The Secretary’s Advisory Committee on Infant Mortality November 14, 2012 Marilyn J. Keefe, MPH, MPP Deputy Assistant Secretary for Population Affairs U.S.

Family Planning and Infant Mortality

The Secretary’s Advisory Committee on Infant Mortality

November 14, 2012

Marilyn J. Keefe, MPH, MPPDeputy Assistant Secretary for Population AffairsU.S. Department of Health and Human Services Office of Population Affairs

U.S. Maternal and Infant Mortality

1900• 100/1,000 infants- infant mortality rate• 6-9 /1,000 women- maternal mortality rate

2010• 6.1/1,000 infants - infant mortality rate• 14.5 /100,000 women died of pregnancy-related

causes

Source: CDC

2

• U.S. continues to have highest unplanned pregnancy rate in developed world

• In 2006, 3.2 (49%) of the 6.7 million pregnancies in U.S. were unintended

• Unintended pregnancy –mistimed or unwanted

Source: Guttmacher Institute

Pregnancy Intention

3

4

Unplanned Pregnancies Correlated with:

Late entry to prenatal care

Elective abortions

Low birthweight

Child abuse and neglect

Intendedness of Births at Conception by Race/Ethnicity

0

20

40

60

69.3

57.146.5

9.318.1 22.921.4

24.830.6

IntendedUnwantedMistimed

5

Source: CDC National Center for Health Statistics

Unintended pregnancy rates for women below 100% FPL are more than five times that of women with incomes at or above 200% of FPL

Source: Guttmacher, Finer 2011

Pregnancy Intention and Income

6

• In 2008, there were nearly 800,000 teen pregnancies and 435,000 births to U.S. adolescents

• Social and economic consequences of teen childbearing notable

• Teens have higher perinatal and infant mortality rates than adults

Teen Pregnancy

7

Allows individuals and couples to anticipate and attain desired number of children and spacing and timing of births

8

Family Planning

•Pregnancies that occur too early, too late or too frequently can have negatively consequences

• After a live birth, the recommended interval before next conception is at least 18 months

Source: JAMA, 2006

Birth Spacing

9

Title X Facts-at-a-Glance• FY 2012 appropriation: $293 million

• CY 2012 – 98 public and private grantees, including state and local health departments, non-profit family planning agencies, independent agencies and community health centers

• CY 2011- 4,300+ service sites across the county

• CY 2011 - 5 million patients – 92% women, 8% men

• CY 2011- 51% of users in their 20s, 28% 30 and over, and 19% 19 and under

• CY 2011 – 57% of users identified themselves as white, 20% as black and 39% as Hispanic

Source: FPAR preliminary 2011 data

10

Title X Family Planning Services

• Contraceptive counseling, services and supplies

• Breast and cervical cancer screening

• STD screening, counseling and treatment

• HIV screening, referral and linkage to care

• Screening for anemia, diabetes, hypertension

• Pregnancy testing and counseling and referral

• Other preventive health services related to contraception

11

The Impact of Title X

Contraceptive services provided at Title X service sites helped prevent 973,000 unintended pregnancies in 2008, which would likely have resulted in 432,000 unintended births and 406,200 abortions

Source: Guttmacher Institute

12

• Family planning a component of preconception and interconception care

• Preconception care and interconception care can also be integrated into family planning services

• Family planning centers an important source of women’s preventive health services

• Family planning providers screen for chronic conditions that impact maternal and infant morbidity and mortality

Preconception Care and Family Planning

13

• Title X has expanded focus on preconception care and reproductive life plans

• Revised Title X clinical guidelines include preconception care as a key component

Preconception Care and Title X

14

What are they?• Contraceptive implants: Implanon/Nexplanon –

(3 years)• Intrauterine devices (IUDs) – Mirena (5 years)

and ParaGard (10 years)

Benefits• Pregnancy rates less than 1% per year• Safe and appropriate for women and

adolescents• High rates of satisfaction and continuation

Long-Acting Reversible Contraception (LARCs)

15

•Women’s Preventive Health Services

•Medicaid expansions

ACA and Family Planning

16

•Provide high quality information and services that can help reduce unintended pregnancy

•Increase access to highly effective contraception

•Provide preconception care as a core part of family planning services

OPA Will Expand Efforts to:

17

18

Marilyn J. Keefe, MPH, MPPDeputy Assistant Secretary

for Population AffairsU.S. Department of Health and Human

Services Office of Population [email protected]

240.453.2805