Restrictions on Abortion and Lobbying Activities in Family Planning Programs Need Clarification

HRD-82-106: Published: Sep 24, 1982. Publicly Released: Sep 24, 1982.

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In response to a congressional request, GAO reviewed the family planning program authorized by title X of the Public Health Service Act to determine whether title X funds have been used to finance lobbying activities or to support abortion-related activities.

GAO found no evidence that title X funds have been used either for abortions or to advise clients to have abortions. The Department of Health and Human Services (HHS) has held that these restrictions on the use of funds are applicable only to that part of a recipient's operation which is supported by title X. Title X recipients are allowed to carry out abortion-related activities if those activities are separate from the title X family planning services. This creates some public confusion on the matter. Congressional guidance may be needed if Congress does not want title X funds to go to organizations which provide abortions. However, family planning clinics need formal guidance on abortion-related matters. GAO found some variations in clinic practices that it believed were questionable, such as: (1) counseling practices which do not present alternatives to abortion; (2) abortion referral practices which may go beyond HHS referral policy; and (3) the use of educational materials which present barrier methods of contraception together with early abortion as a method of family planning in the event of failure. Title X recipients also need more specific guidance on lobbying activities. All of the recipients which GAO reviewed had incurred expenses that raised questions regarding adherence to federal restrictions. The organizations used program funds to pay dues to lobbying organizations and, in two cases, used small amounts of program funds to lobby themselves. To establish more specific guidance on lobbying, HHS has initiated action to amend the cost principles for grantees.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: GAO thought Congress might address this recommendation during 1985 when it considered reauthorizing the title X family planning program. However, no reauthorization hearings are currently planned. Since over 3 years have passed and no action has been taken, or planned, this recommendation should be closed. This was included in the 1984 GAO Annual Report.

    Matter: Congress should consider providing guidance to HHS to clarify the intent of section 1008 if it does not want title X funds to go to organizations providing abortions.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Although HHS has not incorporated guidance into title X regulations, it has completed several actions which have provided the recommended guidance through HHS General Counsel opinions and HHS regional offices. HHS urged grantees to voluntarily separate family planning and abortion activities and directed regional health officials to approve the use of title X funds.

    Recommendation: The Secretary, HHS, should establish clear operational guidance by incorporating into the title X program regulations and guidelines of the HHS position on the scope of the restriction in section 1008. In doing so, the Secretary should provide as explicit guidance as possible on the activities that are not allowed.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: On May 29, 1984, OMB Circular A-122 became effective. This Circular contained regulations on lobbying activities which cannot be performed with title X funds.

    Recommendation: The Secretary, HHS, should provide interim guidance to title X recipients on activities that constitute lobbying and are unallowable as title X program expenditures.

    Agency Affected: Department of Health and Human Services

 

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