Guttmacher Celebrates 40 Years of Bringing Science and Research to Reproductive Health

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:  

1. 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 F. Guttmacher, 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.  

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 research showed 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 agenda. 

2.  Putting--and 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 contraceptive use, 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 their dependents.  

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 abortion between 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 procedures.  

Worldwide 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.