The decision to start a family can be one of the most life-changing, meaningful, and expensive things that a person does. Having a measure of control over that process means choosing the number of children you will have and when you will have them. Family planning services are key to achieving that goal. These include programs that prevent people from having accidental pregnancies, help to control the spread of sexually transmitted diseases, and affect other matters tied to fertility.
U.S. clinics that provide family planning services for low-income people draw support from three places: Medicaid, the Title X Family Planning Program, and Section 330 of the Public Health Service Act. These programs support more than 10,000 clinics across the country, with as many as one-third of women turning to publicly funded clinics to get contraception. Although provisions vary by service and other factors, there are resources for cash-strapped people in need of family planning assistance.
One of the most reliable methods for preventing unplanned pregnancies—and, depending on the method used, slowing the spread of sexually transmitted diseases (STDs)—is birth control. Hormonal birth control is also used for treating menstrual cramps and premenstrual syndrome (PMS). Birth control methods can typically be accessed through organizations such as Planned Parenthood, ranging from pills to birth control implants, intrauterine devices (IUDs), condoms, and diaphragms.
Through Medicaid, most states will cover prescription contraceptives that have approval from the U.S. Food and Drug Administration (FDA). However, many states attach restrictions, such as caps on how much you can get and age limits for receiving services.
Contraception may be free if your state has a program that covers costs. In California, for instance, the Family PACT program covers a range of services, including birth control, cervical cancer screening, and testing for HIV and sexually transmitted infections.
Nevertheless, the American College of Obstetricians and Gynecologists reports that access to contraceptives is restricted by a number of factors, such as inadequate funding for Title X and limited enactment of the Affordable Care Act (ACA) requirement that private health insurance plans cover all FDA-approved contraceptives without cost sharing.
Family planning services most famously safeguard people from having accidental pregnancies, which are costly and life disrupting. They also help control the spread of sexually transmitted diseases and indirectly prevent infertility.
For half a century, abortion has been a legal option for ending unplanned pregnancies or those that develop into situations that endanger life or health. In June 2022, the U.S. Supreme Court removed the federal protection for abortion procedures provided by Roe v. Wade with its decision in Dobbs v. Jackson, leaving abortion access subject to regulation by the states. Post-Dobbs, accessing an abortion has become more complicated and confusing. States across the U.S. have a jumble of laws affecting issues related to abortion, ranging from the legality of the procedure to what private insurers can cover.
One of the impacts of the Dobbs decision has been to make travel for abortion care more common, increasing the cost. A number of corporate employers have offered to help cover reproductive care travel costs for employees; it’s unclear how much of a net effect these corporate benefits will have nationwide.
In addition, a number of organizations now provide assistance to those attempting to get an abortion. Philanthropic organizations known as abortion funds provide money and support for those seeking abortions.
Legal defense funds—such as If/When/How—have also appeared to deal with arrests related to self-managed abortions.
While many men and women could benefit from fertility treatments, plenty of people can’t afford them. In most states, insurers, whether private or public, do not cover infertility treatments. As of 2022, only 15 states—Arkansas, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, and West Virginia—require insurers to cover infertility treatments. Two states, California and Texas, merely require insurers to offer such coverage.
Unfortunately, these treatments are pricey. They will run most people well over $10,000 in out-of-pocket expenses, according to the Kaiser Family Foundation.
There is some help available, mostly in the form of grants and scholarships, many of which are collected by nonprofits that focus on fertility. Some of these are:
Infertility treatments can be helpful for would-be LGBTQ+ parents, but they may be less accessible to this community. The Biden administration is weighing whether to update the definition of infertility in the ACA to make more insurers cover the treatments for LGBTQ+ people, according to a report by Bloomberg Law. Currently, the U.S. Centers for Disease Control and Prevention (CDC) relies on a definition that excludes LGBTQ+ couples, though it doesn’t mention them specifically: “Infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex.”
Birth is expensive. On average, a vaginal birth can cost $14,768 in the United States, according to the Kaiser Family Foundation and the Peterson Center on Healthcare. For women in large employer-sponsored private health plans, this translates to about $2,655 out of pocket. Cesarean section births are more expensive, costing $26,280 on average. That’s about $3,214 out of pocket. The costs are driven up by doctor and hospital fees for delivery and health-related costs ranging from prenatal treatment in pregnancy to postpartum care.
It may require an application through your state’s health department, but there is federally funded assistance for childbirth. In fact, there are many resources available for pregnancy.
Private charities also provide resources, though they tend to vary based on where you live. Catholic Charities is one of the more famous. It offers items that support young children, such as bottles and diapers, as well as educational services. It also provides counseling for adoptions.
The Benefit Finder is a government questionnaire meant to identify the benefits you can access and point you toward the right agency to apply for those benefits.
Another family planning area is adoption, providing a route for those who are infertile to become parents—and for children to find families to love and raise them. The specific assistance programs will differ by state, but adoption and guardianship benefits often include cash payments, medical assistance, and coverage of nonrecurring adoption expenses, according to the Child Welfare Information Gateway, which maintains a database for looking up assistance programs.
Adoptive families also may be able to access post-adoption support. In California, for example, the Adoption Assistance Program gives out financial and medical coverage to encourage the adoption of children in foster care.
Some employers also offer adoption benefits. The most common is time off. About 28% of employers offer paid leave for adoption, according to the Society for Human Resource Management. Another potential employer-based benefit is adoption assistance, which can encompass reimbursement for adoption-related fees and attorney fees.
Family planning refers to the ability to control the number of children you have and when you have them.
Family planning services are health-related services for reproduction, including but not limited to contraception, fertility, pregnancy, birth and postpartum coverage, and cancer and sexually transmitted infection (STI) screening.
Every state Medicaid program has to cover family planning services under the law, but states can control the particulars regarding services and supplies. There is no standardized definition of family planning services in Medicaid.
As of the end of 2021, about 68% of U.S. households could cover an unexpected $400 expense using cash or its equivalent, according to the latest U.S. Federal Reserve System figures. That number is up from previous years, but it also means that a sizable share of Americans might not be able to afford the bill that comes with a surprise pregnancy.
Childbirth costs could be completely out of reach for those Americans, especially if they’re also uninsured or underinsured. Similarly, contraception, fertility treatments, help with adoption, and abortion can also be costly. Finding financial assistance can be crucial to the ability to plan for a family and establish one.
U.S. Department of Health and Human Services, Office of Population Affairs. “About Title X Service Grants.”
Kaiser Family Foundation. “Financing Family Planning Services for Low-income Women: The Role of Public Programs.”
Planned Parenthood. “Can Birth Control Help with Period Cramps?”
Kaiser Family Foundation. “Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey.”
California Department of Health Care Services, Family PACT. “What Services Are Covered by Family PACT?”
American College of Obstetricians and Gynecologists, via Internet Archive. “Access to Contraception.”
National Center for Biotechnology Information. “Overview of Family Planning in the United States.”
U.S. Supreme Court. “Dobbs et al v. Jackson et al.”
The Wall Street Journal. “Yelp Joins Apple, Citigroup, Other Companies Covering Travel Costs for Abortions.”
National Abortion Federation. “NAF Hotline.”
National Network of Abortion Funds. “Need an Abortion?”
If/When/How. “Fund Bail and Legal Support for People Who Are Criminalized for Self-Managed Abortion.”
National Conference of State Legislatures. “State Laws Related to Insurance Coverage for Infertility Treatment.”
Kaiser Family Foundation. “Coverage and Use of Fertility Services in the U.S.”
Bloomberg Law. “LGBTQ Couples’ IVF Hopes Hinge on New Infertility Definition.”
U.S. Centers for Disease Control and Prevention. “Infertility FAQs,” select “What is infertility?”
Peterson-KFF Health System Tracker. “Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care.”
U.S. Department of Health and Human Services, Office of Family Assistance. “About TANF.”
U.S. Department of Health and Human Services, Family and Youth Services Bureau. “Maternity Group Homes for Pregnant and Parenting Youth.”
U.S. Department of Housing and Urban Development. “Housing Choice Vouchers Fact Sheet.”
U.S. Department of Agriculture. “SNAP Eligibility: Frequently Asked Questions,” select “How do I receive SNAP benefits?”
U.S. Health Resources and Services Administration. “Home Page.”
ChildCare.gov. “Child Care Financial Assistance Options.”
Tax Policy Center. “How Does the Tax System Subsidize Child Care Expenses?”
Catholic Charities. “Blessed Beginnings Life Center.”
Child Welfare Information Gateway. “Adoption and Guardianship Assistance by State.”
California Department of Social Services. “Adoption Assistance Program.”
Society for Human Resource Management. “SHRM Releases 2022 Employee Benefits Survey.”
Chard Snyder. “Offering an Adoption Assistance Program.”
Medicaid.gov. “Medicaid Covers Family Planning Services.”
Federal Reserve System. “Federal Reserve Board Issues Economic Well-Being of U.S. Households in 2021 Report.”