Printer Friendly

Efforts to avoid an unplanned pregnancy.

Two-thirds of reproductive-age women-- some 39 million women, including almost 13 million who are poor or low-income--are at risk of an unintended pregnancy; these women are sexually active and could become pregnant if they used no contraceptive, but do not want a child now. The proportion of women at risk varies little by income. (54) The likelihood of becoming pregnant unintentionally, on the other hand, differs markedly by income, and is closely associated with contraceptive use--both whether a woman or her partner uses a contraceptive method and, if so, how successfully. Using Contraceptives

Overall, nine in 10 women at risk of unplanned pregnancy use contraceptives themselves or have a partner who uses a method. Patterns and levels of contraceptive use vary by income, however (Figure 5; see page 18). (55)

* Roughly a third of at-risk women in each income group rely on sterilization, but lower income women are more likely than higher income women to have a tubal ligation and are much less likely to have a partner who has had a vasectomy. The disparity in vasectomy rates may reflect both that lower income women, especially those who are poor, are much less likely to be married, and that vasectomy is uncommon among blacks and Hispanics, (56) who are disproportionately poor.

* income women are slightly more likely than more affluent women to use the pill, but, overall, they are less likely to use reversible methods of contraception.

* Poor women are more likely than other women to have unprotected intercourse: Twenty percent of poor women at risk of unintended pregnancy use no contraceptive method, compared with 11% of low-income women and 8% of higher income women.

* Nonuse is more common among sexually active teenage women of all income levels: Twenty-two percent of poor teenagers aged 15-19 at risk of unintended pregnancy and 29% of low-income adolescents use no method, compared with 17% of higher income teenagers (not shown). (57)

More than half of all unplanned pregnancies occur among women who were not using contraceptives at the time. (58) Since virtually all at-risk, sexually active women have practiced contraception at some time (only 2% of all at-risk women aged 15-44, and 6% of those who are poor, have never used a method (59)), nonuse may frequently reflect gaps in relationships or method use rather than conscious decisions not to practice contraception or lack of awareness of its importance. Some women, however, do not use a method because of concern about side effects, because they or their partner dislike the methods available or because they have negative feelings about contraception in general. (60) Although women generally do not cite cost as a reason for not using a contraceptive, (61) it is likely that the expense involved is a barrier for some poor women, particularly those who want to use a method that requires frequent resupply or a medical visit.

Access to Services

Poor and low-income women, especially teenagers, depend heavily on publicly funded family planning clinics for their contraceptive care, because these clinics will accept Medicaid recipients when few other providers will and most offer subsidized services to lower income women who do not qualify for Medicaid. For women who do not have access to a family planning clinic, the cost of contraceptive care may be prohibitive: Private doctors typically charge $55-$89 for a new patient visit, excluding laboratory fees for Pap tests and sexually transmitted disease (STD) screening. (62)

Medicaid pays for the full range of contraceptive methods, including the contraceptive implant, Norplant, which normally entails significant up-front expense. Poor women who do not qualify for Medicaid can still obtain contraceptive services free of charge at the approximately 4,000 clinics (63) that receive Title X funding, provided they can locate and get to one.

Title X clinics are required to provide services on a sliding fee scale to women with incomes between 100% and 250% of the federal poverty level. Nearly nine in 10 Title X clinics charge women with incomes 25% above the poverty level ($9,200 a year for a single woman and $15,400 for a family of three) for an initial visit, and six in 10 charge for a three-month pill supply; the median charges are $15 and $6, respectively. (64)

Poor women who do not have access to a Title X clinic often have to pay for contraceptive services. About half of non--Title X family planning clinics typically charge poor women $50 for an initial contraceptive visit and a three-month supply of pills. Poor women who cannot afford those fees may be forced to rely on a method that they might find more difficult to use successfully, such as the condom (assuming their partners are willing to cooperate). Women with incomes at 125% of poverty are more likely to be charged for a clinic visit, and the median fees are higher than in Title X clinics: $24 for an initial visit and $19 for pills. (65)

Even in Title X clinics, however, client fees have accounted for a larger proportion of revenue in recent years. (66) There are several reasons for the increased reliance on fees:

* Title X funding declined 72% between 1980 and 1992 (when adjusted for inflation). (67)

* Costs for lab services and contraceptive supplies have risen. (68)

* Clinics have had to devote an increasing proportion of their funds to treat STDs and other medical problems among their clients. (69)

As a result of these trends, many clinics have been forced to cut back their hours of operation, accept fewer patients who need subsidized services and reduce their outreach efforts--changes that have made services less accessible to poor and low-income women. (70) Clinics' efforts to offer new contraceptive methods, such as the contraceptive implant and the injectable, have also increased the economic pressure on providers. (71)

Pregnancy Planning

Unplanned pregnancy rates among American women are high compared with rates among women in many other industrialized countries. (72) About 60%, or 3.3 million, of the 5.5 million pregnancies that occur annually in the United States are unplanned; (73) that is, they occur to women who wanted to delay having a baby until a later time or to women who did not want to have any children in the future. Women of all income levels experience accidental pregnancies, but those who are poor or low-income are much more likely than other women to become pregnant when they did not intend to: Three-quarters of pregnancies among poor women and more than two-thirds of those among women of marginal income are unplanned, compared with less than half of those among higher income women (Figure 6). (74)

Unplanned pregnancy rates are higher among poor and low-income women not only because they are less likely than higher income women to use a contraceptive method, but also because they have more difficulty using contraceptives correctly and consistently. Twenty-one percent of lower income women have an unintended pregnancy within the first year of use of their method, compared with 10% of higher income women. (75)

Like more affluent women, poor and low-income women who become pregnant unintentionally are faced with the dilemma of how to resolve their situation. Their lack of resources is an important factor in their decision-making.

(54.) AGI, 1994a.

Sixty-four percent of poor women, 65% of low-income women and 68% of higher income women are at risk of unintended pregnancy.

(55.) AGI, 1994a.

(56.) Forste, Tedrow and Tanfer, 1994; Mosher, 1990, Table 4, p. 201.

(57.) AGI, 1994a.

(58.) Harlap, Kost and Forrest, 1991, p. 33.

(59.) AGI, 1994a.

(50.) Silverman, Torres and Forrest, 1987, p.95.

(61.) Silverman, Torres and Forrest, 1987, P. 96.

(62.) Chapin, 1993.

(63.) AGI, 1992, p.3.

(64.) Henshaw and Torres, 1994, p. 58.

(65.) Henshaw and Torres, 1994, p. 58.

(66.) Henshaw and Torres, 1994, p. 59.

(67.) Daley and Gold, 1993, p. 248.

(68.) Henshaw and Torres, 1994, p. 59.

(69.) Donovan, 1991, p. 199.

(70.) Donovan, 1991, pp. 201-202; Moore, 1993, p. 3.

(71.) Frost, 1994; Henshaw and Torres, 1994, p. 59.

(72.) Jones et al., 1988.

(73.) Kost and Forrest, forthcoming, 1995.

(74.) AGI, 1994e; AGI, 1994f; Henshaw, 1992.

The total number of pregnancies excludes those that end in miscarriages.

(75.) Jones and Forrest, 1992, Table 4, p. 17.

References

Alan Guttmacher Institute (AGI), Abortions and the Poor: Private Morality, Public Responsibility, New York, 1979.

-----, "Title X Family Planning Clinic Network," unpublished memorandum, New York, Sept. 16, 1992.

-----, "Even as Politics Improve, Challenges Facing Family Planning Providers Mount," Washington Memo, Jan. 12,1993, pp. 3-4.

-----, tabulations of data from the 1988 National Survey of Family Growth, 1994a.

-----, tabulations of data from the 1987 AGI Survey of Reasons Women Have Abortions, 1994b.

-----, unpublished findings from focus groups conducted with poor women in Atlanta and Philadelphia, Apr.20 and May 12, 1994c.

-----, tabulations of data from the March 1992 Current Population Survey, 1994d.

-----, tabulations of data from the 1987 AGI Abortion Patient Survey, 1994e.

-----, tabulations of data from the 1988 National Maternal and Infant Health Survey, 1994f.

-----, tabulations of data from the 1993 AGI Abortion Provider Survey, 1994g.

-----, data from a special tabulation of the 1990 U.S. Census, 1994h.

-----, Sex and America's Teenagers, New York, 1994i.

Althaus, F.A., and S.K. Henshaw, "The Effect of Mandatory Delay Laws on Abortion Patients and Providers," Family Planning Perspectives, 26:228-231,233,1994.

American Political Network, Inc., "New Mexico: Dept. 'Greatly' Expands State Abortion Funding," The Abortion Report, Nov.29, 1994.

Bachrach, CA., K.S. Stolley and K.A. London, "Relinquishment of Premarital Births: Evidence from National Survey Data," Family Planning Perspectives, 24:2732,1992.

Bane, M.J., and D.T. Ellwood, Welfare Realities: From Rhetoric to Reform, Harvard University Press, Cambridge, Mass., 1994.

Bennett, W.J., and P. Wehner, "End Welfare for Single Women Having Children," USA Today, Feb. 1,1994.

Center for Reproductive Law and Policy, "Federal Court Blocks Pennsylvania Medicaid Restrictions," Reproductive Freedom News, Sept.23, 1994.

Centers for Disease Control (CDC), "Effects of Restricting Federal Funds for Abortion--Texas," Morbidity and Mortality Weekly Report, 29:253255, 1980.

Chapin, J., American College of Obstetricians and Gynecologists, personal communication to J.D. Forrest, June 23, 1993.

CHOICE, "An Unacceptable Burden: The Effects of Pennsylvania's Restrictions on Medical Assistance-Funded Abortions," Philadelphia, Sept. 10, 1993.

C.K v. Shalala, "Brief in Support of Plaintiffs' Motion for Preliminary Injunction," Docket No. 935354 (NHP), Civil Action, (D.N.J., Apr.26, 1994).

CNN/USA Today/Gallup Poll, "The New Republican Mandate," Nov. 28-29,1994.

Congressional Quarterly, "House GOP Offers Descriptions of Bills to Enact 'Contract'," Nov. 19, 1994, pp. 3366-3379.

Crepps, J., Center for Reproductive Law and Policy, "Status of Funding for Abortion for Pregnant Women Eligible for Medicaid through Expanded Eligibility," memorandum to P. Donovan, Nov. 7, 1994.

Daley, D., and R.B. Gold, "Public Funding for Contraceptive, Sterilization and Abortion Services, Fiscal Year 1992," Family Planning Perspectives, 25:244-251,1993.

Donovan, P., "The People Vote on Abortion Funding: Colorado and Washington," Family Planning Perspectives, 17:155-159, 1985.

-----, "Family Planning Clinics: Facing Higher Costs and Sicker Ptients, "Family Planning Perspectives, 23:198-203, 1991.

-----, Our Daughters' Decisions: The Conflict in State Law on Abortion and Other Issues, AGI, New York, 1992.

-----, "The Restoration of Abortion Services at Cook County Hospital," Family Planning Perspectives, 25:227-231, 1993.

Forrest, J.D., "Timing of Reproductive Life Stages," Obstetrics and Gynecology, 82:105-111, 1993.

-----, "Epidemiology of Unintended Pregnancy and Contraceptive Use," American Journal of Obstetrics and Gynecology, 170:1485-1489, 1994.

-----, and S. Singh, "Public Sector Savings Resulting from Expenditures for Contraceptive Services," Family Planning Perspectives, 22:6-15, 1990.

Forste, R., L. Tedrow and K. Tanfer, "Sterilization Among Currently Married Men in the United States, 1991," paper presented at the annual meeting of the Population Association of America, Miami, May 5-7, 1994.

Frost, J.J., "The Availability and Accessibility of the Contraceptive Implant from Family Planning Agencies in the United States, 1991-1992," Family Planning Perspectives, 26:4-10, 1994.

Gold, R.B., "After the Hyde Amendment: Public Funding for Abortion in FY 1978," Family Planning Perspectives, 12:131-134,1980.

-----, AGI, unpublished memorandum to J. Rosoff, Mar. 7, 1994.

Hadley, K., Minnesota Housing Finance, personal communication to P. Donovan, June 30,1994.

Harlap, S., K. Kost and J.D. Forrest, Preventing Pregnancy, Protecting Health, AGI, New York, 1991.

Harris, L., "A Survey of Public Attitudes Toward Planned Parenthood and the Supreme Court Decision in Rust v. Sullivan," Louis Harris and Associates, June 1991, Study 912043.

Harris v. McRae, 448 U.S. 297(1980).

Henshaw, S.K., "The Accessibility of Abortion Services in the United States," Family Planning Perspectives, 23:246-252,263,1991.

-----, "Abortion Trends in 1987 and 1988: Age and Race," Family Planning Perspectives, 24:85-86, 96,1992.

-----, and J. Silverman, "The Characteristics and Prior Contraceptive Use of U.S. Abortion Patients," Family Planning Perspectives, 20:158-168,1988.

-----, and A. Torres, "Family Planning Agencies: Services, Policies and Funding," Family Planning Perspectives, 26:52-59,82, 1994.

-----, and J. Van Vort, "Abortion Services in the United States, 1991 and 1992," Family Planning Perspectives, 26:100-106, 112, 1994.

-----, and L.S. Wallisch, "The Medicaid Cutoff and Abortion Services for the Poor," Family Planning Perspectives, 16:170-180,1984.

Jones, E.F., et al., "Unintended Pregnancy, Contraceptive Practice and Family Planning Services in Developed Countries," Family Planning Perspectives, 20:53-67,1988.

-----, and J.D. Forrest, "Contraceptive Failure Rates Based on the 1988 NSFG," Family Planning Perspectives, 24:12-19, 1992.

Kolbert, K., Center for Reproductive Law and Policy, personal communication to P. Donovan, July 20, 1994.

Kost, K.L. and J.D. Forrest, "Intention Status of U.S. Births in 1988: Differences by Mothers' Socioeconomic and Demographic Characteristics," forthcoming, Family Planning Perspectives, January/February 1995.

Maherv. Roe, 432 U.S. 464 (1977).

Minnesota Department of Human Services, "A Market Basket Evaluation of the AFDC Standard of Need: A Report to the 1991 Legislature," St. Paul, Dec. 15,1990.

Moore, K.A., "Facts At a Glance," Child Trends, Washington, D.C., Dec. 1993.

Mosher, W.D., "Contraceptive Practice in the United States, 1982-1988," Family Planning Perspectives, 22:198-205,1990.

Murray, C., "The Coming White Underclass," Wall Street Journal, Oct. 29,1993.

National Governors' Association, "State Coverage of Pregnant Women and Children--July 1994," MCH Update, Washington, D.C., Aug. 1994.

National Network of Abortion Funds, "Summary of Fund Profiles," Hadley, Mass., May 7, 1994.

New York Times, "The Harm in Family Welfare Caps," June 9, 1994.

Omnibus Budget Reconciliation Act (OBRA) of 1987.

Omnibus Budget Reconciliation Act (OBRA) of 1989.

Richard Day Research, Inc., "The Chicago Metro Survey: Attitudes Toward Abortion and Family Issues," Sept. 22-Oct. 2,1994.

Silverman, J., A. Torres and J.D. Forrest, "Barriers to Contraceptive Services," Family Planning Perspectives, 19:94-102,1987.

Standard of Need Advisory Committee, "Report to the Commissioner of Human Services," N.J., Oct. 1990.

Tietze, C., and S.K. Henshaw, Induced Abortion. A World Review, 1986, AGI, New York, 1986.

Torres, A., and J.D. Forrest, "Why Do Women Have Abortions?" Family Planning Perspectives, 20:169-176, 1988.

-----, et al., "Public Benefits and Costs of Government Funding for Abortion," Family Planning Perspectives, 18:111-118,1986.

Trussell, J., etal., "The Impact of Restricting Medicaid Financing for Abortion," Family Planning Perspectives, 12:120-130,1980.

U.S. Bureau of the Census, "Characteristics of the Low-Income Population, 1970," Current Population Reports, Series P-60, No. 81, 1971.

-----,"Poverty in the United States: 1992," Current Population Reports, Series P-60, No. 185,1993.

U.S. Department of Health and Human Services, "Federal Percentages and Federal Medical Assistance Percentages, Effective October 1, 1994 September 30,1995 (Fiscal Year 1995)," Federal Register, 58:66363, 1993.

-----,"Annual Update of the HHS Poverty Guide-lines," Federal Register, 59:6277-6278, 1994.

U.S. Department of Housing and Urban Development, "Schedule B-Fair Market Rents for Existing Housing," Federal Register, 58:51415-51469,1993.

U.S. General Accounting Office, Families on Welfare: Sharp Rise in Never-Married Women Reflects Societal Trend, GAO/HEHS-94-92, Washington, D.C., May 31,1994.

U.S. House of Representatives, Overview of Entitlement Programs: 1994 Green Book, Washington, D.C., July 15,1994.
FIGURE 5

Contraceptive Use

Most American women at risk of an unplanned preqnancy use contracep-
tives; overall, poor women are less likely than other women to use a
contraceptive method.

 Poor Low-Income Higher-Income

Tubal ligation 29 31 22
Pill 31 28 27
IUD 2 2 2
Diaphragm 2 3 7
Condom 11 12 14
Vasectomy 2 8 13
Other 3 5 7
 80% 89% 92%

Women aged 15-14 at risk of unplanned preqnancy, 1988: 39, 286,000

Source: AGI, tabulations of data from the 1988 National Survey of Family
Growth, 1994.

Note: "Other" methods include spermicides, periodic abstinence and
withdrawal.

Note: Table made from bar graph
FIGURE 6

Unplanned Pregnancy

Pregnancies among women aged 15-44, 1988: 5,500,261

The majority of all pregnancies in the United States are unplanned. Poor
and low-income women ar more likely than higher income women to become
pregnant accidentally.

 PERCENTAGE
 UNPLANNED

Poor 76%
Low-income 70%
Higher income 48%

Sources: Abortions--AGI, tabulations of data from the 1987 AGI Abortion
Patient Survey, 1994; and S.K. Henshaw, "Abortion Trends in 1987 and 19-
88: Age and Race," Family Planning Perspectives, 24:85-86, 96, 1992.
Births--AGI, tabulations of data from the 1988 National Maternal and
Infant Health Survey, 1994.

Note: Pregnancies include those that end in births and abortions; those
ending in miscarriage are not included.

Note: Table made from bar graph
COPYRIGHT 1995 Guttmacher Institute
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1995 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:poor women's access to contraceptives and family planning service
Publication:The Politics of Blame: Family Planning, Abortion and the Poor
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Jan 1, 1995
Words:2885
Previous Article:Poor and low-income women: A diverse group.
Next Article:Making the decision to have an abortion.
Topics:


Related Articles
Morbidity and Mortality Weekly Report, 48, 1073-1080.
25 years ago in Perspectives.
Contraceptive miscues tied to pregnancy. (Poor Patient-Provider Communication).
Rekindling efforts to prevent unplanned pregnancy: a matter of 'equity and common sense'.
Associations between low-income women's relationship characteristics and their contraceptive use.
Problems with contraception play big part in unplanned pregnancies, USA.
Improving contraceptive use in the United States.
Reducing unintended pregnancy in Nigeria.
The economics of contraception.

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters