A Review of the HHS Family Planning Program Mission, Management, and Measurement of Results (2009) / Chapter Skim
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2 Overview of Family Planning in the United States
2 Overview of Family Planning in the United States
Pages 29-70
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From page 29... ...
Contemporary family planning efforts in the United States began in the early part of the twentieth century. By 1960, modern contraceptive methods had been developed, and in 1970 federal funding for family planning was enacted through the Title X program, the focus of this report.
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From page 30... ...
The provision of family planning services promotes several HHS goals, including increasing the availability and accessibility of health care services, preventing the spread of infectious diseases (through testing for STDs/HIV) , promoting and encouraging preventive health care, and fostering the economic independence and social well-being of individuals and families.
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From page 31... ...
There is a continued need for investment in family planning and related reproductive health services, particularly for those who have difficulty obtaining these important services. Avoiding Unintended Pregnancy The ability to time and space children reduces maternal mortality and morbidity by preventing unintended and high-risk pregnancies (World Bank, 1993; Cleland et al., 2006)
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From page 32... ...
. While significant advances have been made in contraceptive technology and the availability of family planning services, rates of unintended pregnancy in the United States remain high, particularly for certain segments of the population.
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From page 33... ...
than among women living at or above 200 percent of the federal poverty level (29 per 1,000) (Finer and Henshaw, 2006)
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From page 34... ...
Figure 2-2 SOURCE: Finer and Henshaw, 2006. 100 80 60 Percent 1994 40 2001 20 0 White Black Hispanic Race and Hispanic Origin FIGURE 2-3 Percentage of pregnancies that were unintended, by race and ethnicity, 1994 and 2001.
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From page 35... ...
. Preventing Sexually Transmitted Diseases and Reducing Infertility In addition to preventing unintended pregnancies, Title X was designed, particularly after the 1978 amendment, to emphasize services for adoles cents and infertility services.
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From page 36... ...
. Nonexistent at the time Title X was enacted, HIV/AIDS emerged in the early 1980s, and today more than 1.2 million people in the United States are living with HIV/AIDS.
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From page 37... ...
A significant number of people remain at risk for unintended pregnancy, sexually transmitted diseases, and infertility, and therefore are in need of family planning services. milesTones in Family Planning The United States saw a dramatic decline in maternal and infant mortality, as well as the total fertility rate, during the twentieth century.
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From page 38... ...
concern about population growth; and (3) the availability of new, highly effective contraceptive methods, such as the birth control pill and intrauterine devices (IUDs)
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Margaret Sanger opens the first birth control clinic in America; she is arrested and the clinic is closed FIGURE 2-7 Milestones in family planning in the United States (Part 1 of 3, continues)
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From page 40... ...
The FDA approves the administration proposes the first oral contraceptive pill "gag rule" regulations which and the IUD prohibit Title X funded clinics from counseling women about abortion 1970. Title X is established under the Family Planning Services and Population 1978.
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From page 41... ...
The FDA approves the contraceptives to teenagers bears 2.1 children over the contraceptive implant for use course of her lifetime 1990 1993. President Clinton 2000 2010 suspends the gag rule; First Medicaid family planning waivers are approved by 2009.
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From page 42... ...
. The birth control pill was adopted quickly by American women, and by 1970 approximately 22 percent of married women of reproductive age (nearly 6 million women)
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From page 43... ...
. The impact of family planning and contraceptive use in helping couples achieve their desired family size and timing is reflected in the reduction in the national total fertility rate (live births per 1,000 women aged 15–44)
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From page 44... ...
. As discussed in Chapter 1, the Title X Family Planning Program, established in 1970 under Title X of the Public Health Service Act and signed into law by President Nixon, provides grants for family planning services, training, research, and informational and educational materials.
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From page 45... ...
. (See the discussion of financing of family planning services later in this chapter, and Chapter 3 for discussion of the unique role of Title X funding.)
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From page 46... ...
Figure 2-9 illustrates the percentage of women aged 20–44 who reported current use of a contraceptive method in 2002, by percent of the federal 45 40 0-149 percent 150-299 percent 35 300 percent or more 30 Percentage of Women 25 20 15 10 5 0 Female Male Pill Condom 3-Month Other Sterilization Sterilization Injectable methods FIGURE 2-9 Percentage of women aged 20–44 currently using a method of con traception, by primary method and percent of federal poverty level (FPL) , United States, 2002.
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From page 47... ...
It is the contraceptive method reported most commonly by women living below 149 percent of the federal poverty level (41 percent) , as well as those living at 150–299 percent of that level (33 percent)
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From page 48... ...
The changing context in which family planning services are provided In the 38 years since the establishment of Title X, the health care system and the overall social environment of the United States have changed in ways that dramatically increase the complexity and cost of providing family planning services to the groups served by the program. The numbers of individuals requiring publicly funded family planning services have undergone substantial shifts and grown dramatically overall.
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From page 49... ...
Although projections of the number of people living in poverty are not provided by the Census Bureau, Figure 2-12 indicates that the total number 16 14 12 Number (millions) /Percent 10 8 Number (millions)
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From page 50... ...
Adolescents Providing family planning services to adolescents is a crucial function of Title X programs; the 1978 amendment to Title X emphasized expanding services to this population. As discussed above, the rate of unintended preg nancy is higher in this group compared with women in other age groups.
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From page 51... ...
. African American and Hispanic adolescents are significantly more likely than same-age peers of other racial/ethnic groups to have family incomes at or below the federal poverty level (NAHIC, 2003)
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of whom were living below 100 percent of the federal poverty level (U.S. Census Bureau, 2008a)
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From page 53... ...
of whom were living below 100 percent of the federal poverty level (U.S. Census Bureau, 2008a)
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From page 54... ...
had incomes below the federal poverty level in 2007 (U.S. Census Bureau, 2008a)
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From page 55... ...
Foreign born persons who become naturalized citizens of the United States are less likely to have household incomes below the federal poverty level than citizens born in the United States (13.2 percent of native U.S. citizens aged 18–44 were living below the poverty level in 2007, as compared with 9.1 percent of naturalized U.S.
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From page 56... ...
Figure 2-17 NOTE: These numbers reflect the civilian noninstitutionalized population aged 15–44 living in the United States; institutionalized persons, including those in correctional facilities and nursing homes, are excluded from the Current Population Survey. landscape SOURCES: U.S.
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From page 57... ...
Changes in Technology and Costs Since 1970, the number of contraceptive methods available to men and women has increased. The birth control pill, the IUD, the male condom, and sterilization were the primary methods available when Title X was enacted.
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From page 58... ...
0.8 0.6 78 Mirena (LNG-IUS) 0.2 0.2 80 Implanon 0.05 0.05 84 Female Sterilization 0.5 0.5 100 Male Sterilization 0.15 0.1 100 Emergency contraceptive pills: Treatment initiated within 72 hours after unprotected intercourse reduces the risk of pregnancy by at least 75%.i Lactational amenorrhea method: LAM is a highly effective, temporary method of contraception.
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From page 59... ...
Plan B is the only dedicated product marketed specifically for emergency contraception. The FDA has in addition declared the following 22 brands of oral contraceptives to be safe and effective for emergency contraception: Ogestrel or Ovral (one dose is two white pills)
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From page 60... ...
Family planning by nature requires close attention to social and cultural factors as well. Women and men may experience a number of sociocultural barriers to accessing family planning services, including distance to a family planning provider, difficulty in arranging transportation, limited days and hours of service operation, costs to receive services, long waiting times either to schedule an appointment or to be seen by a provider, poor quality of care, concerns about confidentiality, language barriers for those with limited English proficiency, lack of awareness of the availability of services, and perceived or real cost barriers (discussed further below)
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From page 61... ...
OVERVIEW OF FAMILY PLANNING IN THE UNITED STATES 61 BOX 2-1 Examples of Guidelines for Reproductive Health Care American College of Obstetricians and Gynecologists • 2008 -- Routine Human Immunodeficiency Virus Screening • 2008 -- uman Immunodeficiency Virus and Acquired Immunodeficiency H Syndrome and Women of Color • 2007 -- Intrauterine Device and Adolescents • 2007 -- Brand Versus Generic Oral Contraceptives • 2006 -- Primary and Preventative Care: Periodic Assessments • 2006 -- enstruation in Girls and Adolescents: Using the Menstrual Cycle as M a Vital Sign • 2006 -- The Initial Reproductive Health Visit • 2006 -- Psychosocial Risk Factors: Perinatal Screening and Intervention • 2006 -- Routine Cancer Screening • 2006 -- Breast Concerns in the Adolescent • 2006 -- valuation and Management of Abnormal Cervical Cytology and E Histology in the Adolescent • 2006 -- ole of the Obstetrician-Gynecologist in the Screening and Diagnosis R of Breast Masses • 2005 -- Racial and Ethnic Disparities in Women's Health • 2005 -- Health Care for Homeless Women • 2005 -- he Importance of Preconception Care in the Continuum of Women's T Health Care • 2005 -- Meningococcal Vaccination for Adolescents • 2004 -- renatal and Perinatal Human Immunodeficiency Virus Testing: P Expanded Recommendations • 2004 -- Sexually Transmitted Diseases in Adolescents • 2004 -- Guidelines for Adolescent Health Research • 2004 -- Cervical Cancer Screening in Adolescents • 2004 -- The Uninsured • 2003 -- Induced Abortion and Breast Cancer Risk • 2003 -- Tool Kit for Teen Care -- Lesbian Teens • 2003 -- Tool Kit for Teen Care -- Contraception Society for Adolescent Medicine • 2006 -- Abstinence-Only Education Policies and Programs • 2006 -- HIV Infection and AIDS in Adolescents -- Update • 2004 -- Emergency Contraception • 2004 -- rotecting Adolescents: Ensuring Access to Care and Reporting P Sexual Activity and Abuse • 1981 -- Reproductive Health Care for Adolescents American Academy of Pediatrics • 1998 -- Counseling the Adolescent About Pregnancy Options World Health Organization • 2007 -- Provider Brief on Hormonal Contraception and Bone Health • 2007 -- Provider Brief on Hormonal Contraception and Risk of Sti Acquisition • 2005 -- who Statement on Hormonal Contraception and Bone Health
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From page 62... ...
and those who are incarcerated, may be especially likely to face access and cost barriers. Among teenagers, concern about confidentiality is the most significant barrier to obtaining family planning services (NRC, 2008)
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From page 63... ...
4. Health care organizations must offer and provide language assistance ser vices, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
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From page 64... ...
had limited English proficiency (Flores et al., 2005; U.S. Census Bureau, 2008d)
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From page 65... ...
Such an absence of prenatal care may result in avoidable problems with a woman's pregnancy or delivery and the health of the woman or her child. There are efforts at the state level to provide reproductive health services to undocumented populations.
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From page 66... ...
Most of these latter states set the income eligibility ceiling for Medicaid-covered family planning services at the same level used to determine eligibility for pregnancy-related care, generally at or near 200 percent of the federal poverty level -- well above the usual state-set income ceilings (The Henry J Kaiser Family Foundation, 2008)
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From page 67... ...
This is most likely because younger adults have lower incomes than older adults and are more likely to have jobs without health insurance benefits. Figure 2-20 presents the percentages of the uninsured and of the total population by age group among those below 100 percent of the federal poverty level.
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From page 68... ...
for low-income adults (below 200 percent of the federal poverty level) , having medical expenses amounting to at least 5 percent of income; or (3)
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From page 69... ...
Even those who have employer-based insurance may find that basic family planning services are not a covered benefit. In 2003, 7 percent of health plans did not cover an annual obstetrical and gynecologic visit, 12 percent did not cover oral contraceptives, 13 percent did not provide payment for sterilization, and 28 percent did not cover all major types of contraceptives.
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From page 70... ...
The federal government has a responsibility to support the attainment of this goal. There is an ongoing need for public invest ment in family planning services, particularly for those who are low income or experience other barriers to care.
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