摘要：Objectives . The California Family Planning, Access, Care, and Treatment Program was implemented in 1997 to provide family planning services for uninsured, low-income women and men. We estimated the impact on fertility of providing 500 000 women with contraceptives. Methods . Paid claims and medical record review data were used to estimate pregnancies averted. Pregnancies women experienced while enrolled in the program and pregnancies they would have experienced given methods used before enrollment were modeled as a Markov process. Results . One year of Family Planning, Access, Care, and Treatment services averted an estimated 108 000 unintended pregnancies that would have resulted in 50 000 unintended births and 41 000 induced abortions. Conclusions . Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California. During the next 3 decades, California’s population is expected to grow by 55% (from 33 million to more than 51 million), a rate of growth higher than that of any other state. 1 Although some of this population increase will result from immigration, most of it will be the result of the more than 22 million births that are projected by the year 2025. The California State Assembly established the Family Planning, Access, Care, and Treatment (Family PACT) Program in 1996 to increase access to family planning services. One of the primary goals of the Family PACT Program is to reduce the number of unintended pregnancies among women in the state. The Family PACT Program was created through the 1996/1997 State Assembly Bill 3483, which added provisions to the Welfare and Institutions Code to provide additional state funding to expand the clinical family planning program. The program was originally named the State-Only Family Planning Program. California’s family planning program has several innovative features: both public-sector providers and private, for-profit, providers are eligible to offer program services; client eligibility determination and enrollment occur onsite; providers are reimbursed on a fee-for-service basis; and clinics as well as pharmacies are distribution sites for over-the-counter and prescription drugs. Individuals in need of family planning services who have incomes at or below 200% of the federal poverty level and no other source of reproductive health care coverage are eligible for Family PACT services. These services include all US Food and Drug Administration–approved methods of contraception, male and female sterilization, human immunodeficiency virus testing, screening and treatment for sexually transmitted diseases, and limited cancer screening and infertility services. During Family PACT’s first year (fiscal year 1997–1998), 749 572 women and men received services, a 50% increase over the previous state program in fiscal year 1995–1996. Approximately two thirds of Family PACT clients are Hispanic, 1 in 5 is younger than 20 years, and nearly 1 in 10 is male. Women in the Family PACT Program are at high risk for pregnancy. Approximately 85% of first year–enrolled adult women (20 years of age or older) had had at least 1 prior pregnancy; three fourths had had at least 1 birth, and one fourth had had at least 1 abortion. Nearly half of the adolescent women (younger than 20 years) had already had a pregnancy; one third had had at least 1 birth, and 11% had had at least 1 abortion.
