The Provision of Public-Sector Services By Family Planning Agencies in 1995. (ARTOCLES).

Results from a 1995 survey of a nationally representative sample of 603 publicly funded family planning agencies reveal that 96% rely on federal funding, 60% on state funding and 40% on local funding to provide family planning and other services. Although only 25% of the contraceptive clients served by these publicly funded agencies--including health departments, hospitals, Planned Parenthood affiliates, independent agencies and community and migrant health centers--are Medicaid recipients, 57% have incomes below the federal poverty level and an additional 33% have incomes of 100-250% of the poverty level. Some 40% of the recipients of family planning services are black, Hispanic or from other minority groups, and 30% are younger than 20. Each agency employs an average of three physicians who together provide approximately seven hours of care per week and seven midlevel clinicians who provide 71 hours of care per week. The pill is the only contraceptive method provided by all agencies, but 96% provide the inj ectable; at least 90% spermicide, the condom and the diaphragm; 78% periodic abstinence; and 59% the implant. The remaining methods are provided by fewer than 50% of agencies. Almost 70% of agencies have at least one special program of outreach, education or services to meet the needs of teenagers, but far fewer have special programs for such hard-to-reach groups as the homeless, the disabled or substance users. (Family Planning Perspectives, 29:6-14, 1997)

In 1994, nearly 6.6 million women received contraceptive services from the more than 7,000 clinics that make up the network of publicly funded family planning clinics in the United States. (1) Many of these women were low-income or poor but had neither public nor private insurance. Some were Medicaid recipients who found family planning clinics more willing than private physicians to accept Medicaid reimbursement. (2) Others had private insurance that either did not cover preventive gynecologic care or certain contraceptive methods or supplies, or did not provide women with care from familiar providers or with the level of confidentiality that they desired. (3)

Ensuring that all women have access to affordable and accessible contraceptive care is crucial for the prevention of unintended pregnancies. In 1994, the provision of contraceptive services by publicly funded family planning clinics led to the prevention of an estimated 1.5 million unintended pregnancies. (4) Moreover, the low-income women who avoided pregnancy because of such services are those least likely to be able to afford any additional children and those most likely to rely on public sources for their support.

The funding to support subsidized family planning clinic services comes from a variety of sources, including the federal state Medicaid program (Title XIX of the Social Security Act), the Title X family planning program of the Public Health Service Act, and the maternal and child health and social services block-grant programs, as well as allocations from state and local sources.

These public sources support the provision of contraceptive services through a diverse network that includes hospital outpatient clinics, health department clinics, Planned Parenthood clinics, community and migrant health centers and independent clinics. (5) The majority of contraceptive clients served by publicly funded providers in 1994 obtained services from either health departments (33% of all clients) or Planned Parenthood affiliates (30%), with hospitals serving 16% of all contraceptive clients, community and migrant health centers serving 9% and independent agencies 13%. (6)

Agency types vary considerably in the number of clinics they operate and the number of clients they serve. For example, the more than 1,400 health departments operate, on average, 2.2 clinics each and serve, on average, an annual total of about 1,500 contraceptive clients per department (680 clients per clinic). In comparison, the 159 Planned Parenthood affiliates operate an average of nearly six clinics each and serve an annual average of more than 12,000 contraceptive clients each (2,000 clients per clinic). (7)

Although services and programs may vary from clinic to clinic, some commonalties exist. In particular, clinics funded through the Title X program follow certain federal guidelines and regulations regarding the provision of services, including the range of methods that must be made available and the range of fees that can be charged to women of different income levels. Previous studies have found, however, that the practices and policies of individual family planning agencies, and the mix of funding used to provide contraceptive services, often vary according to the type of sponsoring agency. (8)