Background:
Reaching women pre-conceptually through a variety of channels is key in achieving improved outcomes. Recognizing a growing need for family planning services among low-income individuals, the California's Department of Health Services, Office of Family Planning established the Family PACT Program, (funded through an 1115 Medicaid demonstration project waiver since 1999 and state funds since 1996), aiming at eliminating traditional barriers to care: providing care for uninsured men, women, and adolescents at or <200% of poverty, point of service enrollment, public sector and private for-profit providers; clinics and pharmacies serve as distribution sites for over-the-counter and prescription drugs.

Objectives:
To increase knowledge regarding the potential role of family planning clinics to serve clients pre-conceptually.

Methods:
Family PACT Program client profile data, including quantity and type of contraceptives dispensed were analyzed.

Results:
Family PACT served 1.57 million women and men, three times the number served in the year prior to implementation; 67% are Latina/o, 19% white, 6% African-American, 6% Asian/Filipino/Pacific Islander, 3% Native American/other. Half of clients report that primary language is Spanish. Ethnic/racial minorities were primarily served by private providers. In 2002, Family PACT averted an estimated 205,000 pregnancies and 94,000 births (including 25,000 unintended pregnancies and 6,000 births among adolescents). The unintended pregnancies would have incurred $1.1 billion in public expenditures within 2 years and $2.2 billion within 5 years, significantly more than the $403.8 million incurred. Each dollar spent generated savings of $2.76 within 2 years and $5.33 within 5 years.

Conclusion and implications for practice:
The Family PACT program serves a large and diverse population, while gaining significant public cost savings. Nearly 60% of Latinos are uninsured (vs. 23% whites) and 1/3 of women (ages 18-64) live at or below 200% of poverty. Clients' ability to choose the type of provider, point of service enrollment and reproductive health services have been key factors in its wide acceptability and may be particularly useful in considering in developing programs for this target population.
Cost-effective programs are feasible, while diminishing traditional barriers to care. Creating programs that respond to the multitude of needs of different client sub-groups, including ethnic/racial and age, is doable and represents a potential window for reaching women pre-conceptually.