Family Planning

Goal

Improve pregnancy planning and spacing, and prevent unintended pregnancy.

Overview

Family planning is one of the 10 great public health achievements of the 20th century.1 The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families.1

Family planning services include:

• Contraceptive and broader reproductive health services, including patient education and counseling
• Breast and pelvic examinations
• Breast and cervical cancer screening
• Sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention education, counseling, testing, and referral
• Pregnancy diagnosis and counseling2, 3, 4

Abstinence from sexual activity is the only 100 percent effective way to avoid unintended pregnancy. For individuals who are sexually active and do not want to become pregnant or cause a pregnancy, correct and consistent contraceptive use is highly effective at preventing unintended pregnancy. The most effective methods to prevent unintended pregnancy include long-acting reversible contraceptives such as intrauterine devices (IUDs) and contraceptive implants. Condoms protect against both unintended pregnancy and STIs, and their use should be encouraged. Both men and women should be counseled about using condoms at every act of sexual intercourse, when not in a long-term, mutually monogamous sexual relationship.

Why Is Family Planning Important?

For many women, a family planning clinic is the entry point into the health care system and one they consider their usual source of care.2, 5 Each year, publicly funded family planning services prevent 1.94 million unintended pregnancies, including 400,000 teen pregnancies.3 These services are cost-effective, saving nearly $4 in Medicaid expenditures for pregnancy-related care for every $1 spent.2, 6

Unintended pregnancies are associated with many negative health and economic consequences. Unintended pregnancies include pregnancies that are reported by women as being mistimed or unwanted. Almost half of all pregnancies in the United States are unintended.7 The public costs of births resulting from unintended pregnancies were $11 billion in 2006. (This figure includes costs for prenatal care, labor and delivery, post-partum care, and 1 year of infant care).8

For women, negative outcomes associated with unintended pregnancy can include:

• Delays in initiating prenatal care
• Reduced likelihood of breastfeeding, resulting in less healthy children
• Maternal depression
• Increased risk of physical violence during pregnancy9, 10, 11, 12

Births resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight.13 Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, and have lower educational attainment and more behavioral issues in their teen years.9

The negative consequences associated with unintended pregnancies are greater for teen parents and their children. Eighty-two percent of pregnancies to mothers ages 15 to 19 are unintended.7 One in five unintended pregnancies each year is among teens.7 Teen mothers:

• Are less likely to graduate from high school or attain a GED by the time they reach age 30.
• Earn an average of approximately $3,500 less per year, when compared with those who delay childbearing until their 20s.
• Receive nearly twice as much Federal aid for nearly twice as long.14, 15

Similarly, early fatherhood is associated with lower educational attainment and lower income.14, 16

The average annual cost of teen childbearing to U.S. taxpayers is estimated at $9.1 billion, or $1,430 for each teen mother per year.15 Moreover, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems.14, 15, 16 Sons of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers.16

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Understanding Family Planning

Unintended pregnancies occur among women of all incomes, educational levels, and ages. However, there are disparities in unintended pregnancy rates. The rates of unintended pregnancy are highest among the following groups:

• Women ages 18 to 24
• Women who were cohabiting
• Women whose income is below the poverty line
• Women with less than a high school diploma
• Black or Hispanic women7

Social Determinants of Family Planning Service Usage

Women with lower levels of education and income, uninsured women, Latina women, and non-Hispanic black women are less likely to have access to family planning services.17 In addition, men are less likely to have access to and to receive family planning services than women.18

Barriers to people’s use of family planning services include:

• Cost of services
• Limited access to publicly funded services
• Limited access to insurance coverage
• Family planning clinic locations and hours that are not convenient for clients
• Lack of awareness of family planning services among hard-to-reach populations
• No or limited transportation
• Inadequate services for men
• Lack of youth-friendly services2, 3, 19, 20, 21, 22

Emerging Issues in Family Planning

Many women of reproductive age can benefit from preconception care (care before pregnancy). Preconception care has been defined as a set of interventions designed to identify and reduce risks to a woman’s health and improve pregnancy outcomes through prevention and management of health conditions.23 Preconception care can significantly reduce birth defects and disorders caused by preterm birth.24

Elements of preconception care should be integrated into every primary care visit for women of reproductive age.23 Preconception care must not be limited to a single visit to a health care provider, but rather be a process of care designed to meet the needs of an individual.25 As part of comprehensive preconception care, providers should encourage patients to develop a reproductive life plan. A reproductive life plan is a set of goals and action steps based on personal values and resources about whether and when to become pregnant and have (or not have) children.26 Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.27

Increased awareness of the importance of preconception care can be achieved through public outreach and improved collaboration between health care providers. Currently, only 30.3 percent of women report receiving pre-pregnancy health counseling.13 Future efforts should promote research to further define the evidence-based standards of preconception care, determine its cost-effectiveness, and improve tracking of the proportion of women obtaining these services.

References

1Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: Family planning. MMWR Weekly. 1999 Dec 3;48(47):1073-80. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm

2Gold RB, Sonfield A, Richards C, et al. Next steps for America’s family planning program: Leveraging the potential of Medicaid and Title X in an evolving health care system. New York: Guttmacher Institute; 2009. Available from: http://www.guttmacher.org/pubs/NextSteps.pdf

3Guttmacher Institute. In brief: Facts on publicly funded contraceptive services in the United States. Washington; Guttmacher Institute; 2010 April. Available from: http://www.guttmacher.org/pubs/fb_contraceptive_serv.pdf

4Lindberg L, Frost J, Sten C, et al. Provision of contraceptive and related services by publicly funded family planning clinics, 2003. Perspect Sex Reprod Health. 2006 Sep;38(3):139-47.

5Frost J. US women’s reliance on publicly funded family planning clinics as their usual source of medical care. Paper presented at National Survey of Family Growth Research Conference; 2008 Oct; Hyattsville, MD.

6Frost J, Finer L, Tapales A. The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. J Health Care Poor Underserved. 2008 Aug;19(3):778-96.

7Finer L, Henshaw S. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006 Jun;38(2):90-6.

8Sonfield A, Kost K, Gold RB, et al. The public costs of births resulting from unintended pregnancies: National and state-level estimates. Perspect Sex Reprod Health. 2011 Jun;43(2):94-102. Available from: http://www.guttmacher.org/pubs/psrh/full/4309411.pdf

9Logan C, Holcombe E, Manlove J, et al. The consequences of unintended childbearing: A white paper [Internet]. Washington: Child Trends, Inc.; 2007 May. Available from: http://www.childtrends.org/Files//Child_Trends-2007_05_01_FR_Consequences.pdf

10Cheng D, Schwarz E, Douglas E, et al. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009 Mar;79(3):194-8.

11Kost K, Landry D, Darroch J. Predicting maternal behaviors during pregnancy: Does intention status matter? Fam Plann Perspect. 1998 Mar–Apr;30(2):79-88.

12D’Angelo D, Gilbert BC, Rochat R, et al. Differences between mistimed and unwanted pregnancies among women who have live births. Perspect Sex Reprod Health. 2004 Sep–Oct;36(5):192-7.

13Centers for Disease Control and Prevention. Preconception and interconception health status of women who recently gave birth to a live-born infant—pregnancy risk assessment monitoring system (PRAMS), United States, 26 Reporting Areas, 2004. MMWR Weekly. 2007 Dec 14;56(SS-10):1-40. Available from: http://www.cdc.gov/mmwr/pdf/ss/ss5610.pdf

14Hoffman S, Maynard R, eds. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy, 2nd ed. Washington: Urban Institute Press; 2008.

15Hoffman S. By the Numbers: The Public Costs of Teen Childbearing. Washington: National Campaign to Prevent Teen Pregnancy; 2006. Available from: http://www.thenationalcampaign.org/costs/pdf/report/BTN_National_Report.pdf

16Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am. 2003 Aug;50(4):781-800, viii.

17Chandra A, Martinez G, Mosher W, et al. Fertility, family planning, and reproductive health of US women: Data from the 2002 National Survey of Family Growth. Vital Health Stat. 2005 Dec;23(25):1-160. Available from: http://www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf

18Guttmacher Institute. In brief: Facts on young men’s sexual and reproductive health. Washington: Guttmacher Institute; 2008 Jun. Available from: http://www.guttmacher.org/pubs/fb_YMSRH.pdf

19Guttmacher Institute. In brief: Improving contraceptive services use in the United States. Washington: Guttmacher Institute; 2008 (No.1). Available from: http://www.guttmacher.org/pubs/2008/05/09/ImprovingContraceptiveUse.pdf

20Gold R. An enduring role: The continuing need for a robust family planning clinic system. Guttmacher Policy Review. 2008 Winter;11(1). Available from: http://www.guttmacher.org/pubs/gpr/11/1/gpr110106.pdf

21Sonfield A. Looking at men’s sexual and reproductive health needs. Guttmacher Report on Public Policy; 2002 May;2(5).

22Hock-Long L, Herceg-Baron R, Cassidy AM, et al. Access to adolescent reproductive health services: Financial and structural barriers to care. Perspect Sex Reprod Health. 2003 May;35(3):144-7.

23Johnson K, Posner S, Biermann J, et al. Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006 Apr 21;55(RR-6):1-23. Available from: http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5506a1.htm

24Berghella V, Buchanan E, Pereira L, et al. Preconception care. Obstet Gynecol Surv. 2010 Feb;65(2):119-31.

25Atrash H, Jack B, Johnson K, et al. Where is the “W”oman in MCH? Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):S259-65.

26Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities. Preconception Care Questions and Answers. 2006 April 12. Available at http://www.cdc.gov/ncbddd/preconception/QandA.htm#6

27Moos M, Dunlop A, Jack B, et al. Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):280-9.

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