Abstract
Family planning clinics provide a critical source of health care needs for millions of Americans every year. However federal funding for family planning under Title X has waned and alternative funding streams have become increasingly unreliable in recent decades. -Political and legislative attempts at restricting funding for specific services or to certain family planning providers has forced some clinics to spend more resources on protecting services and clients' access and limited their ability to expand and ensure affordable services. Six Planned Parenthood Affiliates covering twelve states participated in the qualitative project. These states had broad and obvious differences in their state policies related to funding and service mandates or restrictions. Respondents were asked a total of 80 qualitative questions ranging from sources of funding, services provided, services at risk, abortion services, public support, and political environment. The data was then organized by thematic trends related to funding availability, policy impacts, and other challenges affiliates were facing. The interrelationship between funding and policy was readily apparent in respondent answers. States which had more established family planning funds and service requirements had significantly more clinics, served more clients, and expanded services to a greater degree than those states which faced more restrictions in funding and services. Absent significant state funding, the shift from funding family planning services through Title X to an increased reliance on Medicaid dollars had limited the number of people qualified for subsidized services and made it more difficult for clinics to keep up with increased health care costs and new technologies. Advocacy and legislative involvement had increased for all affiliates as well as a shift in messaging to highlight the significant amount of preventative services that clinics provide.