Department of Health Policy, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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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 methods
This 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.
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 direct 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.
The 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.