Executive Summary
Results of a recent survey at U.S. community health centers indicate an unmet need for more comprehensive family planning services at such facilities.
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Meeting these needs is important, as community health centers represent the largest primary care delivery system for people living in underserved urban and rural parts of the United States. In 2013, health centers were operating in more than 9,000 locations and serving more than 21 million patients.
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According to the survey, which polled nearly 2,000 women of childbearing age who receive such care, 90% reported that they were not actively seeking to become pregnant in the next 12 months. However, more than three out of 10 were not using contraceptives at the time of the survey, data indicates.
Results of a recent survey at U.S. community health centers indicate an unmet need for more comprehensive family planning services at such facilities, according to a report issued by the Geiger Gibson /RCHN Community Health Foundation Research Collaborative and the Jacobs Institute of Women’s Health, all in Washington, DC.1
Meeting these needs is important, as community health centers represent the largest primary care delivery system for people living in underserved urban and rural parts of the United States. In 2013, data indicates health centers were operating in more than 9,000 locations in all states, the District of Columbia, and U.S. territories and serving more than 21 million patients.2 Women of childbearing age represent one of the single largest groups of health center patients, and family planning is a required service of all health centers.1
According to the survey, which polled nearly 2,000 women of childbearing age who receive care at U.S. centers, 90% reported that they were not actively seeking to become pregnant in the next 12 months. However, more than three out of 10 were not using contraceptives at the time of the survey, data indicate.1
“Since only 10% of female patients of reproductive age are actively seeking pregnancy, that leaves 90% who should have access to high quality family planning services,” notes the report’s lead author Susan Wood, PhD, executive director of the Jacobs Institute of Women’s Health, based at the Milken Institute School of Public Health at George Washington University. “Contraception, pre-conception care, birth spacing — all are central to primary health care for women.”
To collect information for the report, researchers gathered information directly from 1,868 women ages 18-44 who were patients at 19 community health centers across the country.
The health centers were selected based on four criteria: patient volume (large and medium organizations), enrollment of non-Title X recipients, location within 30 miles of a Title X grantee site, and geographic dispersion across the United States. Researchers specifically chose non-Title X health centers in relative proximity to other family planning options to determine the extent to which patients rely on health centers for family planning services, the reasons they might be going elsewhere for their care, and the opportunities for improving access. Data also were collected through focus groups that explored questions in depth with 82 women in six community health center sites in California, Florida, Kentucky, New York, Oregon, and Texas.
Nearly 70% of women surveyed didn’t want to become pregnant in the next year, and an additional 20% expressed ambivalence about such a possibility. Among women who weren’t actively seeking to become pregnant, 31% were not using contraceptives.
Survey respondents indicated they were highly satisfied with the care they received at centers, including family planning services. Responses from focus group participants mirrored those results.1 Focus group participants said they came to centers for general primary care, but they liked the fact that they could get contraceptive care at the same place.
The most frequently reported contraceptive methods used by survey respondents included male condoms (22%), oral birth control pills (21%), IUDs (13%), injectable contraceptives (13%), and female sterilization (27%).
According to the survey results, more than 80% of survey respondents reported that confidentiality of family planning care was extremely important to them.
Most women reported that “not sharing or releasing medical information without your permission,” was a critical item for maintaining family planning confidentiality. For those women who obtained their family planning care through other clinics, the fact that this care meant separate records, separate providers, and separate contact information was more likely to be identified as important.1
Sara Rosenbaum, JD, the Harold and Jane Hirsh professor of health law and policy at Milken Institute School of Public Health at George Washington University, says, “Privacy and confidentiality are essential to any healthcare, but especially so when the healthcare relates to reproductive health.” Rosenbaum served as a co-author of the report.
Concerns about privacy and ease of access might be causing health center patients to seek family planning services elsewhere, the report notes. If focus group participants did not receive family planning care at the health center, they were likely to have visited a family planning clinic, a local health department, or an office-based health care professional, the report states. Respondents who used other sites most often indicated that they were receiving sexually transmitted disease testing and pregnancy testing at these other locations, which suggests that privacy might be a consideration.1
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Wood SF, Beeson T, Goldberg DG, et al. Patient Experiences with Family Planning in Community Health Centers. Washington, DC: Milken Institute School of Public Health, Department of Health Policy and Management; 2015.
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Department of Health and Human Services. Health Resources and Services Administration. Bureau of Primary Health. HRSA Health Center Program. Accessed at http://1.usa.gov/1MXUzfs.
