© copyright 1998
revised 08/1999

Issues in Brief

Contraception Counts:
State-by-State Information

Americans, by and large, want--and do have--small families: two children, on average. The preference for small families is universal in modern societies, and is also shared by much of the developing world, where contraceptives are becoming more readily available.

In the United States, where contraceptive use is the norm, nine in 10 women who are sexually active, are fertile and do not wish to become pregnant report that they use a contraceptive method. Free or low-cost contraceptive services for poor women and teenagers through publicly supported clinics are available in all 50 states and in 85% of U.S. counties.

When used consistently and correctly, most birth control methods are extremely effective in preventing pregnancy. Yet, more than three million American couples conceive unintentionally each year, leading to high rates of abortion and unwanted births. Why?

In almost half of these pregnancies--particularly when the woman is unmarried, poor or young--the contraceptive method the couple used simply did not work as it should have, or they used it inconsistently or incorrectly. In the rest, however, the couple used no contraceptive method. Consequently, slightly more than half of all unintended pregnancies occur among the small proportion of women who report that they do not use birth control.

The reasons that a small proportion of couples are not using birth control often relate, in one way or another, to lack of access. Some people may not be able to afford birth control methods on an ongoing basis; 15% of women of childbearing age (15-44) live in poverty, and one in six have no Medicaid or private insurance coverage. Some people may live far from the contraceptive services required to use medical methods.

Others may be embarrassed to buy contraceptives or seek services, be reluctant to admit that they are having sex or be afraid of parental or community disapproval. Only 40% of young women go to a doctor or clinic for contraceptive services within the first year after they begin having intercourse.

This Issues in Brief brings together the most recent information on the need for contraceptive services across the United States. Its table and charts also show the opportunity that publicly supported family planning clinics have to meet that need in each of the 50 states and the District of Columbia.

The Need for Services
Millions of abortions and unplanned births are avoided in the United States each year through contraceptive use. But much more could be accomplished.

  • For almost 50% of the six million women who become pregnant annually, their pregnancy is an accident--unplanned and often unwanted. Eight in 10 pregnancies among teenagers are not intended.

  • Unintended pregnancies result in 1.4 million abortions annually, as well as 1.1 million births that the women either did not want to have until later or did not want at all.

  • Each year, one in 10 young women aged 15-19 become pregnant; more than half of them have the baby.

  • The United States has one of the highest rates of both unintended pregnancy and teenage pregnancy among Western nations.

  • The United States has an abortion rate similar to that of many Latin American countries, where contraceptives are not always widely available. These countries have a high abortion rate, even though the procedure is legally restricted.

    Meeting the Need
    Decisions about sexual behavior and childbearing are personal and family decisions. But even if a woman or couple plan to have a larger-than-average family, a woman who is sexually active throughout her reproductive years will need many, many years of contraceptive protection. The woman who wants only two children will need contraceptive protection for more than 20 years of her life.

    Assuring easy access to contraceptive services and supplies, providing choices between birth control methods and furnishing the information needed to make decisions responsibly are central to helping women and couples reach their desired family size. These services are also fundamental to reducing levels of unintended pregnancy, abortion and unplanned childbearing in each state, in the country as a whole and throughout the world.

    For a quarter century, the federal and state governments have recognized the advantages--to individuals, families and communities--of assuring that poor women and teenagers are able to fulfill their childbearing intentions. In 1994, $715 million in federal and state tax revenues provided contraceptive services and supplies to millions of poor women and teenagers--thereby helping to prevent at least 1.5 million unintended pregnancies that would have occurred otherwise. Every dollar spent for contraceptive services saved $3 in public funds that would have been needed for prenatal and newborn medical care alone.

    To continue to realize these gains and more, the nation's commitment to contraceptive services must be maintained and expanded.

    Serving women and teenagers: State-by-state contraceptive need, services and impact
    State PREGNANCY
    No. per 1,000 women aged 15-44 % of births to unmarried women No. per 1,000 women aged 15-19
    Pregnancies Births Abortions Pregnancies Births Abortions
    (1) (2) (3) (4) (5) (6) (7)
    US Total 103 65 23 32 97 54 29
    Alabama 91 62 15 34 106 69 21
    Alaska 104 72 17 31 75 46 18
    Arizona 115 77 21 39 118 74 27
    Arkansas 94 67 12 34 108 75 16
    California 126 75 33 31 125 63 45
    Colorado 97 64 19 25 90 50 28
    Connecticut 99 62 23 31 86 37 37
    Delaware 91 60 18 36 95 57 24
    Dist. Of Columbia 166 62 83 66 256 102 121
    Florida 111 65 31 36 115 59 40
    Georgia 99 65 20 35 109 68 25
    Hawaii 117 73 27 30 101 48 39
    Idaho 96 71 9 21 70 47 12
    Illinois 111 69 25 34 106 57 34
    Indiana 91 63 14 32 88 56 19
    Iowa 84 61 10 26 58 38 12
    Kansas 92 65 12 27 79 50 18
    Kentucky 81 59 9 30 89 61 14
    Louisiana 93 65 13 43 97 67 15
    Maine 73 50 12 29 57 31 18
    Maryland 108 60 33 34 106 46 46
    Massachusetts 100 57 29 26 79 32 37
    Michigan 97 61 22 34 87 46 29
    Minnesota 87 61 13 25 56 32 16
    Mississippi 95 66 14 45 108 75 16
    Missouri 89 62 14 33 86 54 19
    Montana 85 59 13 28 65 39 17
    Nebraska 89 64 11 25 62 39 14
    Nevada 135 76 41 43 140 70 51
    New Hampshire 83 53 17 23 57 29 20
    New Jersey 118 65 36 28 97 35 50
    New Mexico 105 72 17 42 110 71 22
    New York 122 65 40 40 108 42 53
    North Carolina 96 63 19 32 105 63 26
    North Dakota 81 61 8 25 50 32 10
    Ohio 90 60 16 33 81 50 18
    Oklahoma 91 65 12 31 90 63 13
    Oregon 97 63 20 30 90 51 26
    Pennsylvania 86 57 16 32 70 39 20
    Rhode Island 94 57 24 33 87 42 32
    South Carolina 87 60 15 37 98 63 20
    South Dakota 88 67 8 30 59 39 10
    Tennessee 88 61 14 33 100 66 18
    Texas 112 75 20 30 113 73 23
    Utah 116 89 8 16 60 43 8
    Vermont 77 50 15 26 60 30 22
    Virginia 93 58 21 29 87 46 30
    Washington 98 62 21 27 85 45 29
    West Virginia 72 53 9 31 73 50 11
    Wisconsin 84 58 13 27 61 37 15
    Wyoming 89 60 16 27 74 44 20
    Note: u=unavailable. *The number of teenagers in need of publicly supported contraceptive services is equivalent to the number of teenagers in need of contraceptive services and supplies.

    STATE WOMEN IN NEED
    No. of women aged 15-44 % living in poverty % with no insurance or Medicaid No. needing services and supplies No. in need of publicly supported contraceptive services
    Aged 13-44 Aged 13-19*
    (8) (9) (10) (11) (12) (13)
    US Total 59,442,000 15 17 33,156,350 16,512,850 4,905,660
    Alabama 975,000 20 20 489,490 278,510 95,690
    Alaska 140,000 11 16 76,330 32,480 8,220
    Arizona 911,000 18 24 514,800 285,720 68,480
    Arkansas 541,000 17 21 258,840 156,590 50,870
    California 7,202,000 20 25 4,258,620 2,205,920 536,330
    Colorado 870,000 11 16 490,560 224,100 56,400
    Connecticut 727,000 12 12 459,800 165,640 58,670
    Delaware 168,000 11 18 90,340 39,080 13,950
    Dist. of Columbia 138,000 24 20 85,950 41,430 12,770
    Florida 2,906,000 17 21 1,569,090 804,780 227,110
    Georgia 1,741,000 15 20 901,040 456,820 153,060
    Hawaii 258,000 11 11 148,930 59,210 15,310
    Idaho 256,000 15 17 121,640 69,750 19,190
    Illinois 2,680,000 15 13 1,524,790 701,090 227,940
    Indiana 1,332,000 14 14 720,230 363,650 115,050
    Iowa 615,000 14 13 315,970 166,630 50,850
    Kansas 563,000 15 15 295,930 155,260 45,080
    Kentucky 887,000 18 18 431,580 247,150 76,900
    Louisiana 1,006,000 25 24 511,260 314,000 101,160
    Maine 280,000 12 16 156,770 83,550 24,340
    Maryland 1,194,000 12 17 664,580 257,430 87,420
    Massachusetts 1,409,000 12 14 905,210 356,320 118,850
    Michigan 2,196,000 15 12 1,235,320 599,680 190,220
    Minnesota 1,046,000 12 11 578,280 255,870 77,820
    Mississippi 621,000 24 22 295,550 193,330 70,390
    Missouri 1,187,000 15 16 639,550 338,630 99,240
    Montana 185,000 16 16 88,670 52,620 12,160
    Nebraska 361,000 11 12 187,590 100,150 29,710
    Nevada 333,000 13 21 195,920 89,620 21,820
    New Hampshire 271,000 8 13 161,130 64,870 22,230
    New Jersey 1,773,000 10 16 1,114,560 413,420 144,580
    New Mexico 376,000 26 29 199,070 126,230 31,310
    New York 4,107,000 18 19 2,559,740 1,199,410 359,120
    North Carolina 1,648,000 15 17 868,620 445,980 148,370
    North Dakota 138,000 13 10 71,230 40,300 11,420
    Ohio 2,526,000 15 14 1,400,680 690,270 212,980
    Oklahoma 711,000 19 22 355,350 209,450 62,040
    Oregon 689,000 14 15 365,780 187,040 43,050
    Pennsylvania 2,626,000 14 12 1,584,870 747,280 235,800
    Rhode Island 223,000 12 15 140,750 63,350 20,550
    South Carolina 859,000 19 17 444,140 246,980 83,900
    South Dakota 157,000 17 12 78,010 47,260 13,460
    Tennessee 1,208,000 17 15 615,650 336,410 105,460
    Texas 4,330,000 20 29 2,291,830 1,290,080 359,470
    Utah 459,000 10 14 230,510 127,900 37,310
    Vermont 135,000 10 13 77,040 39,960 12,180
    Virginia 1,580,000 12 15 841,080 386,690 125,950
    Washington 1,244,000 14 15 679,290 315,200 75,790
    West Virginia 401,000 19 19 188,280 116,190 36,300
    Wisconsin 1,147,000 11 10 625,000 296,390 92,060
    Wyoming 106,000 13 19 51,110 27,180 7,330
    Note: u=unavailable. *The number of teenagers in need of publicly supported contraceptive services is equivalent to the number of teenagers in need of contraceptive services and supplies.
    STATE PUBLICLY FUNDED CONTRACEPTIVE SERVICES IMPACT
    No. of family planning clinics No. of women served % of all women in need served No. of teens served % of teens in need served No. of pregnancies averted by publicly supported clinics
    (14) (15) (16) (17) (18) (19)
    US Total 7,054 6,498,070 39 1,815,370 37 1,515,900
    Alabama 149 118,410 43 36,730 38 27,600
    Alaska 23 20,370 63 4,870 59 4,800
    Arizona 129 132,190 46 32,010 47 30,800
    Arkansas 133 82,670 53 25,790 51 19,300
    California 582 803,970 36 173,620 32 187,600
    Colorado 122 105,590 47 21,740 39 24,600
    Connecticut 55 92,630 56 20,980 36 21,600
    Delaware 18 20,850 53 5,750 41 4,900
    Dist. of Columbia 23 25,660 62 8,120 64 6,000
    Florida 352 252,790 31 69,850 31 59,000
    Georgia 309 202,610 44 60,030 39 47,300
    Hawaii 30 19,490 33 5,380 35 4,500
    Idaho 59 34,650 50 10,160 53 8,100
    Illinois 173 211,660 30 65,740 29 49,400
    Indiana 116 144,180 40 46,680 41 33,600
    Iowa 89 91,570 55 26,580 52 21,400
    Kansas 93 70,070 45 24,290 54 16,300
    Kentucky 176 124,080 50 40,130 52 28,900
    Louisiana 112 79,910 25 24,520 24 18,600
    Maine 54 40,970 49 9,500 39 9,600
    Maryland 144 105,870 41 29,370 34 24,700
    Massachusetts 137 131,620 37 37,750 32 30,700
    Michigan 238 239,100 40 78,080 41 55,800
    Minnesota 146 101,300 40 33,550 43 23,600
    Mississippi 164 121,110 63 43,540 62 28,300
    Missouri 189 164,030 48 50,910 51 38,300
    Montana 52 35,770 68 10,810 89 8,300
    Nebraska 28 30,300 30 8,380 28 7,100
    Nevada 41 33,960 38 9,210 42 7,900
    New Hampshire 30 35,050 54 8,140 37 8,200
    New Jersey 102 141,010 34 37,280 26 32,900
    New Mexico 119 64,120 51 20,440 65 15,000
    New York 325 439,130 37 115,490 32 102,400
    North Carolina 156 171,010 38 49,700 33 39,900
    North Dakota 22 17,290 43 5,010 44 4,000
    Ohio 195 212,630 31 71,500 34 49,600
    Oklahoma 129 78,780 38 21,290 34 18,400
    Oregon 118 72,550 39 19,540 45 16,900
    Pennsylvania 264 306,450 41 93,340 40 71,500
    Rhode Island 22 21,120 33 4,390 21 4,900
    South Carolina 133 85,280 35 25,690 31 19,900
    South Dakota 43 22,770 48 7,000 52 5,300
    Tennessee 183 131,930 39 38,680 37 30,800
    Texas 563 483,040 37 121,180 34 112,700
    Utah 74 32,930 26 9,970 27 7,700
    Vermont 19 21,110 53 4,890 40 4,900
    Virginia 195 135,480 35 33,750 27 31,600
    Washington 131 151,500 48 39,610 52 35,300
    West Virginia 136 73,710 63 24,310 67 17,200
    Wisconsin 124 150,860 51 45,600 50 35,200
    Wyoming 35 12,940 48 4,500 61 3,000
    Note: u=unavailable. *The number of teenagers in need of publicly supported contraceptive services is equivalent to the number of teenagers in need of contraceptive services and supplies.

    CHART A
    Nearly half of the 6.3 million pregnancies in the United States each year are unintended.

    Chart 1a

    Note: Half of miscarriages result from unintended pregnancies. Source: S.K. Henshaw, "Unintended Pregnancy in the United States," Family Planning Perspectives, 30:24-29 & 46, 1998.
    Most women in need of contraceptive services and supplies use a contraceptive method.

    Chart 2a

    Source: AGI tabulations from the 1995 National Survey of Family Growth.
    The small proportion of women who do not use a method have nearly half of the 3 million unintended pregnancies annually.

    Chart 3a

    Sources: S.K. Henshaw, "Unintended Pregnancy in the United States," Family Planning Perspectives, 30:24-29 & 46, 1998. S.K. Henshaw, "Abortion Patients in 1994-1995: Characteristics and Contraceptive Use," Family Planning Perspectives, 28:140-147 & 158, 1996. AGI tabulations from the 1995 National Survey of Family Growth.
    Unintended pregnancies among women who do not use a method are almost as likely to end in abortion as in birth.

    Chart 4a

    Sources: S.K. Henshaw, "Unintended Pregnancy in the United States," Family Planning Perspectives, 30:24-29 & 46, 1998. S.K. Henshaw, "Abortion Patients in 1994-1995: Characteristics and Contraceptive Use," Family Planning Perspectives, 28:140-147 & 158, 1996. AGI tabulations from the 1995 National Survey of Family Growth.

    CHART B
    Family Planning Clinics
    Publicly funded contraceptive services avert many unintended pregnancies each year among the young, the unmarried and the poor.
    Source: J.D. Forrest and R. Amara, "Impact of Publicly Funded Contraceptive Services on Unintended Pregnancies and Implications for Medicaid Expenditure," Family Planning Perspectives, 28:188-195, 1996.

    Table Sources
    Column 1, Pregnancies per 1,000 women aged 15-44, 1996: Includes number of births (National Center for Health Statistics [NCHS], "Report of Final Natality Statistics, 1996," Monthly Vital Statistics Report, Vol. 46, No. 11, Supplement, 1998, p. 42), number of abortions among residents (unpublished data, 1997 Survey of Abortion Providers, Alan Guttmacher Institute [AGI]) and number of miscarriages (estimated as 20% of births plus 10% of abortions).

    Column 2, Births per 1,000 women aged 15-44, 1996: NCHS, "Report of Final Natality Statistics, 1996," Monthly Vital Statistics Report, Vol. 46, No. 11, Supplement, 1998, p. 42.

    Column 3, Abortions per 1,000 resident women aged 15-44, 1996: Unpublished data, 1997 Survey of Abortion Providers, AGI.

    Column 4, Percentage of births that are among unmarried women, 1996: NCHS, "Report of Final Natality Statistics, 1996," Monthly Vital Statistics Report, Vol. 46, No. 11, Supplement, 1998, p. 52.

    Column 5, Pregnancies per 1,000 women aged 15-19, 1996: AGI, "Teenage Pregnancy: Overall Trends and State-by-State Information," 1999, Table 5.

    Column 6, Births per 1,000 women aged 15-19, 1996: AGI, "Teenage Pregnancy: Overall Trends and State-by-State Information," 1999, Table 5.

    Column 7, Abortions per 1,000 resident women aged 15-19, 1996: AGI, "Teenage Pregnancy: Overall Trends and State-by-State Information," 1999, Table 5.

    Column 8, Number of women aged 15-44, 1995: U.S. Bureau of the Census, Population Estimates and Population Distribution Branches, , accessed Aug. 1996.

    Column 9, Estimated percentage of women aged 15-44 below 100% of the poverty level, 1994-1995 average: AGI calculations using combined data from the March 1994 and March 1995 Current Population Surveys, U.S. Bureau of the Census.

    Column 10, Estimated percentage of women aged 15-44 with no private or public health insurance for the entire year, 1994-1995 average: AGI calculations using combined data from the March 1994 and March 1995 Current Population Surveys, U.S. Bureau of the Census.

    Column 11, Number of women aged 13-44 in need of contraceptive services and supplies, 1995: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995," in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 12, Number of women aged 13-44 in need of publicly supported contraceptive services, 1995: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995," in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 13, Number of women aged 13-19 in need of publicly supported contraceptive services, 1995: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995," in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 14, Number of publicly supported family planning clinics, 1994: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995," in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 15, Number of women served by publicly supported family planning clinics, 1994: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995," in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 16, Percentage of women in need of publicly supported contraceptive services served at publicly supported family planning clinics: The number of women served at publicly supported family planning clinics (column 15) divided by the number of women in need of publicly supported contraceptive services (column 12).

    Column 17, Number of women younger than 20 served at publicly supported family planning clinics: S.K. Henshaw, J.J. Frost and J.E. Darroch, "State and County Estimates of Contraceptive Needs and Services, 1995,"in AGI, Contraceptive Needs and Services, 1995, New York, 1997.

    Column 18, Percentage of teenage women in need of publicly supported contraceptive services served at publicly supported clinics: The number of women younger than 20 served at publicly supported family planning clinics (column 17) divided by the number of teenagers in need of publicly supported contraceptive services (column 13).

    Column 19, Number of unintended pregnancies averted by publicly supported family planning clinics, 1994: J.D. Forrest and R. Samara, "Impact of Publicly Funded Contraceptive Services on Unintended Pregnancies and Implications for Medicaid Expenditures," Family Planning Perspectives, 28:188-195, 1996, Table 5.

    Definitions

  • Women in poverty are those whose family income is below the federal poverty level ($15,569 for a family of four in 1995).

  • Women in need of contraceptive services and supplies are women aged 13-44 who are 1) sexually active, that is, they have ever had sexual intercourse; 2) fecund, meaning that neither they nor their partners have been contraceptively sterilized and they do not believe that they are infecund for any other reason; and 3) during at least part of the year, neither intentionally pregnant nor trying to become pregnant.

  • Women in need of publicly supported contraceptive services are women aged 20-44 who are in need of contraceptive services and supplies and whose income is below 250% of the federal poverty level ($38,923 for a family of four in 1995), plus all women younger than 20 who are in need of contraceptive services and supplies. Publicly supported contraceptive services can be obtained either from publicly supported family planning clinics or from private physicians who serve women on Medicaid.

  • Publicly supported family planning clinics are sites that provide organized family planning services to the general public and receive some form of public or private funding (including Medicaid) that enables them to serve at least some of their clients for free or at a reduced fee.

    Credits
    Jennifer J. Frost and Jacqueline E. Darroch oversaw data compilation and special analyses used for this publication, which was written by Beth Fredrick. This Issues in Brief was made possible by support from The Andrew W. Mellon Foundation and The Rockefeller Foundation. The research on which it is based was funded in part by the Office of Population Affairs of the Department of Health and Human Services and the Prospect Hill Foundation.

    Sources of Data
    The data in this Issues in Brief are the most current available. Most of the data are from research conducted by The Alan Guttmacher Institute and/or published in the peer-reviewed journal Family Planning Perspectives.

    Publicly supported contraceptive services avert many unintended pregnancies each year among the young, the unmarried and the poor.

    • © copyright 1998, The Alan Guttmacher Institute.
    revised 08/1999

    home  ::   about  ::   contact  ::   e-lists  ::   support AGI  ::   buy  ::   help
    publications  ::   article archive  ::   state center  ::   media center  ::   tablemaker