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25 July 2000

Program Reduces Rate of Unintended Pregnancies Among Low-Income Women

A statewide program established in 1997 to expand access to comprehensive family planning services for low-income residents has significantly decreased the number of unintended pregnancies in California, according to a report released by UCSF and the California Department of Health Services (DHS).

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

"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," reports Claire Brindis, DPH, author of the report and professor in the UCSF department of pediatrics.

PACT health care practitioners provided 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 as well.

"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," says Brindis, co-director at the UCSF Center for Reproductive Health Research and Policy.

The program spent $114 million for services provided during its first year and served 749,572 clients -- a 43 percent increase over the number served during the prior fiscal year through the state's previous family planning program. From its inception three years ago through June 1999, Family PACT served more than 1.5 million clients.

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

Evaluation methods included observation of client services, interviews of clients and providers, chart reviews and analysis of service and billing data.

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.

The UCSF Center for Reproductive Health Research and Policy and the UCSF Philip R. Lee Institute for Health Policy Studies prepared the report.

"In addition to fiscal impact, the evaluation also addressed quality of care," says report author Philip Darney, MD, a UCSF professor of obstetrics, gynecology and reproductive sciences and co-director of 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."

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.

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.

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.

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