Introduction.

Because American women want only two children, on average, they require contraceptive protection for most of their reproductive lives--typically, more than two decades. Given the many years that women are sexually active but do not want to have a child, it is perhaps surprising that so many avoid having an accidental pregnancy. For women and their partners to achieve their desired family size, they must be assured of access to family planning services and contraceptive supplies, including a variety of birth control methods to choose from as their needs and circumstances change, and information to help them make childbearing decisions and contraceptive choices responsibly and wisely. Improving these services and their effectiveness is, therefore, fundamental to reducing the high levels of unintended pregnancy, abortion and unplanned childbearing in the United States.

Most adult women obtain their family planning care through a private physician, covering the expense either by themselves or with the help of insurance. However, access to family planning care can be problematic for those who cannot afford a private physician, as well as for younger women and others who need confidential care and women who live in areas where few private clinicians are available. Thus, for more than 30 years, the federal and state governments have worked to ensure that women and their partners who have difficulty obtaining family planning care and contraceptive supplies on their own have access to the services they need to carry out their decisions about whether and when to bear children.

As the only federal program specifically devoted to supporting family planning services, Title X of the Public Health Service Act has played a critical role in providing millions of women with access to these services. Title X--funded clinics are often the only source of family planning care--and related primary health care--for poor and low-income women, uninsured women, minority women, adolescents and women who may be at high risk for unintended pregnancy because of drug or alcohol abuse, domestic violence or other reasons. Title X--supported programs also are an important and growing source of family planning--related counseling, education and service provision for men.

To establish a solid basis for policy decisions and providers' efforts aimed at assuring access to family planning services for all who need them, the Office of Population Affairs, Department of Health and Human Services (DHHS), has identified areas requiring information and analyses. Since 1994, The Alan Guttmacher Institute (AGI) has contributed to this effort, building on its experience with and commitment to research on family planning service provision. AGI's activities represent the first systematic broad-scale series of investigations since the early 1980s to assess and monitor the provision of publicly funded family planning services in the United States.

This volume includes all the major documents (or summary sections of documents) that resulted from this effort through 1998. A second ...