Rate of Unintended Pregnancies Among Low-Income Women
A statewide program
established in 1997 to expand access to comprehensive family planning services for
low-income residents has significantly decreased the number of unintended pregnancies in
California, according to a report released by UCSF and the California Department of Health
The DHS provided this report, the first evaluation results for the California Family
PACT or Planning, Access, Care and Treatment program, to the legislature on July 20.
"Contraceptive services provided during the first year prevented more than 100,000
unintended pregnancies that would have resulted in 50,000 unintended births, 41,000
induced abortions, 15,000 miscarriages and 1,400 ectopic pregnancies," reports Claire
Brindis, DPH, author of the report and professor in the UCSF department of pediatrics.
PACT health care practitioners provided medical care, education, counseling,
medications, supplies and laboratory services related to periodic reproductive health
screening, contraceptive methods, basic infertility services, cervical cancer screening,
sexually transmitted infection (STI) diagnosis and treatment and HIV screening as well.
"Family PACT services also saved over $512 million in public expenditures for
medical care, income support and social services for mothers and children that otherwise
would have been incurred as a result of unintended pregnancies," says Brindis,
co-director at the UCSF Center for Reproductive Health Research and Policy.
The program spent $114 million for services provided during its first year and served
749,572 clients -- a 43 percent increase over the number served during the prior fiscal
year through the state's previous family planning program. From its inception three years
ago through June 1999, Family PACT served more than 1.5 million clients.
"Family PACT has gained national attention as an innovative public health
program," says State Health Director Diana M. Bonta, RN, DPH. "DHS and community
health care providers have accomplished many positive results and the success of this
program is evident in the evaluation results."
Evaluation methods included observation of client services, interviews of clients and
providers, chart reviews and analysis of service and billing data.
The evaluation report was based on analyses carried out by the UCSF Evaluation Team and
on the work of the DHS STD Control Branch, the California Family Health Council, the
Center for Health Training, Berkeley Economic Research Associates, The Pacific Health
Consulting Group, the Public Health Institute and Electronic Data Systems.
The UCSF Center for Reproductive Health Research and Policy and the UCSF Philip R. Lee Institute for Health Policy Studies prepared the report.
"In addition to fiscal impact, the evaluation also addressed quality of
care," says report author Philip Darney, MD, a UCSF professor of obstetrics,
gynecology and reproductive sciences and co-director of the UCSF Center for Reproductive
Health Research & Policy. "This evaluation indicates that implementation of the
Family PACT program was achieved without compromising the quality of care established in
the previous state program."
Providers include community clinics, family planning clinics, health departments and
private practice clinicians. Practitioners who are currently authorized to provide
services through the Medi-Cal program are eligible to become Family PACT providers after
attending a daylong orientation.
Innovative features of the Family PACT program were designed to increase access to
services for women and men who have no other source of care and have a family income below
200 percent of the Federal Poverty Level. Eligibility is determined and clients are
enrolled "on site" by their medical care provider.
Reimbursement for services to Family PACT clients is similar to that for Medi-Cal
services. The program also provides reimbursement to pharmacies for over-the-counter
products and prescription drugs needed for services covered by the program.