Family planning services in the United States

Abstract

In recent years the United States has made considerable progress in providing family planning services for those in need. This does not mean, however, that the problems posed by unwanted pregnancies and unwanted births have been completely overcome. Estimates of the number of low-income women needing and receiving family planning services indicate that roughly 3.6 million women at risk of an unwanted pregnancy were receiving family planning services in 1973. This represented almost two-thirds of those in need at the time. Many programs are also seeking to meet the teenage need demonstrated by very high rates of out-of-wedlock births, premarital conceptions, obstetric problems, and legal abortion demands of women 15 to 19 years of age. As of 1973, it appeared that between 1.3 and 2.2 million never-married teenagers were in need of organized family planning services, and that of these, services were being received by between 25 and 42 per cent.

PIP: Increased federal funding has led to an increase in the number of wo men served by family planning programs in the U. S. from less than 700,0 00 in mid-1967 to 3.2 million in 1973. As of November 1974 3.0 million active contraceptive users were enrolled. Of the $144 million federal funds expended in 1973, 4/5 were direct grants to family planning projects with less than 1/5 indirect reimbursements under the Social Security Act. An estimated additional $35 million was spent by state and local governments and private agencies. Since 1972 fertility rates have fallen slightly below replacement level: 2.0 births per woman in 1972 and 1.9 in 1973 compared with 2.3 in 1971. However, the National Fertility Survey in 1970 revealed that 27% of all births to low-income women and 12% to higher income women were still unwanted. The Dryfoos formula for estimating the number of low-income women at risk of unwanted pregnancy is described. This formula estimates that 58% of women at or below 150% of the Federal Poverty Index need subsidized year-round family planning service, about 5.7 million women in 1973. An estimated 2.3 million women in this group were served in 1973 or about 40%. An additional 1.3 million low-income women were served by private physicians. 76% of these women chose oral contraception, 10% IUDs. Prior to enrollment in the program 47% were not using contraception or were using ineffective means. 50% had never been married. 80% of the teen-agers had never been married. As total fertility decreases the problems of out-of-wedlock teen-age pregnancies come more into focus. This rate rose from 15.3/1000 in 1960 to 22.4/1000 in 1970. 35% of all births to girls 19 and under occurred out-of-wedlock and 42-60% of births in marriage were conceived out-of-wedlock. About 85% did not use contraception. An estimated 1.3 million and perhaps as many as 2.2 million never-married teen-agers need organized family planning services in 1973; 900,000 were served. Today effective contraception accounts for 58% of that practiced in the U.S., compared with 37% in 1965. This period had a 36% decrease in all unwanted pregnancies and a 55% decrease among low-income couples. By 1970 low-income couples had almost reached the level of contraceptive protection enjoyed by higher income couples.