Program that provides family planning services to low income residents helps reduce rate of unintend

By Leslie Harris

A statewide program established in 1997 to expand access to comprehensive
family planning services for low income California residents has helped
decrease the number of unintended pregnancies in the state, according to a
report released by the University of California, San Francisco and the
California Department of Health Services (DHS).

The DHS provided this report, the first evaluation results for the California
Family PACT (Planning, Access, Care and Treatment) program, to the legislature
today, July 20, 2000.

“Family PACT has significantly reduced the number of unintended pregnancies
among low-income women in California,” said Claire Brindis, Dr.PH, author of
the report and professor in the UCSF Department of Pediatrics. She also is
co-director at the UCSF Center for Reproductive Health Research and Policy,
which is under the auspices of the UCSF Institute for Health Policy Studies and
Department of Obstetrics, Gynecology and Reproductive Sciences. “Contraceptive
services provided during the first year prevented more than 100,000 unintended
pregnancies that would have resulted in 50,000 unintended births, 41,000
induced abortions, 15,000 miscarriages and 1,400 ectopic pregnancies.”

“Family PACT services also saved over $512 million in public expenditures for
medical care, income support and social services for mothers and children that
otherwise would have been incurred as a result of unintended pregnancies,”
Brindis said. The program spent $114 million for services provided during the
first year.

During the first full fiscal year of the Family PACT program, 749,572 clients
were served. This is a 43 percent increase over the number served during the
prior fiscal year through the state’s previous family planning program. From
its inception in 1997 through June 1999, Family PACT served more than 1.5
million clients.
The Family PACT program includes education and counseling for clients,
informed consent, confidentiality, provision of a full range of options,
linguistic and cultural competence, timely access to care and provision of
clinical and preventive services.

“In addition to fiscal impact, the evaluation also addressed quality of care,”
said Philip Darney, MD, report author and UCSF professor of obstetrics,
gynecology and reproductive sciences. Darney also co directs the UCSF Center
for Reproductive Health Research & Policy. “This evaluation indicates that
implementation of the Family PACT program was achieved without compromising the
quality of care established in the previous state program.”

Innovative features of the Family PACT program were designed to increase access
to services for women and men who have no other source of care and have a
family income below 200 percent of the Federal Poverty Level.  Eligibility is
determined and clients are enrolled “on site” by their medical care provider. 
Providers include community clinics, family planning clinics, health
departments and private practice clinicians.  Practitioners who are currently
authorized to provide services through the Medi-Cal program are eligible to
become Family PACT providers after attending a daylong orientation. 
Reimbursement for services to Family PACT clients is similar to that for
Medi-Cal services. The program also provides reimbursement to pharmacies for
over-the-counter products and prescription drugs needed for services covered by
the program.

“Family PACT has gained national attention as an innovative public health
program,” said State Health Director Diana M. Bonta, RN, Dr.PH.  “DHS and
community health care providers have accomplished many positive results and the
success of this program is evident in the evaluation results.”

Family planning and related reproductive health services provided by the
program include medical care, education, counseling, medications, supplies and
laboratory services related to periodic reproductive health screening,
contraceptive methods, basic infertility services, cervical cancer screening,
sexually transmitted infection (STI) diagnosis and treatment and HIV screening.

“The program has been a valuable resource in state efforts to control STIs. 
During the first year of the program, approximately 750,000 STI and HIV tests
were provided to program clients,” Darney said. .

“Both the number and the type of providers have expanded with the
implementation of Family PACT,” Darney said.  “The previous state family
planning program included 142 agencies with 450 clinical sites.  By the end of
its first year, Family PACT included 2,172 providers and more than 2,650
providers had joined the program as of June 1999.”

The evaluation report was based on analyses carried out by the UCSF Evaluation
Team and on the work of the DHS STD Control Branch, the California Family
Health Council, the Center for Health Training, Berkeley Economic Research
Associates, The Pacific Health Consulting Group, the Public Health Institute
and Electronic Data Systems. Evaluation methods included observation of client
services, interviews of clients and providers, chart reviews and analysis of
service and billing data.
The UCSF Center for Reproductive Health Research and Policy and the UCSF
Institute for Health Policy Studies prepared the report.