Role of publicly funded clinics in providing contraceptive and preventive gynecological care to uninsured women

In 2004, 17.4 million women at risk of unintended pregnancy were in need of publicly funded services because of age or income. Women needing publicly funded services are at increased risk for poor reproductive outcomes, including contraceptive failure and unintended pregnancy. Forty percent of women needing publicly funded care are served by the 7,700 publicly funded clinics that comprise the nation's family planning “safety net.” Publicly funded clinics are under great financial strain due to inadequate funding, increased costs of delivering care, and growing demand among newly uninsured and low income populations.

We pooled data from the 1995 and 2002 NSFG surveys to examine trends in the relationship between insurance coverage and use of publicly funded clinics for women at risk of unintended pregnancy, who received any contraceptive (n=4,608) or gynecological service (n=6,318) in the 12 months before the surveys. We estimated logistic regression models and tested differences in the probability of clinic use between years by insurance status. We found that between 1995 and 2002 the probability of using a publicly funded clinic for any contraceptive or preventive gynecological service increased significantly for uninsured and Medicaid-insured women, with the largest percentage increases among uninsured women.

Efforts to reduce unintended pregnancy and poor reproductive health outcomes must account for the role of publicly funded clinics in meeting the reproductive health needs of uninsured women, and examine whether funding (federal and state) to support safety net providers is sufficient to meet this demand.