Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program

• Published in: The Milbank quarterly 2014-12, Vol.92 (4), p.696-749
• Main Authors: FROST, JENNIFER J., SONFIELD, ADAM, ZOLNA, MIA R., FINER, LAWRENCE B.
• Format: Article
• Language: English
• Subjects: Abortion, Induced - economics; Abortion, Induced - statistics & numerical data; Abortion, Spontaneous - economics; Abortion, Spontaneous - prevention & control; AIDS Serodiagnosis - economics; Appropriations and expenditures; Benefit cost analysis; Benefits; Birth control; Births; Cervical cancer; Chlamydia; Contraception; Contraceptives; Cost; Cost estimates; Cost savings; Cost Savings - economics; Cost Savings - statistics & numerical data; cost-benefit analysis; Cost-Benefit Analysis - economics; Cost-Benefit Analysis - statistics & numerical data; Death; Diseases; Family planning; Family planning services; Family Planning Services - economics; Family Planning Services - methods; Family Planning Services - organization & administration; Female; financing; Financing, Government - economics; Financing, Government - organization & administration; Health care costs; Health economics; Health policy; Health services; Human immunodeficiency virus; Human papillomavirus; Humans; Infertility; Investments; Male; Original Investigation; Original Investigations; Papillomavirus Vaccines - economics; Papillomavirus Vaccines - therapeutic use; Pregnancy; Pregnancy, Unplanned; Public health; Quantitative analysis; Reproductive health; Return on investment; Saving; Sexually Transmitted Diseases - economics; Sexually Transmitted Diseases - prevention & control; Surveys; U.S.A; United States; Uterine Cervical Neoplasms - economics; Uterine Cervical Neoplasms - prevention & control; Vaccination; Vaccination and vaccines; Women
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12080

Context: Each year the United States' publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Methods: Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. Findings: In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99,100 cases of chlamydia, 16,240 cases of gonorrhea, 410 cases of HIV, and 13,170 cases of pelvic inflammatory disease that would have led to 1,130 ectopic pregnancies and 2,210 cases of infertility. Pap and HPV tests and HPV vaccinations prevented an estimated 3,680 cases of cervical cancer and 2,110 cervical cancer deaths; HPV vaccination also prevented 9,000 cases of abnormal sequelae and precancerous lesions. Services provided at health centers supported by the Title X national family planning program accounted for more than half of these benefits. The gross public savings attributed to these services totaled approximately $15.8 billion—$15.7 billion from preventing unplanned births, $123 million from STI/HIV testing, and $23 million from Pap and HPV testing and vaccines. Subtracting $2.2 billion in program costs from gross savings resulted in net public-sector savings of $13.6 billion. Conclusions: Public expenditures for the US family planning program not only prevented unintended pregnancies but also reduced the incidence and impact of preterm and LBW births, STIs, infertility, and cervical cancer. This invest