Access to Reproductive Health Services Position Statement

ASTHO believes that reproductive services must be based on education and services that are evidence-based and medically accurate. Services must also be “voluntary, comprehensive and culturally sensitive.”¹

Consumers must have access to services regardless of age, geography, disability, race, ethnicity, gender, sex, sexual orientation, education, income, and country of origin, language, or providers’ beliefs. Services should focus on increased access to education and contraception for men to enable responsible and respectful sexual activity. Consumer awareness of medically appropriate family planning options should be maximized and the family planning visit should be recognized as an opportunity to link individuals to additional services.

State and Territorial Health Agency Role

States must ensure all residents have access to comprehensive reproductive health services. States with local health departments (LHDs) should coordinate their efforts to ensure access to essential reproductive services.

ASTHO encourages state and territorial health agencies to:

• Use all available funding sources including: Title X, Title V Maternal and Child Health Block Grant, Medicaid, Social Services Block Grant (SSBG), Temporary Assistance for Needy Families (TANF), 340B Drug Pricing Program, and the §1115 Medicaid waiver option.
• Provide support for public health clinics, including those receiving Title X funds.
• Develop educational campaigns and services that are evidence-based, medically accurate and culturally appropriate.
• Gather and track reproductive health data including access to reproductive health services, contraceptive use, unintended pregnancy, abortions, rates of prenatal care, rates of adverse births outcomes and inter-group variation between populations, and births for all individuals in our states, territories and tribal nations. Inform providers, clients, and educators about state laws and related federal laws on reproductive health, such as access to confidential services and requirements for medically accurate reproductive health information and youth access.
• Strengthen links between family planning providers and other state-funded programs to facilitate access to a range of health and social services and to reduce service duplication.
• Promote private insurance coverage of contraceptives as a basic preventive health benefit by ensuring that state employee health insurance plans include coverage for contraceptives.
• Promote reproductive health within the context of women’s health across the lifespan.
• Facilitate strategies to promote preconception health and health care and reproductive life planning within existing family planning, health care, and public health settings.

Federal Government Role

The role of the federal government is to support access to “complete, accurate, and science-based information appropriate to each population at risk”².

ASTHO encourages the federal government to:

• Provide adequate funding for reproductive health services.
• Develop flexible policy and funding mechanisms that allow programs to address the specific needs of the populations served.
• Implement policies that promote public and private insurance coverage for contraceptives as a basic preventive health benefit, including expansion of Medicaid coverage for family planning services without requiring a §1115 waiver.
• Provide resources to ensure comprehensive collection and compilation of reproductive health data including: access to reproductive health services, contraceptive use, unintended pregnancy, abortions, rates of sexually transmitted infections, rates of prenatal care, rates of adverse births outcomes and inter-group variation between populations, and births to undocumented immigrants.
• Develop laws and regulations to ensure that provider conscience safeguards do not violate patients’ right to access services. These laws must support health professionals in their obligation to provide their patients with complete and accurate information about all of their treatment options.

Background

ASTHO affirms that comprehensive reproductive health services, including family planning and the screening and treatment of sexually transmitted infections (STIs), is a critical way to safeguard and promote public health. Comprehensive reproductive health services yield numerous benefits including improved birth outcomes for both mothers and infants through preconception and prenatal care; increased access to education and contraception for men to enable responsible and respectful sexual activity; reductions in the incidence and prevalence of STIs and related rates of cancer and infertility; and increased overall access to preventive health services.

Unmet need for reproductive health services and education contributes to an estimated three million unintended pregnancies each year. Approximately half of all births each year are unintended.³ In 2006, an estimated 36.2 million women of reproductive age were in active need of contraceptive services. Almost half of these women, 17.5 million, qualify for publicly-funded family planning services (i.e., were either 250 percent below the poverty line or under the age of 20). Publicly-supported reproductive health services, such as those provided through Title X and Medicaid, helped women avoid 1.94 million unintended pregnancies nationally, and therefore about 860,000 unintended births and 810,000 abortions.⁴

In addition, Title X supported clinics conducted an estimated 57.3 million Pap tests, resulting in early detection of approximately 55,000 cases of invasive cervical cancer.⁵ One in three women who received HIV testing or underwent testing, treatment, or counseling for other STIs did so at a publicly funded family planning center, including half of all poor women who received these services. ⁶

Every dollar spent on services provided by publicly funded family planning clinics saves Medicaid an estimated $4.02 in pregnancy-related and newborn care costs.⁷ In 2004, publicly funded clinics saved federal and state governments an estimated $4.3 billion. Services provided at Title X supported clinics accounted for nearly $3 billion of that total.⁸ A CMS funded study of six state family planning (§1115) waiver demonstration sites found that expansions in family planning services were not only budget neutral but also resulted in significant cost savings of up to $30 million in one year (in Arkansas).⁹

Despite these savings and considering inflation, funding for Title X in constant dollars is 61 percent lower today than it was in FY 1980.¹⁰ Medicaid is the major source of public funds for family planning services, providing 71 percent of the $1.85 billion spent by federal and state governments in 2006.¹¹

Approval History:

Policy Committee Review and Approval on July 31, 2009

Executive Committee Review and Approval on August 18, 2009

Position Statement Expires on August 18, 2012

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or reflect further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position Statements are not voted on by the full ASTHO membership.

Related ASTHO Documents:

• ASTHO General Policy Statement
• Access Policy Statement

Notes

1. NFPRHA, Mission Statement. Available a: http://www.nfprha.org/main/about_us.cfm?Category=Mission_Statement&Section=Main
2. NACCHO, Resolution Supporting Comprehensive Sexual and Reproductive Health Promotion and Education. Available at: http://www.naccho.org/advocacy/positions/upload/04-13.pdf
3. Guttmacher Institute, Facts on Publicly Funded Contraceptive Services in the United States, 2009. Available at: http://www.guttmacher.org/pubs/fb_contraceptive_serv.html
4. Gold, R.B. et al., Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System. New York: Guttmacher Institute, 2009. Available at: http://www.guttmacher.org/pubs/NextSteps.pdf
5. Planned Parenthood, Title X: America’s Family Planning Program. Available at: http://www.plannedparenthood.org/issues-action/birth-control/title-x-15505.htm
6. Guttmacher Institute, Facts on Publicly Funded Contraceptive Services in the United States, 2009. Available at: http://www.guttmacher.org/pubs/fb_contraceptive_serv.html
7. Frost JJ, Finer LB and Tapales A, The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings, Journal of Health Care for the Poor and Underserved, 2008, 19(3):778–796.
8. Ibid
9. Edwards, J., Bronstien, J., Adams, K. Evaluation Of Medicaid Family Planning Demonstrations. 2003. The CAN Corporation. CMS Contract No. 752-2-415921.
10. Gold RB, Stronger Together: Medicaid, Title X Bring Different Strengths to Family Planning Effort, Guttmacher Policy Review, 2007, 10(2):13-18; Available at: http://www.guttmacher.org/pubs/gpr/10/2/gpr100213.html
11. Gold, R.B. et al., Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System. New York: Guttmacher Institute, 2009. Available at: http://www.guttmacher.org/pubs/NextSteps.pdf