Dryfoos J G
Fam Plann Perspect. 1988 Nov-Dec;20(6):282-7.
During the 1960s, as demand for effective contraceptives increased and women expressed a desire for smaller families, an "odd lot" of groups came together to press for federally supported family planning services for low-income women. The drive culminated in 1970 with the passage of Title X of the Public Health Service Act, which authorized the funds that fed a network of family planning clinics. At the height of the national family planning program, approximately 2,500 agencies were operating clinics at more than 5,000 sites, providing services annually to almost five million patients. As part of the screening for medical methods of birth control, family planning clinics have provided basic physical examinations and related tests to millions of low-income women and teenagers who might not otherwise have had access to those services. Clinics have also been heavily utilized for pregnancy tests, screening for sexually transmitted diseases (STDs), infertility screening and referral for abortion, adoption and sterilization services. Other desired achievements have been more elusive and difficult to document--reductions in the number of high-risk and unintended pregnancies and in poverty rates, for example. The program's role in providing contraceptive services to teenagers and its involvement in the abortion controversy have led to a number of political, legislative and judicial skirmishes with conservatives, Congress and the Reagan administration. Funding for Title X declined during the 1980s and is now surpassed by Medicaid as the largest source of family planning dollars. Diminishing funds at a time when some expenses--for supplies, malpractice insurance and treatment of STDs, for example--are increasing have resulted in fewer clinic sites and other service cutbacks. The suggestion has been made that it is time to eliminate categorical funds for family planning and integrate all services into the general medical care system. Family planning providers say an integrated arrangement would not meet the needs of much of their patient population and would not provide the special attention they feel is needed for successful contraceptive practice among low-income, high-risk women. Instead, they suggest expanding the scope of services in family planning clinics, out of an awareness that the continuing high prevalence of unintended childbearing, among the young and disadvantaged in particular, is part of a larger problem of living in a desolate social environment.
20世纪60年代，随着对有效避孕措施的需求增加，以及女性希望家庭规模更小，一群“杂牌军”联合起来，施压要求为低收入女性提供联邦支持的计划生育服务。这一推动在1970年达到高潮，当时《公共卫生服务法》第十章获得通过，该章授权拨款用于资助一个计划生育诊所网络。在国家计划生育项目的鼎盛时期，大约有2500个机构在5000多个地点运营诊所，每年为近500万患者提供服务。作为节育医疗方法筛查的一部分，计划生育诊所为数百万低收入女性和青少年提供了基本体检及相关检测，否则这些人可能无法获得这些服务。诊所还被大量用于妊娠检测、性传播疾病（STD）筛查、不孕症筛查以及堕胎、领养和绝育服务的转诊。其他期望达成的成果则更难实现且难以记录——例如，降低高危妊娠和意外怀孕的数量以及贫困率。该项目在为青少年提供避孕服务方面所起的作用及其在堕胎争议中的参与，导致了与保守派、国会和里根政府的一系列政治、立法和司法冲突。20世纪80年代，第十章的资金有所减少，如今医疗补助计划已超过它，成为计划生育资金的最大来源。在一些费用（例如用品、医疗事故保险和性传播疾病治疗费用）不断增加的情况下，资金减少导致诊所地点减少以及其他服务缩减。有人建议，是时候取消计划生育的专项资金，将所有服务纳入普通医疗体系了。计划生育服务提供者表示，综合安排无法满足他们许多患者的需求，也无法提供他们认为低收入、高危女性成功避孕所需的特别关注。相反，他们建议扩大计划生育诊所的服务范围，因为他们意识到意外生育持续高发，尤其是在年轻人和弱势群体中，这是生活在荒凉社会环境这一更大问题的一部分。
