Expanding Access to Contraception Through Medicaid Could Prevent Nearly 500,000 Unwanted Pregnancies, Save $1.5 Billion

Expanding Medicaid coverage for contraception so that it matches Medicaid coverage for pregnancy-related care would enable low-income women to prevent a total of nearly 500,000 unwanted pregnancies annually, including 200,000 abortions. By helping them to prevent an estimated 225,000 unwanted births, such an expansion would also save $1.5 billion in annual federal and state expenditures, according to new research from the Guttmacher Institute. "Rekindling Efforts to Prevent Unplanned Pregnancy: A Matter of ‘Equity and Common Sense’," by Rachel Benson Gold, published in the Summer 2006 issue of the Guttmacher Policy Review, uses the new findings to make the case for doing more to help low-income American women prevent unwanted pregnancies.

"Expanding Medicaid eligibility would be tremendously effective in restarting the nation’s stalled efforts to reduce unplanned pregnancy and, thereby, the need for abortion," says Gold, Guttmacher’s director of policy analysis. "Such a common-sense initiative is urgently needed in light of the fact that unplanned pregnancies, unplanned births and abortions are all becoming ever more concentrated among poor women."

Previous Guttmacher research, published in May, showed that the unintended pregnancy rate for poor women shot up by 29% between 1994 and 2001, even as it fell 20% for more affluent women. A poor woman in the United States is now nearly four times as likely to have an unplanned pregnancy, five times as likely to have an unintended birth and more than three times as likely to have an abortion as her higher-income counterpart—with far-reaching consequences for women, families and society as a whole.

The new Guttmacher study on Medicaid expansion explores different ways to help low-income women obtain contraceptive services. " Estimating the Impact of Expanding Medicaid Eligibility for Family Planning Services," by Jennifer J. Frost, Adam Sonfield and Gold, examines four potential scenarios that build on the actual experiences of states that have moved in recent years to expand eligibility for Medicaid contraceptive services. By the third year of nationwide program operation, each of the various scenarios would

secure women’s access to contraception and allow some women who were using less effective contraceptive methods to switch to more effective methods;
prevent between 375,000–720,000 unplanned pregnancies, 180,000–345,000 unplanned births and 150,000–290,000 abortions;
generate significant cost savings ranging from $1.1 billion to $1.6 billion for federal and state governments.

Of the four, the parity scenario, under which eligibility for Medicaid-covered pregnancy-related care would be the same as eligibility for contraceptive services, offers the greatest cost-benefit ratio, with savings of $2.90 for every $1 invested.* This scenario would avert almost 500,000 unplanned pregnancies, 225,000 unplanned births and nearly 200,000 abortions. Such an expansion has been introduced as legislation by Senators Hillary Clinton and Harry Reid and, in the House, by Rep. Nita Lowey. The Guttmacher study estimates that, if enacted, this expansion would cost about $800 million, but avert more than $2.3 billion in Medicaid costs (by preventing unwanted births that would have been paid for by Medicaid), thus resulting in $1.5 billion in net state and federal Medicaid savings.

* Please note that this sentence was changed on August 16 to clarify the eligibility criteria. It originally read "Of the four, the parity scenario, under which any woman who would be eligible for Medicaid-covered pregnancy-related care would also be eligible for contraceptive services, offers the greatest cost-benefit ratio, with savings of $2.90 for every $1 invested."