Contraception Counts: District of Columbia
Among the 50 states and the District of Columbia, District of Columbia ranked
- 9th in service availability;
- 14th in laws and policies;
- 41st in public funding; and
- 21st overall.
The United States has one of the highest rates of unintended pregnancy in the industrialized world. Half of the six million pregnancies that occur among American women each year are unintended; of these, 1.3 million end in abortion.
What explains this high level of unintended pregnancy? About half of unintended pregnancies occur among couples who were using a contraceptive method in the month the woman became pregnant; either the method did not work properly or the couple did not use it consistently or correctly. Because the likelihood of pregnancy in the absence of contraception is high, the other half of unintended pregnancies occur among the one in 10 sexually active, fertile women who were not using any birth control method even though they were not trying to become pregnant.
Recognizing the personal, social, economic and medical toll associated with unintended pregnancies, the federal government has established a national public health goal to reduce by 40% the proportion of pregnancies that are unintended by 2010. It also has identified family planning as the key to achieving this objective.
States can play a major role in helping women to avoid unintended pregnancy—particularly low-income women, who are more likely than those who are better-off to experience an unintended pregnancy and to rely on publicly supported services for their contraceptive care. Accordingly, the Guttmacher Institute assessed the states (and the District of Columbia) on their efforts to help women obtain contraceptive services and supplies, and to use them consistently and correctly over time. States were scored and ranked on three indicators:
- service availability—how well the states meet existing need for subsidized contraceptive services and supplies;
- laws and policies—whether their laws and policies are likely to facilitate access to contraceptive services and information; and
- public funding—the extent to which they devote their own revenues, and leverage potential federal dollars, to support the delivery of publicly supported contraceptive services and supplies.
Scores on all three indicators were aggregated, and an overall rank was assigned to each state. Additionally, the states were ranked according to the progress they made between 1994 and 2001 in service availability and public funding. Tables that contain the results of these rankings across the 50 states, as well as descriptive information for all states on pregnancies, their outcomes and the need for publicly supported contraceptive services, can be found at www.guttmacher.org.
Pregnancies and Their Outcomes
- In the District of Columbia, 15,520 of the 144,760 women of childbearing age become pregnant each year. 49% of these pregnancies result in live births, and 37% result in abortions; the remainder end in miscarriage.
- Of the 2,410 teenage pregnancies each year in the District of Columbia, 44% result in live births and 43% result in abortions.
- The District of Columbia’s teenage pregnancy rate declined by 50% between 1992 and 2000.
The Need for Publicly Supported Services
- In the District of Columbia, 85,030 women are in need of contraceptive services and supplies. Of these, 35,840 women need publicly supported contraceptive services because they have incomes below 250% of the federal poverty level (27,570) or are sexually active teenagers (8,270).
- In the District of Columbia, 20% of women aged 15–44 have incomes below the federal poverty level, and 15% of all women in this age-group are uninsured (i.e., do not have private health insurance or Medicaid coverage).
- In the District of Columbia, 20% of women aged 15–44 are enrolled in Medicaid.
Service Availability
- In the District of Columbia, 26 publicly funded family planning clinics provide contraceptive care to 19,140 women—including 4,670 sexually active teenagers.
- Family planning clinics in the District of Columbia serve 53% of all women in need of publicly supported contraceptive services and 56% of teenagers in need.
Funding for Publicly Supported Services
- In 2001, the federal and state governments together spent $1,762,000 in the District of Columbia on contraceptive services and supplies. Of this amount, 18% was allocated to contraceptive services at the state’s discretion. (The funds came from either state revenues or federal dollars under the state’s control.) The remainder came from the federal government.
- In the District of Columbia, $41 was spent on contraceptive services and supplies per woman in need (adjusted for the cost of health care in the state).
Impact of Publicly Supported Services
- Publicly funded family planning clinics in the District of Columbia help women prevent 4,500 unintended pregnancies each year.
- Every public dollar spent on family planning services saves the federal and state governments three dollars in Medicaid costs for prenatal and newborn care.
The Key Role of Title X
- Title X of the Public Health Service Act, the only federal program devoted solely to the provision of publicly supported family planning services, supports 17 family planning clinics in the District of Columbia. These clinics serve 14,390 women, including 3,270 teenagers.
- Title X–supported clinics in the District of Columbia help women avert 3,400 unintended pregnancies each year.
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