U.S. Public Support for Domestic Family Planning Remains High; Lags for Program Abroad

Americans continue expressing high levels of support for health insurance coverage of family planning services in the United States, but support for U.S. funding of family planning and abortion services in developing countries is declining, according to a new RAND Corporation study.

The study, published today in the September issue of Studies in Family Planning, is based on a survey that was conducted in 2003 and is a follow-up to a 1998 study. RAND commissioned Belden Russonello & Stewart—a Washington, D.C. public opinion research firm—to conduct the random telephone surveys of more than 1,000 adults 18 and older around the United States in both years.

In both studies, more than 5 in 6 people agreed that family planning services should be part of regular healthcare insurance coverage in the United States. Nearly 4 in 6 strongly agreed.

“What’s interesting is that since 1998, insurance coverage of contraceptives has increased, along with an expansion of legal efforts to ensure access,” said Clifford Grammich, lead author of the report. Julie DaVanzo is the report’s co-author and director of RAND Labor and Population. The other author of the report is Kate Stewart, a partner at Belden Russonello & Stewart.

The researchers found that:

• Approximately the same number of people in 2003 and 1998 favored requiring U.S. health insurers to “cover family planning services, just like other doctor’s visits and services, as part of their regular health care coverage.”
• Public support for U.S. funding of international family planning dropped significantly, from 80 to 69 percent in the five years between surveys. Opposition to U.S. government funding for both international family planning and abortion increased significantly. Despite this decline, the majority of individuals in each socioeconomic, demographic and political subgroup favored support of international family planning.
• Only 45 percent of Americans support U.S. funding for voluntary abortion services in developing countries, down from 50 percent in 1998. Opposition to U.S. support of abortion services increased from 46 to 52 percent, while those in strong opposition to the policy grew from 33 to 40 percent.

The RAND report shows that a majority of those who oppose funding abortion services in developing countries support family planning services, although that figure dropped to 57 percent from 69 percent in 1998. For purposes of the survey, “family planning” was defined to exclude abortion.

Despite weakening support for U.S. funding of international family planning and abortion services, nearly twice as many people provided an unrelated definition for family planning than for birth control.

“Despite the prevalence of family planning signs in drugstores, we found many inaccurate, or completely unrelated definitions, such as retirement planning,” DaVanzo said.

Researchers considered several possible explanations for the disparity in support for domestic and international family planning services:

• Respondents may not connect the issues, feeling that domestic health insurance is more relevant to their daily lives, involving private expenditures rather than public funds used for international aid programs.
• The researchers did not find that events such as the September 11, 2001 attacks against the United States alone impacted general attitudes toward foreign aid in recent years.
• Those who believe that family planning programs effectively reduce the numbers of induced abortions are more likely to favor U.S. support for similar programs in developing countries. In contrast, support for U.S. government sponsorship of family planning programs in developing countries (something the U. S. does not currently provide), has decreased among both those who do and do not believe that such programs can help reduce the numbers of elective abortions.
• To determine how policies affect public opinion, researchers asked respondents their view on a federal policy requiring nongovernmental organizations to agree, as a condition of their receipt of U.S. government funds for international family planning programs, that they will neither perform nor promote elective abortion. While support for this policy has remained steady, opinion has become more ideologically polarized, indicating that changing U.S. policy affects international family planning policies, which is not the case for domestic family planning policies.

RAND’s Population Matters Project, a division of RAND’s Labor and Population program, conducted the 1998 and 2003 studies. The William and Flora Hewlett Foundation funded the 2003 study.

Formed in 1996, RAND’s Population Matters Program researches important population policy issues and to provide a more scientific basis for public debate over policy population questions.