WASHINGTON, Feb. 28 (UPI) -- Access to contraception and family planning services is an issue that blurs the red state-blue state divide, according to a ranking of access to contraception in the 50 states and District of Columbia released Tuesday by the Guttmacher Institute.
California's number one rank -- meaning it appears to offer the best access to family planning -- may not be surprising, but it is followed by Alaska, South Carolina and Alabama, with New York rounding out the top five.
The list of most improved states between 1994 and 2001 is also eclectic, including Alaska, Louisiana, South Carolina, Oregon and California.
"The placement of states on the scale is not related to the red state and blue state differences you see when you look at abortion laws," Institute President Sharon Camp told United Press International. "It's not the usual suspects."
What the numbers reflect is a growing awareness across the ideological spectrum that access to family planning can help prevent unintended pregnancies and abortions, Camp said.
Though some aspects of contraception remain controversial, few dispute the problems that unintended pregnancy can cause.
Unintended pregnancies in the United States, while on the decline, still occur at a rate much higher than any other industrialized country.
Roughly half of the nation's six million pregnancies last year were unintended, and researchers at the National Campaign to Prevent Teen Pregnancy have estimated that as many as 34 percent of U.S. girls become pregnant at least once before the age of 20.
That translates to about 850,000 teen pregnancies per year, or 100 per hour.
The study, which ranks states based on availability of family planning services, public funding for family planning, and policies, found that there are enormous differences between states' attempts to tackle the issue. Scores ranged from California's 73, to a 14 for Nebraska, which was ranked last.
"Every state still has a ways to go before it is doing everything it can to prevent unintended pregnancy," Camp said, "but some states are certainly doing much less than others."
In the time window of the report, the scores of 30 states actually decreased.
The list of leading states, Camp said, indicates that geography does not necessarily preclude the policies measured in the study.
"Any state in the country can do a good job if it has political leadership and commitment. . .there's no reason why other states in the South and Midwest couldn't perform as well as the top states," she said.
States looking to improve their performance can learn from the policies and funding targets of those at the top of the list, Camp said.
The study is a "roadmap for concrete steps states can take to prevent unintended pregnancy," she said. "If a state legislator works through the list of best policies, there's plenty of model legislation."
Making family planning available and pertinent to people who really need it is the priority for Alabama's state services, Tom Miller, director of family health services for the Alabama Department of Public Health, told UPI.
Alabama's third-place ranking comes as a result of policies like making sure each of the state's 67 counties has a clinic for low-income patients, and leveraging available state and federal dollars. In 2001, the last year considered in the study, Alabama spent $33,497,000 in state and federal funds to increase access to contraception.
The department also applied for a federal waiver to extend Medicaid family planning services to women with incomes at 133 percent of the federal poverty line.
The 133 percent figure was chosen because it brought family planning eligibility requirements in line with those for maternity benefits.
"Women should have coverage at a similar level in family planning as in maternity to help them choose when they get pregnant again," Miller said.
Beyond helping women afford family planning, he said, the state also makes an effort to tailor education efforts to the needs of individual women.
"An educated, informed patient, who's had information presented at a level compatible with her educational background, is empowered to make a choice based on her lifestyle, culture and moral beliefs," he said.
"Family planning is a cornerstone piece of healthcare. What we really do is well woman care," he said. "It is a part of your life that shapes how so many other areas of your life are going to shake out."
Nurse-practitioners who work at clinics are trained not to let their biases limit the pregnancy prevention options of their patients, he said. "It's important to remember that you've got to respect someone's choice in terms of contraception. I'm talking about treating folks like you would want to be treated," Miller said.
But not everyone considers a lack of state contraception funding a bad thing.
"The contraception mentality leads to a cultural change where children are seen as a curse and not a blessing," said Denny Hartford, director of Vital Signs Ministries, an evangelical group that opposes non-barrier methods of birth control and encourages couples to use an updated, more effective version of the rhythm method called natural family planning.
"It really is as good at preventing pregnancy as other methods," Hartford told UPI.
The group operates in Nebraska, the state that was ranked last in the report, but, like Utah and some other states ranked low in the report, has a teen pregnancy rate below the national average.
"Obviously, if this is something we see as bad for our culture, government funding is definitely something I would oppose," Hartford said.
But that doesn't mean that efforts are not made to prevent unintended pregnancies, he said.
The group works with Catholic and other religious organizations to offer services to women like pregnancy testing, pre-natal care and counseling and has operated its own clinic for decades.
"We try to explain to women and their boyfriends and husbands what exactly is involved in the creation of a human child," he said. "Our approach has always been very gentle -- not yelling or throwing stuff -- but giving people facts not available at an abortion clinic."