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New research by the Alan Guttmacher Institute in Washington, DC, indicates that one-sixth of U.S. women rely on publicly funded family planning clinics.
Jennifer Frost, senior research associate for Guttmacher, tells State Health Watch that analysts had estimated the usage was that high, but hadn’t had hard data before. Her research also describes the characteristics of the women who use the clinics and the different levels of services provided by clinics and private providers.
Ms. Frost says the level of usage could challenge public clinics financially and, "If policy-makers believe that it is important that women get a wide range of services, they’ll need to see that they are adequately funded. This is definitely a defense for publicly funded clinics."
The survey found that contraceptive and other reproductive health care services are offered by more than 7,000 publicly funded clinics, nearly 28,000 private practice obstetricians/ gynecologists, many of the more than 40,000 private family practice doctors, and other sources such as private clinics, military- or school-based care, and hospital-based care not included in the public family planning clinic network.
The number of women ages 15 to 44 who received family planning services in the prior year increased from 19.8 million in 1982 to 20 million in 1988 and 21.9 million in 1995, reflecting both population growth and changes in the percentages of women obtaining family planning services.
Among women who reported having used family planning services during the past year, approximately one-third obtained one or more of these services in a clinic or nonprivate setting. Overall, this percentage increased from 31% in 1982 to 36% in 1988 and remained at 36% in 1995.
Ms. Frost tells SHW that although the data used are old (1982 through 1995) the issues have not changed. "Later data collected on clinic clients have shown the populations have not changed, and we don’t believe the care has changed."
A recent Guttmacher Institute report highlighting the accomplishments of the public-funded planning clinics indicated they serve one in four women who obtain birth control from a health care provider, one in seven women of reproductive age who receive Pap smears and pelvic examinations, and account for one in four HIV tests and one in three visits for other sexually transmitted disease (STD) services among women of reproductive age.
Frost’s survey found that younger women were significantly more likely than older women to have obtained reproductive health care from family planning clinics, even when the effects of all other background variables and women’s risk for unintended pregnancy were controlled for.
In addition, unmarried women, minority women, those with less education, poor women, and those who had no health insurance or were covered by Medicaid were significantly more likely than women in the reference categories for each group to have obtained care from publicly funded family planning clinics.
"The odds of using a clinic were highest for those covered by Medicaid or having no health insurance," Ms. Frost says in her study. "Such women were three to 3.6 times as likely as women with private insurance to have received reproductive health care from family planning clinics."
The results indicate that among women obtaining any care, those who got care from family planning clinics were significantly more likely to receive contraceptive services than were women who obtained care from private doctors and HMOs. Similar results were found for care for STDs but not for receipt of preventive gynecologic or pregnancy-related care. For the latter services, clinics did not differ significantly from private physicians, except that women getting care from non-Title X clinics were significantly less likely to have obtained preventive gynecologic care than were women going to private doctors.
"That these patterns persisted, even when we controlled for women’s characteristics, indicates that the provision of specific services to women who visit different types of providers is related in part to provider type itself," Ms. Frost writes. "Either women choose different types of providers because they are seeking different types of services, or providers of different types are simply more or less likely to offer certain services."
Ms. Frost tells SHW it was "a surprise that women who went to clinics got a broader range of services than those who went to private physicians."
The study’s analyses suggested which characteristics of women were most important in determining the type of contraceptive or reproductive service they will obtain (among those obtaining any care). Age was the more important predictor of the receipt of contraceptive, pregnancy-related, and STD-related services, but was not important in predicting receipt of preventive gynecologic care.
Non-Hispanic black women were less likely than non-Hispanic white women to have obtained contraceptive services, but were more likely to have obtained preventive gynecologic care.
Hispanic women who obtained any care were significantly less likely than white or black women to have obtained preventive gynecologic care, as were less-educated women compared with college-educated women.
Poverty status had little impact on what services women obtained once other variables were accounted for. Women without any health insurance were significantly less likely than women with private insurance to have obtained contraceptive services or preventive gynecologic care. Those covered by Medicaid are significantly more likely than privately insured women to have received contraceptive services, pregnancy-related care, and STD care.
"Almost half the clinic clients got a range of services," Ms. Frost says, "while only one-quarter of private physician clients got contraceptive care plus other care. Our research confirms that women who go to clinics get more than just contraception. Policy-makers think that’s all the clinics do, but they are mandated to do a lot more."
Ms. Frost says that women’s reproductive health care needs are complex and driven by a variety of personal characteristics, and different providers meet the needs in differing ways. Researchers are not able to assess whether the services provided are adequate and fill the needs of all women, and also cannot assess whether women who report having received no services actually had an unmet need for them.
"But use of contraceptive services has risen over time, as has the percentage of older women obtaining such services. Moreover, publicly funded family planning clinics, particularly those supported by Title X, play an especially important role in serving women and in providing them with a wide range of contraceptive and reproductive health services," she adds.
"With growing numbers of uninsured women in America, growing minority and immigrant populations, as well as a mandate to serve women’s multiple reproductive health care needs, the role of publicly funded family planning clinics in meeting those needs is likely to increase," Ms. Frost continues.
"Given these changes, clinics may face financial challenges in continuing to deliver the wide range of services that they are mandated to provide. Policy-makers and program planners should consider these factors when allocating public expenditures for these programs," she says.
[Contact Ms. Frost at (831) 763-9575.]