Contraceptive Services
WHO NEEDS SERVICES?
• 63 million U.S. women are in the childbearing ages of 13-44; 12 million of these (20%) are 13-19, 18 million (29%) 20-29 and 32 million (51%) 30-44.1
• Over 1/2 of women 13-44 (33 million) are in need of contraceptive services and supplies: They are sexually active; believe they are fertile; are not pregnant, postpartum or seeking pregnancy; and have not undergone sterilization.2
• More than 16 million women are in need of subsidized family planning services; these include all teenagers in need of contraceptive services and supplies and women aged 20-44 who are also in need and whose family income is less than 250% of the federal poverty level (or $38,923 for a family of four).3
• Of women in need of contraceptive services and supplies, 5 million (15%) are teenagers, and 5 million (15%) have incomes below 100% of the federal poverty level.4
• Of those in need of contraceptive services and supplies, 14 million (44%) are currently married, and 19 million (56%) have never married or are widowed, divorced or separated.5
IS THERE PUBLIC FUNDING?
• The federal and state governments spent $715 million on contraceptive services and supplies in FY 1994. Federal funds accounted for $553 million (77%) of the total, and state sources accounted for $162 million (23%). This funding went to family planning clinics serving low-income clients and to private physicians who served women on Medicaid.6
• The joint federal-state Medicaid program is the largest source of public funds for family planning services, supplying $332 million; federal funds account for 90% of these monies. Medicaid reimburses providers of medical care for the contraceptive services they supply to women enrolled in the program.7
• The states' contribution of $162 million makes them the second largest source of public funding for contraceptive services; state funds go primarily to clinics.8
• Title X of the Public Health Service Act is the only federal program specifically devoted to supporting family planning services. It provides funding to clinics ($151 million in FY 1994) and requires that they provide free family planning services to women with incomes of less than 100% of the poverty level, as well as services at a reduced fee to women with incomes that are at 100-250% of the poverty level.9
• When adjusted for inflation, total public expenditures for contraceptive services dropped by 27% between 1980 and 1994. The distribution of funding also changed, with an increase in Medicaid--from 20% to 46%--and a decrease in Title X--from 44% to 21%.10
IS FUNDING EFFECTIVE?
• Every tax dollar spent for contraceptive services saves an average of $3 in Medicaid costs for pregnancy-related health care and for medical care of newborns alone.11
• Each year, publicly supported contraceptive services help women prevent 1.3 million unplanned pregnancies, which would result in 632,300 abortions, 533,800 unintended births and 165,000 miscarriages.12
• Without publicly supported services, there would be 40% more abortions annually in the United States than currently occur.13
• An additional 386,000 teenagers would become pregnant each year. Of these, 155,000 would give birth, increasing the number of teen births by about 25%; 183,000 teenagers would have abortions, increasing abortions among teenagers by 58%.14
• An additional 356,000 never-married women would give birth each year, increasing the number of out-of-wedlock births by approximately 25%.15
• 76,400 unintended births would occur among women already receiving Medicaid benefits and 261,100 among women who would become eligible for Medicaid because of the birth.16
• Federal and state Medicaid expenditures would increase by $1.2 billion each year.17
| Several public programs fund contraceptive services for poor women and teenagers |
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Sollom T, Gold RB, and Saul R, 1996, op. cit. (see reference 6), p. 171, Figure 2. |
WHO RECEIVES SERVICES?
• Low-income and minority women who do not want to become pregnant are twice as likely as other women to be nonusers of contraceptives. Low-income women also have high contraceptive failure rates.18
• Only 25% of women served by publicly supported providers of contraceptive services and supplies are Medicaid recipients. In most states, women can qualify for Medicaid only if they are single, have a child (or are pregnant) and have an income below the state eligibility ceiling; nationwide, the maximum income for eligibility averages approximately $6,100 a year for a family of three.19
• Most poor and low-income women who do not qualify for Medicaid are dependent on publicly supported clinics for family planning services. More than 1/2 (57%) of clients served by publicly supported agencies have incomes below the federal poverty level, and an additional 33% have incomes of 100-249% of the poverty level.20
• Besides offering free or low-cost care for women who need it, family planning clinics provide confidential services for teenagers and, in some cases, offer more educational counseling than may be available through private physicians.21
• 4 in 10 teenagers who are sexually active and in need of contraceptive services are served by family planning clinics.22
• About 30% of women who visit providers of publicly supported contraceptive services are younger than 20; 50% are 20-29 and 20% are 30 or older.23
WHERE ARE SERVICES?
• In 1994, subsidized family planning services were provided by 3,119 agencies--1,413 health departments, 159 Planned Parenthood affiliates, 534 hospitals and 1,013 other types of agencies, such as independent family planning councils and community and migrant health centers.24
• Together, these agencies operated 7,122 clinic sites--state health departments ran 44%, Planned Parenthood affiliates 13%, hospitals 11% and other agencies 32%.25
• This network of publicly funded family planning clinics served 6.6 million women in 1994, representing about 44% of all women in need of subsidized contraceptive services.26
• 1/3 (32%) of women served by clinics receive services from health departments, 30% at Planned Parenthood sites, 16% at hospital outpatient facilities, 13% at independent clinics and 9% at community or migrant health centers.27
• More than 85% of U.S. counties have at least one clinic that provides subsidized family planning services; in nearly 75% of counties, at least one provider of contraceptive services is funded by the federal Title X program.28
• Nearly 2/3 of all women served by family planning clinics (4.2 million) obtain care at one of 4,200 funded at least in part by Title X. 29
• Among women who use a reversible method of contraception, 24% obtain family planning services from a publicly funded clinic or a private doctor reimbursed by Medicaid.30
WHAT ARE THE SERVICES?
• The pill is the only contraceptive method provided by all family planning agencies; 96% also provide injectables; at least 90% offer spermicides, condoms and the diaphragm; 78% teach periodic abstinence; and 59% insert implants. 55% of agencies offer clients free condoms.31
• Tubal sterilization and vasectomy are provided by 28% and 23%, respectively, of agencies.32
• Women making family planning visits routinely receive Pap smears, breast and pelvic exams, blood pressure measurements and education on effective method use and on breast self-examination. Most agencies also provide prenatal, postpartum and well-baby care, as well as infertility counseling.33
• Testing for gonorrhea, chlamydia and syphilis is provided routinely during initial and annual visits by 64%, 54% and 42%, respectively, of agencies. Testing for urinary tract infection and pregnancy is routinely provided at some agencies; more often, these tests are provided if the woman requests them or has symptoms.34
• 9 in 10 agencies routinely obtain women's sexual histories and counsel them regarding risk factors for HIV and other sexually transmitted diseases; 6 in 10 routinely provide education in condom use.35
• More than 1/2 of Planned Parenthood affiliates and independent agencies provide the partners of teenage clients with contraceptive education and counseling, while fewer than 1/3 of hospitals and community health centers do so. Almost 70% of family planning agencies offer noncontraceptive services for men, including sports or work physicals, testicular cancer screening and primary health care.36
• 2/3 of all family planning agencies have at least one special program that serves teenagers. 1/2 provide contraceptive outreach or education in schools or youth centers, and 43% implement programs that emphasize delaying sexual activity.37
• Programs for teenagers are offered by a higher proportion of Title X-funded agencies than of agencies without Title X funding.38
Sources Of Data
The data in this fact sheet are the most current available. All of the data are from research conducted by The Alan Guttmacher Institute and/or published in its peer-reviewed journal, Family Planning Perspectives. This fact sheet was prepared, in part, with support from the Office of Population Affairs of the U.S. Department of Health and Human Services.
Who Needs Services?
1. AGI, Contraceptive Needs and Services, 1995, New York: AGI, 1997, p. 7, Table A.
2. Ibid.
3. Ibid., p. 8, Table C.
4. Ibid., pp. 14-17, Table 1.
5. Ibid., p. 7, Table B.
Is There Public Funding?
6. Sollom T, Gold RB, and Saul R, Public funding for contraceptive, sterilization and abortion services, 1994, Family Planning Perspectives, 1996, 28(4):166-173, p. 169, Table 1.
7. Ibid., p. 169.
8. Ibid., p. 168, Table 1.
9. Ibid.
10. Ibid., p. 170
Is Funding Effective?
11. Forrest JD and Samara R, Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures, Family Planning Perspectives, 1996, 28(5):188-195, p. 193.
12. Ibid., p. 193, Table 4.
13. Ibid., p. 193.
14. Ibid., p. 193, Table 4.
15. Ibid.
16. Ibid.
17. Ibid., p. 193.
Who Receives Services?
18. Forrest JD and Singh S, The sexual and reproductive behavior of American women, 1982-1988, Family Planning Perspectives, 1990, 22(5):206-214, p. 211. Mosher WD and Pratt WF, Contraceptive use in the United States, 1973-88, Advance Data from the National Center for Health Statistics, 1990, No. 182. Jones EF and Forrest JD, Contraceptive failure rates based on the 1988 NSFG, Family Planning Perspectives, 1992, 24(1):12-19, p. 16.
19. Frost JJ and Bolzan M, The provision of public-sector services by family planning agencies in 1995, Family Planning Perspectives, 1997, 29(1):6-14, p. 8.
20. Ibid.
21. Ibid., pp. 10-11.
22. Frost JJ, Family planning clinic services in the United States, 1994, Family Planning Perspectives, 1996, 28(3):92-100, p. 98.
23. Frost JJ and Bolzan M, 1997, op. cit. (see reference 19), p. 8.
Where Are Services?
24. Frost JJ, 1994, op. cit. (see reference 22), p. 94, Table 1.
25. Ibid.
26. Ibid., p. 95 and p. 99, Table 6.
27. Ibid., p. 95.
28. Ibid., p. 97.
29. Ibid., p. 99, Table 6.
30. Forrest JD and Samara R, 1996, op. cit. (see reference 11), p. 192, Table 2.
What Are The Services?
31. Frost JJ and Bolzan M, 1997, op. cit. (see reference 19), pp. 8-9 and 10.
32. Ibid., p. 6, Table 1.
33. Ibid., pp. 8 and 11.
34. Ibid., p. 8.
35. Ibid.
36. Ibid., p. 11.
37. Ibid., p. 10.
38. Ibid., p. 11.
