Why investments in family planning are sound policy.

P olicymakers have long been aware that public investments in family planning services are cost effective. Indeed, this fact helped establish the federal program. In her book Within Our Reach, Lisbeth Schorr described the first federal investment in family planning under the War on Poverty launched by President Lyndon Johnson in 1965. He demanded programs that were “demonstrably cost-effective,” and he charged the Office of Economic Opportunity’s (OEO’s) Division of Research, Planning and Program Evaluation with assessing the effectiveness of various program options for reducing the number of people in poverty. Family planning was found to be the most effective program being considered. Sargent Shriver, the OEO’s director, then courageously decided to fund these services but not before the economist who headed the research and evaluation unit, Dr. James Kershaw, had briefed his wife, Eunice Shriver, and 2 Roman Catholic priests about the cost-benefit analysis one Saturday morning at the Shriver home. Five OEO community projects were initially funded. By 1968 there were 159 such projects, and expansion continued with the passage of Title X of the Public Health Service Act in 1970 under President Richard Nixon, which established a network of family planning providers around the country.1 From these modest beginnings, the public (federal and state) investment in family planning services for low-income individuals had grown to an estimated $2.37 billion in fiscal year 2010 for services provided by 8,400 health centers. The majority of this spending now comes from the Medicaid program.2 While family planning is known to save more money than it costs, the question remains of just how much money is saved. Over time, technical approaches to estimating the benefits and cost savings of family planning programs have become more sophisticated. The article in this issue of The Milbank Quarterly “Return on Investment: A Fuller Assessment of the