State Facts About Title X and Family Planning: Massachusetts
National Background and Context
Title X of the Public Health Service Act is the sole federal program devoted entirely to family planning. Through Title X the federal government sets family planning policy, and its flexible grant funds not only subsidize direct client services, but are critical to putting family planning centers in communities and to supporting their ongoing infrastructure needs.
These services are vital: U.S. women who are not using contraceptives, or who are using them inconsistently, represent one-third of all women at risk of unintended pregnancy and account for 95% of the three million unintended pregnancies that occur every year.(1) Unintended pregnancy, in turn, has been linked with numerous negative maternal and child health outcomes. More broadly, women’s ability to rely on contraception enables them to invest in higher education and to be full participants in the nation’s workforce.(2,3)
Title X is central to helping women meet their reproductive health goals. In 2012, an estimated 6.1 million female contraceptive clients were served at publicly funded family planning centers, 71% of whom—4.3 million women—were served at sites supported by Title X.(4) Contraceptive services at Title X–supported family planning centers helped women and couples avoid 1.1 million unintended pregnancies, which would likely have resulted in 526,900 unplanned births and 362,500 abortions (the remainder would have resulted in miscarriages).(4) Without these services, unintended pregnancy, unplanned birth and abortion in the United States would be 32% higher.(4) And by helping women avoid unintended pregnancies, Title X–supported centers saved taxpayers $5.3 billion in 2010, amounting to $5.68 saved for every $1 spent providing contraceptive care.(5)
One-quarter of all poor women who obtain contraceptive services each year do so at a site that receives Title X funding.(6) Among women overall, 10% obtain a Pap test or pelvic exam at a Title X–supported site, as do 18% obtaining services for a sexually transmitted infection.(6) It is therefore not at all surprising that six in 10 women who obtain care at a Title X–supported center consider it to be their usual source of medical care.(6)
The Need for Title X in Massachusetts
•In 2012, 363,540 women in Massachusetts were in need of publicly supported contraceptive services and supplies.(4) Such women are sexually active; aged 13–44; able to become pregnant and not pregnant, postpartum nor trying to become pregnant; and either have a family income below 250% of the federal poverty level or are younger than age 20.
•In Massachusetts, 7% of women in need of publicly supported contraceptive services and supplies are uninsured, compared with 30% nationally.(4) Title X–supported family planning centers play an especially important role in serving the uninsured, who often cannot afford to pay out-of-pocket at private health care providers.
•In 2008, 58,000 Massachusetts residents had an unintended pregnancy, a rate of 43 per 1,000 women aged 15–44.(7)
•In 2008, births resulting from unintended pregnancies cost the state and federal governments $194 million.(8)
•In 2008, 25,800 Massachusetts residents obtained abortions, a rate of 19.0 per 1,000 women aged 15–44, compared with 19.3 per 1,000 nationally.(9)
•In 2010, there were 8,310 pregnancies among Massachusetts teens aged 15–19, a rate of 37 pregnancies per 1,000 teen women, compared with 57 per 1,000 nationally.(10)
Title X–Supported Services
•Title X–supported centers provided contraceptive care to 57,050 women in Massachusetts in 2012.(4)
•These centers served 16% of women in the state in need of publicly supported contraceptive services and supplies, compared with 22% served by such centers nationally.(4)
•Of the total contraceptive clients served by these centers in 2010, 58% had incomes at or below the federal poverty level, compared with 69% nationally.(11)
•In 2010, 82 family planning centers in Massachusetts received support from Title X.(5) They included:
Health department clinics: 0
Federally qualified health centers: 19
Planned Parenthood clinics: 4
Hospital outpatient clinics: 7
Other independent clinics: 52
•These centers provided contraceptive care to the following numbers of clients:(4)
Health department clinics: 0
Federally qualified health centers: 16,430
Planned Parenthood clinics: 4340
Hospital outpatient clinics: 1,940
Other independent clinics: 41,920
Impact of Services Provided by Title X– Supported Centers in Massachusetts
•In 2012, contraceptive services provided at Title X–supported centers in Massachusetts helped women avoid 14,000 unintended pregnancies, which would have resulted in 6,900 unplanned births and 4,800 abortions.(4)
•In 2010, contraceptive services provided at Title X–supported centers in Massachusetts helped women younger than age 20 avoid 4,700 unintended pregnancies.(5)
•In the absence of these services, the number of unintended pregnancies in Massachusetts would be 25% higher, and the number of abortions would be 23% higher. The number of teen pregnancies in Massachusetts would be 45% higher.(12)
•By helping women avoid unintended pregnancies and the births that would follow, the services provided at Title X– supported centers in Massachusetts saved $100.6 million in public funds in 2010.(5)
1. Sonfield A, Hasstedt K and Gold RB, Moving Forward, Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014.
2. Guttmacher Institute, Testimony of Guttmacher Institute, Submitted to the Committee on Preventive Services for Women, Institute of Medicine, 2011, <http://www.guttmacher.org/pubs/ CPSW-testimony.pdf>, accessed Feb. 14, 2011.
3. Sonfield A et al., The Social and Economic Benefits of Women’s Ability to Determine Whether and When to Have Children, New York: Guttmacher Institute, 2013.,<http://www.guttmacher. org/pubs/social-economic-benefits.pdf> accessed July 26, 2013.
4. Guttmacher Institute, Contraceptive Needs and Services, 2012, New York: Guttmacher Institute, 2012, <http://www.guttmacher.org/pubs/win/contraceptive-needs-2012.pdf>, accessed August 12, 2014.
5. Guttmacher Institute, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, <http://www.guttmacher.org/pubs/win/contraceptive-needs-2010.pdf>, accessed July 15, 2013.
6. Frost JJ, U.S. Women’s Use of Sexual and Reproductive Health Services: Trends, Sources of Care and Factors Associated with Use, 1995–2010, New York: Guttmacher Institute, 2013, <http://www.guttmacher.org/ pubs/sources-of-care-2013.pdf>, accessed July 26, 2013.
7. Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2002, 2004, 2006 and 2008, New York: Guttmacher Institute, 2013, <http://www.guttmacher.org/pubs/ StateUP08.pdf>, accessed September 9, 2013.
8. Sonfield A and Kost K, Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy and Infant Care: Estimates for 2008, New York: Guttmacher Institute, 2013, <http://www.guttmacher.org/pubs/public-costs-of-UP.pdf>,accessed October 22, 2013.
10. Guttmacher Institute, U.S. Teenage Pregnancies, Births and Abortions, 2008: State Trends by Age, Race and Ethnicity, New York: Guttmacher Institute, 2013, <http://www.guttmacher.org/pubs /USTPtrendsState08.pdf>, accessed July 26, 2013.
11. Fowler CI et al., Family Planning Annual Report: 2011 National Summary, Research Triangle Park, NC: RTI International, 2012, <http://www.hhs.gov/opa/ pdfs/fpar-2011-national-summary.pdf>, accessed July 26, 2013.
12. Cohen SA, The numbers tell the story: the reach and impact of Title X, Guttmacher Policy Review, 2011, 14(2):20–23.