Age at first birth: A comparison of California's Family PACT clients to non-Family PACT clients

Traditionally, women could only enroll in Medicaid if they had at least one child, leaving low-income nulliparous women without family planning services. In contrast, California's 1115 Medicaid family planning demonstration waiver, Family PACT (Planning Access, Care and Treatment), expanded services to nulliparous women. Since program inception in 1997, California's teen birth rate has decreased and the proportion of women enrolling with no children has increased from 40% to 49%, suggesting that women in Family PACT enroll to prevent or delay pregnancy. To examine the extent to which clients delay their first birth we analyzed California's vital statistics and Family PACT data. Birth records from 2008 were linked to Family PACT records to find women who used Family PACT prior to conception. Their age at first birth was compared to that of women grouped according to whether their birth was Medicaid-funded, privately-insured or had another payer source. Of low-income women, average age at first birth for Family PACT clients (25 years) was higher than for Medicaid clients (22 years). Age at first birth among privately-insured women was 29 years. When stratified by race/ethnicity, Family PACT clients were in between Medicaid and privately-insured women in every category. The demographic profile of Family PACT, Medicaid and privately-insured women was examined. These findings suggest that publicly-funded family planning programs help low-income women to delay their first birth until they desire to start a family and suggest the possible impact of expanding Medicaid enrollment to include nulliparous women nationwide under the Affordable Care Act.