About 1.6 million abortions were performed in this country in 1985, but only 484 were financed by general federal health and welfare programs. As far as is known, not a single abortion was financed with funds from the $142.5 million-a-year federal Family Planning Program.
Nevertheless, the program has again become the center of a bitter and envenomed struggle over abortion, which on Tuesday resulted in a regulation, written at the express order of President Reagan, proposing a drastic revision of longstanding program rules.
In past years, the abortion issue has led to repeated squabbles over reauthorization of the program, which is now operating under emergency funding, and blowups between the White House and the Department of Health and Human Services on the grounds that HHS was not moving fast enough to expunge abortion-related activities from the program.
Federal law permits HHS funding for abortion only if the pregnancy endangers the life of the woman, an extremely rare situation.
The 1970 law creating the Family Planning Program, Title X of the Public Health Service Act, authorized federal aid to family planning clinics for contraception, infertility and other such services to low-income and other women. But the law explicitly forbade abortion as a method of family planning and prohibited the use of program funds to perform or advocate abortion.
The current struggle over Title X represents the latest sortie in a wide range of efforts by organizations such as the National Right to Life Committee and the American Life League to turn the tide against abortion.
In the past decade antiabortion groups succeeded in winning adoption of amendments sponsored by Rep. Henry J. Hyde (R-Ill.) and others to bar the use of virtually all federal funds under Medicaid, federal employe health insurance policies and other federal programs from being used to fund abortions directly. Now such groups are turning to programs that they contend indirectly fund abortion.
At issue is a rule that has been in effect since the start of the Family Planning Program and that was spelled out specifically in progam guidelines developed during the Carter administration.
That rule specifies that while a federally funded clinic cannot advise a pregnant woman to have an abortion nor fund an abortion for her, it must inform her in a "nondirective" manner that her options include keeping the baby, putting it up for adoption or having an abortion. If she requests it, the clinic must provide her with a list of abortion facilities operating outside Title X.
HHS, at the president's direction, now proposes to rescind this rule, forbidding federally funded clinics from informing a pregnant woman of options or from providing her with a list of abortion clinics. Instead, it would tell her to seek medical advice outside the program.
Moreover, to answer the charge that some organizations use the same offices to carry on family planning activities (financed with federal funds) and to perform abortions (paid for with nonfederal funds), the two activities would have to be kept separated physically, meaning different offices.
Douglas Johnson, legislative director of the National Right to Life Committee, which strongly favors the proposed change, has called the existing options-counseling and referral system a "giant funnel" to channel pregnant women to abortion clinics, particularly to Planned Parenthood, the single largest private provider of family planning services.
David O'Steen, executive director of NRLC, said the Carter counseling and referral requirement was contrary to the original intent of the law.
Planned Parenthood groups, using nonfederal funds, perform about 90,000 abortions yearly. NRLC officials contend that in many cases the women have been referred to the nonfederal abortion clinics from the Title X clinics also run by Planned Parenthood.
"The practical effect of the past practice -- requiring options-counseling and referral -- is simply to treat abortion as another method of birth control," Johnson said.
He said the proposed change will remove a powerful pro-abortion bias from the program's structure.
But Planned Parenthood, the National Family Planning and Reproductive Health Association and the National Abortion Rights Action League strongly disagree with that analysis, and are threatening to go to court to block the changes. They say that abortion is legal in the United States and that it is ethically unacceptable not to inform a woman of her options.
"We do not believe the physician should be restricted from giving the woman the best medical advice on her options at the time of the examination, so that she knows all the options available to her," said Laurie Hall of the American College of Obstetricians and Gynecologists.
Dr. Harry Jonas, immediate past president of the organization, told Congress recently, "A prohibition on the content of counseling between the patient and her physician is contrary to medical standards, and severely erodes the patients' right to . . . decide what medical care they wish to receive."
Planned Parenthood President Faye Wattleton said, "Obviously we're outraged by these regulations. To say this is a funnel to abortion is based on no evidence. There is no evidence that these funds are being used indirectly or directly to support abortion.
"The General Accounting Office and the inspector general of HHS have studied such charges and said there is no evidence," Wattleton said.
In an era when teen-age pregnancy and heavy welfare costs for families are major social and political concerns, the dispute over Title X is more than a Washington policy battle.
While most women in the United States, according to the Alan Guttmacher Institute, a research associate of Planned Parenthood, pay for their own contraception and medical advice privately or through their health insurance, the Title X program is one of the major providers of such information and assistance to low-income women.
Title X provides about a third of all public funding for contraceptive programs. The rest of the money is provided by the states, Medicaid -- which does not make grants for public clinics but pays fees for individual Medicaid patients using private doctors or public clinics -- and several other smaller federal programs.
According to program figures, about 4,500 clinics receive some or all of their funding from Title X. The clinics serve about 4.3 million patients a year, with five-sixths classified as low income. State and local health departments get the bulk of the grants, then channel part of the money to local health clinics.
The Planned Parenthood Federation of America and its affiliates are estimated to receive about $30 million of the Title X money, or about a quarter of the money that goes out in grants for local services.
A great deal of the Title X money, plus Medicaid payments to clinics for the treatment of Medicaid patients, ends up in the hands of hospitals and local state and county clincs or free-standing community-organization clinics.
In the District, for example, the Metropolitan Washington Council of Governments is the actual recipient of the federal money, but then, a spokesman said, hands it over to six different clinical groups, run by Children's Hospital, Providence Hospital (which focuses on natural methods of contraception), the East of the River Health Association, National Health Plan Inc., the Washington Free Clinic and Planned Parenthood.
Such funding splits are reasonably typical of what happens nationwide. According to Sen. Edward M. Kennedy (D-Mass.) in a June 16 statement introducing legislation to reauthorize Title X, state and local health department clinics serve about 40 percent of the people handled by facilities that get Title X funds, Planned Parenthood clinics 27 percent, hospitals 13 percent, and other nonprofit centers the rest.
In a typical clinic, such as Planned Parenthood's here, the full fee for a first visit can run $46 but low-income women pay less or nothing. The visit includes a gynecological examination, Pap test, blood work and disease screening. Contraceptive pills and devices are also available.
"For most of these women, the clinic is the only health-care provider they have," said Kate Michelman of the National Abortion Rights Action League.
A particular sore point with antiabortion groups is the size and power of the Planned Parenthood Federation of America, whose affiliates run 750 clinics, most of which get some Title X funds. The total federation budget for domestic clinic operations is about $230 million a year, with an eighth of that coming from Title X.
The current dispute over Title X is almost certainly headed for the courts, and both sides are watching the upcoming battle over Judge Robert H. Bork's nomination to the Supreme Court for clues to the future.
"The question is whether abortion is going to be regarded as just another means of birth control," said Johnson of the National Right to Life Committee.
"The money we get is really not the issue," said Wattleton of Planned Parenthood. "We're not going to agree to collusion with the government against poor women and teen-agers for whom Title X is the main source of services and information."