Investigators recently studied the techniques federally qualified health centers (FQHCs) have used to integrate contraceptive care services with primary care in rural populations.
- Staff at centers with a contraception integration model asked women seeking primary care about their reproductive needs and concerns. They used evidence-based materials to educate them about the different types of birth control.
- Further research is needed to learn how clinics can offer same-day access to long-acting reversible contraceptives as well as how to overcome financial barriers.
- This integrated contraception and primary care model could be replicated nationwide in clinics that serve low-income populations as well as at primary care providers for any population.
A contraception integration model at federally qualified health centers (FQHCs) has helped to ensure comprehensive healthcare for reproductive-age individuals in some rural areas, new research shows.1
Investigators studied how FQHCs integrated services — not just offering contraceptives, but also integrating contraception care with primary care.
Some employees at FQHCs that work with rural populations told investigators they were systematically integrating contraceptive counseling, says Sophie Wenzel, DrPH, MPH, associate director of the Center for Public Health Practice and Research and assistant professor of practice in the department of population health sciences at Virginia Tech.
“Any time a woman comes in for primary care, they will ask her, ‘Do you want to get pregnant in the next few years? What contraceptives are you using? If you’re not using contraceptives, what are you interested in?’” Wenzel says. “A lot of women in rural areas [of Virginia] may have been taught abstinence until marriage is the way to go, so the FQHCs took it upon themselves to offer this service.”
One FQHC received private funding from a local nonprofit to start the integrated contraception care and primary care program. “They since continued the program because it was successful, and women were coming and getting access to education,” Wenzel says.
Although the same population could access contraceptive care at a Title X program in their state, they would have to know they want contraceptives before visiting the reproductive health centers.
“That’s a big difference, because for women coming in to the FQHC for primary care services — and not necessarily with contraceptives on their mind — they were asked about reproductive intentions,” Wenzel says.
At centers with the integrated services, all primary care providers were on the same page in terms of providing initial counseling and systematically assessing reproductive intention.
“They put extra time into their initial primary care visit to have a conversation and then provide services on site,” Wenzel adds. “A lot of the women in this rural area, which included an Amish population, had never been exposed to knowledge about contraceptives.”
The providers would talk about reproduction and how it works, and would provide some contraceptives directly on site. They also followed specific guidelines for same-day insertion of long-acting reversible contraceptives (LARCs).
“One of my recommendations is to increase access to same-day LARC to further reduce the barrier,” Wenzel says. “They do a lot of things really well, but there are things they could do even better.”
Providers use evidence-based materials when educating patients. They explain all of the different birth control methods available and help them find the right fit.
“The big difference between this program and a Title X program is, in the primary care visit, if someone doesn’t ask for contraceptives, the provider doesn’t necessarily have to ask,” Wenzel says. “But, the integrated care program at the FQHC has providers systematically assessing patients for that intention.”
Investigators found that many patients at the FQHC lacked knowledge about contraceptive services and birth control and were susceptible to misinformation and misconceptions.1
“One of the big things I’ve been looking at is the lack of comprehensive sex education in middle and high schools,” Wenzel adds. “One of the reasons women are not accessing birth control is they’re not getting comprehensive information when they need it in middle and high school, or they are taught abstinence is the only way to go.”
There was stigma about seeking contraceptive services. Some women said they received sex education, but not as much as they would have liked.
Stocking LARC was a big barrier for FQHCs because of the cost, Wenzel notes. Further research is needed into barriers to offering same-day access to LARC and how to overcome them.
The integrated contraception and primary care model at FQHCs could be replicated at other clinics nationwide that also serve low-income populations. It also could work at any primary care provider office for any population.
“I would love to see a model like this provided systematically at all primary care providers,” Wenzel says. “They could assess reproductive intention among patients, and that could go a long way to reduce unintended pregnancies.”
- Wenzel SG, Risley KY. Providing comprehensive contraceptive services in primary care at a rural federally qualified health center in the USA: Adapting to patient need in a culturally conservative, rural environment. Rural Remote Health 2021;21:6308.