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Examining the Title X Family Planning Program's Examining the Title X Family Planning Program’s (Public Law 91-572) Legislative History through a Feminist Lens: A Thematic Analysis and Oral Histories with Key Stakeholders in Florida by Cheryl A. Vamos A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Community and Family Health College of Public Health University of South Florida Major Professor: Ellen Daley, Ph.D. Eric Buhi, Ph.D. Charles Mahan, M.D. Marilyn Myerson, Ph.D. Kay Perrin, Ph.D. Date Submitted: April 8, 2009 Keywords: Reproductive Health, Policy, Public Health, Contraception, Unintended Pregnancy © Copyright 2009, Cheryl A. Vamos Dedication To all those who work towards upholding reproductive health as a human right ACKNOWLEDGMENTS Many people have supported me throughout this journey. Dr. Ellen Daley, thank you for your invaluable mentorship, friendship, passion for women’s and reproductive health, and for your endless guidance, support, patience and time throughout my entire doctoral program. Dr. Eric Buhi, thank you for your support, encouragement, expertise in sexual health and policy, and for your talent in bringing new perspectives to research. Dr. Charles Mahan, thank you for your extraordinary expertise in reproductive health and policy, your generosity to help students, and for your legacy of being a true public health leader. Dr. Marilyn Myerson, thank you for your support, passion for women’s health, and for introducing me to the importance of feminist research methods. Dr. Kay Perrin, thank you for your time, patience, and encouragement throughout my doctoral program, for your realism and ability to make things clear, and for always being there to listen to new ideas. My parents, John and Diane Vamos, for your love and support, your encouragement, your generosity in providing me with opportunities, and for your value in education; for which none of this would be possible without you. My brothers J and Bob and my sister Sandy, for your support and for your uncanny ability to make things fun. I would also like to thank Dee Jeffers, for your encouragement, your help and guidance during the dissertation process, and for your expertise in maternal and child health. Cheryl McCoy, Government Documents Librarian at the University of South Florida Tampa Library, for your invaluable time in guiding my through the policy process and for your assistance in compiling the legislative history. Dr. Rasheeta Chandler, for your assistance with the qualitative analyses; and Elizabeth Outler, Lawton Chiles Legal Information Center, University of Florida, for your assistance with the policy documents. TABLE OF CONTENTS List of Tables ................................................................................................................... viii List of Figures .................................................................................................................... ix Abstract ................................................................................................................................x Chapter One: Introduction ...................................................................................................1 Statement of the Problem .........................................................................................2 The History of Title X..............................................................................................3 Need for the Study……………………… .............................................................11 Purpose of the Study ..............................................................................................12 Research Questions ................................................................................................12 Phase I: Thematic Analysis on Title X’s Legislative History ....................13 Phase II: Oral Histories ..............................................................................13 Overview of Study .................................................................................................14 Assumptions ...........................................................................................................16 Significance ............................................................................................................16 Organization of Dissertation ..................................................................................17 Definition of Key Terms ........................................................................................18 Chapter Two: Literature Review .......................................................................................21 Background of Women’s Health ...........................................................................21 Historical Underpinning of Women’s Health ............................................21 Definition of Women’s Health ...................................................................22 Women’s Health Care: Access and Coverage ...........................................23 Background on Reproductive Health……………………………………………. 25 Reproductive Health as a Human Right .....................................................25 Definition of Reproductive Health……. ....................................................26 Reproductive Health Care and Services ....................................................27 Adverse Outcomes from Unprotected Sexual Activity .............................29 Unintended Pregnancies .................................................................30 Sexually Transmitted Infections ....................................................33 Background on Family Planning ...........................................................................35 Definition of Family Planning ..................................................................35 History of Family Planning ........................................................................35 Contraceptive Use ......................................................................................39 Family Planning Clinics .............................................................................40 Policy and Reproductive Health ............................................................................44 The Role of Policy in Reproductive Health ...............................................44 i Reproductive Health Policy: A Controversial Topic .................................47 A Review of Title X ...................................................................................51 Legislative History of Title X ........................................................52 Introduction to Policy Studies ................................................................................56 Policy Analysis ..........................................................................................56 Feminist Research and Methodology.........................................................60 Feminist Policy Analysis ...........................................................................63 The Feminist Policy Analysis Framework ......................................67 Values ................................................................................69 State-market control ...........................................................69 Multiple identities ..............................................................69 Equality ..............................................................................70 Special treatment/protection ..............................................70 Gender neutrality ...............................................................71 Context ...............................................................................71 Language ............................................................................72 Equality/rights and care/responsibility ..............................72 Material/symbolic reforms .................................................72 Role change and role equity ...............................................73 Power analysis ...................................................................73 Other ..................................................................................73 Application of the Feminist Policy Analysis Framework ..........................73 Chapter Three: Methodology .............................................................................................76 Purpose of the Study ..................................................................................76 Justification of a Feminist Policy Analysis ................................................76 Phase I: Thematic Analysis on Title X’s Legislative History Study .........78 Research Questions ........................................................................78 Sources of Data ..............................................................................78 Data Analysis .................................................................................79 Reliability of Coding..........................................................80 Phase II: Oral Histories ..............................................................................81 Background on Oral History ..........................................................81 Justification of Oral History...........................................................83 Justification of the State of Florida as a Case Study ......................83 Instrument Development and Refinement .....................................84 Pilot-Testing .......................................................................85
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