Background: Since the 1990s, policymakers have successfully increased cervical cancer screening through federal and state public policies. However, the most dramatic gains in Pap smear use occurred in the 1960's and 70's, during the establishment of federal support for family planning clinics through the War on Poverty and Title X. This study estimated the effect of this support on cervical cancer screening, and quantified its role in dramatic increases in Pap smear use. Methods: Using a natural experiment in the timing and receipt of federal family planning grants, the screening behavior of women who did and did not have access to a federally funded family planning clinic were analyzed. Cross-sectional probability models of annual and lifetime Pap smear use using the 1970 National Fertility Survey were estimated and linked to administrative data on grant timing and receipt between 1964 and 1973. Findings: Federal support for family planning clinics was associated with a 7-percentage point increase in annual use (< .01), and a 5-percentage point decrease in never use of the Pap smear (< .001). Scaled by the fraction of women who used funded clinics, federal support for family planning was associated with a roughly 70% increase in Pap smear use. Estimates suggest that the establishment of federal support could explain as much as 15% of the national increase in Pap smear use between 1966 and 1973. Conclusions: Federal support for family planning played an important-and previously unacknowledged-role in promoting cervical cancer screening and investments in future health.
Bibliographical noteFunding Information:
Supported by a T-32 Agency for Healthcare Research and Quality Graduate Student Traineeship and a University of Michigan Population Studies Center Graduate Student Traineeship. The author thanks Martha Bailey for data on family planning center grants and National Fertility Survey geographic identifiers.
© 2016 Jacobs Institute of Women's Health.