ISSUES IN BRIEF

The Impact of Publicly Funded Family Planning

Almost one in four of the 21 million women in the United States using some form of reversible contraception rely on public funds for their contraceptive care. Each year, publicly funded family planning helps 1.3 million women avoid an unintended pregnancy. If not prevented, 632,000 of these pregnancies would be terminated by abortion, 534,000 would result in unintended births and 165,000 would end in miscarriage.

According to a new analysis by The Alan Guttmacher Institute (AGI),* because a large percentage of the women obtaining publicly funded family planning services are Medicaid recipients or would become eligible if they became pregnant, every public dollar spent on contraception saves $3.00 that would otherwise have to be spent for pregnancy-related and newborn medical care alone. Anticipating the transfer of the federal welfare program to the states, this analysis is limited to savings in Medicaid; it greatly understates the total public costs that would be incurred in the absence of publicly funded family planning.

*J. D. Forrest and R. Samara, "Impact of Publicly Funded Contraceptive Services on Unintended Pregnancies and Implications for Medicaid Expenditures," Family Planning Perspectives, 28:188, 1996.

For a quarter century, the federal and state governments have subsidized family planning services for women who might otherwise not be able to obtain them. While there are many ways to assess the value of publicly funded family planning, the new AGI calculations are the latest in a line of examinations of one aspect of this question: What, if any, savings eventually accrue back to the tax-payer from expenditures for contraceptive services that help women avoid unintended pregnancies?

The methodology of this new study closely follows those of previous efforts. However, with the shape and scope of the nation's public assistance programs in flux, the current effort calculates only the public sector costs of the medical care that would be necessitated in the absence of publicly funded family planning. Unlike past examinations, it does not include any associated welfare expenses that would be incurred.

Estimating the impact of publicly funded family planning involved four key steps:

• Data from the 1988 National Survey of Family Growth were used to determine the number and characteristics of women who obtain contraceptives from publicly supported programs; these are the most recent characteristics data available.
• Because it is impossible to predict exactly what women would do if funding were discontinued, three probable scenarios were averaged together to produce a composite picture of contraceptive use in the absence of publicly funded contraceptive services (see Note, below).
• Data on failure rates of the various contraceptive methods in actual use were then used to estimate the number of births, abortions and miscarriages women would experience if public funding for contraceptive services were no longer available.
• The Medicaid costs that would be associated with the additional pregnancies and births (and the abortions in those few states in which public funds for abortion are available) were then calculated for women who would be eligible for such aid.

Note: If all of the women relying on publicly funded family planning services (5 million) had no difficulty accessing care in the absence of public subsidy, their annual number of unplanned pregnancies would not change (429,000). If none of them used contraception in the absence of publicly funded care, 4.5 million pregnancies would result. To provide a more realistic estimate of what would occur in the absence of publicly funded family planning services, this effort averages together the probable impact of three more likely scenarios. Scenario I assumes that the women's contraceptive behavior would resemble that of similar women (in terms of age, marital status and poverty status) who do not obtain publicly funded care; 1.4 million pregnancies would occur under this scenario. Scenario II assumes that the women would follow patterns similar to those of women of the same age and marital status who discontinue use of oral contraceptives; 2.2 million pregnancies would occur under this projection. Scenario III, under which 1.7 million pregnancies would occur, assumes that women would return to the contraceptive behavior women practice prior to a first visit to a family planning clinic.

These calculations yielded the following major findings:

• Each year, publicly funded contraceptive services help women avoid 1.3 million unintended pregnancies, which would result in 534,000 births, 632,000 abortions and 165,000 miscarriages (see Figure 1, below).
• In the absence of publicly funded family planning, the number of abortions performed in the U.S. each year would be 40% higher than it currently is.
• Without publicly funded contraceptive services, an additional 386,000 teenagers would become pregnant each year. Of these, 155,000 would give birth, increasing the number of teen births by one-quarter. A total of 183,000 teenagers would have abortions, increasing teen abortions by 58% (see Figure 1, below).
• Without publicly funded contraceptive services, an additional 356,000 women who have never been married would give birth each year, increasing total out-of-wedlock births by one-quarter (see Figure 1, below).
• Of the 534,000 more women who would give birth, 338,000 would be eligible for Medicaid-covered pregnancy-related care; 8 in 10 would not have been eligible if they had not become pregnant.
• The federal and state governments together spend $412 million to provide family planning. However, in the absence of publicly funded contraceptive services, they would spend $1.2 billion through Medicaid to cover the costs associated with the additional births and abortions that would occur. Therefore, for every dollar spent to provide publicly funded contraceptive services, the public saves an average $3.00 in Medicaid costs for pregnancy-related and newborn care.

Big Impact . . .

Publicly subsidized family planning services allow U.S. women to avert hundreds of thousands of unintended pregnancies each year—and the births, abortions and miscarriages that would follow.

Implications for Public Policy

Publicly funded contraceptive services not only help large numbers of individual women and families fulfill their childbearing goals but also play a major role in addressing important national concerns.

While Americans overwhelming believe that abortion should be legal, most also would prefer that far fewer occur. The nation's family planning effort dramatically reduces the number of abortions by enabling thousands of women each year to avoid an unintended pregnancy in the first place.

Moreover, while many strategies have been tried in a 20-year effort to reduce teen pregnancy, none has had the demonstrated effectiveness of the national family planning effort. Each year, publicly subsidized family planning makes it possible for hundreds of thousands of teenagers not to have their lives interrupted by an unplanned pregnancy—and the inevitable births or abortions that would follow.

Finally, public debate has returned to the issue of reducing out-of-wedlock births as a way of reducing welfare dependency. In fact, the recently passed federal welfare legislation in no small measure is premised on the assumption that curtailing public assistance to unmarried women will itself prevent out-of-wedlock births. Whether this strategy will have any effect remains untested. In sharp contrast, public funding of family planning is one of the few strategies with a documented track record in assisting large numbers of unmarried women to avoid unintended pregnancy.

Americans are rightly concerned about high rates of abortion, teen pregnancy and out-of-wedlock births. Publicly funded family planning services have a proven record in addressing these social problems.

© copyright October 1996, The Alan Guttmacher Institute.