RESEARCH | Publicly Funded Contraception Programs, Methods Cost Effective, Study Finds
[Feb. 26, 2009]

Summary of "Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program," Foster et al., American Journal of Public Health, March 2009.

Although unintended pregnancies occur more frequently and disproportionately to women with limited resources, the provision of contraceptive services to low-income women has shown substantial savings in pregnancy-related medical expenses. California's Family Planning, Access, Care and Treatment program, or Family PACT, provides FDA- approved contraception and reproductive health services to men and women whose incomes are at or below 200% of the federal poverty level and who do not receive reproductive health care coverage through another program. Family PACT has served more than 1.6 million people annually in recent years. Family PACT covers all FDA-approved contraceptive methods at no cost to the client. The percentage of women who received barrier methods with or without another method has been steady at about 45%, while the rates of women receiving oral and injectable contraceptives have decreased slightly. The study examines the cost-effectiveness of covering new contraceptive methods under the Family PACT program for women and girls ages 13 to 44.

Methods
For the study, Diana Greene Foster of the Bixby Center for Global Reproductive Health at the University of California-San Francisco and colleagues analyzed the fertility effect of each contraceptive method offered by the Family PACT -- including oral and injectable contraceptives, intrauterine devices, sterilization and barrier methods. The researchers also estimated the number of unintended pregnancies that were avoided through each specific method. The researchers used Family PACT data on contraceptive method dispensing claims from three different years: 2002 to determine previous methods dispensed, 2003 to determine currently dispensed methods and 2004 to predict methods dispensed.

Using data from a separate cost-benefit study, the researchers estimated that public savings of each avoided pregnancy that would have ended in abortion in 2002 was $372 and that the cost savings associated with prenatal care and delivery was $3,228 for each avoided pregnancy. A total of $11,545 was saved in medical, welfare and other social service costs for a woman and infant from conception to two years after birth. The cost savings of providing the contraceptive services was calculated based on the contraceptive method dispensed at each visit. All subsequent expenses for each client were attributed to the original contraceptive method unless a different method was dispensed at a later date.

Results

According to the study, 738,000 women ages 20 to 44 and 217,000 women ages 13 to 19 years received contraceptive services through Family PACT in 2003. Oral contraceptives were prescribed to about 449,000 clients, while 405,000 clients received condoms or other barrier methods, 162,000 received contraceptive injectables, 22,000 long-term methods, 129,000 the contraceptive patch and 11,000 the vaginal ring. Emergency contraception was dispensed without another contraceptive to 37,000 clients.


The study found that prior to enrolling in Family PACT, 27% of women were not using any contraceptive method, while 3% were using natural family planning methods. About 38% were using condoms, while the remaining 32% were using IUDs or hormonal methods. The researchers estimated that 43% of the women would have become pregnant over 12 months if they had not received contraceptive services through Family PACT. An estimated 178,000 pregnancies were averted in 2003 through the provision of specific contraceptive methods, and more than 50% of the averted pregnancies were attributed to oral contraceptive use, the study found. According to the study, all contraceptive methods were cost-effective at preventing unintended pregnancies; however, the cost savings varied by method. The contraceptive implant had the highest savings of the long-term methods, while IUDs had the second highest savings among long-term methods. Injectable contraceptives saved $5.60 per $1.00 spent, the highest of the short-term methods. Oral contraceptives saved $4.07, the patch saved $2.99, the ring saved $2.55 and barrier methods saved $1.34 per $1.00 spent. EC saved the lowest amount, with $1.43 per $1.00 spent.

Discussion

According to the authors, because all contraceptive methods were found to be cost-effective, public health programs should "offer a range of methods to increase the chances that their clients will find a method that suits her needs." In addition, contraceptive providers "should be encouraged to dispense or prescribe more months of contraceptive protection per visit as appropriate, which would reduce the number of clinic visits and costs while increasing method continuation," the authors write, adding that "follow-up support should be available" for new users of any contraceptive method to ensure proper use. People using barrier methods and EC also should be "encouraged to use additional, longer-term methods of contraception," the authors write, concluding, "Together, these measures will contribute to higher contraceptive compliance and continuation, lower failure rates and fewer unintended pregnancies."





The information contained in this publication reflects media coverage of women’s health issues and does not necessarily reflect the views of the National Partnership for Women & Families.

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