The impact of publicly-financed family planning services on pregnancies, births, and costs: A critical review of the peer-reviewed literature

Abstract

Introduction Low-income women in the United States obtain access to family planning services in large part through publicly subsidised federal, state and local programmes. Public support for publicly funded family planning care is based on the belief that these programmes reduce unintended pregnancy, promote better birth outcomes and save governments money. There is, therefore, a need to assess the results from and quality of existing research in this area. This article discusses the impact of publicly financed family planning services on pregnancies, births and costs. Materials and methodsThis article reviews 11 published evaluations of publicly financed family planning services and its impact on pregnancies, births and costs for the period 1990-2013. Relevant studies were identified through a search of PubMed and SCOPUS databases and the strength of their methodology was assessed using the US Preventive Services Task Force quality rating criteria. Results All reviewed articles received a quality rating of 'fair' but varied on a number of different dimensions, including their methodology, data sources, time frame, outcomes of interest and scope, preventing directThe impact of publicly financed family planning services on pregnancies, births and costs: a critical review of the peer-reviewed literature MT Gerstein*, AR Markus* comparisons across studies. Results from reviewed analysis do, however, suggest that publicly funded family planning services avert a significant proportion of unintended pregnancies, improve birth outcomes and reduce governmental costs. ConclusionThe reviewed literature demonstrates that publicly financed family planning care promotes control over childbearing decisions and improved birth outcomes, while saving local, state and federal governments money. However, this review also identified several important research gaps and flaws in the existing evidence base, particularly in the generalisability of results and narrow set of measures used to estimate impact. We suggest several ways to expand the field of available research by leveraging opportunities afforded through state Medicaid reform legislation and Medicaid expansions under the Affordable Care Act.

The Status of Women's Reproductive Rights and Adverse Birth Outcomes

“…Two policies benefitting low-income women in particular were associated with lower rates of LBW, including expanded Medicaid eligibility for family planning and coverage of abortion services for Medicaid-eligible women by use of public funds. This finding is in line with previous work demonstrating not only improvements in maternal and child health outcomes, but financial benefits for states choosing to enact these policies (Gerstein & Markus, 2013;Lindrooth & McCullough, 2007;Meier &McFarlane, 1994). Some conflicting evidence regarding the direct impact of restricting Medicaid funding for abortion on birth weight suggests associations may be owing to unobserved characteristics of states with legislative restrictionsdthose associated with both enactment of funding restrictions and with LBWdand we cannot discount this possible explanation for our finding as well (Currie, Nixon, & Cole, 1996;Henshaw et al, 2009).…”