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Expanded State Family Planning Services and Behavior Change
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David Paton, Professor of Industrial Economics Nottinghan University Business School
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David.Paton{at}nottingham.ac.uk David Paton
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In the August issue of this journal, Foster and colleagues conclude that the Family PACT Program “significantly reduced the number of unintended pregnancies in California” (1, p.1341). This conclusion is not warranted by the authors findings. They actually estimate pregnancies averted as a result of women on the program using a more efficient contraception method than prior to enrolment. That methodology will provide an estimate of actual pregnancies averted only if there is no associated change in sexual behavior. Although some studies conclude that family planning programs do not lead to an increase in sexual activity amongst adolescents (2,3), there is evidence of a significant effect in other groups (4). Further, most of the studies finding no impact on adolescent sexual behavior have been also unable to identify any consequent reduction in pregnancy or abortion rates, perhaps suggesting low take-up from these programs. Foster et al’s findings provide a useful test of the assumption that PACT had no impact on sexual behavior. They establish that PACT had a significant impact on contraceptive efficiency of sexually active women in California. The estimated numbers of births and abortions averted are of such a magnitude that, if there was indeed no induced change in behavior, we should undoubtedly observe them in actual data. For example, the authors find that one year of PACT averted 41,455 induced abortions in California, arguing that this is a conservative estimate. In 1996 (the last full year before PACT started) there were estimated to be 237,830 abortions in California. In 2000 (the first year after the start of the program for which data are available) the figure was 236,060 – a reduction of 1,770. The abortion rate went down by 5%, exactly the same amount as for the whole of the USA (5). These figures provide scant evidence that PACT had any net impact at all on the abortion rate in California. Examining the Census Bureau data on births yields similar conclusions. Unless California experienced some contemporaneous social phenomenon that would otherwise have caused abortions to increase by nearly 20% over just four years, we must conclude that the PACT state-funded family planning program led to some change in risky sexual behavior amongst its target population. It further seems likely that this behavior change was sufficient to negate some, and perhaps all, of the positive effects of the program in terms of unintended pregnancies averted. 1. Foster D.G., Klaisle C.M., Blum M. et al. Expanded State-Funded Family Planning Services: estimating pregnancies averted by the Family PACT program in California, 1997-1998. American Journal of Public Health, 2004, 94: 1341-1346. 2. Kirby D. Emerging Answers: research findings on programs to reduce teen pregnancy, Washington D.C.: National Campaign to Prevent Teen Pregnancy; 2001. 3. DiCenso A., Guyatt G., Willan A. and Griffith L ‘Interventions to Reduce Unintended Pregnancies among Adolescents: systematic review of randomised controlled trials’, British Medical Journal, 2002, 324: 1426- 1434. 4. Richens J., Imrie J. and Copas A. Condoms and Seat Belts: the parallels and the lessons, Lancet, 2000, 355: 400-403. 5. Finer LB, Henshaw, SK. Abortion Incidence and Services in the United States in 2000, Perspectives on Sexual and Reproductive Health, 2003, 35: 6-15. |
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