This year, the Guttmacher Institute
celebrates its 40th anniversary. Although the Institute has evolved
in many ways over the past four decades, one thing has remained constant:
the core belief that scientific evidence can and should shape public
policy. Our experience has only strengthened our conviction that well-designed,
rigorously conducted research, compellingly presented and systematically
disseminated to the right people, can fundamentally shift the public
debate and help usher in critical policy and program reforms.
Join me in looking back over
the past four decades, and in noting four of Guttmacher’s defining
institutional achievements that are testimony to the power of science
to drive human progress:
Helping to Create a National Network
of Family Planning Clinics
In 1970, landmark federal legislation
was enacted establishing a national family planning program. The purpose
of the new law — Title X of the Public Health Service Act — was to address
the unmet contraceptive needs of low-income women and narrow the wide
gap between rich and poor women in unintended pregnancy. Two years before,
as congressional deliberations were just getting under way, the Center for Family
Planning Program Development
was born. Alan
one of the country’s most eminent obstetrician-gynecologists and then-president
of the Planned Parenthood Federation of America, recognized the need
for the Center and nurtured its development as a semiautonomous division
within Planned Parenthood.
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The Center was determined not
just to shepherd the Title X legislation through Congress, but also
to ensure that the new program would endure — because it would be built
on sound science. Throughout the 1970s, the Center’s expert staff
provided hands-on assistance in developing the network of clinics authorized
under Title X by creating regional family planning councils; helping
state agencies and community clinics make an evidence-based case for
Title X funding; guiding prospective Title X grantees through the application
process; and fostering best practices in family planning services, as
documented by the Center’s ongoing research.
In 1974, following Alan Guttmacher’s
death, the Center was renamed in his honor, and in 1977, it became an
entirely independent agency. Meanwhile, the Title X clinic network grew
to encompass more than 4,000 family planning clinics, serving more than
four million low-income women and teens. By the 1990s, Guttmacher research
was able to document a substantial narrowing of gaps in contraceptive
use and unintended pregnancy among women in different racial, ethnic
and income groups, proof of the public health benefits brought about
by Title X.
Today, there are family planning
clinics in nine out of every 10 U.S. counties, which together constitute
a major national provider of preventive health care. According to Guttmacher
data, one in four
U.S. women of reproductive age who obtain a contraceptive service, one
in three who obtain an STI service and one in six who obtain either
a Pap test or a pelvic exam do so at a Title X family planning clinic.
While Title X funding continues
to play a key role in the U.S. family planning effort, Guttmacher research
has also documented a fundamental
transition in financing for family planning services. Medicaid has gradually overtaken
Title X as the principal source of support, accounting, by 2005, for
more than 70% of all family planning public funding. This sea change
came about in no small measure because of innovative income eligibility
expansions first developed in a handful of states in the early 1990s.
The original advocate for these programs, Guttmacher has since served
as a clearinghouse for information on their operations and impact, as
well as provided technical assistance to states engaged in the arduous
process of obtaining the required federal approval to expand coverage.
Thanks in part to our efforts,
three in four American women in need of publicly subsidized family planning
now live in a
state where expanded Medicaid coverage is available. In 2006, Guttmacher
the potential these Medicaid program expansions have to reduce unintended
pregnancy and the need for abortion while saving federal and state dollars.
These findings helped accelerate efforts to extend these programs nationwide
and rocketed the issue to the top of the reproductive health and rights
Keeping–Teenage Pregnancy on the Policy Agenda
The Institute’s blockbuster
report "11 Million Teenagers," published in 1976, was a wake-up
call for Americans, providing the first comprehensive picture of adolescent
sexual activity and its consequences. It documented that 11 million
teenagers — the overwhelming majority of whom were unmarried — were
already sexually active, and that one million of them were getting pregnant
every year. The report put teen pregnancy on the policy agenda and refocused
the debate in the United States, spurring the development of teen pregnancy
prevention programs across the country. The incidence of teenage pregnancy,
which peaked in 1991, had declined by a whopping 36% by 2005.
Unfortunately, increased support
for adolescent services and sex education generated its own opposition
in the form of the abstinence-only-until-marriage education movement
and a wave of "junk science" claiming a key role for abstinence
in recent teen pregnancy declines. Guttmacher moved quickly to counter
this growing threat to evidence-based policies with a series of analyses
showing that declines in teen pregnancy were due mainly to improved
not less sex. As federal abstinence-only programs became more hard-line,
targeting not only young teens but also unmarried adults as old as 29,
Guttmacher countered with research showing that 95% of
Americans have sex before marriage — and
have done so for three generations.
The Institute has also expanded
its focus to include teens in the developing world as well. Early this
year, the Institute released the last of a dozen studies based on qualitative
research and national surveys of nearly
20,000 African adolescents aged 12-19.
The studies make clear that meeting their needs will be critical to
preventing unintended pregnancy and halting the AIDS epidemic in Africa.
3. Achieving Contraceptive
Equity in Prescription Drug Coverage
In addition to charting the
path toward sexual and reproductive health coverage in the public sector,
Guttmacher has played a pivotal role in the fight to increase coverage
of these services by private health insurance plans. Amidst the Clinton-era
uproar over health care reform, Guttmacher’s 1993 study of insurance
coverage for reproductive health care put the issue of contraceptive
coverage on the map. It showed that coverage patterns, in the words
of the study report’s title, were wildly "uneven and unequal."
The Institute’s study galvanized broad support for change at the federal
and state levels.
In 1997, a bipartisan group
of members of Congress introduced legislation requiring coverage of
contraceptive services and supplies in health plans nationwide. Although
that bill has yet to pass, Congress did move in 1998 to require coverage
in the largest employer-sponsored health insurance program in the country,
the constellation of plans offered to federal employees, retirees and
Meanwhile, even more significant
progress was occurring at the state level. Beginning with California
in 1994, only months after publication of the Guttmacher study, measures
to require coverage of contraceptive services began to be introduced
in state legislatures. Maryland was the first state to enact such a
law, in 1998; eight states followed suit the next year. Today, fully 27
states mandate coverage,
and 54% of women of reproductive age live in a state that requires contraceptive
coverage in insurance plans that offer presecription drug coverage.
A follow-up Guttmacher study
conducted in 2002 cast this progress in sharp relief. By that year,
nearly nine in 10 group insurance plans purchased by employers for their
employees covered a full range of prescription contraceptives-three
times the proportion just a decade earlier. Moreover, the proportion
of plans covering no method at all plummeted from 28% to only 2%.
4. Understanding Abortion
in Women’s Lives
The legalization of abortion
in 1973 was an immense stride forward in self-determination for American
women. Given the different levels of abortion reporting among states,
however, there was no accurate count of how many women chose abortion,
much less any clear picture of who they were, what kind of care they
received or why they chose to terminate a pregnancy.
The Institute recognized that
a lack of reliable data on abortion would only work to the advantage
of a growing antiabortion movement. In 1974, Guttmacher helped fill
in the blanks with its first of 14 periodic censuses of U.S. abortion
providers. In its most
recent survey of abortion providers,
released in January 2008, Guttmacher documented the continuing — if
somewhat slowed — decline in U.S. abortions. These surveys still provide
the most comprehensive estimate of abortion incidence in the United
States. Although abortion remains one of the most divisive issues in
American politics, partisans on all sides of the abortion debate accept — and
use — Guttmacher data.
Guttmacher’s periodic counts
of U.S. abortion procedures have also helped make possible accurate
calculations of unintended pregnancy — the underlying cause of nearly
all abortions. In addition, the Institute’s quantitative and qualitative
research on U.S. abortion patients has helped
put a human face on abortion,
showing, for example, that fully six in 10 women seeking abortion already
have one or more children and that nearly all women make the decision
to terminate a pregnancy out of concerns for their responsibilities
to other family members.
Recent Guttmacher studies also
document the growing
disparities in unintended pregnancy and
rich and poor women in America. After years of declining unintended
pregnancy rates among low-income women (largely a result of public support
for family planning services), the
gap between rich and poor is again increasing.
Women living in poverty are
now four times as likely to have an unintended pregnancy, three times
as likely to have an abortion and five times as likely to have an unplanned
birth as are other women. Poor women seeking abortion are also more
likely to have their abortions later than they want — an average of
two weeks later than nonpoor women — because in the absence of public
funding, they face multiple financial and logistical barriers to timely
and regional abortion estimates
jointly released in October 2007 by the Guttmacher Institute and the
World Health Organization showed that the lowest rates of abortion are
in the western European countries that place few restrictions on abortion
and provide easy access to contraceptives and comprehensive sex education.
The sharpest declines in abortion over the past decade occurred in neighboring
eastern Europe, where access to and use of modern methods of contraception
soared after the collapse of the Soviet Union. The highest rates are
in Latin America and Sub-Saharan Africa, where almost all abortions
are illegal. These data are crucial to informing better, evidence-based
policies and interventions in countries around the world.
Visit the Guttmacher Institute’s
website for more information about the Institute and its work.