Medicaid and Pregnancy Prevention

While such a scenario may sound too good to be true, a recent study from the Guttmacher Institute, Estimating the Impact of Expanding Medicaid Eligibility for Family Planning Services, suggests these outcomes are easily within reach if federal and state governments expand Medicaid coverage for contraception.

Addressing Income Disparities

Between the early 1980s and mid-1990s, the United States seemed to be on the right course with family planning and pregnancy prevention.  The use of birth control by American women increased substantially, and in turn, the rates of both unintended pregnancies and abortions decreased.  But as the Guttmacher Institute reported in a separate study in May, this steady decline in the rate of unintended pregnancies began to stall between 1994 and 2001.

At the root of this halt in declining rates was a great disparity in pregnancy prevention among American women based on income.  Between 1994 and 2001, the rate of unintended pregnancies for poor women increased by 29 percent; during the same period, the unintended pregnancy rate for more affluent women decreased by 20 percent.  Today, the Guttmacher Institute estimates, a poor woman in the United States, compared to her higher-income counterpart, is

•  nearly four times as likely to have an unintended pregnancy
•  five times as likely to have an unintended birth
•  more than three times as likely to have an abortion

The numbers speak for themselves.  The United States is now on a regressive course with preventing unintended pregnancies, and our society is quickly emerging as a starkly divided one — with those who have the economic power to plan their families on one side and those who do not on the other.

The Solution

In its recent study on Medicaid, released in August, the Guttmacher Institute examined the potential impact of various strategies for expanding Medicaid coverage of contraceptives:

•  equating the eligibility levels for contraceptive services with those for pregnancy-related care under national Medicaid funding guidelines
•  requiring each state to extend Medicaid eligibility to more women by expanding income requirements
•  giving states the option to extend eligibility at the state level by expanding income requirements

Although all scenarios could expand women’s access to contraception while saving federal and state governments a significant amount of money, the study found that the first scenario — equating the eligibility levels for contraceptive services with those for pregnancy-related care — would be the most cost-effective. 

Under this scenario, women who would be eligible for Medicaid funding to give birth would now also be eligible for coverage of contraceptive services and supplies.  Such a move, the study concluded, would cost about $800 million, but save about $2.3 billion in costs from unplanned births.  By the third year of implementation, the move would yield a net savings of $1.5 billion in Medicaid costs.  It would also reduce the number of unplanned pregnancies nationwide by 15 percent, preventing nearly 200,000 abortions.

A Win-Win Situation

The Guttmacher study confirms what reproductive health care providers like Planned Parenthood have long been advocating — that expanded access to preventive services is a win-win situation for those on all sides of the abortion issue.  By helping to prevent more unintended pregnancies, expanding Medicaid coverage for contraception would help reduce the need for abortion.  And in this case, such a move would also save the government a substantial sum of money.

The ability to plan one’s family is a basic, human right — one that should not be granted on the basis of socioeconomic status.  As Rachel Benson Gold, co-author of the Guttmacher study, wrote in an article summarizing her findings, “To be sure, being able to determine whether and when to bear children is one of the most basic aspects of self-determination, and it has become a prerequisite for women’s full participation in modern life.”