February 2008

Family Planning Annual Report:

2006 National Summary

Prepared for

Office of Family Planning
Office of Population Affairs
Office of Public Health and Science
U.S. Department of Health and Human Services
1101 Wootton Parkway, Suite 700
Rockville, MD 20852

Prepared by

RTI International*
3040 Cornwallis Road
P.O. Box 12194
Research Triangle Park, NC 27709

*RTI International is a trade name of Research Triangle Institute

SUGGESTED CITATION

Fowler, CI, Gable, J, and Wang, J. (February 2008). Family Planning Annual Report: 2006 National Summary. Research Triangle Park, NC: RTI International.

ADDITIONAL COPIES

This report can be viewed, downloaded, or printed from the Office of Population Affairs/Office of Family Planning Web site at http://www.hhs.gov/opa/familyplanning/toolsdocs/index.html.

ACKNOWLEDGMENTS

This report was prepared at RTI International by Christina Fowler (Reproductive Health Researcher), Julia Gable (Statistician), and Jiantong Wang (Statistician). Jennifer Drolet and Laura Small edited the report; Cathy Boykin provided document preparation support; and Teresa Bass, Cassandra Carter, and Pam Prevatt converted the report for the Web.

The authors wish to thank U.S. Department of Health and Human Services (HHS) staff members Susan Moskosky (Director, Office of Family Planning) and Evelyn Glass (FPAR Data Coordinator) for their assistance with resolution of data validation issues and review of the final report. We also thank Brad Hendrick (Senior Policy Analyst) for his assistance with the electronic data files.

RTI prepared this report under Office of Population Affairs (OPA) contract number 233020090. The conclusions expressed in this report are those of the authors and do not necessarily represent the views of HHS or the Office of Population Affairs/Office of Family Planning.

1. Introduction
     Title X National Family Planning Program
     Family Planning Annual Report (FPAR)
     Report Structure

2. FPAR Methodology
     Data Collection
     Data Reporting
     Data Validation

3. Findings
     Grantee Profile
     Family Planning User Demographic Profile
          Total Users (Exhibit 3)
          Users by Gender (Exhibits 4 and 5)
          Users by Age (Exhibits 4 and 5)
          Users by Race (Exhibits 6 to 14)
          Users by Ethnicity (Exhibits 6 to 14)
     Family Planning User Social and Economic Profile
          Users by Income Level (Exhibit 15)
          Users by Insurance Coverage Status (Exhibit 16)
          Limited English Proficient (LEP) Users (Exhibit 17)
     Family Planning Method Use
          Female Users by Primary Contraceptive Method (Exhibits 18 to 21)
          Male Users by Primary Contraceptive Method (Exhibits 22 to 25)
     Cervical and Breast Cancer Screening Activities
          Cervical Cancer Screening Activities (Exhibit 26)
          Breast Cancer Screening Activities (Exhibit 26)
     Sexually Transmitted Disease (STD) Screening
          Chlamydia Testing (Exhibits 27 and 28)
          Gonorrhea and Syphilis Testing (Exhibit 29)
          HIV Testing (Exhibit 29)
     Staffing and Family Planning Encounters (Exhibit 30)
     Revenue (Exhibits 31 to 33)
          Medicaid
          Title X
          State and Local Government
          Client Payment for Services
          Private Third-Party Payers
          Other Revenue Sources

4. References

5. Appendixes
     A. Trend Tables
     B. State Tables
     C. Methodological Notes

EXHIBITS

1. Introduction

Title X NATIONAL FAMILY PLANNING PROGRAM

The National Family Planning Program, created in 1970 and authorized under Title X of the Public Health Service Act,¹ is administered within the Office of Population Affairs (OPA) by the Office of Family Planning (OFP). The Title X program is the only federal program dedicated solely to the provision of family planning and related, preventive, health care. The program is designed to provide contraceptive supplies and information to all who want and need them, with priority given to low-income persons. Title X-funded agencies offer a broad range of effective and acceptable contraceptive methods on a voluntary and confidential basis. Title X funds also support the delivery of related, preventive, health services, including patient education and counseling; cervical and breast cancer screening; sexually transmitted disease (STD) and HIV prevention, education, testing, and referral; and pregnancy diagnosis and counseling. By law, Title X funds may not be used in programs where abortion is a method of family planning.² For many clients, Title X clinics provide the only continuing source of health care and health education. In fiscal year 2006, the program received $283.1 million in funding.³

OPA allocates Title X service funds to U.S. Department of Health and Human Services (HHS) offices in 10 regions, shown in Exhibit 1. Each regional office manages the competitive review of Title X grant applications, makes grant awards, and monitors program performance for its respective region.

Exhibit 1. U.S. Department of Health and Human Services (HHS) regions

Exhibit 1

Note: The 10 HHS regions (and regional office locations) are as follows:
Region I (Boston, MA) – Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.
Region II (New York, NY) – New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands.
Region III (Philadelphia, PA) – Delaware, Washington, D.C., Maryland, Pennsylvania, Virginia, and West Virginia.
Region IV (Atlanta, GA) – Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
Region V (Chicago, IL) – Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.
Region VI (Dallas, TX) – Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.
Region VII (Kansas City, MO) – Iowa, Kansas, Missouri, and Nebraska.
Region VIII (Denver, CO) – Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.
Region IX (San Francisco, CA) – Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands, and Republic of Palau.
Region X (Seattle, WA) – Alaska, Idaho, Oregon, and Washington.

FAMILY PLANNING ANNUAL REPORT (FPAR)

The Family Planning Annual Report (FPAR) is the only source of annual, uniform reporting by all Title X service grantees. The FPAR provides consistent, national-level data on program users; service providers; utilization of family planning and related, preventive, health services; and sources of Title X and other program revenue. Annual submission of the FPAR is required of all Title X service grantees for purposes of monitoring and reporting program performance.^{4, 5} The FPAR data are reported and presented in summary form to protect the confidentiality of the persons that receive Title X-funded services.⁶

Title X administrators and grantees use FPAR data to

monitor program performance and compliance with statutory requirements;
comply with accountability and federal performance requirements for Title X family planning funds, as required by the 1993 Government Performance and Results Act and the Office of Management and Budget's (OMB's) Program Assessment Rating Tool;
guide strategic and financial planning and respond to inquiries from policy makers and Congress about the program; and
estimate the impact of Title X-funded activities on key reproductive health outcomes, including prevention of unintended pregnancy, infertility, and invasive cervical cancer.

REPORT STRUCTURE

The Family Planning Annual Report: 2006 National Summary presents data for the 88 Title X service grantees that submitted reports for the 2006 reporting period. It has five sections:

Section 1—Introduction—describes the Title X National Family Planning Program and the role of FPAR data in Title X program management and performance reporting.

Section 2—FPAR Methodology—describes the procedures for collecting, reporting, and validating FPAR data, and presents the definitions for key FPAR terms.

Section 3—Findings—presents the results for each FPAR table, and includes a discussion of national and regional patterns and trends (1999–2006) for selected indicators. Section 3 also presents definitions for table-specific FPAR terms and reporting instructions.

Section 4—References—is a list of key FPAR and report references.

Section 5—Appendixes—consists of three appendixes. Appendix A presents trend data from 1999 to 2006 for the total unduplicated number of users by region, age group, race, ethnicity, and income level. Appendix A also presents trend data for primary contraceptive method use among female users, revenue by source, and Title X revenue. Appendix B presents information on the number and distribution of users served in 2006 by gender and income level for each state, the District of Columbia, and eight U.S. territories and jurisdictions (American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico, Republic of the Marshall Islands, Republic of Palau, and U.S. Virgin Islands). Appendix C presents general and table-specific notes about the data presented in this report.

2. FPAR Methodology

DATA COLLECTION

The Title X Family Planning Annual Report: Forms and Instructions⁷ consists of a Grantee Profile Cover Sheet and 14 reporting tables. OPA instructs grantees to report on the scope of services or activities that are proposed in their approved grant applications and supported with Title X grant and related sources of funding. OPA provides definitions for key FPAR terms to ensure uniform reporting among Title X grantees. The key terms describe the persons receiving family planning and related, preventive, health services at Title X-funded service sites; the range and scope of the services provided; and the family planning providers that render care. In this report, we reproduce table-specific FPAR guidance alongside the table-specific findings.

[See Key Terms and Definitions for FPAR Reporting]

DATA REPORTING

Title X service grantees are required to submit an FPAR by February 15 for the completed reporting period (January 1–December 31). In February 2007, 88 Title X service grantees submitted FPARs for 2006. Eighty-three reports (94%) were submitted by the February 15 due date, and 82 reports (93%) were submitted using OPA's Web-based electronic grants management system (GrantSolutions). Regional Program Consultants (RPCs) entered into GrantSolutions the data for six hardcopy reports, thereby consolidating all reports into a single electronic file. HHS regional staff and the FPAR Data Coordinator reviewed and approved all FPAR data prior to their tabulation.

DATA VALIDATION

FPAR data undergo both electronic and manual validations. GrantSolutions performs a set of automated validation procedures that ensure consistency within and across tables. The automated validation procedures include calculation of row and column totals and cross-table comparisons of selected cell values, including but not limited to the FPAR checkpoints (AA = unduplicated number of female family planning users, BB = unduplicated number of male family planning users, and CC = unduplicated number of all family planning users). Each validation procedure is based on a validation rule that defines which table cells to compare and what condition or validation test (e.g., = , < , > , ≤ , ≥ ) to apply.

RTI performs further validations to identify potential reporting errors and problems (e.g., ≥ 10% unknown/not reported) and to identify extreme or unexpected values for selected data items (e.g., STD test-to-user ratios). RTI also performs a manual review of each hardcopy FPAR. The results of the RTI validations are presented in a grantee-specific report that is sent to the FPAR Data Coordinator for followup and resolution. Once OPA staff addresses all outstanding validation issues and updates the electronic reports in GrantSolutions, OPA sends RTI a second data file for tabulation and analysis.

Appendix C, Methodological Notes summarizes general and table-specific notes about limitations and other issues related to the data presented in this report.

3. Findings

GRANTEE PROFILE

In 2006, OPA regional offices awarded Title X service grants to 88 public and private grantees, including state and local health departments (57%) and nonprofit family planning agencies, independent clinics, and community health agencies (43%). In turn, grantees distributed these funds to 1,195 subcontractors ("delegates") and their own clinics, ultimately supporting a family planning service network of 4,480 service sites in the 50 United States, the District of Columbia, and the eight U.S. territories and jurisdictions (Exhibit 2).

Between 2005 and 2006, the total number of service grantees increased from 87 in 2005 to 88 in 2006 due to the addition of one grantee in Region II. Six regions experienced an increase in the number of service sites (I, II, III, V, IX, and X) while four (IV, VI, VII, and VIII) experienced declines. Overall, the number of Title X-funded service sites increased by 54 (1%) from 4,426 in 2005 to 4,480 in 2006, with Region X experiencing the largest increase of 50 additional service sites (Exhibit 2).

**Exhibit 2. Number of and percentage change in grantees, delegates, and service sites, by region: 2005–2006 (Source: FPAR Grantee Profile Cover Sheet)**
Region	Number						% Change 2005–2006
	Grantees		Delegates		Service Sites		Grantees	Service Sites
	2005	2006	2005	2006	2005	2006	Grantees	Service Sites
I	10	10	68	68	219	224	0.0%	2.3%
II	6	7	96	98	299	302	16.7%	1.0%
III	9	9	228	228	634	638	0.0%	0.6%
IV	10	10	185	185	1,152	1,145	0.0%	-0.6%
V	12	12	165	165	427	432	0.0%	1.2%
VI	6	6	82	92	589	587	0.0%	-0.3%
VII	5	5	109	107	282	279	0.0%	-1.1%
VIII	6	6	63	74	191	184	0.0%	-3.7%
IX	15	15	119	114	460	466	0.0%	1.3%
X	8	8	58	64	173	223	0.0%	28.9%
Total	87	88	1,173	1,195	4,426	4,480	1.1%	1.2%

FAMILY PLANNING USER DEMOGRAPHIC PROFILE

[See FPAR Guidance for Reporting User Demographic Profile Data in Tables 1 to 3]

Total Users (Exhibit 3)

In 2006, Title X service grantees served 4,994,278 family planning users. Regions IV and IX accounted for 21% and 19%, respectively, of the total users served in 2006. Regions II, III, V, and VI served between 9% and 12% of total users, and Regions I, VII, VIII, and X served between 3% and 5% (Exhibit 3).

Between 2005 and 2006, there was a small decrease of 0.2% (8,683 users) in the total number of users served. The number of family planning users decreased between 3% and 6% in three regions (V, VI, and X), increased between 1% and 5% in two regions (III and IX), and stayed about the same in five regions (I, II, IV, VII, and VIII) (Exhibit 3). The average number of users per clinic decreased from 1,130 in 2005 to 1,117 in 2006, or an average decrease of almost 14 users per service site (not shown).

**Exhibit 3. Number, distribution, and percentage change in all family planning users, by region: 2005–2006 (Source: FPAR Table 1)**
Region	Number		Distribution		% Change 2005-2006
Region	2005	2006	2005	2006	% Change 2005-2006
I	211,693	212,169	4%	4%	0.2%
II	468,237	470,148	9%	9%	0.4%
III	562,173	567,583	11%	11%	1.0%
IV	1,051,887	1,051,330	21%	21%	-0.1%
V	600,145	582,313	12%	12%	-3.0%
VI	513,130	483,632	10%	10%	-5.7%
VII	243,299	245,133	5%	5%	0.8%
VIII	157,150	156,482	3%	3%	-0.4%
IX	931,827	973,524	19%	19%	4.5%
X	263,420	251,964	5%	5%	-4.3%
Total All Users	5,002,961	4,994,278	100%	100%	-0.2%

Since 1999 the distribution of total users served across regions has remained relatively stable, except in Region IV, where the percentage decreased from 23% of total users served in 1999 to 21% in 2006, and in Region IX, where the percentage of total users served increased from 16% in 1999 to 19% in 2006. Numerically, only Regions VI and VII experienced declines (1%) in the number of users served between 1999 and 2006 (Exhibits A–1a and A–1b in Appendix A).

Users by Gender (Exhibits 4 and 5)

Of the total number of users in 2006, 95% (4,721,869) were female and 5% (272,409) were male. The distribution of users by gender ranged from 90% female (10% male) in Region IX to 98% female (2% male) in Region IV (Exhibits 4 and 5). Exhibit B–1 (Appendix B) presents the number and distribution of family planning users for 2006 by gender and state, including the U.S. territories and jurisdictions.

Between 1999 and 2006, the percentage of users that was female decreased from 97% of total users in 1999 to 95% in 2006. Numerically, however, the number of female users increased 9%, from 4,315,040 in 1999 to 4,721,869 in 2006. During this same time, the number of male users more than doubled (114%), increasing from 127,098 in 1999 to 272,409 in 2006 (Exhibit A–1a).

Users by Age (Exhibits 4 and 5)

In 2006, just over one of every two (2,525,697) family planning users were in their 20s, and about one of every four were either 19 and younger (25%) or 30 years and older (23%). The highest percentage of users was aged 20 to 24 years (32%), followed by those 15 to 19 (24%) and 25 to 29 (19%). By region, the percentage of users in their early 20s ranged from 29% (I) to 35% (V), while the percentage 15 to 19 ranged from 21% (IX) to 28% (III and VIII). Teens younger than 15 years accounted for 1% (67,627) of total users nationally, and between 1% and 2% of total users across the regions (Exhibits 4 and 5).

Nationally, about the same percentages of male (28%) and female (26%) users were in their teens, and a slightly higher percentage of female (32%) than male (30%) users were in their early 20s. Across regions there was substantially more variation in the age distribution of male users than female users. For example, the percentage of male users who were teens ranged from 16% (VII) to 46% (IV), compared with a range of 22% (IX) to 29% (III, V, and VIII) for female users (Exhibits 4 and 5).

Since 1999, the distribution of family planning users by age group has remained relatively stable, with only small changes between 1999 and 2006. Numerically, however, the only age group to experience a decline (2%) were those 17 years and under (Exhibits A–2a and A–2b).

**Exhibit 4. Number of family planning users, by gender, age, and region: 2006 (Source: FPAR Table 1)**
Age Group (Years)	All Regions	Region
Age Group (Years)	All Regions	I	II	III	IV	V	VI	VII	VIII	IX	X
Female Users
Under 15	55,491	1,575	4,615	8,304	16,532	5,875	5,684	1,860	1,767	6,753	2,526
15–17	518,998	22,180	50,282	73,192	109,384	68,514	47,908	22,418	18,157	79,464	27,499
18–19	639,844	27,500	60,452	74,901	134,225	88,515	57,113	31,458	23,159	110,170	32,351
20–24	1,501,981	57,339	140,198	167,668	327,244	196,917	141,206	79,329	50,737	264,297	77,046
25–29	895,548	34,202	85,841	94,190	203,412	99,895	93,855	42,621	25,960	170,100	45,472
30–34	488,004	18,231	46,656	48,463	110,353	48,209	57,264	21,802	12,153	100,800	24,073
35–39	298,627	12,830	29,418	30,920	63,938	27,659	34,018	13,455	6,992	65,285	14,112
40–44	177,168	9,290	16,571	19,595	37,026	15,467	18,126	9,376	4,214	39,670	7,833
Over 44	146,208	11,760	13,023	19,182	24,184	10,462	12,157	9,070	3,387	36,929	6,054
Total Female Users	4,721,869	194,907	447,056	536,415	1,026,298	561,513	467,331	231,389	146,526	873,468	236,966
Male Users
Under 15	12,136	465	518	1,047	6,996	330	395	142	633	1,442	168
15–17	30,846	2,105	3,490	6,326	2,540	2,530	2,182	780	1,723	7,924	1,246
18–19	32,183	1,876	3,250	4,277	2,054	2,991	2,427	1,320	1,040	11,307	1,641
20–24	80,707	5,131	7,832	8,325	4,224	7,722	5,060	4,760	2,971	30,006	4,676
25–29	47,461	3,117	3,937	4,253	2,961	3,747	2,717	2,909	1,743	19,061	3,016
30–34	24,169	1,382	1,627	2,101	1,942	1,583	1,431	1,329	752	10,483	1,539
35–39	15,861	963	939	1,495	1,393	789	889	790	444	7,134	1,025
40–44	11,339	783	639	1,265	1,072	466	544	684	246	4,994	646
Over 44	17,707	1,440	860	2,079	1,850	642	656	1,030	404	7,705	1,041
Total Male Users	272,409	17,262	23,092	31,168	25,032	20,800	16,301	13,744	9,956	100,056	14,998
All Users
Under 15	67,627	2,040	5,133	9,351	23,528	6,205	6,079	2,002	2,400	8,195	2,694
15–17	549,844	24,285	53,772	79,518	111,924	71,044	50,090	23,198	19,880	87,388	28,745
18–19	672,027	29,376	63,702	79,178	136,279	91,506	59,540	32,778	24,199	121,477	33,992
20–24	1,582,688	62,470	148,030	175,993	331,468	204,639	146,266	84,089	53,708	294,303	81,722
25–29	943,009	37,319	89,778	98,443	206,373	103,642	96,572	45,530	27,703	189,161	48,488
30–34	512,173	19,613	48,283	50,564	112,295	49,792	58,695	23,131	12,905	111,283	25,612
35–39	314,488	13,793	30,357	32,415	65,331	28,448	34,907	14,245	7,436	72,419	15,137
40–44	188,507	10,073	17,210	20,860	38,098	15,933	18,670	10,060	4,460	44,664	8,479
Over 44	163,915	13,200	13,883	21,261	26,034	11,104	12,813	10,100	3,791	44,634	7,095
Total All Users	4,994,278	212,169	470,148	567,583	1,051,330	582,313	483,632	245,133	156,482	973,524	251,964

**Exhibit 5. Distribution of family planning users, by gender, age, and region: 2006 (Source: FPAR Table 1)**
Age Group (Years)	All Regions	Region
Age Group (Years)	All Regions	I	II	III	IV	V	VI	VII	VIII	IX	X
Female Users
Under 15	1%	1%	1%	2%	2%	1%	1%	1%	1%	1%	1%
15–17	11%	11%	11%	14%	11%	12%	10%	10%	12%	9%	12%
18–19	14%	14%	14%	14%	13%	16%	12%	14%	16%	13%	14%
20–24	32%	29%	31%	31%	32%	35%	30%	34%	35%	30%	33%
25–29	19%	18%	19%	18%	20%	18%	20%	18%	18%	19%	19%
30–34	10%	9%	10%	9%	11%	9%	12%	9%	8%	12%	10%
35–39	6%	7%	7%	6%	6%	5%	7%	6%	5%	7%	6%
40–44	4%	5%	4%	4%	4%	3%	4%	4%	3%	5%	3%
Over 44	3%	6%	3%	4%	2%	2%	3%	4%	2%	4%	3%
Total Female Users	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%
Male Users
Under 15	4%	3%	2%	3%	28%	2%	2%	1%	6%	1%	1%
15–17	11%	12%	15%	20%	10%	12%	13%	6%	17%	8%	8%
18–19	12%	11%	14%	14%	8%	14%	15%	10%	10%	11%	11%
20–24	30%	30%	34%	27%	17%	37%	31%	35%	30%	30%	31%
25–29	17%	18%	17%	14%	12%	18%	17%	21%	18%	19%	20%
30–34	9%	8%	7%	7%	8%	8%	9%	10%	8%	10%	10%
35–39	6%	6%	4%	5%	6%	4%	5%	6%	4%	7%	7%
40–44	4%	5%	3%	4%	4%	2%	3%	5%	2%	5%	4%
Over 44	7%	8%	4%	7%	7%	3%	4%	7%	4%	8%	7%
Total Male Users	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%
All Users
Under 15	1%	1%	1%	2%	2%	1%	1%	1%	2%	1%	1%
15–17	11%	11%	11%	14%	11%	12%	10%	9%	13%	9%	11%
18–19	13%	14%	14%	14%	13%	16%	12%	13%	15%	12%	13%
20–24	32%	29%	31%	31%	32%	35%	30%	34%	34%	30%	32%
25–29	19%	18%	19%	17%	20%	18%	20%	19%	18%	19%	19%
30–34	10%	9%	10%	9%	11%	9%	12%	9%	8%	11%	10%
35–39	6%	7%	6%	6%	6%	5%	7%	6%	5%	7%	6%
40–44	4%	5%	4%	4%	4%	3%	4%	4%	3%	5%	3%
Over 44	3%	6%	3%	4%	2%	2%	3%	4%	2%	5%	3%
Total All Users	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%	100%
Female users	95%	92%	95%	95%	98%	96%	97%	94%	94%	90%	94%
Male users	5%	8%	5%	5%	2%	4%	3%	6%	6%	10%	6%

Users by Race (Exhibits 6 to 14)

In 2006, 65% (3,239,675) of family planning users were white, 19% (953,580) were black, 3% (129,155) were Asian, 1% (44,708) were Native Hawaiian or other Pacific Islander, and 1% (38,098) were American Indian or Alaska Native. Two percent (122,583) of all users self-identified with two or more of the five minimum OMB race categories,⁸ and race was either unknown or not reported for 9% (466,479) (Exhibits 6, 9, and 10). The race profile for female users (Exhibits 7, 11, and 12) was similar to the profile for all users, while it varied somewhat for male users (Exhibits 8, 13, and 14). Among female users, 65% were white and 19% were black, compared to 57% and 24%, respectively, among male users. Race was unknown or not reported for a slightly higher percentage of male (11%) than female (9%) users (Exhibits 7 and 8).

The distribution of family planning users by race varied across regions, reflecting differences in the geographic distribution of racial groups. More than 80% of users in two regions (VII and VIII) were white, compared with less than seven in ten users in Regions II, III, IV, and IX. Approximately 30% of users in Regions III and IV were black, compared with 2% to 7% in Regions VIII, IX, and X. Region IX, which includes the Pacific territories, had the highest percentage of users identifying themselves as Asian (6%) or Native Hawaiian or other Pacific Islander (4%). The percentage of users for whom race was unknown or not reported exceeded the national average (9%) in three regions (II, IX, and X) (Exhibits 9 and 10).

Since 1999, there have been small shifts in the distribution of family planning users by race. Between 1999 and 2006, the percentage of total users that was white remained at or slightly below 65%, while the percentage that was black decreased from 22% to 19%. There were only small changes in the percentages of users in other race groups, and numerically, black users were the only group to experience a decrease (3%) compared to 1999 levels. The number of users identifying with two or more race groups, a category that was introduced in the 2005 reporting period, decreased from 3% to 2% of total users (4,960 users). The percentage of users for whom race was unknown or not reported declined from 12% in 2002–2004 to 9% in 2006 (Exhibits A–3a and A–3b).

Users by Ethnicity (Exhibits 6 to 14)

Nationally, one of every four users (1,223,732) identified themselves as Hispanic or Latino, including 24% (1,154,224) of female users and 26% (69,508) of male users. Ethnicity was unknown or not reported for 2% of total and female users and 3% of male users (Exhibits 6, 7, and 8). For both female and male users, the highest percentages of Hispanic or Latino users were in Regions IX (46% of females and 39% of males), VI (41% of females and 47% of males), and II (31% of females and 27% of males) (Exhibits 11, 12, 13, and 14).

Beginning with the FPAR for 2005, grantees report race and ethnicity data in a single, cross-tabulated table for female (FPAR Table 2) and male (FPAR Table 3) users. The revised format provides new information on the ethnic composition of users reported in each race category and for whom race is unknown or not reported. Among the 9% (435,985) of female users for whom race was not reported in 2006, 71% (311,080) were Hispanic or Latino (Exhibit 7). Similarly, among the 11% (30,494) of male users for whom race was not reported, 68% (20,883) were Hispanic or Latino (Exhibit 8). One percent of female and male users did not identify themselves with either a race or an ethnicity.

Between 1999 and 2006, the percentage of family planning users reporting Hispanic or Latino ethnicity increased from 17% of total users in 1999 to 25% in 2006, while the percentage of users with unknown Hispanic or Latino ethnicity decreased from 4% to 2% (Exhibits A–4a and A–4b). Numerically, the number of Hispanic or Latino users increased 58% from 772,129 in 1999 to 1,223,732 in 2006.

**Exhibit 6. Number and distribution of all family planning users, by race and ethnicity: 2006 (Source: FPAR Tables 2 and 3)**
Race	Number				Distribution
Race	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total
UK/NR=unknown or not reported. † Percentage is less than 0.5%.
American Indian/ Alaska Native	5,621	31,730	747	38,098	0%†	1%	0%†	1%
Asian	3,531	123,192	2,432	129,155	0%†	2%	0%†	3%
Black/African American	23,147	918,983	11,450	953,580	0%†	18%	0%†	19%
Native Hawaiian/ Pacific Islander	3,619	40,016	1,073	44,708	0%†	1%	0%†	1%
White	789,334	2,400,897	49,444	3,239,675	16%	48%	1%	65%
More than one race	66,517	54,058	2,008	122,583	1%	1%	0%†	2%
Unknown/ not reported	331,963	102,018	32,498	466,479	7%	2%	1%	9%
Total All Users	1,223,732	3,670,894	99,652	4,994,278	25%	74%	2%	100%

**Exhibit 7. Number and distribution of female family planning users, by race and ethnicity: 2006 (Source: FPAR Table 2)**
Race	Number				Distribution
Race	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total
UK/NR=unknown or not reported. † Percentage is less than 0.5%.
American Indian/ Alaska Native	5,128	29,454	661	35,243	0%†	1%	0%†	1%
Asian	3,258	117,584	2,247	123,089	0%†	2%	0%†	3%
Black/African American	21,475	857,632	9,848	888,955	0%†	18%	0%†	19%
Native Hawaiian/ Pacific Islander	3,377	33,161	951	37,489	0%†	1%	0%†	1%
White	745,976	2,292,120	45,939	3,084,035	16%	49%	1%	65%
More than one race	63,930	51,305	1,838	117,073	1%	1%	0%†	2%
Unknown/ not reported	311,080	95,053	29,852	435,985	7%	2%	1%	9%
Total Female Users	1,154,224	3,476,309	91,336	4,721,869	24%	74%	2%	100%

**Exhibit 8. Number and distribution of male family planning users, by race and ethnicity: 2006 (Source: FPAR Table 3)**
Race	Number				Distribution
Race	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total	Hispanic or Latino	Not Hispanic or Latino	Ethnicity UK/NR	Total
UK/NR=unknown or not reported. † Percentage is less than 0.5%.
American Indian/ Alaska Native	493	2,276	86	2,855	0%†	1%	0%†	1%
Asian	273	5,608	185	6,066	0%†	2%	0%†	2%
Black/African American	1,672	61,351	1,602	64,625	1%	23%	1%	24%
Native Hawaiian/ Pacific Islander	242	6,855	122	7,219	0%†	3%	0%†	3%
White	43,358	108,777	3,505	155,640	16%	40%	1%	57%
More than one race	2,587	2,753	170	5,510	1%	1%	0%†	2%
Unknown/ not reported	20,883	6,965	2,646	30,494	8%	3%	1%	11%
Total Male Users	69,508	194,585	8,316	272,409	26%	71%	3%	100%

**Exhibit 9. Number of all family planning users, by race, ethnicity, and region: 2006 (Source: FPAR Tables 2 and 3)**
Race and Ethnicity	All Regions	Region
Race and Ethnicity	All Regions	I	II	III	IV	V	VI	VII	VIII	IX	X
American Indian or Alaska Native
Hispanic or Latino	5,621	49	843	508	763	288	775	127	286	1,584	398
Not Hispanic or Latino	31,730	428	1,229	767	2,057	1,857	6,626	1,268	2,117	12,367	3,014
Unknown/not reported	747	9	75	16	3	62	97	12	27	163	283
Total	38,098	486	2,147	1,291	2,823	2,207	7,498	1,407	2,430	14,114	3,695
Asian
Hispanic or Latino	3,531	77	246	1,006	307	163	165	92	38	1,323	114
Not Hispanic or Latino	123,192	6,621	9,052	8,329	19,203	5,282	3,121	2,781	1,385	59,223	8,195
Unknown/not reported	2,432	37	59	252	18	90	149	34	7	858	928
Total	129,155	6,735	9,357	9,587	19,528	5,535	3,435	2,907	1,430	61,404	9,237
Black or African American
Hispanic or Latino	23,147	1,740	5,508	2,931	8,527	953	936	180	105	1,989	278
Not Hispanic or Latino	918,983	21,251	95,665	157,302	349,299	102,046	81,892	32,487	3,539	67,889	7,613
Unknown/not reported	11,450	173	2,174	3,568	538	1,048	911	128	74	1,386	1,450
Total	953,580	23,164	103,347	163,801	358,364	104,047	83,739	32,795	3,718	71,264	9,341
Native Hawaiian/ Pacific Islander
Hispanic or Latino	3,619	200	258	244	796	79	244	139	21	1,062	576
Not Hispanic or Latino	40,016	366	553	537	904	598	451	393	344	34,294	1,576
Unknown/not reported	1,073	3	264	29	0	20	11	11	1	481	253
Total	44,708	569	1,075	810	1,700	697	706	543	366	35,837	2,405
White
Hispanic or Latino	789,334	19,384	50,251	26,429	95,038	53,666	180,810	23,494	14,021	304,105	22,136
Not Hispanic or Latino	2,400,897	137,233	194,149	296,820	505,965	364,432	174,991	173,926	116,196	285,215	151,970
Unknown/not reported	49,444	1,356	571	16,714	399	3,180	1,251	728	1,623	7,840	15,782
Total	3,239,675	157,973	244,971	339,963	601,402	421,278	357,052	198,148	131,840	597,160	189,888
More Than One Race
Hispanic or Latino	66,517	4,694	7,966	1,650	31,064	6,919	876	161	1,426	11,563	198
Not Hispanic or Latino	54,058	2,545	2,004	2,083	1,925	20,227	2,950	875	1,412	19,230	807
Unknown/not reported	2,008	32	29	103	2	980	121	9	101	555	76
Total	122,583	7,271	9,999	3,836	32,991	28,126	3,947	1,045	2,939	31,348	1,081
Race Unknown or Not Reported
Hispanic or Latino	331,963	13,608	78,186	30,569	16,765	14,618	15,921	4,489	12,048	119,525	26,234
Not Hispanic or Latino	102,018	1,728	16,288	14,018	14,438	3,759	7,407	2,637	1,323	32,598	7,822
Unknown/not reported	32,498	635	4,778	3,708	3,319	2,046	3,927	1,162	388	10,274	2,261
Total	466,479	15,971	99,252	48,295	34,522	20,423	27,255	8,288	13,759	162,397	36,317
All Races
Hispanic or Latino	1,223,732	39,752	143,258	63,337	153,260	76,686	199,727	28,682	27,945	441,151	49,934
Not Hispanic or Latino	3,670,894	170,172	318,940	479,856	893,791	498,201	277,438	214,367	126,316	510,816	180,997
Unknown/not reported	99,652	2,245	7,950	24,390	4,279	7,426	6,467	2,084	2,221	21,557	21,033
Total All Users	4,994,278	212,169	470,148	567,583	1,051,330	582,313	483,632	245,133	156,482	973,524	251,964

**Exhibit 10. Distribution of all family planning users, by race, ethnicity, and region: 2006 (Source: FPAR Tables 2 and 3)**
Race and Ethnicity	All Regions	Region
Race and Ethnicity	All Regions	I	II	III	IV	V	VI	VII	VIII	IX	X
† Percentage is less than 0.5%.
American Indian or Alaska Native
Hispanic or Latino	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†
Not Hispanic or Latino	1%	0%†	0%†	0%†	0%†	0%†	1%	1%	1%	1%	1%
Unknown/not reported	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†
Total	1%	0%†	0%†	0%†	0%†	0%†	2%	1%	2%	1%	1%
Asian
Hispanic or Latino	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†
Not Hispanic or Latino	2%	3%	2%	1%	2%	1%	1%	1%	1%	6%	3%
Unknown/not reported	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†
Total	3%	3%	2%	2%	2%	1%	1%	1%	1%	6%	4%
Black or African American
Hispanic or Latino	0%†	1%	1%	1%	1%	0%†	0%†	0%†	0%†	0%†	0%†
Not Hispanic or Latino	18%	10%	20%	28%	33%	18%	17%	13%	2%	7%	3%
Unknown/not reported	0%†	0%†	0%†	1%	0%†	0%†	0%†	0%†	0%†	0%†	1%
Total	19%	11%	22%	29%	34%	18%	17%	13%	2%	7%	4%
Native Hawaiian/ Pacific Islander
Hispanic or Latino	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†
Not Hispanic or Latino	1%	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	4%	1%
Unknown/not reported	0%†	0%†	0%†	0%†	0%	0%†	0%†	0%†	0%†	0%†	0%†
Total	1%	0%†	0%†	0%†	0%†	0%†	0%†	0%†	0%†	4%	1%
White
Hispanic or Latino	16%	9%	11%	5%	9%	9%	37%	10%	9%	31%	9%
Not Hispanic or Latino	48%	65%	41%	52%	48%	63%	36%	71%	74%	29%	60%
Unknown/not reported	1%	1%	0%†	3%	0%†	1%	0%†	0%†	1%	1%	6%
Total	65%