Family Planning Clinic Services In the United States, 1994. (ARTICLES).

In 1994, almost 6.6 million women received contraceptive services from more than 7,000 subsidized family planning clinics; these providers were located in 85% of US. counties. Health department clinics and Planned Parenthood sites served the largest proportions of these women (32% and 30%, respectively), followed by hospital outpatient sites (16%), in dependent clinics (13%) and community or migrant health centers (9%). The mix of agency types varied considerably by region and state, and the average annual number of contraceptive clients served per clinic also varied from fewer than 500 at community and migrant health centers to more than 2,000 at Planned Pa rent hood clinics. Nearly two-thirds of all women served (4.2 million) obtained care atone of the 4,200 clinics receiving funds from the federal Title X family planning program. Health department sites were the most likely to receive Title X funding (78%), followed by independent clinics and Planned Parenthood sites (66% each), hospital clinics (28%) and community and migrant health centers (18%). Overall, clinics receiving Title X funds serve an average of 25% more contraceptive clients than do clinics not receiving such funds. (Family Planning Perspectives, 28:92-100, 1996)

For two and a half decades, the network of family planning clinics in the United States has played a critical role in ensuring access to contraceptive services for millions of women: Of all women making a family planning visit, 36% receive services from a family planning clinic. Among women seeking family planning services, the percentage who obtain care from clinics rises to 60% of women whose family income is below the federal poverty level and to 62% of women younger than 20. (1)

Women have numerous reasons for seeking family planning services from clinics rather than from private physicians. For many women, the primary reason is financial. (2) Clinics are subsidized by federal, state, local or private funds, and many offer uninsured low-income women services free or at reduced fees. In addition, many insured women do not have coverage for contraceptive services, drugs or devices. (3)

Clinics usually charge these women less than a private physician would charge for services and methods. Moreover, clinic providers are more likely than private physicians to accept Medicaid (83% vs. 73%). (4) In addition, clinic providers are more likely than private physicians to be located in the areas where low-income women live. Finally, family planning clinics are often perceived by women as providing greater confidentiality (a factor that is particularly important to teenage women) than might otherwise be possible when services are provided by a doctor who serves their entire family. (5)

The universe of subsidized family planning clinics in the United States was last fully described for the year 1983. (6 ) A total of 2,462 agencies with operating responsibility for 5,174 family planning clinics were identified and data were collected on the numbers and characteristics of women receiving contraceptive services (including age, poverty status, race and contraceptive methods used) from these sites. In 1992, the universe was updated and found to contain 2,614 agencies with operating responsibility for between 5,460 and 5,960 family planning clinic sites. At that time, data on client numbers and agency policies and procedures were collected from only a sample of agencies. (7)

Thus, since 1983, there has not been a thorough enumeration of the network of family planning providers and the women who receive care from them. Such an enumeration is critical now. As the level of funding and structure of the programs that currently subsidize family planning clinics (Title X, maternal and child health and social services block grants, Medicaid and others) are being reevaluated, current data on the women and clinics dependent on these funding sources are needed to ensure that vital services are not lost in the process.

Subsidized family planning providers depend on a variety of funding sources to sustain their programs. One of the most important of these sources is the Title X program of the Public Health Service Act, which is the only federal program specifically designed to provide funding for family planning services. In 1992, this program provided family planning clinics with more than $110 million to provide contraceptive services to low-income women in the United States. (8) Current expenditures are undoubtedly higher, given that congressional appropriations for Title X rose by more than 20% between 1992 and 1994. Although the impact of potential changes in this program, such as shifting its funds into block grants or consolidating it with other public health programs, remains uncertain, (9) the data provided in this study document how many millions of women and thousands of clinics nationwide stand to be affected by such changes.