By Jennifer Salcedo, MD, MPH and Andrea Sorensen, BA
For full report click here.
Approximately half of all pregnancies in the United States are unintended, and over forty percent of these pregnancies end in abortion. Low-income women have higher rates of unintended pregnancy and are consequently disproportionately represented among women seeking abortion. The provision of contraception at the time of abortion is within the medical standard of care and is desired by a high percentage of women. Additionally, provision of contraception at the time of abortion has been demonstrated to decrease rates of subsequent abortions compared to the planned provision of contraception at abortion follow-up. Despite these facts, as a result of the fragmentation of abortion and contraception services and policies that restrict federal funds from being used for abortions, less than one-third of high-volume abortion providers in the U.S. are able to offer placement of intrauterine devices (IUDs), a form of long-acting reversible contraception, at the time of abortion.
In California, one of a minority of states to fund both abortion and contraception for low-income women, confusion over how healthcare providers may seek reimbursement for concurrently provided abortion and contraception services serves as a major barrier to women’s access to immediate postabortal contraception. This is particularly true for women with incomes between 100% and 200% of the Federal Poverty Line (FPL) who receive abortion coverage under Presumptive Eligibility or Limited-Scope Medi-Cal, and contraception care under the separate Family PACT program. In 2007 this population of women represented 30,500 of the 80,069 publiclyfunded abortions performed in the state.
In this report, we analyze current barriers to the provision of immediate postabortal contraception for low-income women in California. Additionally, we create a decision analytic model to evaluate the potential cost-savings to public programs if immediate postabortal contraception was made available to low-income women undergoing abortion, compared to planned provision of contraception at abortion followup. Through these evaluations, we aim to provide recommendations to the UCSF Bixby Center for Global Reproductive Health (Bixby Center) regarding how California can best provide postabortal contraception to its low-income women in a way that: (1) is consistent with the medical standard of care, (2) reduces the number of unintended pregnancies and abortions, and (3) minimizes public program costs. The Bixby Center’s mission is to advance women’s health worldwide through research, training, policy analysis and services. Consistent with these goals, the Bixby Center provides ongoing evaluation of California’s Family PACT program to ensure its continued positive impact on health outcomes and cost-savings.