Advances in reproductive health service delivery are guided by past and present research. The following articles highlight several opportunities for family planning providers to improve the accessibility and quality of reproductive health services:
Borrero S, Schwarz E, Creinin M, and Ibrahim S. The Impact of Race and Ethnicity on Receipt of Family Planning Services in the United States. Journal of Women's Health. 2009; 18(1):91-96.*
This seminal article by Borrero, et al., examines use of family planning services in the United States by race and ethnicity. Although there were no racial/ethnic differences in overall use of family planning services, researchers discovered significant racial/ethnic differences in the specific types of services women received. Of note, although Hispanic and black women were 1.6 times more likely to receive contraceptive counseling than white women, these groups were roughly 0.8 times less likely to have received a method or prescription for a contraceptive method compared to their white counterparts. These findings reveal that contraceptive counseling does not necessarily lead to a prescription for a contraceptive method. The authors' postulate that this disconnect between receipt of contraceptive counseling and leaving with a contraceptive method (or a prescription for a method) may indicate the presence and effect of provider bias, as it may point towards variation in the way in which providers approach and counsel about contraception. For an example, the authors suggest patient race/ethnicity may influence the rate at which providers initiate conversations about contraception. Improving our understanding of the process through which women obtain contraception through research like this is vital to the reproductive health care community addressing persistent racial/ethnic disparities in contraceptive use and unintended pregnancy. To access this full article, go to: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743980/pdf/jwh.2008.0976.pdf
Beeson T, Wood S, Bruen B, et al. Accessibility of long-acting reversible contraceptives (LARCs) in Federally Qualified Health Centers (FQHCs). Contraception. 2014; 89:91-96.
In this article, Beeson, et al., examines on-site availability of LARC methods at FQHCs. Study findings reveal great variability in on-site access to LARC methods by location (urban/rural), clinic size, and Title X funding. Discouragingly, researchers found that slightly over half of the FQHCs offered LARC methods on-site (56% LNG-IUD; 52% Copper IUD; 36% Implant); the remaining clinics offered LARC methods by prescription or referral. Larger clinics and clinics receiving Title X funding were significantly more likely than their smaller and non-Title X-funded counterparts to offer on-site IUD insertions, at 2.12 and 3.12 times, respectively. As more women gain health insurance due to the Affordable Care Act, access to and utilization of reproductive health services will increase. FQHCs will be essential to meeting the health care needs of this newly insured population, underscoring the importance of ensuring high-quality reproductive health care services are delivered in these settings, including first-line recommended LARC services. This study sheds important light on the current state of practice and challenges related to providing LARC methods in FQHC settings. Full article provided upon request.
Ventura A, Garbers S, Meserve A, and Chiasson MA. Agreement between patient-reported and provider-reported choice of contraceptive method among family planning patients in New York City: implications for public health. International Journal of Women's Health. 2013; 5:533-540.
In this article, Ventura, et al., of Public Health Solutions examines patient and provider agreement around the contraceptive method chosen by a patient following a reproductive health visit. In other words, when a patient and provider are asked separately about the contraceptive method ultimately selected, are they in agreement? Agreement was not achieved if the patient and provider reported different methods. Analysis revealed that patient-provider agreement was highest (94%) for hormonal methods (pill, patch, NuvaRing, Depo-provera). In contrast, researchers found that agreement was lowest for condoms (53.5%) and no method (31.2%). In almost half of the instances where the provider reported that a client chose condoms, the client reported choosing no method of contraception. The authors postulate that providers may overestimate patient use of condoms as their contraceptive method, so rates of condom use derived from provider reports may be overestimates. It is important to be aware of the strengths and drawbacks associated with data sources. Continued research is necessary to better understand these varying levels of patient and provider agreement on contraceptive choice. To access this full article, go to: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770710/pdf/ijwh-5-533.pdf
*The NYS Center of Excellence is preparing a comprehensive literature review addressing topics discussed above. Findings will be disseminated when complete.