Deborah R. McFarlane

State family planning and abortion expenditures : their effect on public health

OBJECTIVES This study examines whether state family planning expenditures and abortion funding for Medicaid-eligible women might reduce the number of low-birthweight babies, babies with late or no prenatal care, and premature births, as well as the rates of infant and neonatal mortality. METHODS Using a pooled time-series analysis from 1982 to 1988 with the 50 states as units of analysis, this study assessed the impact of family planning expenditures and abortion funding on several public health outcomes while controlling for other important variables and statistical problems inherent in pooled time-series studies. RESULTS States that funded abortions had a significantly higher rate of abortions and significantly lower rates of teen pregnancy, low-birthweight babies, premature births, and births with late or no prenatal care. States that had higher expenditures for family planning had significantly fewer abortions, low-birthweight babies, births with late or no prenatal care, infant deaths, and neonatal deaths. CONCLUSIONS Funding abortions for Medicaid-eligible women and increasing the level of expenditures for family planning are associated with major differences in infant and maternal health in the United States.

The Politics of Funding Abortion State Responses to the Political Environment

This research examines the politics of funding abortions for low-income women in the American states. State policies on abortion funding reflected the relative strength of citizen groups on both sides of the issue and an array of partisan forces. After policy adoption, the number of abortions funded was determined by public policy and the relative demand for abortion services.

The impact of state-level restrictions on abortion

This research examines 23 different laws passed by state governments in an effort to restrict the number of abortions. It assesses both laws passed and laws actually enforced after the Supreme Court permitted states to restrict access to abortion in 1989. None of the policy actions by state governments has had a significant impact on the incidence of abortion from 1982 to 1992. Abortion rates continue to reflect past abortion rates, the number of abortion providers, whether the state funds abortions for Medicaid-eligible women, urbanism, and racial composition of the population. Recent restrictive policies have not affected these trends.

Statutory Coherence and Policy Implementation: The Case of Family Planning

Policy theory suggests that coherent statutes--those with precise, clear goals, supported by an adequate causal theory, with clear administrative responsibilities, clear implementation rules, and assigned to committed agencies--are more likely to have their intended impact. This paper examines US family planning policies with a pooled time series analysis from 1982-88 using the Mazmanian and Sabatier policy implementation framework. Of the four family planning statutes (Title V, Title X, Title XIX, and Title XX), only Title X, the categorical grant program, meets the criteria of a coherent statute. The study reveals that a dollar spent through Title X has a much greater impact on births, abortion rates, late prenatal care, and infant neonatal mortality than does a dollar spent through other programs. The findings are strong evidence in support of designing policies with coherent statutes.

The politics of fertility control: family planning and abortion policies in the American States

In this groundbreaking work on American public policy and human fertility control, policies and practices of the 70s, 80s, and 90s are reviewed and analyzed in each of the fifty states. Arguing that morality politics have helped make fertility policies contentious and complex, McFarlane and Meier conclude that current policies are inadequate for addressing unintended pregnancy and even contribute to high abortion rates. The authors offer alternative public policy designed to be more effective in the future.

Teaching Health Policy and Politics in U.S. Schools of Public Health

Because most public health endeavors in the United States are funded by the public sector, public health practitioners need to be adept at working within the political system. However, the 1988 Institute of Medicine report, The Future of Public Health, found that many public health professionals are ignorant or disdainful of political processes and will not participate in activities that they perceive to be political. Our study examined the health policy and politics curricula of the 24 accredited schools of public health in the U.S., finding that most public health students are not exposed to these areas during their graduate coursework. Moreover, those students who do take health policy and politics courses study these areas within the context of health care delivery; the politics of public health and prevention are ignored by most schools of public health. Recommendations for improving public health curricula in health policy and politics are presented, including linkages with prevention activities.

Do Different Funding Mechanisms Produce Different Results? The Implications of Family Planning for Fiscal Federalism

The 104th Congress considered massive structural changes in federal aid to the states. Not only would federal categorical grants be consolidated into block grants, but entitlement programs would be converted to block grants too. Using family planning as a case study, this article examines whether program impacts change if different grant mechanisms are employed. Findings from a pooled time series analysis of state family planning expenditures show that categorical funding (here, title X of the Public Health Service Act) is the most cost effective in producing desired outcomes, such as lowering infant mortality. Policies using entitlement grants are generally more cost effective than those that rely upon block grants. We discuss the implications of these findings for health policy more broadly and for fiscal federalism in general.

Public Health Practitioner Incubation Plight: Following the Money Trail

Schools of public health have a proud history of educating personnel for leadership roles in the field of practice. Such personnel have played key roles in developing public health. Over the years, however, the missions of the schools of public health have become blurred. To a significant degree, a focus on health care has displaced public health as schools have followed the money trail. Often research takes precedence over teaching, so that, ironically, research findings are not disseminated to those who will practice public health. Educating personnel for practitioner leadership roles in environmental health and protection is inadequate. These and other trends have serious, long-term ramifications for public health practice. This article offers suggestions for improving the situation, including making use of practitioners in schools of public health, encouraging partnerships between practitioners and academics for research and funding support, developing paid student practica, developing a market for MPH graduates, and changing the accreditation requirements of the Council on Education for Public Health.

Restructuring federalism: the impact of Reagan policies on the family planning program.

Through fiscal cutbacks and structural changes, Reagans federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagans federalism upon social programs and have manifold implications for public health.

The Affordable Care Act and Abortion

Abstract. The 2010 Affordable Health Care Act (ACA) treats abortion differently than any other health service, precluding public funding for abortion and imposing other restrictions on American states. To determine whether the ACAs abortion restrictions are uniquely American or have counterparts in other national health systems, this study employs a cross-sectional design comparing abortion restrictions in the ACA with those in 17 Western European countries. Using a six-item scale, the intensity of abortion restrictions is compared across Western European nations. A similar scale is employed for a five-state sample of state-level abortion restrictions. Although the United States is not alone in having abortion restrictions, how abortion is proscribed in the ACA has no counterpart in Western Europe. Unlike many Western European countries, the ACAs restrictions focus on abortion funding, not the length of gestation or the health of the pregnant woman.