Family planning programs in the U.S.
The organizational and financial problems facing the American family planning movement are described. Family planning services are provided in the context of a medical economy dominated by private practice which perpetruates the division between curative and preventive medicine. The care available to the needy is primarily for emergency or chronic conditions, and offers even less access to preventive services than is available to higher income individuals. A unified health care system, into which family planning services could be integrated is nonexistent, but the last decade has seen the rapid transformation of public policy and attitudes towards support of a national family planning policy. The substantial degree of fertility control displayed by most Americans is evidence more of their desire to limit family size than of the effectiveness of health programming. In 1965, 84% of all married white women aged 18-39 had used some method of contraception and 90% either had used or expected to use birth control after the birth of additional wanted children. Comparable indices for nonwhite couples were 77% and 86%. However, two out of five couples were found to rely on methods of doubtful effectiveness, particularly those whose income limited their access to medical care. The National Academy of Sciences has suggested that American population growth since World War II has been the result of a preference for larger families among those who choose the number of children they have rather than by high fertility rates among the impoverished segment of the population. U.S. family planning programs are characterized by two distinct objectives: 1) increased efficiency of contraceptive practive for all couples of childbearing age to eliminate unwanted births and improve spacing control; 2) "catch-up" programs to provide low-income couples with economic access to modern methods of birth control. However, studies show that nearly 40% of births among the poor and near-poor are unwanted compared to 14% among the nonpoor. It has been estimated that a possible three-fourths of excess fertility could be prevented by perfertly efficient contraception. Some degree of immediate improvement might be achieved if physicians routinely offered family planning instruction rather than waiting until the patient has requested it. In the last several years, a program to create an adequate network of facilities providing modern family planning servies for a defined population (the poor) has become the key issue of domestic policy. Due to the close relation between high fertility and the incidence of poverty and infant mortality, the extension of services to low-income persons who would have no other access to them has become the immediate objective of Federal policy and has been assigned highest priority by Planned Parenthood. The implementation of a national "closing the gap" program requires that family planning be assigned high priority at all levels of government which would lead to a major redirection of effort and resources, coupled with the development of adequate professional incentives. The cost of delivering modern services to five million low-income couples is estimated at 150-200 million dollars a year, compared to annual governmental expenditures on health care totaling more than 16 billion dollars.