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  • Title: Restructuring federalism: the effects of decentralized federal policy on states' responsiveness to family planning needs.
    Author: McFarlane DR.
    Journal: Women Health; 1992; 19(1):43-63. PubMed ID: 1475995.
    Abstract:
    The Reagan Administration sought to decentralize many federal programs by (1) consolidating categorical grants into black grants; (2) reducing their funding; and (3) relying more upon state fiscal support. This study examines the effects of this decentralist policy upon the federal family planning program. Two periods are analyzed: (1) FY 1976-1981, the period immediately prior to the Reagan Administration and (2) FY 1982-1987, the period during the Reagan Administration. Findings show that a more decentralized program produced less responsiveness to individual state needs for family planning, and that these effects could have been predicted from the previous period. Restructuring of federal responsibility to emphasize state's rights has had consequences for the structure and composition of family planning programs in the US. The Reagan administration consolidated categorical grants into block grants, reduced federal funding, and encouraged state support of preexisting programs. An examination of decentralization effects is made for several periods: fiscal year 1976-81 and 1982-87. The policy history of federal support for family planning services is traced from the early 1960s and the War on Poverty through the efforts of the Office of Economic Opportunity, Title V of the Social Security Act (Maternal and Child Health), Title X of the Public Health Services Act (Family Planning Services and Population Research), Title XIX of the Social Security Act (Medicaid), and Title XX of the Social Security Act (Social Services Block Grant). The policy goal was to make states more responsive to needs. Hypotheses are tested for whether block grants were more responsive to states' FP needs and whether states versus the federal government were more responsive. Data is provided on the expenditures for FP per woman at risk of unplanned pregnancy flow- income, sexually active, fecund women). The measure reflected both he responsiveness to needs within the state and the need for publicly subsidized FP services. The findings showed that the coefficients of variation for Titles V and XX were not less than those for Titles X and XIX, but larger. It was expected that annual coefficients of variation would be less for state appropriations for Titles V, X, XIX, and XX but the actual results were larger between 1976-81, and Title V and XX together were more than Titles X and XIX; Titles V, XX, and XIX were more than Title X. Similar results were found for the period 1982-87. Block grants and state appropriations were found to be less responsive to FP needs before the Reagan Presidency and the blocking of Title X and capping of Title XIX continued the trend. State expression of diverse values and political traditions really meant responsiveness to political preferences and business interests. Little thought was given to the problem that responsiveness to state social needs is dependent on state resources. Equitable state spending did not materialize; the number of unwanted births increased, particularly for women below the poverty level.
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