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Family Planning and Infant Mortality. The Secretary’s Advisory Committee on Infant Mortality November 14, 2012. Marilyn J. Keefe , MPH, MPP Deputy Assistant Secretary for Population Affairs U.S. Department of Health and Human Services Office of Population Affairs. - PowerPoint PPT Presentation
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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
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• 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
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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
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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
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• 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
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Allows individuals and couples to anticipate and attain desired number of children and spacing and timing of births
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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
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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
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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
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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
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• 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
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• 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
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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)
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•Women’s Preventive Health Services
•Medicaid expansions
ACA and Family Planning
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•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:
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Marilyn J. Keefe, MPH, MPPDeputy Assistant Secretary
for Population AffairsU.S. Department of Health and Human
Services Office of Population AffairsMarilyn.Keefe@hhs.gov
240.453.2805
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