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Reproductive Health Care for Women: Coverage, Access, and Financing. Usha R. Ranji, M.S. Principal Policy Analyst Kaiser Family Foundation Tutorial December 2008. Figure 2. Prevention. Contraception Screenings Pap tests Breast exams Sexually transmitted infections.

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reproductive health care for women coverage access and financing
Reproductive Health Care for Women: Coverage, Access, and Financing

Usha R. Ranji, M.S.

Principal Policy Analyst

Kaiser Family Foundation Tutorial

December 2008


Figure 2

  • Contraception
  • Screenings
    • Pap tests
    • Breast exams
    • Sexually transmitted infections

Figure 3


Allow women to prevent unintended pregnancies as well as plan and space their childbearing

Typical U.S. woman who wants only 2 children must use contraceptives for roughly 3 decades

62% of women aged 15–44 currently use a contraceptive

Most (64%) using reversible methods, such as oral contraceptives or condoms, but some differences between age and racial groups

emergency contraception

Figure 4

Emergency Contraception
  • Prevents pregnancy after unprotected sex; does not affect established pregnancy
  • EC available over-the-counter for women 18 and older, younger women require a prescription
  • ~ One-third of women of reproductive age report that they did not know about EC
  • State policies can facilitate/limit access
    • Mandate referral/provision of EC to sexual assault survivors
    • Allow pharmacists to refuse dispense EC for moral or religious reasons

Figure 5

Contraceptive Coverage

State Mandates for

Contraceptive Coverage, 2008

  • Some employer-based plans still not covering full range of contraceptives
  • No federal mandate requiring coverage
  • 27 states require coverage, but self-funded plans are exempt
  • Plans in states with mandates more likely to provide coverage

Comprehensive mandate (8 states)

Limited mandate* (19 states)

None (23 states + DC)

*Allows religious or ethical exemptions to the mandate.

Source: Alan Guttmacher Institute, State Policies in Brief, May 2008.

medicaid and family planning

Figure 6

Medicaid and Family Planning

Sources of Public Funding for Family Planning, 2006

  • Enhanced federal matching rate
  • In 2006, 7.3 million women of reproductive age (15-44) relied on Medicaid for care
  • Pays for majority of publicly-funded family planning care
  • 26 states extend family planning services to low-income women not eligible for full Medicaid benefits



Other StateFunds13%

Total= $1.8 Billion

Note: Federal Grants includes Title X (11.7%), MCH Block Grant (2.1%), TANF and Social Service Block Grant (2.6%). Source: Sonfield, A. and Gold, R.B., Public Funding for Family Planning, Sterilization and Abortion Services, FY 1980–2006, AGI, 2008.

title x program

Figure 7

Title X Program

Annual Title X Appropriation Levels ($ millions)

  • Publicly-financed network of clinics and providers for family planning services
  • Serves ~ 5 million low-income women annually
  • Funding levels have not kept up with inflation and demand









Sources: AGI, Fulfilling the Promise, 2000; NFPRHA, Title X Factsheet.

sexually transmitted infections

Figure 8

Sexually Transmitted Infections
  • At least 19 million new STIs annually; almost half among young people ages 18-24
  • Racial/ethnic differences - Nearly half of young African-American women (48%) were infected with an STI, compared to 20% of young white women
  • Condoms effective in reducing transmission of STIs
  • HPV most common sexually transmitted virus
  • New vaccine prevents strains of HPV responsible for most cases of cervical cancer; recommended for girls and women ages 11-26

Source: Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutritional Examination Survey (NHANES) 2003-2004

women as a proportion of newly reported aids cases 1985 2006

Figure 9

Women and HIV/AIDS

Women as a Proportion of Newly Reported AIDS Cases, 1985-2006
  • Proportion more than tripled since beginning of epidemic
  • Women of color, particularly African Americans, disproportionately affected
  • Young women at particular risk











Note: Includes reported cases among women 13 years of age and older.

Source: CDC, HIV/AIDS Surveillance Reports, Vol. 18. 2008.


Figure 10

Teen Issues

  • Half (48%) of high school students have ever had sex
  • About one-quarter of teen females and 18% of teen males used no method of contraception at first intercourse
  • Rate of teen births much lower than in previous decades; very slight rise recently
  • National and state debates about content of sex education

Live births per 1,000 women ages 15 to 19:

Sources: CDC National Youth Risk Behavior Survey, 2007. Hamilton BE, Martin JA & Ventura SJ. Births: Preliminary data for 2006. CDC National Vital Statistics Reports, 56(7). 2007.; Martin JA, Hamilton BE et al. Births: Final data for 2005. CDC National Vital Statistics Reports, 56(6). 2007.

pregnancy and childbirth

Figure 12

Pregnancy and Childbirth

Distribution of hospital stays for women, 18-44, 2000

  • 4.1 million births annually
  • C-section rates rising – accounted for 31% of live births in 2006
  • Many new technologies available
  • Complications in 1/3 of births
    • - 13% births pre-term
    • - Higher rate of maternal mortality among African American women

Nonobstetric-related 40%


Source: Estimates based on AHRQ, Care of Women in U.S. Hospitals, 2000: HCUP Fact Book No. 3, September 2002.

paying for maternity care

Figure 13

Figure 3

Paying for Maternity Care

Average expenditures for maternity care, 2004

  • ESI plans cover all pregnancy-related care, including prenatal care, childbirth and delivery, and post-partum care
  • Individual insurance plans often do not cover maternity care
  • Medicaid covers 41% of births - higher eligibility threshold for pregnant women than for other adults
  • Costs can be unaffordable for uninsured women



Vaginal Delivery

C-Section Delivery

Source: March of Dimes, Cost of Maternity and Infant Care, 2007.

trends in abortion

Figure 14

Trends in Abortion

Abortion Rates Among Women, Ages 15-44, 1980-2005

Abortions per 1,000 women

  • Half of unintended pregnancies end in abortion
  • Overall rate declining, but not among low-income women
  • 9 out of 10 abortions occur within first trimester
  • 74% are self-pay

















Source: Jones RK, et al. 2008. Abortion in the United States: Incidence and Access to Services, 2005, Perspectives on Sexual and Reproductive Health.

access and financing abortion services

Figure 15

Access and Financing Abortion Services
  • Federal Policy
    • Hyde Amendment bans Federal financing of abortions except in cases of rape, incest, or to save the life of the woman. Impacts:
      • Medicaid
      • Women in military, federal employees & dependents, Native Americans covered by Indian Health Services, Women with disabilities covered by Medicare
    • “Partial birth” abortion ban – passed by Congress and signed into law by President Bush in 2003, upheld by Supreme Court in Gonzales vs. Carhart in 2007
  • State Policy
    • Waiting periods (24 states)
    • Provider/Facility Regulations (30 states)
    • Parental consent/notification for minors (35 states)
    • Health care provider refusal clauses
infertility services

Figure 16

Infertility Services

Number (in thousands) of ART Cycles at Reporting Clinics, 1996-2005

  • Broader range of treatments now available
  • Use of ARTs estimated to have nearly doubled between 1996 and 2002
  • Costs $12,000 on average per IVF cycle
  • Relatively limited insurance coverage; 15 states mandate at least limited coverage for diagnosis and treatment

Source: CDC, 2005 Assisted Reproductive Technology Report.


Figure 17

  • Range of reproductive health services has expanded tremendously
  • Access is central to women’s overall health and well-being
  • Federal and state policies wield significant influence on reproductive health
  • Likely to continue to be at center of several policy debates
related resources

Figure 18

Related Resources
  • Kaiser Family Foundation Women’s Health Policy
  • Guttmacher Institute:
  • Sexuality Information and Education Council of the United States:
  • Reproductive Health Technologies Project:
  • National Family Planning and Reproductive Health Association:
  • Association of Reproductive Health Professionals:
  • Childbirth Connection: