California Leads in Prevention

The report, Contraception Counts: Ranking State Efforts, which was released in February, assessed states on the provision of family planning services and placed California at the head of the class. The United States currently has one of the highest rates of unintended pregnancy in the industrialized world, making the report and its findings on California especially relevant.

The Prevention Perspective

The need for state public health policies that are effective in preventing unintended pregnancies is clear:

• About half of the six million pregnancies in the U.S. each year are unintended, resulting in 1.3 million abortions.

• Unintended pregnancies have significant effects on the lives of individual women, entailing unexpected expenses, potential social hardships, and medical risks.

• Unintended pregnancies also result in collective costs to society by weighing heavily on public resources. This is particularly true when it comes to unintended pregnancies among low-income women, the group most likely to experience them.

Half of all unintended pregnancies occur among couples who haven't used contraception, and the other half occur among couples who use birth control incorrectly or inconsistently. As California policymakers have already come to realize, education and expanded access to contraception would prevent many of these unintended pregnancies and reduce their associated monetary and social toll.

The Report

The report evaluated three areas related to family planning — service availability, laws and policies, and public funding. "To rank number one, you have to do well all across the board," says Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. And California did.

Service Availability

California has 821 publicly funded family planning clinics — at least one in every county. These clinics provide care to more than one million women each year, including 246,890 teens, and help to prevent 236,500 unintended pregnancies. More than two million California women need publicly funded access to contraception; 46 percent of them are served by these clinics, including 43 percent of teens in need.

Laws and Policies

Thanks to a long history of state leaders committed to reproductive rights, California ranked first in the area of laws and policies, in addition to ranking first overall. "We've been in a position, due to the composition of our legislature and our governor's office, to move proactive legislation forward," says Kneer.

Perhaps most significantly, California has one of the most extensive Medicaid expansion programs in the country, which pays for family planning services for low-income women, men, and teens. Medicaid is funded with both federal and state dollars, and the program does not traditionally cover contraceptive services. But over the past decade, states have been able to petition for waivers that allow for different types of coverage as long as the overall federal tab does not increase.

California is one of several states that have taken advantage of this rule by applying it to family planning. In 1999, it won a waiver to provide family planning coverage, arguing that the provision of family planning services costs far less than the provision of pregnancy-related services to Medicaid recipients who might otherwise become pregnant.

In 2003, California's Family PACT (Planning, Access, Care, and Treatment) program covered family planning care for more than 1.5 million women, men, and teens with incomes less than twice the federal poverty standard. Since its inception, the program has saved the state $2 billion; every dollar spent through Family PACT saves an estimated $5.33 in medical and social services costs. Extending coverage to teens has also helped fuel a dramatic reduction in the state's teen pregnancy rate — a decline of 40 percent over the last 10 years.

Another factor contributing to California's high ranking is the California Comprehensive Sexual Health and HIV/AIDS Prevention Act, which mandates comprehensive sex education in public schools. The law requires that students attending publicly funded sex education classes learn medically accurate lessons about both abstinence and contraception. The passage of this act precluded California from accepting federal funding for abstinence-only education. It was the first state (now one of three) to refuse federal abstinence-only funding.

Other state laws and policies cited in the report include the Contraceptive Equity Act, which requires all health insurance plans to provide coverage for birth control, and several bills that expand access to emergency contraception (EC). These bills established protocols that enable women to get EC from a pharmacist without a prescription and ensure timely access to EC for survivors of sexual assault.

Also, unlike several other states, California has never passed a refusal clause law regarding contraceptives, which means that pharmacists, physicians, and other health care providers cannot legally refuse to prescribe or fill prescriptions for birth control because of their own personal biases.

Public Funding

California ranked eighth in the area of public funding. State and federal governments in 2001 spent $354,941,000 in the state on contraceptive services and supplies. This is equal to $124 for each woman in need, well above the national average of $79.

California's Secret to Success

California has been blessed with state officials who have made reproductive rights a top priority, says Kneer, and many other states haven't been so lucky. "For states that are faced with hostile legislatures, moving proactive legislation is harder than it sounds," she says. "Even in states with proactive legislatures, moving proactive legislation forward still requires long-term commitment and financial support."

Another factor contributing to California's success has been a team approach to advocacy. Planned Parenthood has joined with other groups to pass legislation that expands access to contraception and prevents unintended pregnancies. "We strongly believe in working as a coalition to achieve results," says Kneer. "By forming alliances with other health care providers as well as our pro-choice coalition advocates, we've been successful."

© 2006 Planned Parenthood Federation of America, Inc. All rights reserved.