Report documents unmet need for expanded family planning services at CHCs

As part of a unique survey of nearly 2,000 women of childbearing age who receive health care at the nation's community health centers, 90 percent reported that they were not actively seeking to become pregnant in the next 12 months. Yet more than 3 out of 10 were not using contraceptives at the time of the survey.

The survey's findings signal a clear unmet need for more comprehensive family planning services at health centers, according to a report issued today by the Geiger Gibson /RCHN Community Health Foundation Research Collaborative and the Jacobs Institute of Women's Health, both based at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

"Family planning services are one of the most effective ways of keeping women and their families healthy," said Susan F. Wood, PhD, the executive director of the Jacobs Institute of Women's Health at Milken Institute SPH and the study's lead author. "This report suggests that patient satisfaction with community health centers is high but that health centers can do more to further improve the effectiveness of their care."

"Health centers are the single largest source of comprehensive primary health care for low-income, medically underserved women of childbearing age," adds Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH and a study co-author. "Their role in ensuring the quality of women's preventive health care is absolutely central."

The report is part of a series undertaken by Wood and her colleagues to examine the role that family planning plays at community health centers (CHCs), clinics that represent the largest primary care delivery system for people living in underserved urban and rural parts of the United States. A 2013 report by the same group—the first study to ever look at family planning and CHCs—found that while virtually all CHCs offered such services, the depth and quality of the care varied widely. The current study is a follow-up to that earlier report.

For this study, the researchers gathered information directly from 1,868 women ages 18 to 44 who were patients at 19 CHCs located across the country. In addition, the researchers also conducted a series of focus groups that explored questions in depth with 82 women in six different CHC sites around the country.

Among the key findings of the report:

• Nearly 70 percent of women surveyed did not want to become pregnant in the next year and an additional 20 percent expressed ambivalence (were unsure or were okay either way).
• Among women who were not actively seeking to become pregnant, 31 percent were not using contraceptives at the time of the survey.
• Survey respondents reported being highly satisfied with the care they received at CHCs, including family planning services. The focus group participants echoed that response and also said that they came to CHCs for general primary care but liked the fact that they could get contraceptive care at the same place.
• Some survey respondents also reported barriers to getting family planning services, including real and perceived financial concerns. Some focus group participants said that they delayed or went without birth control because they thought, in some cases mistakenly, that their insurance wouldn't pay for it. The report notes that the confusion is troubling as family planning is covered by both Medicaid and private insurance without cost-sharing.

Based on the report findings, the researchers make a series of recommendations to strengthen family planning services provided by CHCs. For example, they recommend that CHCs consider recruiting family planning counselors and investing in a broad array of on-site contraceptive care. The report also recommends that health centers adopt a system to rapidly identify women who do not wish to become pregnant so that they can receive family planning counseling and information on available options, as well as the care they need during the same visit.

"Community health centers are already high-quality, trusted providers of family planning services for medically underserved women," said Feygele Jacobs, president and CEO of the RCHN Community Health Foundation, which provided partial funding for the report. "The study suggests that with support, health centers can build on this strong foundation to strengthen and expand these needed services in our communities."