Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program

Context

Each year the United States’ publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program''s services extend well beyond preventing unintended pregnancy, they never have been fully quantified.

Methods

Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child.

Findings

In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion—$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion.

Conclusions

Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This investment saved the government billions of public dollars, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent.     

Faecal Aeromonas spp. in Balinese children

Abstract Aeromonas species were found in the faeces of 15.5% of Balinese children with diarrhoea and 12.7% of children without diarrhoea. When only the strains which produce cytotoxic enterotoxin are considered, the isolation rate in the group with diarrhoea (7.1%) was more than twice that in the control group (2.8%). The predominant species was A. hydrophila , a strain associated with environmental sources. Faecal isolates found in Bali may reflect ingestion of contaminated water and may simply be transient. Further studies are needed to clarify the importance of Aeromonas species as an enteric pathogen in developing countries.     

Effects of Gender on Cardiac Arrhythmias

Gender Effects on Cardiac Arrhythmias. The purpose of this study is to review published data regarding gender differences in cardiac electrophysiology and in the occurrence of clinical arrhythmias. ECG differences between men and women include a faster resting heart rate in women, a longer corrected QT interval, and a lower QT dispersion than in men. The faster resting heart rate in women appears to be primarily related to differences in physical conditioning. The mechanism for the longer corrected QT interval in women is not completely known, but does not appear to be related to acute effects of estrogen or progesterone or differences in autonomic innervation. Women also appear to have a lower incidence of atrial fibrillation, a difference in the age distribution of supraventricular tachycardia, and a lower incidence of sudden death than men. Much of the lower incidence of sudden death in women may relate to a difference in the prevalence of coronary artery disease, but other factors such as inherent differences in repolarization, which may be reflected by a gender difference in the corrected QT interval, also may be operative. The paradox of a longer corrected QT interval and higher incidence of torsades de pointes, but lower population-based incidence of sudden death in women, has not been completely resolved. Further studies will be required to help better understand the basic mechanisms involved in gender differences in electrophysiology and arrhythmias and determine the extent to which these differences have implications for clinical management of cardiac arrhythmias.     

Chronic sun exposure alters both the content and distribution of dermal glycosaminoglycans

Summary Chronic sun exposure leads to structural and functional alterations in exposed skin. Photoageing is a process distinct from the changes taking place due to chronological ageing. Unique alterations in the dermal extracellular matrix occur as a result of photoageing and are responsible for many of these physiological changes taking place in sun-damaged skin. Accompanying the deposition of abnormal elastic tissue, or solar elastosis, are significant alterations in dermal glycosaminoglycans (GAGs). Accumulation of GAGs as a result of photoageing as demonstrated in both humans and animal models of photoageing seems almost paradoxical in view of the large amounts of GAGs present in the skin of newborns, making their skin well hydrated and supple, in sharp contrast to the weathered appearance of photoaged skin. We investigate the relative GAG content of photoaged skin using immunoperoxidase stains specific for hyaluronic acid and chondroitin sulphate, and determine the location of these GAGs using confocal laser scanning microscopy. Our results demonstrate significant increases in GAG staining in sun-damaged vs. sun-protected skin from the same individuals, as measured by computer-based image analysis. Furthermore, confocal laser scanning microscopy reveals that the increased dermal GAGs in sun-damaged skin are deposited on the elastotic material of the superficial dermis of photodamaged skin, and not between collagen and elastic fibres as in normal skin. The abnormal location of GAGs on these fibres may explain the apparent paradoxical weathered appearance of photodamaged skin despite increased GAGs.     

SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS DIAGNOSED WITH TREATMENT-RESISTANT ACNE

Background. Systemic lupus erythematosus (SLE) may involve any number of organ systems and varies greatly in the severity and type of involvement. Cutaneous manifestations of SLE are equally numerous and varied throughout the course of the disease within an individual, as well as varying between patients. Cutaneous manifestations of SLE are frequently the presenting symptoms, typically noted in the classic malar “butterfly” rash; however, other cutaneous patterns are frequently observed. Methods. We present here two patients who presented with what was thought to be acne refractory to treatment. Results. These patients actually were found to have a facial eruption associated with SLE as confirmed by skin biopsy. Conclusions. The importance of investigating atypical or treatment-resistant eruptions, especially in patients experiencing other symptoms, is emphasized.     

MAKING SENSE OUT OF IN SITU PCR

Given the limited sensitivity of existing in situ hybridization methods for detecting specific nucleic acid sequences, amplification in situ by means of the polymerase chain reaction (PCR) seems to be an attractive alternative. Recent studies using in situ PCR technology have not assessed the gain in signal strength that has been achieved, nor evaluated quantitatively the efficiency of amplification. An accompanying article in the current issue of the Journal examines the reproducibility and amplification efficiency of an RT-PCR in situ hybridization method that uses a sense probe, capable of detecting only amplified target sequences. The amplification procedure resulted in approximately 3–6-fold increased sensitivity that depended upon cell type and disease status. © 1997 John Wiley & Sons, Ltd.     

US State Policy Contexts and Population Health

Policy Points

• This Perspective connects the dots between the polarization in US states’ policy contexts and the divergence in population health across states.
• Key interlocking forces that fueled this polarization are the political investments of wealthy individuals and organizations and the nationalization of US political parties.
• Key policy priorities for the next decade include ensuring all Americans have opportunities for economic security, deterring behaviors that kill or injure hundreds of thousands of Americans each year, and protecting voting rights and democratic functioning.