Report

Publicly Funded Contraceptive Services at U.S. Clinics, 2015
Jennifer J. Frost
,
Lori F. Frohwirth
,
Nakeisha Blades
,
Mia R. Zolna
,
Ayana Douglas-Hall
 and
Jonathan Bearak

State and county maps

MAP 1. Clinics providing publicly funded contraceptive services, by county

MAP 2. Title X–funded clinics providing contraceptive services, by county

MAP 3. Contraceptive clients served at publicly funded clinics, by county

MAP 4. Contraceptive clients served at Title X–funded clinics, by county

Maps are available for the years 2010 and 2015. All maps can be viewed by county-level density of women in need of publicly funded contraceptive services.
 

Go to state and county maps

Notes and definitions

  • A publicly funded clinic is a site that offers contraceptive services to the general public and uses public funds (e.g., federal, state or local funding though programs such as Title X, Medicaid or the federally qualified health center program) to provide free or reduced-fee services to at least some clients. Sites must serve at least 10 contraceptive clients per year. These sites are operated by a diverse range of provider agencies, including public health departments, Planned Parenthood affiliates, hospitals, federally qualified health centers (FQHCs) and other independent organizations. In this report, these sites are primarily referred to as “clinics”; other Guttmacher Institute reports may use the synonymous term “center.” 
  • A Title X–funded clinic is a site that receives federal funding from the Title X national family planning program.
  • A female contraceptive client is a woman who made at least one initial or subsequent visit for contraceptive services during the 12-month reporting period covered by this data collection effort. This includes all women who received a medical examination related to the provision of a contraceptive method, made supply-related return visits, received contraceptive counseling and a method prescription but deferred the medical examination, or chose nonmedical contraceptive methods, even if a medical examination was not performed, as long as a chart was maintained.
  • Women in need of publicly funded contraceptive services are those women who a) are younger than 20 or are poor or low-income (i.e., have a family income less than 250% of the federal poverty level) and b) are sexually active and able to become pregnant but do not want to become pregnant. In the maps, the number of women in need of publicly funded contraceptive services is shown per 100 square miles, calculated using data from Guttmacher’s Contraceptive Needs and Services 2010 report and 2014 update for the 2010 and 2015 maps, respectively.
  • All client estimates have been rounded to the nearest 10. Therefore, county and state totals do not always sum to the state and national totals, respectively. 
  • Percentages have been rounded and do not always sum to 100.

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Key Points

  • A total of 6.2 million women received publicly supported contraceptive services from 10,700 clinics in the United States in 2015. Clinics funded by the federal Title X program served 3.8 million of these women. An estimated 2.4 million additional women received Medicaid-funded contraceptive services from private doctors.
  • In 2015, for family planning clinics overall, Planned Parenthood sites accounted for 6% of clinics and served 32% of all contraceptive clients, public health departments administered 21% of clinics and served 20% of clients, and federally qualified health centers (FQHCs) administered 54% of clinics and served 30% of clients. Hospital outpatient sites accounted for 8% of clinics and served 10% of clients, and other independent clinics represented 10% of total clinics and served 8% of clients.
  • Among Title X–funded family planning clinics, Planned Parenthood sites represented 13% of clinics and served 41% of all contraceptive clients, public health departments administered 48% of clinics and served 28% of clients, FQHCs accounted for 26% of clinics and served 19% of clients, hospital outpatient sites represented 4% of clinics and served 5% of clients, and other independent clinics accounted for 9% of total clinics and served 7% of clients.
  • In 2015, all publicly funded contraceptive services helped women prevent 1.9 million unintended pregnancies; 876,100 of these would have resulted in unplanned births and 628,600 in abortions. Without publicly funded contraceptive services, the rates of unintended pregnancies, unplanned births and abortions in the United States would have been 67% higher; the rates for teens would have been 102% higher.
  • Services provided by clinics that received Title X funding helped women avert 822,300 unintended pregnancies in 2015, thus preventing 387,200 unplanned births and 277,800 abortions. Without the services provided by Title X–funded clinics, the U.S. unintended pregnancy rate would have been 31% higher and the rate among teens would have been 44% higher.

National and state tables

TABLE 1. Number of clinics providing publicly supported contraceptive services and percentage change, by state—2001, 2006, 2010 and 2015

TABLE 2. Number of women receiving publicly supported contraceptive services, by state—2001, 2006, 2010 and 2015

TABLE 3. Number of clinics providing publicly funded contraceptive services, by clinic type, for all publicly funded clinics and for Title X–funded clinics—2001, 2010 and 2015 national summary and 2015 state detail

TABLE 4. Number of female contraceptive clients served at publicly funded clinics and at Title X–funded clinics, by clinic type—2001, 2010 and 2015 national summary and 2015 regional and state detail

TABLE 5. Number and distribution of clinics providing publicly funded contraceptive services and the number and distribution of female contraceptive clients served, by clinic type and Title X funding status, 2001, 2010 and 2015, and the percentage change in clinics and clients, 2001–2010 and 2010–2015

TABLE 6. Number of unintended pregnancies, unplanned births and abortions averted among clients served by all publicly supported providers and by Title X–funded providers, by state, 2015

 TABLE 7. Number of teenage contraceptive clients served at publicly funded clinics, and the numbers of unintended pregnancies, unplanned births and abortions among teens averted by all publicly supported providers and by Title X–funded providers, by state, 2015 

METHODOLOGY

Clinics and clients served. We estimated the total number of women who received publicly supported contraceptive care in 2015 using multiple sources. To estimate contraceptive clients served at publicly supported clinics, we collected service data for 2015 for all agencies and clinics that provided publicly funded family planning services in the 50 states and the District of Columbia, and we used similar methodology and definitions as those used in previous surveys.1,3,4 For each clinic, we collected the total number of female contraceptive clients served in 2015, the number of those clients who were younger than age 20 and clinics’ Title X funding status.

We obtained clinic and client data from several federal sources. We received data for a large proportion of all clinics with Title X funding from the Office of Population Affairs (OPA), U.S. Department of Health and Human Services. We received data for all FQHCs from the Health Resources and Services Administration (HRSA). We received data from the Indian Health Service (IHS) for all IHS sites. The HRSA data were at the agency, not individual clinic, level, and we contacted each FQHC agency to obtain information on which specific sites provided contraceptive services and how to distribute the agency total among sites. For some FQHCs, data were also received from other federal (OPA or IHS) or agency-level sources, and this information was used to facilitate distribution of data among the appropriate sites. In other cases, no additional information was received, and FQHC agency-level data from HRSA were distributed evenly across sites that had been confirmed as providing contraceptive care. 

For sites that do not report to these federal sources, we requested data from either state-level reporting entities (typically state health departments) or from the individual organizations that administer one or several clinics. In total, we received data for 90% of the 10,708 clinics known to be providing publicly funded contraceptive services in 2015. For the 10% of clinics for which no 2015 data were received, we estimated the number of contraceptive clients as either the number that were served by that clinic in 2010 (461 sites) or by imputing a number based on the number of women served by similar clinics (according to type and funding status) in a similar area (according to region and population density; 605 sites).

In addition to women served at clinics, many women went to private physicians for services that are supported by public dollars (typically Medicaid). To estimate the number of women receiving Medicaid-funded contraceptive services from private physicians, we used information on payment and source of care for contraceptive services reported by respondents to the 2011–2015 National Survey of Family Growth (NSFG).5


Numbers of unintended events averted. We estimated the numbers of unintended pregnancies, unplanned births and abortions that were averted by the provision of publicly funded contraceptive care in 2015 using a methodology similar to that used for previous estimates.6 We began with the number of women who received publicly supported contraceptive care in 2015. We examined the current mix of contraceptive methods used by these women and compared it with a hypothetical mix of contraceptive methods that would likely be used by these same women in the absence of publicly funded care. To calculate this hypothetical mix, we used the 2011–2015 NSFG to look at the mix of methods currently used by similar women who did not obtain publicly supported care in the prior 12 months but who were in need of publicly funded contraceptive services (see definition above). 

We calculated the number of unintended pregnancies that would have occurred among each group (the group currently using publicly funded services and the hypothetical group without access to publicly funded care), based on the current and hypothetical method mix for each group and updated failure rates7 for each method. We adjusted the proportion of contraceptive failures expected among method users to be consistent with actual national numbers of unintended pregnancies occurring among contraceptive users. We then estimated the additional pregnancies that would have occurred in the absence of services by subtracting the number of unintended pregnancies expected to occur among actual service users from the number of unintended pregnancies expected among the hypothetical group. From this we estimated the annual number of unintended pregnancies that were prevented per 1,000 contraceptive clients and applied this to all contraceptive clients served. Finally, we classified the unintended pregnancies averted according to observed outcomes at the national level for specific subgroups of women. Overall, 47% of unintended pregnancies result in an unplanned birth, 34% in an abortion and 19% in a miscarriage; these percentages vary slightly for poor and low-income women and for teens.5,8

REFERENCES
 

1. Frost JJ, Zolna MR and Frohwirth L, Contraceptive Needs and Services, 2010, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/contraceptive-needs-and-services-2010.

2. Frost JJ, Frohwirth LF and Zolna MR, Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/contraceptive-needs-and-services-2014….

3. Guttmacher Institute, Contraceptive Needs and Services, 2006, New York: Guttmacher Institute, 2009, https://www.guttmacher.org/report/contraceptive-needs-and-services-2006.

4. Frost JJ, Frohwirth L and Purcell A, The availability and use of publicly funded family planning clinics: U.S. trends, 1994–2001, Perspectives on Sexual and Reproductive Health, 2004, https://www.guttmacher.org/journals/psrh/2004/availability-and-use-publ….

5. Special analysis of data from the 2011–2015 National Survey of Family Growth, 2017.

6. Frost JJ et al., Contraceptive Needs and Services, 2010: Methodological Appendix, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/contraceptive-needs-and-services-2010….

7. Sundaram A et al., Contraceptive failure in the United States: estimates from the 2006–2010 National Survey of Family Growth, Perspectives on Sexual and Reproductive Health, 2017, https://www.guttmacher.org/journals/psrh/2017/02/contraceptive-failure-….

Suggested Citation

Frost JJ, et al., Publicly Funded Contraceptive Services at U.S. Clinics, 2015, New York: Guttmacher Institute, 2017, https://www.guttmacher.org/report/publicly-funded-contraceptive-service….

Acknowledgments

The mapping tool was developed by Jonathan Bearak. Data collection and analysis was supervised by Jennifer Frost and coordinated by Nakeisha Blades, Ayana Douglas-Hall, Lori Frohwirth and Mia Zolna. Research assistance was provided by Kristen Burke, Kate Castle, Alexandra Devenport, Shivani Kochhar, Vivian Gor, Lorraine Kwok, Ellie Leong and Emma Pliskin. All are of the Guttmacher Institute.

The authors thank the following Guttmacher colleagues for reviewing drafts of maps, notes and tables: Lawrence B. Finer, Rachel Benson Gold and Kinsey Hasstedt.

This research was supported by the Office of Population Affairs, U.S. Department of Health and Human Services, under grant FPRPA006050. The Guttmacher Institute also gratefully acknowledges the unrestricted funding it receives from many individuals and foundations—including major grants from the William and Flora Hewlett Foundation and the David and Lucile Packard Foundation—which undergirds all of the Institute’s work.

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Topic

United States

Geography

Tags

birth control, Medicaid, Planned Parenthood, public health, Title X

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