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Family planning is one of the 10 great public health achievements of the 20th century. The availability of family planning services allows individuals to achieve desired birth spacing and family size and contributes to improved health outcomes for infants, children, women, and families.
Abstinence from sexual activity is the only 100% effective way to avoid unintended pregnancy. For individuals who are sexually active, correct and consistent contraceptive use is highly effective at preventing unintended pregnancy. The most effective methods to prevent unintended pregnancy include long-acting reversible contraceptives such as intrauterine devices (IUDs) and contraceptive implants, followed by other hormonal contraceptives including oral contraceptives (pills), the patch, the ring, and the Depo-Provera shot (DMPA). Condoms protect against both unintended pregnancy and STIs, and their use should be encouraged. Both men and women should be counseled about using condoms in every act of sexual intercourse when not in a long-term, mutually monogamous sexual relationship.
For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care. In 2015, publicly funded family planning services helped prevent 1.9 million unintended pregnancies, including 440,000 teen pregnancies. In 2010, every public dollar spent on family planning saved the federal and state governments $7.09.
Unintended pregnancies include pregnancies that are reported by women as being mistimed or unwanted. Almost half (45%) of the 6.1 million annual pregnancies in the United States are unintended. Unintended pregnancies are associated with many negative health and economic consequences. The public cost of births resulting from unintended pregnancies was estimated at $21 billion in 2010 (this figure includes costs for prenatal care, labor and delivery, post-partum care, and 1 year of infant care).
For women, negative outcomes associated with unintended pregnancy can include:
Births resulting from unintended pregnancies can have negative consequences including birth defects and low birth weight. Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood and have lower educational attainment and more behavioral issues in their teen years.
The negative consequences associated with unintended pregnancies are greater for teen parents and their children. Eighty-two percent of pregnancies to mothers ages 15 to 19 are unintended.7Twenty percent of all unintended pregnancies occur among teens. Teen mothers:
Unintended pregnancies occur among women of all incomes, educational levels, and ages. However, there are disparities in unintended pregnancy rates. The rates of unintended pregnancy are highest among the following groups:
Women with lower levels of education and income, uninsured women, Latina women, and non-Hispanic black women are less likely to have access to family planning services. In addition, men are less likely to have access to and receive family planning services than women.
Barriers to people’s use of family planning services include:
Many women of reproductive age can benefit from preconception care (care before pregnancy). Preconception care has been defined as a set of interventions designed to identify and reduce risks to a woman’s health and improve pregnancy outcomes through the prevention and management of health conditions. Preconception care can significantly reduce birth defects and disorders caused by preterm birth.
Elements of preconception care should be integrated into every primary care visit for women of reproductive age. Preconception care must not be limited to a single visit to a health care provider, but should rather be a process of care designed to meet the needs of an individual. As part of comprehensive preconception care, providers should encourage patients to develop a reproductive life plan. A reproductive life plan is a set of goals and action steps based on personal values and resources about whether and when to become pregnant and have (or not have) children. Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.
Increased awareness of the importance of preconception care can be achieved through public outreach and improved collaboration between health care providers. Currently, only 30.3% of women report receiving pre-pregnancy health counseling. Future efforts should promote research to further define the evidence-based standards of preconception care, determine its cost-effectiveness, and improve tracking of the proportion of women obtaining these services.
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