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Arizona could save tens of millions of dollars a year by providing more birth-control services to lower-income women, public-health experts say.

That's one of the primary reactions the experts had to last week's news that taxpayers are now paying for slightly more than half of all the state's births, at a cost of about $223 million last year.

Arizona offers birth control to low-income women only after they give birth, and then for only two years.

Instead of costing the state more, increasing the availability of the Arizona Health Care Cost Containment System's family-planning benefits could save money in the end, the experts say.

That's in part because the federal government pays $9 for every $1 the state spends on family planning services offered through AHCCCS.

In addition, studies have shown that for every $1 states spend on family planning services, they save $3 on prenatal care for mothers and babies.

And experts point to a 2002 report from the Centers for Disease Control and Prevention that showed regardless of women's income levels, 49 percent of all pregnancies in this country are unplanned or unwanted; and of those, about half will end in abortion.

Conservative groups say they would oppose an expansion of family planning under AHCCCS.

"It borders on 'Because these women are poor, they shouldn't be having babies,' " said Cathi Herrod, president of the Center for Arizona Policy. "That's a fairly strong judgmental statement to be making."

But family-planning advocates say that's not at all their intent.

"Family planning promotes the health of mothers. It promotes the health of babies. Families do better when their children are spaced and planned," said Charlotte Harrison, executive director of the Arizona Family Planning Council.

"Nobody is trying to dictate how many kids people should have. This is to give people choices, because women who can't plan their pregnancies can plan very little else in their lives."

Family-planning services are critical in states like Arizona, with high percentages of uninsured and low-income residents, said Alina Salganicoff, director of women's health policy at Kaiser Family Foundation, a national health research group.

"This is a service these women value a lot. Many times it's their only access to health care," Salganicoff said.

Stephanie Hamilton of Tucson, whose third child was born May 2, agreed on the need to expand family-planning services to more women.

Hamilton stopped working last year after she and her husband, a schoolteacher, decided their two incomes would not cover the costs of child care and health insurance for their growing family. By quitting her job as a church youth director, Hamilton and the couple's two sons qualified for AHCCCS.

Throughout her third pregnancy — her first covered by AHCCCS — Hamilton received information about AHCCCS' family-planning services. She is not sure yet whether she will use the benefit or go back on her husband's insurance.

"If we didn't have insurance available to us, absolutely I would take them up on it," Hamilton said of AHCCCS' birth-control benefit. Expanding the benefit, she said, is "a great idea. I think the more you can make those services available, it's better for everybody."

AHCCCS is the state's version of Medicaid. The federal program, started in 1965, is based on a state and federal cost-share formula. In 1972, Medicaid began paying for family-planning services, partly in response to governors of Southern states alarmed about their high rates of infant mortality.

In 1982, Arizona became the last state to join the Medicaid program — without any provision for family planning. Advocates were preparing to file suit against the state when the Legislature added the benefit, about two years later.

Medicaid's special 9-to-1 matching rate for family-planning services is meant as a strong incentive to the states.

AHCCCS spends less than $2 million a year in state money on family-planning services, said spokeswoman Rainey Daye Holloway. About 8,700 women were enrolled in the program last month, at a cost of about $17 each, for a one-month state expenditure of about $14,800, Holloway said. To that, Medicaid added $148,000, she said.

In contrast, AHCCCS spends, on average, about $4,200 for each pregnancy and birth it covers. That translated to $223 million for the more than 53,000 births AHCCCS covered last year — about 52 percent of the babies born in Arizona.

Over the past 12 years, Arizona became one of 26 states to expand their family planning benefits. But Arizona is one of six states that chose the narrowest expansion allowed by Medicaid: If a woman loses her AHCCCS eligibility after her baby is born, AHCCCS will continue to cover birth control and related services for up to two years after she gives birth.

Most of the 26 states adopted the broadest expansion of basic family planning benefits allowed by Medicaid, providing family planning services to any woman up to a certain income level, regardless of whether they qualify for their state Medicaid program as a whole.

Under that type of expansion, Alabama saved more than $19 million and New Mexico saved more than $6.5 million in 2001; and California saved more than $76 million the year before, according to a recent study by the Kaiser Foundation and the Alan Guttmacher Institute.

Claire D. Brindis, a nationally respected health policy expert with the University of California-San Francisco, has extensively studied the impact of that state's family-planning program, which serves more than 1.5 million women.

"Our evaluation has demonstrated that the availability of reproductive health services has helped to avert over 205,000 unintended pregnancies in one year," Brindis said.

"People think if we make it too easy for people to use these services, they will abuse them," Brindis said. "But then, who is paying the price? We're going to pay a lot more for food stamps, health care, child care — there's a whole domino effect if we don't provide this kind of care."

Some conservative leaders say they strongly oppose spending more AHCCCS money on birth control.

"I think we need to teach more abstinence, and for those who think that's unrealistic, I certainly disagree with that," said Sen. Robert Blendu, R-Litchfield Park. "Abstinence programs work. We just live in a culture that's getting more and more promiscuous. If you're going to bring children into the world, you ought to be able to take care of them."

Conservatives seem more willing to spend more AHCCCS money on prenatal care.

The Arizona Catholic Conference, the influential lobbying group for the dioceses of Tucson, Phoenix and Gallup, N.M., has "strongly supported" expanding prenatal care under AHCCCS, said Ron Johnson, executive director.

A Senate Republican plan to do that is included in the state budget expected to be approved this week. It would raise the AHCCCS income limit for most pregnant women from 133 percent of poverty level, or about $27,000 a year for a family of four, to 150 percent of federal poverty level, or $30,000 a year for a family of four.

The Catholic Church opposes the use of contraceptives, and the conference would oppose any effort to expand AHCCCS' family-planning service, Johnson said Friday.

Despite the Catholic ban on contraception, about 64 percent of her state's family planning clients are Hispanic women, Brindis said.

"Latinas are a heterogenous group. We are not one group with one set of ideas," said Rachel Chánes, a vice president of Planned Parenthood of Southern Arizona.

"I see more and more Latinas coming to our clinics" for birth control and abortions, she said. "I do think the Catholic Church to some degree plays a role in their decision-making, but I don't think it's as big a role as is being projected in the media."