Policy and Economics Brief Executive Summary

The Department of Health of Human Services has a mandate to increase the proportion of wanted pregnancies by 10% by 2020, which means reducing unwanted pregnancies. While there are a number of different options for achieving this, the one that is most proven in terms of the literature is structured contraceptive counseling. As our clinic has a mandate to safeguard the health of the women in our community, and as unwanted pregnancies have a variety of adverse impacts, particularly on vulnerable populations, we should offer structured contraceptive counseling. To do so would allow us to reduce the number of unwanted pregnancies among our patients, improving their health and economic outcomes. Further, the economics of such counseling are exceptionally positive. As with a lot of preventative medicine, structured contraceptive counseling costs little in terms of either fixed or ongoing costs. Furthermore, because it diverts patients away from unwanted pregnancy, it lowers the demand on our services, which will in turn have a net opportunity benefit, rather than an opportunity cost.

Background and Significance

Reducing the unintended pregnancy rate in the United States is a national public health goal, driven by the Department of Health and Human Services, which aims to see an increase by 10% in the proportion of pregnancies that are intended between 2010 and 2020 (Guttmacher Institute, 2016). In 2011, 45% of pregnancies in the US were unintended. There are significant social, economic and health consequences to unintended pregnancies, and these are the issues that are driving the campaign to increase the proportion of intended pregnancies. In particular, it has been found that unintended pregnancy is correlated with lower rates of positive health behaviors during the prenatal period (Lindberg et al, 2015). The consequences are more strongly negative the younger the mother is. For teen mothers, unintended pregnancy is associated with increased dropout rates, living in poverty and reliance on public assistance (Logan et al, 2007). There are also mental health consequences for the mother later in life associated with unplanned pregnancy (Herd, et al, 2016).

There are social and economic consequences as well as the health consequences. Some of the documented negative social and economic consequences are reduced quality of life, diminished workforce efficiency. Furthermore, public health care systems often bear the burden of the cost, largely because unintended pregnancies often lead to poverty, or occur more frequently in low income communities (Guttmacher Institute, 2016). 64% of births from unintended pregnancies were publicly funded, compared with 48% of all births and 35% of births resulting from planned pregnancies (Sonfield, et al, 2011). Across social, economic and health measures, none have been found to improve with unplanned pregnancy. This is the background against which HHS has instituted its policy to reduce the number of unplanned pregnancies.

The HHS mandate, and the public health consequences, are the drivers of the policy being proposed in this document. It has been documented that abstinence programs are ineffective at delaying the onset of intercourse or at reducing the number of unplanned pregnancies (DiCenso, et al, 2002). By contrast, women who receive contraceptive counseling are more likely to report the use of contraceptives post-counseling (Lee, et al, 2011). Contraceptive counseling increases the knowledge of different forms of contraception, leading to an increase in the adoption of intrauterine devices and subdermal implants, compared with women who received unstructured contraceptive counseling (Madden, 2013). These results show that the best means of reducing unintended pregnancies, and therefore avoiding the health,...

When we do this, we will achieve superior health outcomes, and better serve our communities. As health care administrators, we seek to lower the cost of health care, and reduce the barriers to accessing health care. When we can do this at the same time as we are providing superior health care, this is a fantastic achievement. In the case of structured contraceptive counseling, the evidence is clear. Not only does contraceptive counseling of all types correlate with superior health and economic outcomes, but it lowers the cost of care for the provider, and structured contraceptive counseling is the best available form of contraceptive counseling, according the literature.
Position Statement

As an outpatient OB/GYN clinic, we serve women of childbearing age specifically. This constituency comes from all corners of our community, through a variety of payers, and we serve them all. The objectives by which we operate our clinic, and treat our patients, should only be to look after the best interests of women. While some may come to us with high confidence, we are often on the front lines serving marginalized women, teenagers, women of color, and other vulnerable populations. These are the populations most at risk for things like unwanted pregnancy, and in the greatest need of our help.

We believe that pregnancy and parenthood are among the greatest things that a woman can experience, but we also believe these it should be her choice whether or not to have these experiences. We believe that it is a fundamental right of every woman to have full control and sovereignty over her own body.

These beliefs should be evident in everything that we do. First and foremost, we serve as experts, who can leverage our education and experience to provide knowledge, insight and guidance for the women who walk through our doors. It is not possible to simply pose as experts, we must perform as experts every single day. Part of being an expert means aligning current practice with the best available evidence on medical practice.

Recent research supports the use of structured contraceptive counseling as a means of both improving health for vulnerable communities and for improving the social and economic health of our society as a whole. Our facility will also benefit from adopting this practice, because of the impacts that it has on the overall cost environment. The upfront costs are just a fraction of what it costs our facility in the long run.

We should adopt structured contraceptive counseling as a matter of policy because it fits our mandate of providing low-cost access to health care for women in our community. It fulfills our mandate of lowering the health risks to the women in our community, and by extension to their children as well. We should adopt structured contraceptive counseling because it provides superior results in terms of both health care behaviors and outcomes for the women in our community that alternative programs. Abstinence counseling has no impact on adult women and minimal if any impact on teen girls. Unstructured contraceptive counseling has some positive impact but less than structured contraceptive counselling.

The benefits afforded by structured contraceptive counselling arise specifically because of the structured nature. The structure allows the counsellor to control the conversation in a way that allows the patient to hear all of the options that are available. The patient can then make an informed decision about her body. The structure of the counseling also allows for the consistent delivery of counseling services to the community. In all fields both in…