Modern contraception has given women and couples the means to control whether and when to have children, which in turn has had important health, social and economic benefits. Nonetheless, many people find it difficult to effectively practice contraception for the bulk of their reproductive lives when they prefer not to become pregnant. As a result, nearly half of U.S. pregnancies—almost three million each year—are unintended, and these pregnancies are highly concentrated among poor and low-income women.1
The federal and state governments have worked for decades to expand access to family planning services for young and low-income women and men, channeling public funds through multiple programs. Most notably, the joint federal-state Medicaid insurance program provides the large majority of public funding for clinical care, and the Title X national family planning program buttresses the system of family planning centers, sets standards of care and fills gaps in services and coverage.
This public effort serves millions of U.S. women and men each year. The contraceptive services provided help them avoid pregnancies they do not want, and avoid the unplanned births, abortions and miscarriages that would otherwise follow. Moreover, publicly supported family planning visits also include screenings for STIs such as chlamydia, gonorrhea and HIV; cervical cancer prevention services, including Pap tests and testing and vaccination for human papillomavirus (HPV); and other key preventive care services, all of which have their own health benefits. Collectively, these family planning services yield substantial government savings—$13.6 billion nationally in 2010, or $7.09 for every public dollar spent.2
Need for Services
In 2010, 23,000 Iowa residents experienced an unintended pregnancy, a rate of 39 such pregnancies per 1,000 women aged 15–44.3 These unintended pregnancies cost the state and federal governments $175.8 million.4 In 2011, there were 4,080 pregnancies among Iowa teens aged 15–19, a rate of 39 pregnancies per 1,000 teen women.5
In 2014, 190,270 women in Iowa were in need of publicly supported contraceptive services and supplies.6 Women are considered to be in need of publicly supported contraceptive services and supplies if they have ever had sex, are aged 13–44, are able to become pregnant, are not pregnant or postpartum nor are they trying to become pregnant, and either have a family income below 250% of the federal poverty level or are younger than age 20. Large proportions of these women are young, nonwhite, low-income or uninsured.6
Provision of Services
Public funding for family planning comes from a variety of sources. In Iowa, 83% of funding is from Medicaid and 16% is from Title X.7
Most women who obtain publicly funded family planning services do so at safety-net health centers. These family planning providers are particularly critical for those most likely to fall through the cracks of the U.S. health care system. For example, centers are trusted, accessible sources of contraceptive counseling and care for teens, who often lack financial resources and have confidentiality concerns that may bar them from seeking resources from their families or even from using their insurance coverage.
Publicly supported health centers provided contraceptive care to 54,730 women in Iowa in 2014, including 43,470 women served by Title X–supported centers.6 Health centers in Iowa served 12,010 teenage women in 2014, including 9,580 teens served by Title X–supported centers. These totals amount to substantial proportions—but not nearly all—of the women in need of publicly supported contraception.6
Safety-net health centers include state and local health departments, federally qualified health centers (FQHCs), Planned Parenthood affiliates, hospital-based clinics and other independent agencies, such as family planning councils. In 2010, 105 publicly funded health centers in these five categories provided family planning services in Iowa, including 79 that received support from Title X.8,9
Distribution of Iowa health centers and Title X-supported centers and proportion of clients served in 2010, by type of health center.
Impact of Services
Making effective methods of contraception available to women who want them but could not otherwise afford to use them consistently and correctly prevents a substantial number of unintended pregnancies.2,6 That, in turn, reduces the incidence of the unplanned births, abortions and miscarriages that would otherwise follow. Many unplanned births also result in short interpregnancy intervals (defined as periods of less than 18 months between a birth and a subsequent pregnancy) and in babies being born prematurely or at low birth weight.
In the absence of the publicly supported family planning services provided at safety-net health centers, the rates of unintended pregnancy, unplanned birth and abortion for all women would be 57% higher in Iowa, and the teen pregnancy rate would be 70% higher.10,11
Unintended Pregnancy Prevention
Outcomes prevented in Iowa as a result of services provided by publicly funded family planning centers
|Year||All health centers||Title X centers|
|Short interpregnancy interval births||2010||2,700||2,160|
|Preterm/low birth weight births||2010||1,400||1,120|
Screening for STIs, including chlamydia and gonorrhea, is an integral component of the family planning services provided at safety-net health centers. STI screening results in early detection and treatment of these infections, reducing transmission to partners and helping women and men avoid negative health outcomes that might otherwise follow, such as pelvic inflammatory disease, ectopic pregnancy and infertility. Cervical cancer screening through Pap tests and HPV tests is another basic preventive care service provided at publicly funded family planning visits, along with vaccination for HPV. These services help to prevent cases of cervical cancer, either by detecting abnormal cervical cells and precancer cases before they develop into cancer or by preventing the HPV infection that leads to future health problems. In Iowa, publicly funded providers helped women and men avoid many such negative health outcomes.8
STI and Cervical Cancer Prevention
Outcomes prevented in Iowa as a result of publicly funded services provided in 2010
|All health centers||Title X centers|
|Pelvic inflammatory disease cases||120||91|
|Abnormal cervical cell cases||71||56|
|Cervical cancer cases||34||27|
By helping clients avoid unintended pregnancies, reproductive cancers and STIs, these services lead to considerable savings on Medicaid and other taxpayer-funded health programs. In Iowa, the publicly funded family planning services provided at safety-net health centers in 2010 helped save $137,357,000 in public funds.2 That includes savings from reduced maternity and birth-related costs, along with reduced costs related to miscarriage and abortion and savings related to STI screening and cervical cancer prevention services.2
Public Cost Savings
Cost savings achieved in Iowa as a result of publicly funded services provided in 2010
|All health centers||Title X centers|
|$155,240,000||Maternity- and birth-|
|$123,894,000||Maternity- and birth-|
|+||$4,630,000||Miscarriage costs||+||$3,677,000||Miscarriage costs|
|+||$114,000||Abortion costs||+||$89,000||Abortion costs|
|+||$461,000||Chlamydia, gonorrhea and HIV testing||+||$366,000||Chlamydia, gonorrhea and HIV testing|
|+||$197,000||Pap and HPV testing and HPV vaccination||+||$155,000||Pap and HPV testing and HPV vaccination|
|=||$160,642,000||Total gross savings||=||$128,181,000||Total gross savings|
|-||$23,285,000||Family planning costs||-||$18,493,000||Family planning costs|
|=||$137,357,000||Total net savings||=||$109,687,000||Total net savings|
2. Frost JJ et al., Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, 92(4):696–749, http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1468-0009.12080/
3. Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since 2002, New York: Guttmacher Institute, 2015, https://www.guttmacher.org/report/unintended-pregnancy-rates-state-level-estimates-2010-and-trends-2002.
4. Sonfield A and Kost K, Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for 2010, New York: Guttmacher Institute, 2015, https://www.guttmacher.org/report/public-costs-unintended-pregnancies-and-role-public-insurance-programs-paying-pregnancy.
5. Guttmacher Institute, U.S. Teenage Pregnancies, Births and Abortions, 2011: State Trends by Age, Race and Ethnicity, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/us-teen-pregnancy-state-trends-2011.
6. Frost JJ, Frohwirth L and Zolna MR, Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/contraceptive-needs-and-services-2014-update.
7. Sonfield A and Gold RB, Public Funding for Family Planning, Sterilization and Abortion Services, FY 1980–2010, New York: Guttmacher Institute, 2012, https://www.guttmacher.org/report/public-funding-family-planning-sterilization-and-abortion-services-fy-1980-2010.
8. Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/contraceptive-needs-and-services-2010.
9. Unpublished tabulations of data from Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010.
10. Special tabulations of data from Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2012 Update, New York: Guttmacher Institute, 2014, and Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2002, 2004, 2006 and 2008, New York: Guttmacher Institute, 2013.
11. Special tabulations of data from Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2012, and Kost K and Henshaw S, U.S. Teenage Pregnancies, Births and Abortions, 2008: State Trends by Age, Race and Ethnicity, New York: Guttmacher Institute, 2013.