Lindberg Laura Duberstein, Frost Jennifer J, Sten Caroline, Dailard Cynthia
Guttmacher Institute, New York, USA.
Perspect Sex Reprod Health. 2006 Mar;38(1):37-45. doi: 10.1363/psrh.38.037.06.
Publicly funded family planning agencies face significant challenges in delivering quality services to low-income women because of the higher costs of newer contraceptive methods, changes in health care financing and a growing uninsured population.
In 2003, 627 of a nationally representative sample of 956 U.S. agencies receiving public funding for family planning services responded to an eight-page survey. Responses were compared with results from similar surveys in 1995 and 1999 to describe changes in the availability of contraceptive methods, policies on method provision and funding issues. Variation was examined by agency type and Title X funding status.
Between 1995 and 2003, the number of contraceptive methods available to women increased and agencies reduced barriers to oral and emergency contraceptives by liberalizing policies for their provision. By 2003, many agencies offered the newest contraceptive methods available-the progestin-only IUD (58%), the patch (76%) and the vaginal ring (39%). However, more than half of agencies did not stock certain methods because of their cost, and some key funding sources had declined. Between 1995 and 2003, the proportion of agencies receiving Medicaid funding fell from 91% to 80%, and the proportion of clients paying full fee for their contraceptive services fell from 19% to 14%. The share of agencies waiving fees for adolescents fell from 66% in 1999 to 44% in 2003.
Continued funding challenges limit the ability of publicly funded providers to offer all available methods to all women.
由于新型避孕方法成本更高、医疗保健融资方式的变化以及未参保人口的增加，由公共资金资助的计划生育机构在为低收入女性提供优质服务方面面临重大挑战。
2003年，在956家接受公共资金资助提供计划生育服务的美国机构的全国代表性样本中，有627家机构回复了一份长达八页的调查问卷。将回复结果与1995年和1999年类似调查的结果进行比较，以描述避孕方法的可获得性、方法提供政策和资金问题的变化。按机构类型和第十类拨款状况对差异进行了研究。
1995年至2003年期间，可供女性使用的避孕方法数量有所增加，各机构通过放宽口服避孕药和紧急避孕药的提供政策，减少了获取这些药物的障碍。到2003年，许多机构提供了当时最新的避孕方法——仅含孕激素的宫内节育器（58%）、避孕贴片（76%）和阴道环（39%）。然而，超过半数的机构因成本原因未储备某些方法，而且一些关键资金来源有所减少。1995年至2003年期间，接受医疗补助资金的机构比例从91%降至80%，为避孕服务支付全额费用的客户比例从19%降至14%。为青少年减免费用的机构比例从1999年的66%降至2003年的44%。
持续的资金挑战限制了由公共资金资助的提供者向所有女性提供所有可用方法的能力。
