Fulfilling the promise: public policy and U.S. family planning clinics.

Introduction

For most of our nation's history, family planning was not considered a proper topic for public discussion, and government support in this area was largely unthinkable. That situation began to change at an extraordinary pace in the 1960s. The oral contraceptive burst onto the U.S. market in 1960, and it was immediately adopted by large numbers of American women who wanted a safe, reliable and convenient means to control their childbearing. In 1965, the Supreme Court recognized the constitutional right of married couples to use contraceptives (1) (a right that was extended to single persons in 1972 (2)). Also in 1965, the federal government issued its first grants to subsidize family planning services for low-income women as part of its War on Poverty. By 1970, a national law devoted solely to family planning had been enacted.

The goal of the new law, Title X of the Public Health Service Act, was ambitious: to "assist in making comprehensive, voluntary family planning services readily available to all persons desiring such services." (3) Its enactment sprang from a fundamental recognition that absent government support, only women who could afford a visit to a private physician and the method the physician prescribed would benefit from the new era of modern contraception.

As envisioned, the funding made available under Title X resulted in the rapid proliferation of family planning clinics across the country. By the late 1970s, a network of clinics covered the vast majority of U.S. counties. Over the years, these clinics have provided services to many millions of women--some 6.5 million in 1997 alone. (4) Women served by the clinic system are generally young, and they overwhelmingly have very low incomes. Those who are employed often work at entry-level jobs that offer no health benefits. Many are still in school or are young parents struggling to make ends meet. For substantial numbers of women, a family planning clinic is their only source of health care.

Family planning clinics are a place where women can not only get confidential, sensitive contraceptive counseling and choose from a wide range of methods, but also obtain other important preventive health services. As a result, the clinic network has become an integral part of the American health care system, serving as a major source of Pap smears, breast and pelvic examinations, and screening and treatment for sexually transmitted diseases, as well as contraceptive services and supplies.

The ongoing impact of publicly funded family planning services on the lives and well-being of American women and their families is nothing short of stunning. Each year, subsidized family planning services help American women avoid 1.3 million unintended pregnancies (Chart 1); without this support, the U.S. abortion rate would be 40% higher than it is, and the teenage birthrate would be 25% higher. (5) The widespread availability of family planning services has improved the public health and allowed millions of couples to take advantage of economic opportunity that might not be available to them absent the ability to decide whether and when to have children. (6) And all of this has brought about significant savings: For every dollar that the federal and state governments spend on family planning services, three dollars are saved in Medicaid costs for pregnancy-related and newborn care. (7)

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