The impact of government programs on reproductive health disparities: three case studies.

During the last several decades the health of Americans overall has steadily improved. However many low-income poorly educated or disabled Americans as well as people of color have not benefited from many of the recent health gains for the population as a whole. Across the board these groups are disproportionately more likely than others to struggle with diabetes heart disease cancer and obesity. Some groups have higher death rates from unintentional injuries and suicide than the general population and others tend to report more anxiety pain sleeplessness and days of depression. Recognizing the magnitude of health inequalities in the United States one of the goals of the Department of Health and Human Services Healthy People 2010 is to eliminate health disparities. In the field of sexual and reproductive health three government initiatives stand out as case studies of policies and their impact on disparities. The first examines the federally funded family planning program which was a conscious attempt to ensure that any woman-regardless of her age marital status income or health insurance status-has access to the contraceptive services she wants and needs. The second highlights the Hyde Amendment in which the government has abdicated its responsibility to poor women faced with an unintended pregnancy. And the third focuses on a Medicaid eligibility expansion for pregnant women that revolutionized how pregnancy-related care is paid for in this country. Each of these case studies presents a starkly different portrait of government policies and the lessons that can be learned about addressing inequalities in the United States. (excerpt)