document. Compare that figure to the $73 million total state and federal dollars saved from the family planning budget cut from fiscal year 2010–11 to fiscal year 2012–13. In fact, the Guttmacher Institute (
www.guttmacher.org) says births as a result of unplanned pregnancy cost Texas Med- icaid nearly $1.3 billion per year. “Policy Solutions for Preventing Unplanned Pregnancy,” pub-
lished in April by The Brookings Institution, says expanding access to publicly funded family planning services is the most cost-effective way to reduce unplanned pregnancy while sav- ing taxpayer dollars. Dr. Carter emphasizes the need to take into account Medic- aid costs that encompass more than prenatal care, labor, and delivery. “We’re paying for the fact that many of these mothers have uncontrolled medical problems, such as diabetes, that affect their pregnancies and can lead to a lifetime of problems for their children,” she said. “Additionally, when women don’t have access to contraception and aren’t able to space their pregnancies by 18 months, they have an increased risk of pre- term labor and low birth weight.” For more information, log on to
www.mayoclinic.com/ health/family-planning/MY01691. Preterm births cost the United States more than $26 billion
annually, according to the Institute of Medicine. Disabilities and health complications can follow some pre- term babies throughout their lives. Children may suffer from asthma, poor cognitive ability and academic achievement, cerebral palsy, delayed motor skills, visual disability, or poor social adaptive functioning, Dr. Carter says. Many require care from occupational therapists, physical therapists, nutritionists,
likely to drop out of school, remain unmarried, and live in poverty. Their children are more likely to be born at low birth weight, grow up poor, live in single-parent households, suffer abuse and neglect, and enter the child welfare system. Their daughters are more likely to become teen parents themselves, and their sons are more likely to end up in jail. Failure to adequately fund preventive services for women is shortsighted, Dr. Carter says. “If we don’t fully fund family planning services, we need to
be prepared to budget for more prisons, additional neonatal intensive care unit expenses, more special education teachers, and other resources to care for children who are the products of unplanned pregnancy. If we don’t pay for preventive servic- es up front, we have no choice but to pay for the consequences on the back end,” she said.
WHP in transition Texas Health and Human Services Commission (HHSC)
“In texas, we’re shooting ourselves in both feet, and the situation has reached crisis level.”
urologists, cardiologists, ophthalmologists, home nurses, so- cial workers, speech therapists, and a slew of other medical professionals. Unplanned pregnancy has societal costs, as well. Guttm- acher Institute data show that unintended pregnancy is high- est among unmarried, low-income black or Hispanic women aged 18 to 24. “Children born to those mothers are more likely to go to
prison, more likely to suffer from neglect, and have lower lev- els of school readiness,” Dr. Carter said. Unplanned pregnancy has negative consequences for teen mothers and their children. The National Campaign to Prevent Teen and Unplanned Pregnancy says teen mothers are more
22 TEXAS MEDICINE July 2012
spokesperson Stephanie Goodman stresses women enrolled in the WHP will experience “no disruption in services” during its transition to a program funded solely by the state. “The change will be invisible to clients and providers. It will be a behind-the-scenes change in the funding source the state uses to pay for the program. The state is not changing who qualifies for the program or how providers are paid. Texas has never limited enrollment, and we’ll continue that policy of en- rolling every eligible woman who applies,” she said. Ms. Goodman says HHSC is “looking at a number of op- tions” to replace the approximately $30 million in federal funds the WHP receives annually. “We have some administrative savings that can be used for that purpose. We’re confident that we can find the funding needed for the WHP with- in our $30 billion-a-year budget without reducing other programs,” she said. State Sen. Jane Nelson (R-Flower Mound) says transitioning the WHP from a federally funded program to one sustained by state funds has benefits and challenges. “We created the WHP because we believe in the power of prevention and are commit- ted to ensuring that these services continue through the current budget cycle. Obviously,
the federal government’s decision to withdraw its support of this program presents funding challenges, but that was the administration’s decision — not ours,” said Senator Nelson, chair of the Senate Committee on Health and Human Services. She is working with HHSC to identify possible funding
sources. “I am confident we will identify the necessary funds to con- tinue these services through the end of the budget cycle,” she said.
Whether funding of the program will continue beyond then worries Mr. Camacho. He says FQHCs have experienced a 50-percent reduction in funding for family planning services. Nevertheless, he says Texas’ community health centers contin-
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