Compton Sarah D, Pangori Andrea, Widner Audrey, Davis-Wilson Kamilah, Wallett Sarah, Dalton Vanessa K
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor.
Planned Parenthood of Michigan, Ann Arbor.
JAMA Netw Open. 2025 Jul 1;8(7):e2522203. doi: 10.1001/jamanetworkopen.2025.22203.
The Title X Family Planning Program is a US federal grant program designed to offer comprehensive and confidential family planning and preventive health services to individuals in the US, regardless of their ability to pay. In 2019, a major change to the program-called the Final Rule-led to about 25% of participating clinics, including all Planned Parenthood affiliates, leaving the Title X program. Because Planned Parenthood of Michigan (PPMI) had served about 70% of Michigan's Title X clients, its withdrawal from Michigan's Title X program was anticipated to significantly alter the service coverage provided by the Title X program in the state.
To examine the changes in geographic distribution, organizational profiles, and service delivery volumes of Title X health centers in Michigan-including those that left the program and then rejoined-before and after the implementation of the Final Rule.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included Title X-funded health centers in Michigan's 83 counties from January 1, 2017, to December 31, 2023.
The enactment and reversal of the Title X Final Rule.
Changes in service delivery volume, seen in (1) Title X penetration rate (number of unique females served at Title X-funded health centers), (2) PPMI penetration rate (number of unique females served by PPMI), and (3) reproductive health safety net penetration rate (sum of the females served by the Title X program and PPMI during the years it was excluded from Title X).
Title X service delivery counts decreased from 92 clinics before the implementation of the Final Rule in 2019 to 76 clinics during the Final Rule and increased to 92 after reversal of the Final Rule. Penetration rates were significantly higher before implementation of the Final Rule (incidence rate ratio [IRR], 3.98; 95% CI, 3.93-4.02) and after the Final Rule period (IRR, 2.96; 95% CI, 2.93-3.00). However, when PPMI service counts were included during the Final Rule period when PPMI was not formally part of Title X, there was considerably more stability in service delivery rates across the 3 periods (preperiod vs Final Rule period: IRR, 1.33; 95% CI 1.32-1.34; and postperiod vs Final Rule period: IRR, 0.99; 95% CI, 0.98-1.00). The mean PPMI penetration rate was only 1.41 times higher in the preperiod than in the Final Rule period (IRR, 1.41; 95% CI, 1.40-1.43).
This cohort study highlights PPMI's role in the state's Title X program and overall reproductive health safety net. During the relatively short time the Final Rule was in place, PPMI was able to maintain service delivery, protecting the public's health against these regulations. It is not clear if PPMI, or similar organizations, could maintain service delivery over a longer period.
第十条计划生育项目是一项美国联邦拨款项目，旨在为美国个人提供全面且保密的计划生育及预防性健康服务，无论其支付能力如何。2019年，该项目的一项重大变更——即“最终规则”——导致约25%的参与诊所（包括所有计划生育联合会分支机构）退出第十条项目。由于密歇根州计划生育组织（PPMI）服务了密歇根州约70%的第十条项目客户，预计其退出密歇根州的第十条项目将显著改变该州第十条项目所提供的服务覆盖范围。
研究在“最终规则”实施前后，密歇根州第十条健康中心（包括那些退出项目后又重新加入的中心）在地理分布、组织概况和服务提供量方面的变化。
设计、背景和参与者：这项队列研究纳入了2017年1月1日至2023年12月31日期间密歇根州83个县中由第十条项目资助的健康中心。
第十条“最终规则”的颁布与撤销。
服务提供量的变化，体现在（1）第十条渗透率（在第十条项目资助的健康中心接受服务的独特女性数量）、（2）PPMI渗透率（由PPMI服务的独特女性数量）以及（3）生殖健康安全网渗透率（在第十条项目排除PPMI的那些年份里，由第十条项目和PPMI服务的女性总数）。
第十条项目的服务提供诊所数量从2019年“最终规则”实施前的92家减少至“最终规则”实施期间的76家，在“最终规则”撤销后又增加到92家。渗透率在“最终规则”实施前（发病率比值[IRR]，3.98；95%置信区间，3.93 - 4.02）和“最终规则”实施后（IRR，2.96；95%置信区间，2.93 - 3.00）显著更高。然而，当在“最终规则”期间将PPMI的服务数量纳入（此时PPMI并非第十条项目的正式组成部分）时，三个时期的服务提供率有了相当大的稳定性（前期与“最终规则”时期：IRR，1.33；95%置信区间1.32 - 1.34；后期与“最终规则”时期：IRR，0.99；95%置信区间，0.98 - 1.00）。前期的平均PPMI渗透率仅比“最终规则”时期高1.41倍（IRR，1.41；95%置信区间，1.40 - 1.43）。
这项队列研究凸显了PPMI在该州第十条项目及整体生殖健康安全网中的作用。在“最终规则 ”实施的相对短时间内，PPMI能够维持服务提供，保护公众健康免受这些规定的影响。目前尚不清楚PPMI或类似组织能否在更长时期内维持服务提供。
