease in syphilis testing was adherence to testing guidelines.
Confidential HIV Testing Rate—Of the 88 grantees that submitted an FPAR in both 2016
and 2017, 48 grantees reported an increase, 39 reported a decrease, and 1 reported no change
in the number of confidential HIV tests per female user. In addition, 50 grantees reported an
increase, 34 reported a decrease, and 4 reported no change in the number of confidential HIV
tests per male user.

▪ Reasons given by grantees for the increase in confidential HIV testing included an

increase in clients, an increase in clients with risk factors associated with abuse of opioids
and other substances, and continuation or implementation of opt-out testing.

▪ Reasons given by grantees for the decrease in confidential HIV testing included clients

obtaining testing elsewhere, withdrawal of a subrecipient that had a special focus on HIV
testing, a reduction in clients as a result of site closures, loss of targeted funding, a decrease
in rapid HIV testing because of weather-related disruptions in electricity, and adherence to
testing guidelines.

Positive Confidential HIV Tests—Of the 88 grantees that submitted an FPAR in both 2016
and 2017, 33 reported a decrease in the number of positive confidential HIV tests per 1,000
tests performed, 30 reported an increase, 23 reported no change (ratio was zero in both years),
and 2 conducted no confidential HIV testing.

▪ One grantee attributed the decrease in confidential HIV tests to improved data reporting
by subrecipients and the inability of subrecipients to report HIV testing data.

▪ Reasons cited by grantees for the increase in positive confidential HIV tests included

introduction of PrEP (pre-exposure prophylaxis) services, targeted outreach to high-risk
populations, an increase in clients with risk factors associated with abuse of opioids and
other substances, and improved reporting.

Family Planning Annual Report: 2017 National Summary

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FPAR TABLE 13: FAMILY PLANNING ENCOUNTERS AND STAFFING
Clinical Services Provider (CSP) Full-Time Equivalent (FTE)—Of the 88 grantees that
submitted an FPAR in both 2016 and 2017, 38 reported an increase in the total number of
FTE CSPs delivering Title X-funded services, 38 reported a decrease, and 12 reported no
change.

▪ Reasons given for an increase in CSP FTEs included better understanding of what

constitutes a family planning encounter and user, provision of training on CSP FTE
calculations for service site staff, increased hiring, improved data capture, and an increase
in CSP staffing associated with the addition of new subrecipients and service sites.

▪ Reasons given for a decrease in CSP FTEs included difficulty retaining or recruiting staff,
improved and standardized methodology for calculating FTEs, overreporting of FTEs in
the 2016 FPAR, and a response to the decline in users.

Physician FTEs—Thirty-six grantees reported an increase in physician FTEs, 29 reported a
decrease, and 23 reported no change. Reasons cited for the increase in physician FTEs
included an increased demand for care, the addition of Federally Qualified Health Centers to
the Title X network, and collaboration with physician residency programs. Reasons for a
decrease in physicians included not filling vacancies, recruitment difficulties, and a reduction
in physician CSP hours.
Midlevel Clinician FTEs—Thirty-six grantees reported an increase in midlevel clinician
FTEs, 38 reported a decrease, 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 FTEs.
Other CSP FTEs—Most grantees (N=72) reported zero other CSP FTEs in both years, 10
reported a decrease, 6 reported an increase, and 2 reported no change. In addition to the
reasons cited above for the change in CSP FTE levels, several grantees mentioned
overreporting of other CSP FTEs in 2016.
Family Planning Encounters—Of the 88 grantees that submitted an FPAR in both 2016 and
2017, 50 grantees reported a decrease in the number of total encounters and 38 reported an
increase. Several grantees gave the following reasons for the change in encounter numbers:

▪ Reasons given for the decrease in encounters included a decline in clients, patients

migrating to private health care because of their insured status, inconsistent data collection,
staff turnover and shortages, an increase in the number of LARC users who require fewer
visits, loss of productivity due to EHR implementation, and less frequent screening
requirements for selected services (e.g., Pap test).

▪ Reasons given for the increase in encounters included better understanding of what

constitutes a family planning encounter, underreporting of 2016 encounters, increased
staffing and capacity to serve more clients, clients’ reliance on Title X sites as a medical
home, clients returning for resupply visits and follow-up care, and provision of integrated
family planning services.

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Family Planning Annual Report: 2017 National Summary

FPAR TABLE 14: REVENUE REPORT
Total revenue (row 18)—All Regions—Of the 88 grantees that submitted an FPAR in both
2016 and 2017, 45 reported a decrease in total revenue, and 43 reported an increase.
Title X revenue (row 1)—All Regions—Title X revenue includes 2017 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 26 states:

▪
▪
▪
▪
▪
▪
▪
▪
▪
▪

Region I—Connecticut, Maine, New Hampshire, and Rhode Island
Region II—New York
Region III—Maryland, Pennsylvania, and Virginia
Region IV—Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina
Region V—Indiana, Minnesota, and Wisconsin
Region VI—Louisiana, New Mexico, and Oklahoma
Region VII—Iowa
Region VIII—Montana and Wyoming
Region IX—California
Region X—Oregon and Washington

Other revenue (rows 12 through 16)—All Regions—An illustrative list of “other” revenue
sources reported in rows 12 through 16 includes the following: 340B Drug Discounting
Program; agency or applicant contribution/funds; bad debt; Breast and Cervical Cancer Early
Detection Program; Breast and Cervical Cancer Program; Breast, Cervical, and Colon Health
Program; cash; client contributions/donations; Community Service Block Grant; consultation
fees; contraceptives; contractual services; DC Campaign Teen Pregnancy Prevention Fund;
donations (foundation, individual, client, and other); Early Detection Works Program; earned
and special funds; earned interest; education and training fees; Every Woman Matters;
Farmworker Program; Foundation (private and corporate) grants and other funding; FPNTC
travel support; Health Safety Net; Healthy Woman Breast and Cervical Cancer Program; HIV
testing funds/grant; HRSA Ryan White; Individual donations/contributions; Insurance
Exchange; interest; Meaningful Use payment/incentive; Migrant Worker Program; mileage;
Net Assets Released From Restrictions; other federal grant (HRSA Ryan White or STD);
Personal Responsibility Education Program; Preventive Health and Health Service Block
Grant; Public Health Screening Program for low-income and at-risk individual under 40;
refunds (worker’s compensation, vendor); rental income; restricted donations and grants
(various sources); revenue recovery; School Based Health Center; Set-Off Program; St. James
Physician Hospital Organization; state and federal STD funding; subrecipients (contributions,
reimbursements, and unspecified); supplies; Tobacco Settlement; travel reimbursement;
UNFPA; United Way; university grants; and Yavapai County Investment Pool earned
interest.

Family Planning Annual Report: 2017 National Summary

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Office of Population Affairs
Office of the Assistant Secretary for Health
U.S. Department of Health and Human Services
1101 Wootton Parkway, Suite 700
Rockville, MD 20852
www.hhs.gov/opa


File Typeapplication/pdf
File TitleFamily Planning Annual Report: 2017 National Summary
SubjectTitle X, Office of Population Affairs, FPAR, Family Planning Annual Report, family planning, family planning services, contracep
AuthorHHS/OPA
File Modified2018-08-27
File Created2018-08-06

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