Three important questions about family planning
The election of Pope Francis as the Catholic Church’s 266th pontiff has prompted dialog among social policy researchers, Catholic and non-Catholic alike. As Cardinal Jorge Bergoglio, the pope was well known for his service to the poor and underprivileged. Those of us who have seen public programs struggle with increased demand and reduced funding hope he will use his worldwide platform to affirm the importance of a strong social safety net. Yet those of us who study family planning programs must expect to be left out of the conversation.
Given how many people in the United States have relied on publicly funded family planning programs—more than 9 million women according to the Guttmacher Institute —we can count them among the most widely used services government provides. But the personal, private nature of these programs, and the opposition they engender can make research into their use and efficacy challenging. Though much valuable research on family planning programs has been conducted in recent years, gaps in the literature remain. My colleagues Embry Howell, Fiona Adams, Jennifer Rogers, and I have highlighted these in “Focus on the Future: Revisiting the Family Planning Research Agenda.”
1. How can we better deliver family planning services ?
Demand for family planning services has increased under Title X, enacted in the 1970s to help low-income populations get access to information and contraception. While Title X has been successful, funding has not kept pace with growing demand. Researchers must continue to document both the demand and the barriers to access that vulnerable populations experience.
“Focus on the Future” also highlights new research on interventions that effectively decrease unwanted pregnancies. These interventions are vital, as knowledge about contraceptive use (particularly that of vulnerable populations) remains scarce, and evidence supporting best practices that improve the provision and use of contraception remains weak.
2. How can we improve access to family planning services ?
The literature suggests that some populations have benefited from increased access to family planning services over time: minority and disadvantaged groups, adolescents and 20-somethings, men, those with physical or mental health risk factors, and those with HIV. But gaps in access still exist, particularly among isolated communities such as immigrant populations, incarcerated individuals, and rural women.
Significant research has been conducted on adolescents, particularly on confidentiality and parents’ involvement. However, conclusions on the effectiveness of confidential services remain unclear. And as a group, older adolescents (20-somethings) have not received nearly enough attention in the literature, though 64 percent of pregnancies among this group are unintended.
Similarly, we know little about which services tailored toward men would be most beneficial, or how family planning services designed for men interact with the provision of services to women. We also need to learn more about how family planning services intersect with risk factors such as depression, obesity, and hypertension. Research on these topics has tended to be broad in scope but lacking in depth.
3. How can family planning clinics improve their organization and administration?
The effects of Medicaid expansion on family planning services warrant future in-depth research. The expansion efforts that 28 states began in 2012 with Medicaid family planning waivers have proven effective. Yet the full impact of new Obamacare expansions and their new reimbursement and funding models isn’t yet known.
Our findings demonstrate that significant research is still necessary to pin down best practices for delivering family planning services and reaching those with the greatest need. Filling in these gaps is essential if we are to gain a clear picture of the effectiveness of family planning service delivery programs.