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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
To characterize the effect of the final rule, the Departments compares the policy scenario forecast to the baseline forecast described in the previous section. Table D5 reports the difference between these two scenarios, which
represents the net effect of the proposed rule. For example, in year one after this rule is effective, the number of clients served would increase by approximately 736,000 as compared to the baseline scenario. Approximately 88 percent of
clients served in 2016 to 2018 are female, and the Department uses this percentage to estimate the increase in clients served by sex under the policy scenario.

TABLE D5EFFECT OF THE PROPOSED RULE ON TITLE X SERVICES
Year
2022

Increase in Grantees
Increase in Subrecipients
Increase in Service Sites
Increase in Clients Served
Female
Male

Clients served under the Title X
program experience outcomes that include reducing unintended pregnancy through greater access to contraception.
The averted unintended pregnancies translate to a reduction in unplanned births, a reduction in abortions, and reduction in miscarriages. Also, Title X
clients receive cancer screenings and testing for STIs. These screenings and testing can identify treatable conditions, improving the quality of life and extending the lives of beneficiaries. In the case of STIs, additional testing and corresponding earlier treatment can reduce the likelihood of worse health outcomes and future infertility resulting from those infections. This final rule will expand service to socioeconomically disadvantaged populations, most of whom are female,
9 123
436
735,892
648,996
86,896

2023

2024

2025

2026

18
245
872
1,471,783
1,297,992
173,791

18
245
872
1,471,783
1,297,992
173,791

18
245
872
1,471,783
1,297,992
173,791

18
245
872
1,471,783
1,297,992
173,791

low-income, and young. The Department discusses this in greater detail in the Section on Distributional Effects.
To further explore the likely effect of the Title X program on unintended pregnancy, we rely on existing methodology for estimating number of unintended pregnancies prevented each year among U.S. women who depend on publicly funded family planning services.16 Among this subgroup of women who use any method of contraception, 46 in 1,000 women are expected to experience an unintended pregnancy. This figure can be compared to 296 unintended pregnancies per 1,000 women who are unable to access publicly funded family planning services. The Department applies this estimate of a reduction of 250
unintended pregnancies per 1,000

contraception clients to the number of additional female clients served under the Title X program who adopt any method of contraception.
For year one, the analysis reflects multiplying 735,892 clients by 88
percent to yield 648,996 female clients.
Among female clients, approximately 14
percent indicate they are not using a method of contraception, according to figures in the 2019 Title X Family Planning Annual Report. The analysis reduces the potential number of clients that would potentially reduce the likelihood of an unintended pregnancy by 14 percent to yield 558,205 clients expected to benefit from a contraceptive method. Approximately 47 percent of unintended pregnancies result in births, 34 percent in abortion, and 19 percent in a miscarriage.17

TABLE D6EFFECT OF THE PROPOSED RULE ON TITLE X-ASSOCIATED CONTRACEPTION
Year
2022

lotter on DSK11XQN23PROD with RULES3

Clients Served
Women Served
Women Served Using Contraception

735,892
648,996
558,205

2023

2024

2025

2026

1,471,783
1,297,992
1,116,411

1,471,783
1,297,992
1,116,411

1,471,783
1,297,992
1,116,411

1,471,783
1,297,992
1,116,411

Unintended pregnancies increase the risk for poor maternal and infant outcomes. Women who give birth following an unintended pregnancy are less likely to have benefitted from preconception care, to have optimal spacing between births, and to have been aware of their pregnancy early on, which in turn makes it less likely that
they would have received prenatal care early in pregnancy.18 19
Title X funding recipients also perform preventive health services such as cervical and breast cancer screening, and testing for STIs, including chlamydia, gonorrhea, syphilis, and HIV. Table D7 presents the effect of the final rule on Title X-associated cervical and breast cancer screenings. These
figures are calculated by multiplying the number of additional women served by the program in each year by approximately 23 percent for clinical breast exams, of which five percent result in a referral for further evaluation;
and 20 percent for Pap testing, of which 13 percent with a result of atypical squamous cells ASC that require further evaluation and possibly
16 Jennifer J. Frost and Lawrence B. Finer 2017.
Memo entitled Unintended pregnancies prevented by publicly funded family planning services:
Summary of results and estimation formula.
https www.guttmacher.org/sites/default/files/
pdfs/pubs/Guttmacher-Memo-on-Estimation-ofUnintended-Pregnancies-Prevented-June-2017.pdf.
Accessed on March 14, 2021.

17 Jennifer J. Frost, Lori F. Frohwirth, Nakeisha Blades, Mia R. Zolna, Ayana Douglas-Hall, and Jonathan Bearak 2017. Publicly Funded Contraceptive Services at U.S. Clinics, 2015.
https www.guttmacher.org/sites/default/files/
report_pdf/publicly_funded_contraceptive_
services_2015_3.pdf. Accessed on March 14, 2021.
18 Jessica D. Gipson, Michael A. Koenig, and Michelle J. Hindin. The Effects of Unintended
Pregnancy on Infant, Child, and Parental Health: A
Review of the Literature. Studies in family planning 39.1 2008: 1838. Web.
19 Power to Decide. Maternal and Infant Health and the Benefits of Birth Control in America.
Accessed on March 8, 2020 from https powerto decide.org/sites/default/files/resources/supportingmaterials/getting-the-facts-straight-chapter-3maternal-infant-health.pdf.

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