Public benefits and costs of government funding for abortion

In state referenda to end public funding of abortions for poor women, one of the most successful tactics of abortion foes has been to charge that abortion funding increases the burden on taxpayers. A state-by-state analysis by The Alan Guttmacher Institute (AGI) shows that the opposite is the case. For every tax dollar spent to pay for abortions for poor women, about four dollars is saved in public medical and welfare expenditures. The savings are in public expenditures that otherwise would have to be incurred because of the babies that poor women would have borne. On the basis of earlier research, it was assumed that 20 percent of Medicaid-eligible women who could not obtain abortions would give birth. Public costs examined in the AGI analysis include Medicaid expenditures for prenatal care, delivery and postnatal care for the mother, and for newborn care, neonatal intensive care and pediatric care for the child for the first two years of life; as well as expenditures for Aid to Families with Dependent Children (AFDC), food stamps and the Special Supplemental Food Program for Women, Infants and Children (WIC) during those first two years. The benefit-to-cost ratio varies from about 9:1 in Massachusetts to 2:1 in Hawaii and Pennsylvania. The net savings for the nation as a whole over a two-year period if abortions were publicly funded in every state would total at least $339.6 million.     

Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States

BackgroundSince 1976, federal Medicaid has excluded abortion care except in a small number of circumstances; 17 states provide this coverage using state Medicaid dollars. Since 2010, federal and state restrictions on insurance coverage for abortion have increased. This paper describes payment for abortion care before new restrictions among a sample of women receiving first and second trimester abortions.MethodsData are from the Turnaway Study, a study of women seeking abortion care at 30 facilities across the United States.FindingsTwo thirds received financial assistance, with those with pregnancies at later gestations more likely to receive assistance. Seven percent received funding from private insurance, 34% state Medicaid, and 29% other organizations. Median out-of-pocket costs when private insurance or Medicaid paid were $18 and $0. Median out-of-pocket cost for women for whom insurance or Medicaid did not pay was $575. For more than half, out-of-pocket costs were equivalent to more than one-third of monthly personal income; this was closer to two thirds among those receiving later abortions. One quarter who had private insurance had their abortion covered through insurance. Among women possibly eligible for Medicaid based on income and residence, more than one third received Medicaid coverage for the abortion. More than half reported cost as a reason for delay in obtaining an abortion. In a multivariate analysis, living in a state where Medicaid for abortion was available, having Medicaid or private insurance, being at a lower gestational age, and higher income were associated with lower odds of reporting cost as a reason for delay.ConclusionsOut-of-pocket costs for abortion care are substantial for many women, especially at later gestations. There are significant gaps in public and private insurance coverage for abortion.     

State family planning and abortion expenditures: their effect on public health.

OBJECTIVES. This study examines whether state family planning expenditures and abortion funding for Medicaid-eligible women might reduce the number of low-birthweight babies, babies with late or no prenatal care, and premature births, as well as the rates of infant and neonatal mortality. METHODS. Using a pooled time-series analysis from 1982 to 1988 with the 50 states as units of analysis, this study assessed the impact of family planning expenditures and abortion funding on several public health outcomes while controlling for other important variables and statistical problems inherent in pooled time-series studies. RESULTS. States that funded abortions had a significantly higher rate of abortions and significantly lower rates of teen pregnancy, low-birthweight babies, premature births, and births with late or no prenatal care. States that had higher expenditures for family planning had significantly fewer abortions, low-birthweight babies, births with late or no prenatal care, infant deaths, and neonatal deaths. CONCLUSIONS. Funding abortions for Medicaid-eligible women and increasing the level of expenditures for family planning are associated with major differences in infant and maternal health in the United States.     

The consequences of the legalization of abortion within the Rostock area (GDR)

On March 9, 1972, the German Democratic Republic legalized abortion as one of the social and health policy measures with humanitarian goals to promote family life and improve living conditions. In evaluating the effect of the law, the development of fertility and frequency of abortion in Rostock District were studied for the years 1965 to 1973. In the first year after the new law went into effect, legal abortions increased about fivefold, which was expected; hospital abortions in 1973 decreased by about 40%. Compared to other Eastern European countries and to New York City, the frequency of abortion was still low. In the second year of the law, a further increase in abortions was not seen either in Rostock or the GDR as a whole. More women decided to continue their pregnancies; the number of women on oral contraceptives increased from about 1 million at the beginning of 1972 to about 1.2 million at the beginning of 1973. In 1972, for every 1000 women of reproductive age, there were 33 legal abortions in Rostock District; in the same period, for every 100 live births, there were 56 abortions.     

Welfare Reform and the Perinatal Health and Health Care Use of Latino Women in California, New York City, and Texas

OBJECTIVES: This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996. METHODS: We used a pre-post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998. RESULTS: The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P <.05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996. CONCLUSIONS: There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.     

Trends in rates of live births and abortions following state restrictions on public funding of abortion

Abortion rates rose following the expanded legalization of abortion by the Supreme Court decision in Roe v. Wade. As a result, the impact of the restriction on Federal funding of abortions under the Hyde Amendment in 1977 was not clear. However, abortion rates had plateaued by 1985, when State funding of Medicaid abortions was restricted in Colorado, North Carolina, and Pennsylvania. Analysis of statewide data from the three States indicated that following restrictions on State funding of abortions, the proportion of reported pregnancies resulting in births, rather than in abortions, increased in all three States. In 1985, the first year of State restrictions on the use of public funds for abortion, Colorado, North Carolina, and Pennsylvania recorded 1.9 to 2.4 percent increases in the proportion of reported pregnancies resulting in live births, after years of declining rates. With adjustments for underreporting of abortion, there was an overall 1.2 percent rise in the proportion of pregnancies resulting in live births in those States. Nationally the proportion rose only 0.4 percent. By 1987, the three States had experienced increases above 1984 levels of 1.6 to 5.9 percent in the proportion of reported pregnancies resulting in live births. The experiences of the three States can be used in projecting an expected increase in the proportions of reported pregnancies resulting in live births, rather than in abortions, for similar States. A projection for California, for example, showed that an increase could be expected in the first year of restrictions on the use of public funds for abortion of at least 4,000 births, which could be expected largely to affect women of low income.     

State abortion rates. The impact of policies, providers, politics, demographics, and economic environment

This paper uses data on abortion rates by state from 1974-1988 to estimate two-stage least squares models with fixed state and year effects. Restrictions on Medicaid funding for abortion are correlated with lower abortion rates in-state and higher rates among nearby states. A maximal estimate suggests that 19-25% of the abortions among low-income women that are publicly funded do not take place after funding is eliminated. Parental notification laws for teen abortions do not significantly affect aggregate abortion rates. A larger number of abortion providers in a state increases the abortion rate, primarily through inducing cross-state travel.     

The effect of Medicaid eligibility expansions on fertility

In the United States, pregnant women and children’s eligibility for Medicaid was expanded dramatically during the 1980s and early 1990s. By lowering pregnancy and child health care costs, the Medicaid expansions may have increased the incentives for women to have children. To investigate this possibility, we examine whether state-level birth and abortion rates are related to the extent of states’ Medicaid eligibility expansions and the fraction of women eligible for Medicaid, controlling for economic and demographic factors, during the period 1982 to 1996. We examine birth rates by race, marital status and education as well as overall abortion rates. We find little evidence that the Medicaid expansions led to changes in birth rates or abortion rates. However, some results do suggest that the Medicaid expansions boosted the birth rate among white women who have not completed high school. We find that restrictions on Medicaid funding of abortions decrease abortion rates and increase birth rates. The results thus do not provide definitive evidence that expansions in public health insurance eligibility have sizable effects on women’s fertility.     

Strategies for securing funding for abortion under the Hyde Amendment: a multistate study of abortion providers' experiences managing Medicaid

Objectives. We investigated systematic barriers, identified by previous research, that prevent women from obtaining Medicaid coverage for an abortion even when it should legally be available: when the pregnancy resulted from rape or incest or threatens the mother''s life. We also aimed to document strategies to improve access to federal Medicaid funding in qualifying cases.Methods. We conducted in-depth interviews from 2007 to 2009 with representatives of 49 facilities that provided abortions in 11 states. Interviews focused on participants’ experiences and strategies in seeking federal Medicaid funding for abortions. We coded data both inductively and deductively and analyzed them thematically.Results. Common strategies described by the few participants who secured Medicaid funding for abortions in cases of rape, incest, and life endangerment were facility-level interventions, such as developing relationships with Medicaid staff, building savvy billing departments, and encouraging clients to advocate for themselves, as well as broader legal and collaborative strategies.Conclusions. Multipronged state-level interventions that combine advocacy, legal, and on-the-ground resources show the most promise of increasing access to federal Medicaid funding for abortion care.Low-income women''s access to reproductive health care services in the United States is limited by many health care providers’ difficulties navigating the Medicaid reimbursement system.^1,2 Addressing the challenges providers experience securing reimbursements is critical to ensuring access to reproductive health care for a significant number of low-income women. Indeed, Medicaid, a joint federal and state project, is the largest health insurance program in the United States.³ In 2006 it provided coverage for 7.3 million women, or 12% of all women of reproductive age.⁴Since 1976, the Hyde Amendment has prevented women on Medicaid from using their insurance for abortion care, with few exceptions. Currently, the amendment prohibits the use of federal funds for abortions except when the pregnancy results from rape or incest, or when it endangers the mother''s life. States have the option to use their own funding to expand Medicaid coverage for abortions in a broader range of circumstances, but only 17 do. Thirty-two states ban the use of state Medicaid funding for abortions except in the cases outlined by the Hyde Amendment; South Dakota, in open violation of federal law, covers abortions only when the mother''s life is endangered.⁵A growing body of evidence shows that the implementation of these exceptions is inconsistent and that several systematic barriers prevent health care providers from securing Medicaid coverage for women seeking abortions for pregnancies in cases of rape, incest, or life endangerment.^6–8 Identified obstacles to securing federal Medicaid funding include complex paperwork requirements, inconsistent support from Medicaid when filing claims, and frequent inappropriate denials of submitted claims.⁶When Medicaid coverage for abortion care is inaccessible or denied, low-income women must scramble to find other resources to cover the cost of the procedure. The search for funding for an abortion can force women to delay a desired abortion or continue an unwanted pregnancy.^6–13 In some cases, women with life-endangering conditions must delay treatment while they raise money for their abortion.⁶What strategies can be used to prevent women in these circumstances from being denied timely access to abortion services? We investigated abortion providers’ experiences navigating obstacles to securing Medicaid coverage for qualifying abortions for their clients.     

Medicaid Covered Births, 2008 Through 2010, in the Context of the Implementation of Health Reform

BackgroundMedicaid is a major source of public health care financing for pregnant women and deliveries in the United States. Starting in 2014, some states will extend Medicaid to thousands of previously uninsured, low-income women. Given this changing landscape, it is important to have a baseline of current levels of Medicaid financing for births in each state. This article aims to 1) provide up-to-date, multiyear data for all states, the District of Columbia, and Puerto Rico and 2) summarize issues of data comparability in view of increased interest in program performance and impact assessment.MethodsWe collected 2008–2010 data on Medicaid births from individual state contacts during the winter of 2012–2013, systematically documenting sources and challenges.FindingsIn 2010, Medicaid financed 48% of all births, an increase of 19% in the proportion of all births covered by Medicaid in 2008. Percentages varied among states. Numerous data challenges were found.Conclusions/Implications for Research and PolicyConsistent adoption of the 2003 birth certificate in all states would allow the National Center for Health Statistics Natality Detail dataset to serve as a nationally representative source of data for the financing of births in the United States. As states expand coverage to low-income women, women of childbearing age will be able to obtain coverage before and between pregnancies, allowing for access to services that could improve their overall and reproductive health, as well as birth outcomes. Improved birth outcomes could translate into substantial cost savings, because the costs associated with preterm births are estimated to be 10 times greater than those for full-term births.     

A mystery caller evaluation of Medicaid staff responses about state coverage of abortion care

ObjectivesThe Hyde Amendment prohibits federal Medicaid funding for abortion except when a woman is seeking an abortion for a pregnancy that is the result of rape or incest, or that threatens her life. We investigated how Medicaid staff in 17 states responded to inquiries about coverage for abortion in the few circumstances that qualify for federal Medicaid funding.MethodsUsing a mystery caller approach, we surveyed Medicaid staff about the availability of abortion coverage, the process for obtaining coverage, and the associated costs for an abortion in circumstances of rape and life endangerment in five states where Medicaid coverage should be available to cover most abortions and in 12 states with restrictions on the circumstances under which Medicaid funding can be used for abortion.FindingsWe were able to complete 82% of surveys. Medicaid staff definitively provided information about the availability of coverage that was consistent with state policies in 64% of surveys. However, 52% of staff reported that coverage could be difficult to obtain and that rigorous documentation of the circumstances of the abortion was required. Information about copays for abortion was given in 78% of surveys. We subjectively rated the caller’s experience with Medicaid staff as excellent during 32% of the surveys, adequate in 61% of surveys, and poor in 7% of surveys.ConclusionMedicaid staff provided inconsistent information that was often discouraging of women seeking abortion coverage, suggesting that women may have difficulties obtaining accurate information about Medicaid coverage of abortion, which may deter access to care.     

Insurance coverage of special foods needed in the treatment of phenylketonuria.

Optimal medical management of phenylketonuria (PKU) requires the use of special low-phenylalanine foods for many years. For women with PKU, elevated maternal blood levels of phenylalanine even at conception can lead to fetal damage. Despite this need, private health insurance, Medicaid, and other public health programs often exclude the cost of these foods from their benefits. The New York State Department of Health conducted a survey of metabolic disorders treatment centers to elucidate the problems PKU patients have obtaining and paying for the special foods essential to their care. Payment for special foods was denied to nearly half of those with private health insurance policies and was covered for only 10 percent of Medicaid-eligibles. A public program for children with special health care needs covered these food costs in upstate New York but not in New York City. There is no program of assistance for adults who are not eligible for Medicaid and who do not have private insurance coverage of special foods. At present, many private health insurance policies and public programs do not cover the costs of low-phenylalanine foods other than infant formula. Payment for this essential part of the management of PKU should be mandated for all public programs for persons with chronic illnesses, public medical assistance (Medicaid) programs, and private health insurance. There is a need for a public program to assist adults with PKU who are not eligible for Medicaid and who do not have health insurance that covers these costs.     

Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape,Incest and Life Endangerment

CONTEXT: The Hyde Amendment bans federal Medicaid funding for abortion in the United States except if a pregnancy resulted from rape or incest or endangers the life of the woman. Some evidence suggests that providers do not always receive Medicaid reimbursement for abortions that should qualify for funding. METHODS: From October 2007 to February 2008, semistructured in‐depth interviews about experiences with Medicaid reimbursement for qualifying abortions were conducted with 25 respondents representing abortion providers in six states. A thematic analysis approach was used to explore respondents’ knowledge of and experiences seeking Medicaid reimbursement for qualifying abortions, as well as individual, clinical and structural influences on reimbursement. The numbers of qualifying cases that were and were not reimbursed were assessed. RESULTS: More than half of Medicaid‐eligible cases reported by respondents in the past year were not reimbursed. Respondents reported that filing for reimbursement takes excessive staff time and is hampered by bureaucratic claims procedures and ill‐informed Medicaid staff, and that reimbursements are small. Many had stopped seeking Medicaid reimbursement and relied on nonprofit abortion funds to cover procedure costs. Respondents reporting receiving reimbursement said that streamlined forms, a statewide education intervention and a legal intervention to ensure that Medicaid reimbursed claims facilitated the process. CONCLUSIONS: The policy governing federal funding of abortion is inconsistently implemented. Eliminating administrative burdens, educating providers about women’s rights to obtain Medicaid reimbursement for abortion in certain circumstances and holding Medicaid accountable for reimbursing qualifying cases are among the steps that may facilitate Medicaid reimbursement for qualifying abortions.     

The dynamic relationship between low birthweight and induced abortion in New York City. An aggregate time-series analysis

We use a vector autoregression to examine the dynamic relationship between the race-specific percentage of pregnancies terminated by induced abortion and the race-specific percentage of low-birthweight births in New York City. With monthly data beginning in 1972, we find that induced abortion explains low birthweight for blacks, but not for whites. There is no evidence of feedback from low birthweight to induced abortion. The findings suggest that unanticipated decreases in the percentage of pregnancies terminated by induced abortion would worsen birth outcomes among blacks in New York City.     

States rebel against Federal abortion orders

Despite the ascent of Bill Clinton to Presidential power in the US and his early successful repeals of bans on abortion counseling at federally funded clinics, abortions in military hospitals, and fetal tissue research, the controversy and debate over a woman's right to abortion continues in the US. The Hyde Amendment, named after Representative Henry Hyde, Republican from Illinois, has been in effect since 1976 barring Medicaid from funding abortions except to save the life of the pregnant woman. Congress in 1993, however, eased the amendment to allow states to use Medicaid funds to pay for abortions for low-income women in the cases of rape or incest. Anti-abortion lawmakers were assured by the provision's sponsors that the Clinton Administration would not force states to comply. The Department of Health and Human Services (HHS) instead sent a letter to state Medicaid directors on December 28, 1993, ordering them to use Medicaid funds to pay for abortions for low-income women who were the victims of rape or incest. President Clinton subsequently complained that HHS had bypassed his office in issuing the directive, state Medicaid directors protested that the directive had been imposed without the usual notice and allowance of time for public comment, and states claimed that the order clashes with existing state laws which ban the public funding of abortions not required to save the life of the mother. Officials from Arkansas, Colorado, North Dakota, Pennsylvania, and Utah have stated that they may fight the directive, while the HHS will most likely not move to rescind or change its directive. The issue will probably be resolved in the courts. The authors note that this state/federal battle over Medicaid-funded abortions is only part of a larger war scheduled to take place in Congress over whether pregnancy-related services, including abortion, will be covered in the Administration's Health Security Act.     

Relying on Surveys to Understand Abortion Behavior: Some Cautionary Evidence

OBJECTIVES: The reliability of abortion self-reports has raised questions about the general usefulness of surveys in research about abortion behavior; however, the extent of underreporting remains a subject of some debate. This study sought to examine abortion reporting in a sample of welfare mothers and to determine factors in underreporting. METHODS: In New Jersey, which covers abortions requested by welfare recipients under its Medicaid program, the responses of a randomly drawn sample of 1236 welfare mothers about abortion events were compared with the Medicaid claims records of these women. RESULTS: Only 29% of actual abortions were self-reported by the women in the sample. This finding varied dramatically by race, with substantially higher rates of underreporting by Blacks than by Whites or Hispanics. CONCLUSIONS: Although race is the most consistent predictor of underreporting behavior, attitudinal factors and survey technology also help in explaining abortion reporting behavior.     

Does the family cap influence birthrates? Two new studies say "no"

Some have argued that imposing a cap upon welfare benefits would reduce birthrates among welfare recipients. However, recent studies in New Jersey and Arkansas determined that denying an increase in cash assistance to women who have another child while on welfare has no effect upon births in the states. When New Jersey became the first state, 4 years ago, to impose a family cap, then-governor James Florio declared the cap a success after just 2 months. An analysis by researchers at Rutgers University released in September 1997 disagrees. While birthrates among welfare recipients declined between August 1992 and July 1995, the decline was no different from that observed in a control group which continued to receive a benefit increase if they had another child. Among both groups, and consistent with birthrates in the general New Jersey population, birthrates fell from 11% in 1992-93 to 6% in 1994-95. These results did not change when researchers controlled for the age and race of the almost 8500 women studied. Abortion rates in the state declined both among women subject to the cap and among the control group. Although researchers studying the impact of the family cap in Arkansas could not determine its effect upon abortion rates because Arkansas fails to pay for abortions under Medicaid, no statistically significant difference was observed between the birthrates of women subject to the cap and a control group. The findings of these 2 studies cast doubt upon the notion that an increase in monthly benefits after the birth of a new baby is an incentive for welfare recipients to have more children.     

The social and economic correlates of pregnancy resolution among adolescents in New York City, by race and ethnicity: a multivariate analysis.

This study utilizes a data set combining vital records from live birth and induced abortion certificates in New York City in 1984 to examine the correlates of the two outcomes among pregnant adolescents. Four groups totaling 31,207 teenagers were examined: Black non-Latinos (51 per cent), White non-Latinos (17 per cent), Puerto Ricans (25 per cent), and non-Puerto Rican Latinos (8 per cent). Multivariate regressions were fit for each group. Simulations based on the regressions reveal that the proportion of live births plus induced abortions among unmarried 18-year-olds, on Medicaid, with a previous live birth, no previous induced abortions, and nine years of completed schooling was .55 in the case of Puerto Ricans, .34 for non-Puerto Rican Latinos, .60 for Blacks, and .51 for Whites. For nulliparous adolescents of the same age and marital status, with an additional year of schooling, but not on Medicaid, and with a previous induced abortion, the fraction of pregnancies that were terminated rose to .84 in the case of Puerto Ricans, .81 for non-Puerto Rican Latinos, .87 for Blacks, and .96 for Whites. The results suggest that attitudes toward abortion as proxied by previous induced terminations substantially increase the likelihood of aborting as well as narrow the racial and ethnic differences with respect to pregnancy resolution.     

Abortion surveillance--United States, 1997.

PROBLEM/CONDITION: In 1969, CDC began abortion surveillance to document the number and characteristics of women obtaining legal induced abortions, to monitor unintended pregnancy, and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions. REPORTING PERIOD COVERED: This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States in 1997. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state where the abortion occurred. The data are received from 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. RESULTS: In 1997, a total of 1,186,039 legal abortions were reported to CDC, representing a 3% decrease from the number reported for 1996. The abortion ratio was 306 legal induced abortions per 1,000 live births, and since 1995, the abortion rate has remained at 20 per 1,000 women aged 15-44 years. The availability of information about characteristics of women who obtained an abortion in 1997 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions by state is reported by state of residence and state of occurrence; characteristics of women obtaining abortions in 1997 are reported by state of occurrence. Women who were undergoing an abortion were more likely to be young (i.e., aged < 25 years), white, and unmarried; approximately one half were obtaining an abortion for the first time. More than one half of all abortions for which gestational age was reported (55%) were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. Overall, 18% of abortions were performed at the earliest weeks of gestation (< or = 6 weeks), 18% at 7 weeks of gestation, and 20% at 8 weeks of gestation. From 1992 through 1997, increases have occurred in the percentage of abortions performed at the very early weeks of gestation. Few abortions were provided after 15 weeks of gestation--4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained at > or = 21 weeks. A total of 19 reporting areas submitted information regarding abortions performed by medical (nonsurgical) procedures, comprising < 1% of procedures reported by all states. Younger women (i.e., aged < or = 24 years) were more likely to obtain abortions later in pregnancy than were older women. INTERPRETATION: From 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, and in 1997, the number of abortions in the United States declined to it lowest level since 1978. PUBLIC HEALTH ACTIONS: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed and efforts to prevent unintended pregnancy can be evaluated.     

Public funding of contraceptive, sterilization and abortion services, 1982

The federal government and the states spent $328 million to support the provision of contraceptive services in fiscal 1982, 13 percent less than they had spent the previous year. Federal funds for family planning services came from Title X of the Public Health Service Act, Title XIX of the Social Security Act (Medicaid), and the Maternal and Child Health (MCH) and Social Services block grants, which are administered by the states. Title X continued to provide the largest, although a diminishing, share of public funds for contraceptive services--36 percent of all such funds in 1982. (In 1980, Title X had accounted for 44 percent of public funding.) Medicaid expenditures for family planning totaled $94 million; $17 million was spent under the MCH block grant, and $46 million under the Social Services block grant. State governments contributed an additional $53 million, about the same figure reported for the previous year, indicating that the states did not use their own funds to soften the impact of cuts in federal expenditures for contraceptive services in 1982. The federal government and the states spent an estimated $55 million, almost all of it through Medicaid, to provide sterilization services for poor women. The states spent $67 million and the federal government spent $1 million to provide abortions for 210,000 indigent women. These figures come from the 11th annual survey of state health and welfare agencies and state Medicaid programs by The Alan Guttmacher Institute (AGI). The AGI conducted this survey in January 1983 to determine the levels and sources of public funding for contraceptive, sterilization and abortion services in each state during FY 1982.