Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures

Abstract

Of U.S. women who use a reversible method of contraception, 24% each year obtain family planning services from a publicly funded clinic or a private doctor reimbursed by Medicaid. If these subsidized contraceptive services were not available, women who currently use them would have an estimated 1.3 million additional unplanned pregnancies annually, of which 29% would involve women aged 15-19, 67% would involve never-married women and 61% would involve women with a household income below 200% of the federal poverty level. An estimated 632,300 of these pregnancies would end in induced abortion, an increase of 40% over the current national level. Another 533,800 pregnancies would result in unintended births. Some 76,400 of these would be births to families already receiving public assistance, and 64,100 would be to families that would become eligible for public assistance because of the birth; another 197,000 would be to women whose families would not receive public assistance, but would be eligible for Medicaid coverage of pregnancy, delivery and newborn care. In FY 1987, public-sector expenditures for contraceptive services totaled an estimated $412 million. If subsidized services had not been available, the federal and state governments would have spent an additional $1.2 billion through their Medicaid programs for expenses associated with unplanned births and abortions. Thus, for every dollar spent to provide publicly funded contraceptive services, an average of $3.00 was saved in Medical costs for pregnancy-related health care and medical care for newborns.

PIP: Publicly funded family planning programs have played a crucial financial and social role in the US by enabling low-income women to prevent unintended pregnancies. In 1988, a publicly funded clinic or private physician reimbursed by Medicaid was the source of contraception for 24% of users of reversible methods. An analysis of National Survey of Family Growth-derived method-specific pregnancy rates by age, marital status, and poverty status indicated that the five million users of reversible contraception who rely on publicly funded services have about 429,000 unintended pregnancies each year, 203,800 of which are terminated through abortion. An annual average of 263 unintended pregnancies per 1000 family planning clinic clients are averted. Depending on the scenario selected, elimination of publicly funded family planning services would result in 1.4-4.5 million unintended pregnancies, 559,700-1.8 million unplanned births, and 663,000-2.2 million abortions. Of the estimated minimum of 1.3 million pregnancies averted each year by publicly funded contraceptive services, 29% involve 15-19 year olds, 67% involve never-married women, and 61% affect women in households below 200% of the poverty level. If 533,800 of the currently averted unplanned pregnancies were carried to term, 64,100 new families would become eligible for public assistance, while 76,400 additional children would be born into families already receiving such aid. In 1987, public sector expenditures for contraceptive services totaled US$412 million. If publicly funded family planning services were not available, the federal and state governments would spend an additional $1.2 billion each year in Medicaid programs to cover costs associated with unplanned births and abortions. Thus, for every dollar spent to provide publicly funded contraceptive services, an average of $3.00 is saved in Medicaid costs for prenatal, delivery, and newborn care.