Estimating the Fertility Effect of Expansions of Publicly Funded Family Planning Services in California

Objective

To estimate the number of unintended pregnancies averted through the provision of family planning services to low income women in Family PACT, California's Medicaid waiver program.

Study Design

We use a Markov model to estimate the number of pregnancies in the absence of Family PACT based on the contraceptive method mix used before program enrollment, and pregnancies in the presence of the program, based on method dispensing claims.

Results

Nearly 1 million (998,084) women were provided with contraceptives in Family PACT in 2007. Contraceptive services averted over an estimated 286,700 unintended pregnancies including 122,000 abortions, 133,000 unintended births, and over 40,000 births among teens.

Conclusion

This conservative measure of the effect of Family PACT on unintended pregnancies indicates the benefit of expanding access to contraceptive services, an example for other states considering expanding access to family planning services through a state plan amendment under health care reform.     

Abstinence at Successful Discharge in Publicly Funded Addiction Health Services

Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.     

Use of Performance-Based Contracting to Improve Effective Use of Resources for Publicly Funded Residential Services

This article details the process that was undertaken to convert the financing mechanism for publicly funded mental health residential programs in a large urban setting from nonincentivized agreements to performance-based contracts. The initial target for change was improving occupancy rates for residential services targeted to persons with serious and persistent mental illness. Improving occupancy rates enhanced efficiency such that 25 additional cents for every dollar spent on mental health residential services went to direct care. Challenges met in the process of effecting the contracting conversion of this expansive system are addressed. The importance of centralized gatekeeping, stakeholder involvement, and setting modest expectations are emphasized as keys to success. Although the system still has less capacity than client demand warrants, existing beds are no longer underutilized. Recent efforts to expand contracting targets beyond efficiency goals to include improved quality and effectiveness are also discussed.     

First Family Planning Visit in School-Based Clinics

The timing of the first family planning visit for 144 female adolescents using school-based clinics in four St. Paul, Minn., high schools was studied. Mean delay time for the sample was 11.4 months and the median was 7.8 months. Almost 50% of the sample arrived within two months of either a planned onset of sexual intercourse (virgin group) or a recent start of sexual activity (short delay group). Early onset of sexual activity (v age 15) was more prevalent among long delayers (47.9%) than among short delayers (21.1%). Longer delayers were more likely to come from the lowest socioeconomic groups. Short delayers and longer delayers were equally likely to have been motivated to attend the clinic because they feared they were pregnant. Reasons for choosing this clinic over others reflected the importance of confidentiality, comprehensiveness of services, and the specific adolescent orientation of care.     

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.     

Meeting the Contraceptive Needs of Teens and Young Adults: Youth-Friendly and Long-Acting Reversible Contraceptive Services in U.S. Family Planning Facilities

PurposeIncreased use of contraceptive services, including long-acting reversible contraceptives (LARCs), among sexually active teens and young adults could significantly reduce unintended pregnancy. Objectives were to describe youth-friendly contraceptive services (including LARC) available to teens and young adults at U.S. publicly funded family planning facilities.MethodsBetween April and September 2011, center directors at a nationally representative sample of 1,196 U.S. publicly funded family planning facilities were surveyed to assess accessibility and provision of contraceptive services for teens and young adults; 584 (52%) responded.ResultsFacilities were accessible to young clients in several ways, including not requiring scheduled appointments for method refills (67%) and having flexible hours (64%). Most facilities provided outreach and/or education to young people (70%), and 27% used social network media to do this. Most facilities took steps to ensure confidentiality for young clients. These youth-friendly practices were more common at Planned Parenthood, Title X, and reproductive health focused facilities than at other facilities. Long-acting reversible contraceptive methods were regularly discussed with younger clients at less than half the facilities. Youth-friendly sites had increased rates of LARC provision among younger clients. The most common challenges to providing contraceptive and LARC services to younger clients were the costs of LARC methods (60%), inconvenient clinic hours (51%), staff concerns about intrauterine device (IUD) use among teens (47%), and limited training on implant insertion (47%).ConclusionsImproving the ability of family planning facilities to provide youth-friendly contraceptive and LARC-specific methods to younger clients may increase the use of highly effective contraception in this population.     

中国西部县乡级计划生育服务机构宫内节育器服务及管理现况调查

目的:了解中国西部县乡级计划生育服务机构宫内节育器(IUD)放置服务与管理特点,并探讨其成因,为有效提高县级IUD放置服务质量提出建议。方法:根据国家计划生育优质服务县的标准将云南省129个县分为好、中等、差3层,每层抽取1个县,进行横断面调查。采用情景分析方法,收集与IUD放置服务和管理相关的数据及资料,并进行深入分析。结果:①计划生育服务机构平均放置IUD种类,县级为(6.17±2.55)种,乡级为(4.08±0.92)种,县级多于乡级(Z=2.37,P=0.023)。②计划生育服务机构人员平均每年人均放置IUD数量,县级为(129.83±47.42)个,乡级为(288.75±35.18)个,县级低于乡级(F=22.26,P<0.000 1)。此外,县级仍在使用一些失败率较高的IUD类型(如某些T型环)。③定性研究结果表明,西部农村IUD失败率较高,与县计划生育服务机构IUD放置服务的管理粗放有密切关系,放置人员与管理人员间沟通、IUD的采购和机构文化都有很大改进空间。结论:西部县计划生育服务机构可通过适当控制IUD种类数和强化IUD服务管理提高服务质量。     

中国西部县乡级计划生育服务机构宫内节育器服务及管理现况调查

目的:了解中国西部县乡级计划生育服务机构宫内节育器(IUD)放置服务与管理特点,并探讨其成因,为有效提高县级IUD放置服务质量提出建议.方法:根据国家计划生育优质服务县的标准将云南省129个县分为好、中等、差3层,每层抽取1个县,进行横断面调查.采用情景分析方法,收集与IUD放置服务和管理相关的数据及资料,...     

到医院门诊寻求计划生育服务妇女宫颈糜烂患病情况调查

目的:了解到医院门诊寻求计划生育服务妇女宫颈糜烂患病情况,为制定切实有效的临床预防服务措施提供依据。方法:非选择性地对到医院门诊寻求计划生育服务的740名妇女的人口学特征及宫颈糜烂患病情况进行调查。结果:740名妇女的宫颈糜烂总患病率为43.24%,与人工流产、放置IUD和取IUD妇女的宫颈糜烂患病率比较,2χ=4.916,P=0.085,差异无统计学意义;均以I度糜烂为主,在3个人群中平均占81.2%。结论:到医院门诊寻求计划生育服务妇女宫颈糜烂患病率较高,医生要把握患者就诊的时机,通过对患者本人及其配偶的生殖健康教育使患有宫颈糜烂的妇女能得到及时治疗;同时提高妇女的自我保健意识,减少宫颈糜烂的发生。