October 27, 2011 — Summary of "Publicly Funded Contraceptive Care: A Proven Investment," Gold/Sonfield, Contraception, Sept. 15, 2011.
Publicly funded family planning programs have faced "unprecedented threats" in 2011, Rachel Benson Gold and Adam Sonfield of the Guttmacher Institute write in a Contraception editorial. Some of the threats seemed to be "driven primarily by policymakers struggling to close budget deficits, many of whom have set their sights on Medicaid." However, other threats took "the form of more overtly ideological attacks" on the Title X family planning program and Planned Parenthood, the authors add.
In February, the House passed legislation to eliminate the Title X program, which funds family planning and reproductive health services for low-income individuals. Another provision in the bill was designed to block "all federal funding -- notably including Medicaid reimbursement -- to Planned Parenthood affiliates," Gold and Sonfield note. Both "extreme positions" were blocked by the Democratically led Senate and President Obama, they add.
This year, many states also have weakened their family planning programs, Gold and Sonfield continue. Montana "completely eliminated" its program, while New Hampshire and Texas severely reduced funding for their programs. Indiana, Kansas, North Carolina, Texas and Wisconsin also took steps to restrict or deny funding "to Planned Parenthood affiliates specifically or specialized family planning providers more generally," the authors add. Several of those policies are being challenged in court, they note.
Importance of Family Planning Programs
Gold and Sonfield write that reductions to family planning programs "run counter to a major national priority: reducing unintended pregnancy." Nationwide, about half of pregnancies are unintended. Gold and Sonfield explain that the "reasoning behind this goal [of reducing unintended pregnancy] is that problems in planning pregnancy have clear health, social and economic consequences for women and their families."
For example, many "studies point to a causal link between birth spacing and three major birth outcomes measures: low birthweight, preterm birth and small size for gestational age," according to Gold and Sonfield. "Similarly, unintended pregnancy has been linked to delayed initiation of prenatal care and to reduced breastfeeding after a child is born," they add. In addition, "unintended pregnancy can hinder women's educational and financial success and deprive women and couples of the ability to have children when they feel best prepared."
According to Gold and Sonfield, problems in planning pregnancies "are particularly acute for low-income families, many of whom are struggling to provide for the children they already have." Low-income women in the U.S. are "five times as likely to have an unintended pregnancy as more affluent women," a discrepancy that "has been growing in recent years," they write. This "translate[s] into fiscal problems for already strained public insurance programs, most notably Medicaid," which pays for 64% of births resulting from unintended pregnancies, Gold and Sonfield write. "Accounting just for medical care during pregnancy and the first year of an infant's life, the one million births from unintended pregnancies cost the federal and state governments about $11 billion annually, half of all public expenditures for births," they state.
"Publicly subsidized contraceptive counseling, services and supplies each year put the goal of effective contraceptive use in reach for nine million women and help them avoid about two million unintended pregnancies," the authors continue. In the absence of these services, the rate of unintended pregnancy in the U.S. would be nearly two-thirds higher, at a cost of about $18 billion annually, according to Gold and Sonfield.
Building a Stronger Safety Net
Family planning programs have a "proven track record" that "belies the notion that making cuts to funding or placing restrictions on the provider network -- as so many conservative policy makers attempted in 2011 -- would have any positive outcome," Gold and Sonfield argue. To the contrary, given the recent the recession, "policymakers would be well served to ramp up their support for programs and services that enable low-income women and couples to plan their pregnancies," the authors state.
Gold and Sonfield write, "Additional investment in publicly funded family planning services would further improve maternal and child health outcomes and help more women and couples achieve their fundamental childbearing goals, as well as economic security for themselves and their existing children." They note that "every public dollar spent to provide family planning services saves almost $4 in Medicaid costs over the following year," which "could substantially reduce pressure on a Medicaid program struggling to meet enrollees' needs." The savings "should be deployed to expand access to health care for low-income women and men, including their reproductive health needs," Gold and Sonfield propose.
"In sum, expanding access to contraceptive care would provide a rare opportunity for states to make simultaneous progress in improving their residents' health and well-being and in shoring up the financial sustainability of a health program on which four in 10 poor women of reproductive age rely," they write, concluding, "Policymakers should set aside their blinders and biases and take full advantage of this opportunity."