To: Representative Nydia M. Velazquez
7From: Elizabeth Katz
Date: January 20, 2017
Re: Federal Mandate for Equal Access to Family Planning Services
Statement of Issue–
According to the CDC, family planning is one of the 10 greatest public health achievements of the twentieth century, on par with such accomplishments as vaccination and motor vehicle safety. The most recent data at a national level states that 45% of all pregnancies in the US are unintended. Women with unintended pregnancies that carry to term are more likely to receive inadequate prenatal care and have poorer health outcomes such as low birth weight, infant mortality, and maternal mortality and morbidity. There are currently 67 million US women of reproductive age, 38 million of which have sought contraceptive services and supplies and 20 million of whom needed publicly funded services and supplies because they either had an income 250% below the federal poverty line or were younger than 20. Of that 20 million, only 6.61 million women received the publicly funded family planning services they were in need of.
- A reduction in federal appropriations to Title X is decreasing access to family planning services from the most vulnerable populations.
- The goal of Healthy People 2020 of improving pregnancy planning and spacing, and preventing unintended pregnancy is not being met with only 4 of the 42 stated objectives meeting or exceeding the target and the majority of objectives showing little to no detectable change (23) or that they are getting worse (9).
- For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care.
- In 2015, publicly funded family planning services helped prevent 1.9 million unintended pregnancies and for every $1.00 spent on these services state and federal governments saved $7.09 per person
Policy Options–
- Institute a federal mandate that commits to the continued annual appropriation to Title X. The Title X Family Planning program was enacted in 1970 as the Title X of the Public Health Services Act. It is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.
- Advantages:Programs and clinics funded by Title X serve as a significant family planning resource for underserved and those of low socioeconomic status who would otherwise not have access to care.Health care disparities are just as prominent in family planning as they are in other areas of the health care system and allowing women from discriminated against demographic groups to control their fertility as desired breaks the cycle of disadvantaged experience with in the health care systems and reduces the rate of unintended pregnancy, abortion, and unintended births.
- Disadvantages:Individual policy makers and special interest groups with specific moral or religious ideals may oppose passage of this mandate and seek to undermine its implementation at the state or local level.
- Mandate a reduced cost for contraceptives for clinics that benefit from Title X funding. One of the great difficulties facing many of the clinics today is maintaining contraceptive choice as required by Title X statute. Historically, Title X clinics purchased contraceptive supplies, notably oral contraceptive pills, from manufacturers at nominal or low cost, but these costs have risen over time, straining the clinics’ budgets for contraceptive supplies. Furthermore, the introduction of long-lasting hormonal methods such as the contraceptive implant, Nexplanon, and the injectable contraceptive Depo-Provera have increased the financial demands placed on clinics.
- Advantages:By mandating lower costs for contraceptives dispensed by Title X clinics you are ensuring continued access to an equal quality of care and contraceptive choice. Also, by presenting women with a range of options for contraceptives you are allowing them to choose what method will work best for their lifestyle thereby assuring a greater adherence to proper use and efficacy.
- Disadvantages:Opposition from policy makers and special interest groups that oppose the use of contraceptives as well as push back from the pharmaceutical lobby on the lowered pricing.
Policy Recommendation–
Unintended pregnancies are associated with many negative health and economic consequences. The public cost of unintended pregnancies was estimated at $21 billion in 2010. For women, negative outcomes associated with unintended pregnancy can include: delaying prenatal care, reduced likelihood of breast feeding, increased risk of maternal depression and physical violence while pregnant. Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, have lower educational attainment and more behavioral issues in their teen years. Additionally, 82 percent of teenage pregnancies (ages 15 to 19) are unintended and 20 percent of total unintended pregnancies occur among teens. Title X provides a vital resource for the most vulnerable population and yet its continued funding is threatened on an annual basis. A federal mandate protecting this funding and freeing up further funds by reducing the cost of contraceptives purchased by Title X clinics ensures that women have continued access to quality care and reduces the overall financial burden placed on federal, state, and local governments.
References–
https://www.healthypeople.gov/2020/topics-objectives/topic/family-planning
https://www.ncbi.nlm.nih.gov/books/NBK215219/
http://www.genderhealth.org/the_issues/family_planning/
https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-C13-FP.pdf
https://www.nationalfamilyplanning.org/title-x_budget-appropriations
https://www.hhs.gov/opa/title-x-family-planning/index.html
https://www.hhs.gov/opa/title-x-family-planning/about-title-x-grants/funding-history/index.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835625/
https://www.guttmacher.org/fact-sheet/publicly-funded-family-planning-services-united-states
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