Between 2000 and 2004, the number of U.S. women in need of publicly funded contraceptive services and supplies increased by 6%—more than one million women—to a total of 17.4 million (see table). The overall number of women in need of contraception, regardless of financial need, increased only marginally, suggesting that broader economic trends of the period, rather than population growth, have driven the change. The increasing need for subsidized family planning comes at a time when the very programs that provide these services are facing serious economic and political challenges.

Women are defined as being in need of contraceptive services and supplies if they are of reproductive age (13–44), have ever had sexual intercourse, and are able to become pregnant but do not wish to do so. Those with an income below 250% of the federal poverty level or who are younger than 20 (and thus presumed to have a low personal income) are considered in need of publicly funded contraception.

These trends, from a Guttmacher Institute analysis released in July 2006 and funded by the Department of Health and Human Services, point toward an especially rapid increase in need for family planning services among the nation's poorest women. Over the four-year period, growth in the number of women in need was four times greater—15% compared with 3%—among those with incomes under the federal poverty line ($15,670 in 2004) than among those with slightly higher incomes (100–250% of poverty). Meanwhile, the number above 250% of poverty (and not deemed in need of subsidized care) actually declined by 3%. Forty-one states experienced an increase between 2000 and 2004 in the number of women in need of publicly funded contraceptive services.

The same economic difficulties that seem to have driven these trends have also posed serious budgetary problems for the federal government and, especially, the states (related articles, August 2004, page 6, and December 2001, page 8). Together with the ascendancy of conservative ideology, these difficulties threaten to undermine the public programs, such as Medicaid and the Title X family planning program, that provide the funding necessary to meet this growing need for subsidized contraceptive services and supplies (related article, February 2005, page 4). Notably, changes to Medicaid law enacted in February 2006 allow states, for the first time since 1972, to exclude family planning from the package of services offered to some Medicaid recipients (related article, Spring 2006, page 2). Notably, these trends also come at the same time as the rate of abortion in the United States has essentially stagnated after a decade of steady decline (related article, page 2).—Adam Sonfield