This brief describes a recent analysis of the impacts of state policies that expanded eligibility for Medicaid family planning services to women who do not meet regular Medicaid eligibility criteria. The results of this research show that these expanded eligibility policies had a significant impact on reducing unplanned births. The effect on birth rates was largest for women ages 18 to 24. Data on individual behavior confirms that this reduction in births was achieved through increased use of contraception among sexually-active women. The authors estimate the policy cost of preventing an unwanted birth to be around $6,800. They conclude that this is a cost-effective policy intervention relative to other policies and programs targeted at reducing teen and unwanted births.
There is widespread consensus among the American public that rates of teen pregnancy and unintended pregnancies to young, unmarried women are too high. Approximately 30 percent of teenage girls in the United States become pregnant and 20 percent give birth by age 20. Increasingly, policy makers and advocacy groups are recognizing that the high rate of unintended pregnancy among unmarried women in their twenties is also a major social issue. Half of all pregnancies in the United States are reported by the mother as being unintended. More than one-third of these (1.1 million pregnancies in 2001) are to unmarried women in their twenties. The National Campaign to Prevent Teen and Unplanned Pregnancy estimates that these pregnancies accounted for nearly half of the 1.3 million abortions in 2001. Rates of teen pregnancy and unplanned pregnancy are higher among young unmarried women, lower income women, women with lower levels of education, and minority women.
Advocates often call for increased access to contraception as a way to combat high rates of teen and unintended pregnancies. But it is not always clear what is meant when a woman says that her pregnancy or birth was unintended. About half of these women also report that they were not using contraception; one might reasonably wonder how committed they were to preventing a pregnancy. If teenagers or young, unmarried women who get pregnant are not committed to avoiding pregnancy, then a policy of increased access to contraception will not have much impact on pregnancy or birth outcomes. The recent headlines from Gloucester, Massachusetts provide a dramatic example. Eighteen teenagers in the high school in Gloucester became pregnant in one school year, four times more than in the previous year. The principal told reporters the girls made a pact to get pregnant and to raise their babies together. Although some of the details reported in the press have been challenged, this story nonetheless demonstrates the potential limitations of a policy focused solely on contraceptive access. Such a policy will be effective only to the extent that teenagers or other young women are committed to avoiding pregnancy.
This brief describes research we recently completed that speaks directly to the potential impacts of a policy of expanded access to publicly provided family planning services. Twenty-six states since 1993 have been granted waivers by the federal government to expand eligibility for Medicaid coverage of family planning services to women who would not otherwise qualify for the program. We examine the impact of this policy on service take-up, birth rates, sexual activity, and contraceptive use. Our results indicate that expanding eligibility to women at higher levels of income (above the traditional Medicaid eligibility level) reduced overall birth rates among women age 18-19 and 20-24 by 7 percent and 5 percent, respectively. The policy led to a 15 percent decline in births among just those 20-24 year old women made newly eligible for family planning coverage.