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It's been more than 50 years since Congress created a federal family planning program

STEVE INSKEEP, HOST:

Many Americans get health care like contraceptives and cervical cancer screenings with the help of federal funds. The money comes thanks to a law passed by Congress more than 50 years ago known as Title X. It is not money for abortion, but it's increasingly caught up in the politics of abortion. Here's Ben Paviour from member station VPM.

BEN PAVIOUR, BYLINE: Rhea Beddoe hadn't been expecting the call from her doctor's office. She'd been laid off from her job and had other worries. But the doctor said this was important. She'd had a procedure to remove pre-cancerous cells and now needed a follow-up appointment. She asked how much it would cost without insurance.

RHEA BEDDOE: And they said, oh, a visit would be $300. And I definitely did not have 300 extra dollars laying around.

PAVIOUR: Her local Planned Parenthood in New York was less expensive, so Beddoe went there instead. She got a pap smear that showed no signs of cancer.

BEDDOE: It was such a relief that I was able to get that care that I needed when I was uninsured and unemployed.

PAVIOUR: The pap smear cost less because it was funded by Title X, a federal program designed to help those who are financially strapped. Title X-funded clinics are often a first stop for reproductive health care for people like Beddoe.

BEDDOE: I continue to get services from Planned Parenthood for my regular checkups, for birth control.

PAVIOUR: Those Title X services aren't available everywhere. Congress hasn't increased funding in nearly a decade, and more health care providers are now competing for a share of that money. Some lose out. This year, clinics in California, Nevada and Virginia scaled back services. Claire Coleman heads the National Family Planning & Reproductive Health Association, which advocates on behalf of Title X-funded providers.

CLARE COLEMAN: We still have the problem that we've never had enough resources to be able to meet need.

PAVIOUR: When the program was created in 1970, it had bipartisan support. But over the years, the debate over abortion has made it more difficult for Congress to agree on more funding. And then in 2019, the Trump administration banned Title X providers from providing or referring patients for abortion. In response, around 25% of clinics decided to withdraw from Title X or stopped getting funding. Coleman says there was an immediate impact.

COLEMAN: Then the number of people being served in a Title X-funded setting just dropped like a stone.

PAVIOUR: Trump's rules were popular among anti-abortion activists. Olivia Gans Turner heads American Victims of Abortion.

OLIVIA GANS TURNER: What we wanted to prevent was the funding of organizations or programs that were also promoting or practicing abortion.

PAVIOUR: Title X doesn't actually fund abortions, but Turner believes groups that offer abortion services shouldn't get any federal money, even if it's intended to pay for other types of care, like birth control.

GANS TURNER: You could say, well, one doesn't go to the other, except that if I give you the money to pay the rent, you've got a lot more money to go to the movies this week, don't you?

PAVIOUR: The Biden administration disagreed and rolled back Trump's rules last year. Then came June's Supreme Court verdict. With restrictions on abortion access, Coleman thinks demand for birth control could increase. That's another reason advocates say Title X needs more funding now. Coleman also believes the right to contraception itself is at risk. Justice Clarence Thomas said in his opinion the court should reconsider its past rulings related to birth control. Coleman says it's worth taking him seriously.

COLEMAN: We need to stop questioning whether or not this is possible. This is clearly possible.

PAVIOUR: Sensing the urgency, some Democrats in Congress have proposed sharp increases in funding for Title X. But Coleman says, given Republican opposition, it's going to be a fight.

For NPR News, I'm Ben Paviour in Richmond, Va. Transcript provided by NPR, Copyright NPR.

Ben Paviour