Improve pregnancy planning and spacing, and prevent unintended pregnancy.
Family planning is one of the 10 great public health achievements of the 20th century. 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 counseling
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. Each year, publicly funded family planning services prevent 1.94 million unintended pregnancies, including 400,000 teen pregnancies. These services are cost-effective, saving nearly $4 in Medicaid expenditures for pregnancy-related care for every $1 spent.
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. 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
Increased risk of physical violence during pregnancy.
Births resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight. 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.
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. 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
Similarly, early fatherhood is associated with lower educational attainment and lower income.
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. Moreover, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems. Many of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers.
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 women
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. In addition, men are less likely to have access to and to receive family planning services than women.
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 services
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. Preconception care can significantly reduce birth defects and disorders caused by preterm birth.
Elements of preconception care should be integrated into every primary care visit for women of reproductive age. 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. 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. Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.
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. 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.