Persistent health disparities between poor and better-off Americans are an enduring challenge we face as a nation, and disparities in critical reproductive health outcomes are no exception.
Women with incomes below the federal poverty line are four times as likely to have an unintended pregnancy as their higher-income counterparts, and they are five times as likely to have an unintended birth. Abortion, too, is becoming increasingly concentrated among poor women: In 2008, fully 42 percent of abortion patients were poor, compared with 27 percent in 2000.
This situation has only become more challenging during the Great Recession. Across the country, the number of women of reproductive age with private insurance fell by 2.3 million between 2008 and 2009, as widespread job losses caused many Americans to lose employer-based coverage. The number on Medicaid rose by a million, but even so, 1.3 million more reproductive-age women in the United States were without any insurance at all in 2009 than in 2008. In Pennsylvania, some one in seven women of reproductive age are completely uninsured.
These are not abstract statistics for individual women and their families, as Guttmacher Institute research clearly illustrates. Nearly half of the low- and middle-income women we surveyed in 2009 said they wanted to delay pregnancy or limit the number of children they have as a result of the economic downturn. And yet, many of them reported having to skimp on their contraceptive use -- or forgo it entirely -- to save money. It's truly a bleak situation when significant numbers of Americans are forced to choose between paying for housing, groceries and other necessities, or paying for birth control to avoid pregnancies they say they just cannot afford right now.
These findings also underscore the critical importance of publicly funded family planning services. The bulk of these services are provided under Medicaid, and they form a safety net for women who cannot otherwise afford the contraceptive services and supplies they need to prevent an unintended pregnancy. Between 2000 and 2008, an additional 1 million American women found themselves in need of publicly funded family planning services. In Pennsylvania alone, there were 684,800 women in need of publicly supported contraceptive services and supplies in 2008. Of those, 21,510 live in York County.
At the individual level, publicly funded contraceptive counseling and services empower low-income women to prevent pregnancies they don't want to have and to become pregnant only when they want to be -- thereby maximizing their chances of having a healthy pregnancy and giving birth to a healthy infant.
Realizing these significant health benefits, 21 states have increased their Medicaid income eligibility ceilings for family planning services, often pegging them to the same income level they have for pregnancy-related care. Pennsylvania wisely is among them.
The impact is significant: Publicly funded family planning services -- the bulk of which are provided by Medicaid -- avert 1.94 million unintended pregnancies each year. In Pennsylvania alone, publicly funded family planning services helped women avoid 67,700 unintended pregnancies, which would have otherwise resulted in about 30,100 unintended births and 28,300 abortions.
What's more, these subsidized contraceptive services are extremely cost effective: By helping low-income women prevent births they themselves do not want to have, these services save almost $4 in public expenditures for every $1 invested. The services provided in Pennsylvania saved the federal and Pennsylvania governments more than $208 million in 2008.
Given these benefits, Americans of all political persuasions -- prominently including conservatives -- should strongly support publicly subsidized contraceptive services. Fiscal conservatives should applaud the fact that these services save substantial public dollars. Social conservatives should be reassured that without them, the U.S. abortion rate would be two-thirds higher than it is. And pro-business conservatives should appreciate the value of enabling women to postpone childbearing while they complete their education, undergo job training or establish themselves in their career.
Publicly funded family planning services are essential to the health of millions of American women and infants. And they are an important tool in the ongoing struggle to reduce persistently large disparities in unintended pregnancies, unintended births and abortions between poor and better-off women. In short: smart, fiscally responsible government action at its best.
-- Sharon Camp is presi dent and CEO of the Guttmacher Institute, a New York City organization that promotes sexual and reproductive health worldwide.