Glory Okwori and CARE Faculty Publish on Contraception

Glory Okwori, Health Management and Policy concentration student in East Tennessee State University College of Public Health’s Doctor of Public Health program, is lead author of an article in The Journal of Rural Health.  The article, “Geographic differences in contraception provision and utilization among federally funded family planning clinics in South Carolina and Alabama,” discusses the importance of federally funded family planning clinics to ensure women have access to contraceptive care, especially in rural areas.

Drs. Michael Smith, Kate Beatty, Amal Khoury, and Nathan Hale, faculty in the Department of Health Services Management and Policy, are co-authors.  Liane Ventura, research project manager in the department, is an additional co-author.  All authors are members of the Center for Applied Research and Evaluation in Women’s Health.

Reproductive health care, including access to the full range of contraceptive services, is fundamental to women’s health and well-being and to reducing unintended and teen pregnancies. In the United States (2017-2018), rural counties had on average an additional 7.8 births per 100,000 females aged 15-19 compared to urban counties.  

“Given historical disparities and barriers among rural population, this study provides important findings regarding rural and urban variation in contraceptive use and provision,” said Ms. Okwori.  “We must continue to identify factors that contribute to the variation in the use of contraceptive methods particularly at the individual level, where intervention is possible.”

This study focused on publicly funded family planning services in two states, Alabama and South Carolina. The proportion of women who reported wanting to be pregnant at the time of pregnancy or sooner in these states is among the lowest across the country. A survey of publicly funded family planning clinics in Alabama and South Carolina was conducted in 2017-2018 at the clinic level. Health department and federally qualified health clinics in Alabama and South Carolina that offered any contraceptive service were eligible for the study.  The survey was designed to measure organizational characteristics of clinics, clinic policies, and practices related to contraceptive care delivery, scope of contraceptive services provided, and clinic-level utilization of contraceptive methods.

The authors found urban clinics had more staff on average than rural clinics, but rural clinics reported greater ease in recruiting and retaining family planning providers. Patient characteristics did not significantly vary between rural and urban clinics. While no significant differences were observed in the provision of long-acting reversible contraceptives overall, a greater proportion of patients in urban clinics utilized them.  While provision of most contraceptives is similar between rural and urban federally funded family planning clinics, important differences in other factors continue to result in women who receive care in rural clinics being less likely to choose long-acting reversible contraceptive methods.

“Increased efforts ensuring access to such methods in rural clinics is warranted,” continued Ms. Okwori.  “It is important to monitor trends among publicly funded family planning clinics to identify whether clinics are successfully meeting the contraceptive service needs of women in underserved areas.”