CARE Women’s Health publishes on contraceptive access

Liane Ventura, Research Project Manager for the East Tennessee State University College of Public Health’s Center of Applied Research and Evaluation (CARE) Women’s Health, is lead author of a Center article on contraceptive access in South Carolina.  The article, “Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences,” examined perceptions of staff from Choose Well-participating Federally qualified health centers (FQHCs) regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors.

Co-authors include other faculty of CARE Women’s Health Kate Beatty, Amal Khoury, Michael Smith, Oluwatosin Ariyo, Deborah Slawson, and Amy Weber.  

More than 7 million women at risk of unintended pregnancy obtain contraceptive services from publicly funded safety-net clinics nationwide. Key to supporting the reproductive autonomy of these women is contraceptive counseling that honors their needs and preferences and access to the full range of contraceptive methods.

FQHCs provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022.

The study aim was to assess changes in contraceptive access associated with the Choose Well initiative and to identify facilitators and challenges to the provision of IUDs and implants as well as perceptions of sustainability of funding from the perspective of clinical and administrative staff at Choose Well participating FQHCs.

Ventura stated, “This work illuminates important components for access to contraception at the clinic-level and will be useful for further evaluation work."

Based on the interview findings, the Choose Well initiative was perceived by clinic staff to have contributed to increased provision and access to contraception at participating FQHC clinics in SC through changes to clinic-level policies and practices and enhanced counseling. Staff also highlighted on-going challenges and perceived barriers to sustainability over time.

Optimizing the impact of Choose Well, and potentially of other contraceptive initiatives, requires coupling organizational change at the clinic/health system level with broader structural and policy changes to reinforce benefits of training and clinic enhancements. For example, state-level contraceptive access initiatives could advocate to strengthen health care delivery systems (through protecting contraceptive access under the Patient Protection and Affordable Care Act and restoring contraceptive access through expanded Medicaid programs) and support innovative policymaking and implementation of new delivery channels such as pharmacist prescribing.