Family Planning

Background

Family planning involves establishing the preferred number and spacing in a family and selecting the means by which this objective is accomplished. Effective family planning and avoidance of unintended pregnancy may assist in reducing the incidence of maternal morbidity, low birthweight, and infant mortality because of more adequate spacing between pregnancies and good gynecological health care. The West Virginia Family Planning Program provides comprehensive reproductive health care for low income women, men, and adolescents by providing services and education to prevent unintended pregnancies.

When federal funding was made available for family planning in 1970, the Office of Maternal and Child Health (OMCH), West Virginia Bureau for Public Health, accepted responsibility for the program. Services were initially developed through the county health departments across the state. Later, as primary care centers were created, they were added to the service delivery area. Currently, the Family Planning Program contracts with 128 provider sites across the state (see map on next page). The Family Planning Program is the lead agency in meeting the objectives.

The Objectives

OBJECTIVE 5.1 Reduce to no more than 30% the proportion of all pregnancies that are unintended.

UPDATE Data provided by the Pregnancy Risk Assessment Monitoring System (PRAMS) for 1994 indicated that 56% of the women surveyed wanted to be pregnant either sooner, later, or not at all. This compares to baseline data from the 1988/89 PRAMS surveys that indicated that 37.8% of women surveyed wanted to be pregnant sooner, later, or not at all. A 1990 report by the Alan Guttmacher Institute estimated that 93,460 West Virginia women at or below 185% of the federal poverty level were at risk of unintended pregnancy.

OBJECTIVE 5.2 Increase to at least 85% the proportion of people aged 10-18 who have discussed human sexuality, including values surrounding sexuality, with their parents and/or have received information through another parentally endorsed source such as youth, school, or religious programs.

UPDATE West Virginia baseline data addressing this objective are not available. Data are to be tracked nationally using the National Health Interview Survey. Early sexual activity is strongly associated with unintended pregnancies, sexually transmitted diseases, and negative effects on social, physiological, and psychological development. Data from the 1995 Youth Risk Behavior Survey indicated 61% of West Virginia high school students reported having engaged in sexual intercourse. Also, 11% of respondents reported having sexual intercourse for the first time prior to age 13.

OBJECTIVE 5.3 Increase to at least 90% the proportion of sexually active, unmarried people aged 19 and younger who use contraception, especially combined method contraception that both effectively prevents pregnancy and provides barrier protection against disease.

UPDATE No state-specific baseline data currently exist for this objective. In both the United States and West Virginia, the number and percentage of live births occurring out-of-wedlock have risen steadily during the past decade. Approximately three out of every ten (30.5%) resident births in 1995 were to unmarried mothers. The percentage of out-of-wedlock births among teenage mothers was 64.5%.

(ADDED 1996) OBJECTIVE 5.4 Contain pregnancies among females aged 15-17 to no more than 50 per 1,000 adolescents.

UPDATE According to 1990 Alan Guttmacher Institute data, the pregnancy rate for state females aged 15-17 was 50 per 1,000 adolescents. The Institute estimated that in that year there were 35,540 teenagers at risk for unintended pregnancy in West Virginia. The Family Planning Program is concerned with serving sexually active adolescent clients in a manner that is sensitive and supportive. During 1995, 23,713 female teens and 1,171 male teens were served in family planning provider sites. Adolescents currently constitute 32.8% of the total client load.

Meeting the Objectives

The West Virginia Family Planning Program is addressing Objectives 5.1-5.4 through the health promotion channels to the communities listed in the box. The Director of the Program is the contact person for plan development and strategies aimed at accomplishing the family planning goals for West Virginia. There has been a steady increase in the number of clients receiving clinical services each year. Over the past five years, the Program has seen a 6% growth in clients utilizing contraceptive services. The data reflect a growing need for subsidized services. Strategies to meet the objectives include the following:

• In the past five years, two new, effective, and long-term contraceptive options have been made available to clients enrolled in the Family Planning Program. Depo-Provera contraceptive injection and the Norplant contraceptive system have been offered through the state network of family planning clinics. After extensive counseling and education sessions, many clients of all ages are selecting these birth control options.

• The Family Planning Program provides financial support for male and female sterilization procedures. In 1995, the Program sponsored sterilization services for 247 females and 49 males.

• In an effort to increase the overall number of clients served, the Program supports community outreach and education activities. The target audience is composed of the general public, Medicaid and AFDC recipients, and local health care providers. Activities in 1995-96 included distribution of Program brochures, fact sheets, and posters in health care facilities, community agencies, and local shopping areas; displays at local health fairs and health awareness sessions; and the distribution of posters to all WV hospital emergency room and social work departments to increase awareness of Family Planning Program services, with particular attention to the availability of free pregnancy testing.

• Based on 1995 data, 14 counties have a documented family planning "need met" below an acceptable level of 60% of the population at risk for unintended pregnancy.

• Professional provider continuing education is offered to keep Family Planning Program providers abreast of current issues in reproductive health, contraceptive methods, treatment modalities, and counseling and education processes. In 1995-96, the Program sponsored four provider training courses and one live, interactive teleconference. The two-hour teleconference, "Contraception and Beyond: Meeting Women's Reproductive Health Needs," was broadcast to 26 West Virginia sites for approximately 200 participants, with 64 out-of-state downlink sites.

• To increase access to contraceptive services and to improve client knowledge about contraception, the Family Planning Program developed and presented two proposals to the WV Medicaid Program to extend eligibility for family planning services to a greater number of Medicaid recipients, allowing government to evaluate utilization and a community-based network of family planning service delivery. Final action on this initiative is pending.

• As West Virginia moves forward with welfare reform initiatives, a key strategy for reducing long-term welfare dependency and discouraging out-of-wedlock childbearing is preventing unintended pregnancies, and teenage pregnancies, in particular. The OMCH has begun to refocus and revitalize statewide pregnancy prevention activities and has developed an initiative to target unmarried adolescents, young women, and males. The initiative will focus on abstinence education for adolescents and activities to reduce the incidence of out-of-wedlock pregnancies. OMCH has formed a workgroup to address these issues, coordinate activities within OMCH and across state agencies, evaluate effectiveness, and measure progress toward meeting the goals of reducing illegitimacy and preventing teen pregnancies.

Family planning is a preventive measure that supports reproductive health, as well as the emotional and social health of individuals and families. Family Planning Program services have had, and will continue to have, a significant impact on maternal and child health and the socioeconomic status of West Virginians.

Family Planning - Meeting the Objectives

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