Estimating family planning program effects on U.S. fertility rates.
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Biomedical subjects
Publications and source records attributed to P Cutright.
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There are four major determinants of racial differences in nonmarital fertility rates in the U.S.: differential sexual activity (exposure to risk); differential in spontaneous and induced abortion; differential contraceptive use (including method efficacy); and differential legitimation, through marriage, of births conceived out of wedlock. Racial differences in all four indicators encourage higher black than white nonmarital fertility rates in every age-group examined; however, the relative contribution of each determinant to differences in nonmarital fertility varies according to age. The gap between whites and blacks in contraceptive use is of greatest concern to policy-makers, because family planning effectiveness can, at least theoretically, be changed by program effort. However, even if black women and white women had equivalent levels of contraceptive use, sexual activity and recourse to abortion, there would still be substantial racial differences in nonmarital fertility rates because of the greater propensity among whites to legitimate premaritally conceived births.
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Between 1969 and 1975, the U.S. family planning program helped its patients avert 1.1 million unwanted and mistimed births. These averted births resulted in short-term savings to the government for health and social welfare services of $1.1 billion, compared to a federal investment in family planning of $584 million--a benefit/cost ratio of $1.80 for every federal dollar invested.
The availability of abortion services--the number of facilities and the number of types of agencies providing abortions--is the most powerful determinant of variations in abortion rates in U.S. metropolitan communities. The increase in abortion availability is also the most important factor in explaining the increase in abortion rates that occurred between 1973 and 1975. Other factors affecting abortion rates (but less substantially) include rural residence, population density, female labor force participation, the proportion Catholic and the proportion receiving public assistance.
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Under rigorous statistical controls, it has been shown that the larger the proportion of lower SES women enrolled in organized family planning programs, the lower their fertility. Program effects independent of other social, economic and cultural factors were shown for lower SES whites and blacks, and for most age groups. The potential of a fully implemented program to reduce fertility differentials between upper and lower SES groups was assessed, using 1969-1970 fertility rates and the estimates of 1969 program impact. Although we believe that the program's impact has increased in magnitude over time, even these estimates from an early point in U.S. program development provide impressive documentation that the program reduces fertility in the subpopulation served by the program, and, by implication, that there is a genuine need for organized family planning services, even in an industrialized nation like the United States. If there were no need, there could be no program effect. The family planning program was one of the major new health and social programs introduced in the mid-1960s. This study shows that, far from failing, the program was succeeding very well in attaining its objectives. The program works because it gives women of lower socioeconomic status access to modern and effective methods of contraception that they would not otherwise have. As a result, the rates of unwanted and mistimed pregnancy of patients are lower than those of comparable women who lack access to organized clinic programs.