Improve pregnancy planning and spacing, and prevent unintended pregnancy.
Family planning is one of the 10 great public health achievements of the 20th century.1 The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families.1, 2, 3
- Contraceptive services
- Pregnancy testing and counseling
- Pregnancy–achieving services including preconception health services
- Basic infertility services
- Sexually transmitted disease services
- Broader reproductive health services, including patient education and counseling
- Breast and pelvic examinations
- Breast and cervical cancer screening
- Sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention education, counseling, testing, and referral
Abstinence from sexual activity is the only 100% effective way to avoid unintended pregnancy. For individuals who are sexually active, correct and consistent contraceptive use is highly effective at preventing unintended pregnancy. The most effective methods to prevent unintended pregnancy include long-acting reversible contraceptives such as intrauterine devices (IUDs) and contraceptive implants, followed by other hormonal contraceptives including oral contraceptives (pills), the patch, the ring, and the Depo-Provera shot (DMPA). Condoms protect against both unintended pregnancy and STIs, and their use should be encouraged. Both men and women should be counseled about using condoms at every act of sexual intercourse when not in a long-term, mutually monogamous sexual relationship.
Why Is Family Planning Important?
For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care.2, 7 In 2015, publicly funded family planning services helped prevent 1.9 million unintended pregnancies, including 440,000 teen pregnancies. In 2010, every public dollar spent on family planning saved the federal and state governments $7.09.2, 8
Unintended pregnancies include pregnancies that are reported by women as being mistimed or unwanted. Almost half (45%) of the 6.1 million annual pregnancies in the United States are unintended.9 Unintended pregnancies are associated with many negative health and economic consequences.10 The public cost of births resulting from unintended pregnancies was estimated at $21 billion in 2010 (this figure includes costs for prenatal care, labor and delivery, post-partum care, and 1 year of infant care).11
- Delays in initiating prenatal care
- Reduced likelihood of breastfeeding
- Increased risk of maternal depression
- Increased risk of physical violence during pregnancy
Births resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight.16 Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, and have lower educational attainment and more behavioral issues in their teen years.12
The negative consequences associated with unintended pregnancies are greater for teen parents and their children. Eighty-two percent of pregnancies to mothers ages 15 to 19 are unintended.7 Twenty percent of all unintended pregnancies occur among teens.9 Teen mothers:
Similarly, early fatherhood is associated with lower educational attainment and lower income.17, 19 The average annual cost of teen childbearing to U.S. taxpayers is estimated at $9.1 billion, or $1,430 for each teen mother per year.18 Moreover, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems.17, 18, 19 Sons of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers.19
Understanding Family Planning
Unintended pregnancies occur among women of all incomes, educational levels, and ages. However, there are disparities in unintended pregnancy rates. The rates of unintended pregnancy are highest among the following groups:9
- Women ages 18 to 24
- Women who were cohabiting
- Women whose income is below the poverty line
- Women with less than a high school diploma
- Black or Hispanic women
Social Determinants of Family Planning Service Usage
Women with lower levels of education and income, uninsured women, Latina women, and non-Hispanic black women are less likely to have access to family planning services.20 In addition, men are less likely to have access to and receive family planning services than women.21
- Cost of services
- Limited access to publicly funded services
- Limited access to insurance coverage
- Family planning clinic locations and hours that are not convenient for clients
- Lack of awareness of family planning services among hard-to-reach populations
- No or limited transportation
- Inadequate services for men
- Lack of youth-friendly services
Emerging Issues in Family Planning
Many women of reproductive age can benefit from preconception care (care before pregnancy). Preconception care has been defined as a set of interventions designed to identify and reduce risks to a woman’s health and improve pregnancy outcomes through prevention and management of health conditions.26 Preconception care can significantly reduce birth defects and disorders caused by preterm birth.27
Elements of preconception care should be integrated into every primary care visit for women of reproductive age.26 Preconception care must not be limited to a single visit to a health care provider, but should rather be a process of care designed to meet the needs of an individual.28 As part of comprehensive preconception care, providers should encourage patients to develop a reproductive life plan. A reproductive life plan is a set of goals and action steps based on personal values and resources about whether and when to become pregnant and have (or not have) children.26 Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.29
Increased awareness of the importance of preconception care can be achieved through public outreach and improved collaboration between health care providers. Currently, only 30.3% of women report receiving pre-pregnancy health counseling.16 Future efforts should promote research to further define the evidence-based standards of preconception care, determine its cost-effectiveness, and improve tracking of the proportion of women obtaining these services.
1Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: Family planning. MMWR Weekly. 1999 Dec 3;48(47):1073-80. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm
2Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014.
3Gipson J, Koenig M, Hindin M (2008). The effects of unintended pregnancy on infant, child and parental health: A review of the literature. Studies in Family Planning; 39(1): 18-38.
4Guttmacher Institute. In Brief: Facts on Publicly Funded Contraceptive Services in the United States. New York, NY: 2014. Available from: https://www.guttmacher.org/pubs/fb_contraceptive_serv.html
5Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the US Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-04).
6Gavin L, Pazol K. Update: Providing Quality Family Planning Services — Recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016;65:231–234. DOI: http://dx.doi.org/10.15585/mmwr.mm6509a3.
7Frost J. US women’s reliance on publicly funded family planning clinics as their usual source of medical care. Paper presented at National Survey of Family Growth Research Conference; 2008 Oct; Hyattsville, MD.
8Frost, J, Frohwirth L, Blades N, et al. Publicly Funded Contraceptive Services at U.S. Clinics, 2015, New York: Guttmacher Institute, 2017. Available from: https://www.guttmacher.org/report/publicly-funded-contraceptive-services-us-clinics-2015
9Lawrence B. Finer, Ph.D., and Mia R. Zolna, M.P.H. Declines in Unintended Pregnancy in the United States, 2008–2011, N Engl J Med 2016; 374:843-852 March 3, 2016 DOI: 10.1056/NEJMsa1506575. Available from: http://www.nejm.org/doi/full/10.1056/NEJMsa1506575
10Tsui A, McDonald-Mosley R, Burke A (2010). Family planning and the burden of unintended pregnancies. Epidemiol Rev; 32: 152-174.
11Sonfield A and Kost K (2015). Public Costs from Unintended Pregnancies and the Role of Public Insurance Programs in Paying for Pregnancy and Infant Care: Estimates for 2010, the Guttmacher Institute. Available from https://www.guttmacher.org/report/public-costs-unintended-pregnancies-and-role-public-insurance-programs-paying-pregnancy.
12Logan C, Holcombe E, Manlove J, et al. The consequences of unintended childbearing: A white paper [Internet]. Washington: Child Trends, Inc.; 2007 May. Available from: https://pdfs.semanticscholar.org/b353/b02ae6cad716a7f64ca48b3edae63544c03e.pdf [PDF - 1.4 MB]
13Cheng D, Schwarz E, Douglas E, et al. Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception. 2009 Mar;79(3):194-8.
14Kost K, Landry D, Darroch J. Predicting maternal behaviors during pregnancy: Does intention status matter? Fam Plann Perspect. 1998 Mar–Apr;30(2):79-88.
15D’Angelo D, Gilbert BC, Rochat R, et al. Differences between mistimed and unwanted pregnancies among women who have live births. Perspect Sex Reprod Health. 2004 Sep–Oct;36(5):192-7.
16Centers for Disease Control and Prevention. Preconception and interconception health status of women who recently gave birth to a live-born infant—pregnancy risk assessment monitoring system (PRAMS), United States, 26 Reporting Areas, 2004. MMWR Weekly. 2007 Dec 14;56(SS-10):1-40. Available from: https://www.cdc.gov/mmwr/pdf/ss/ss5610.pdf [PDF - 609 KB]
17Hoffman S, Maynard R, eds. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy, 2nd ed. Washington: Urban Institute Press; 2008.
18Hoffman S. By the Numbers: The Public Costs of Teen Childbearing. Washington: National Campaign to Prevent Teen Pregnancy; 2006.
19Elfenbein DS, Felice ME. Adolescent pregnancy. Pediatr Clin North Am. 2003 Aug;50(4):781-800, viii.
20Chandra A, Martinez G, Mosher W, et al. Fertility, family planning, and reproductive health of US women: Data from the 2002 National Survey of Family Growth. Vital Health Stat. 2005 Dec;23(25):1-160. Available from: https://www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf [PDF - 4.6 MB]
21Guttmacher Institute. In brief: Facts on young men’s sexual and reproductive health. Washington: Guttmacher Institute; 2008 Jun.
22Guttmacher Institute. In brief: Improving contraceptive services use in the United States. Washington: Guttmacher Institute; 2008 (No.1). Available from: https://www.guttmacher.org/pubs/2008/05/09/ImprovingContraceptiveUse.pdf [PDF - 171 KB]
23Gold R. An enduring role: The continuing need for a robust family planning clinic system. Guttmacher Policy Review. 2008 Winter;11(1). Available from: https://www.guttmacher.org/pubs/gpr/11/1/gpr110106.pdf [PDF - 82 KB]
24Sonfield A. Looking at men’s sexual and reproductive health needs. Guttmacher Report on Public Policy; 2002 May;2(5).
25Hock-Long L, Herceg-Baron R, Cassidy AM, et al. Access to adolescent reproductive health services: Financial and structural barriers to care. Perspect Sex Reprod Health. 2003 May;35(3):144-7.
26Johnson K, Posner S, Biermann J, et al. Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006 Apr 21;55(RR-6):1-23. Available from: https://www.cdc.gov/mmwR/preview/mmwrhtml/rr5506a1.htm
27Berghella V, Buchanan E, Pereira L, et al. Preconception care. Obstet Gynecol Surv. 2010 Feb;65(2):119-31.
28Atrash H, Jack B, Johnson K, et al. Where is the “W”oman in MCH? Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):S259-65.
29Moos M, Dunlop A, Jack B, et al. Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. Am J Obstet Gynecol. 2008 Dec;199(6 Suppl 2):280-9.