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

U.S. Maternal and Infant Mortality /1,000 infants- infant mortality rate 6-9 /1,000 women- maternal mortality rate /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

Unplanned Pregnancies Correlated with: Late entry to prenatal care Elective abortions Low birthweight Child abuse and neglect 4

Intendedness of Births at Conception by Race/Ethnicity 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 ,300+ service sites across the county CY million patients – 92% women, 8% men CY % 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, MPP Deputy Assistant Secretary for Population Affairs U.S. Department of Health and Human Services Office of Population Affairs