States and community health centers could do a better job of removing access barriers to oral contraceptives, according to the results of a new study.

Only a small percentage of states and community health centers provide patients with a one-year supply of oral contraceptives on site.1

Community health centers play an important role in women’s health and quality of life, says Julia Strasser, DrPH, MPH, senior research scientist in the department of health policy and management at George Washington University Milken Institute School of Public Health.

“There are barriers to access family planning services, especially for low-income women,” Strasser says. “Community health centers can help reduce those barriers.”

Community health centers provide primary care as well as family planning services to patients across the United States. These services are offered regardless of a person’s ability to pay.

Knowing how important these health centers are to women of reproductive age, Strasser wanted to study how they handled oral contraceptives, which are the most common non-permanent method of contraception in the United States.

“I was looking at current practices, related to providing an entire year’s supply of oral contraceptives, as opposed to one month or three months at a time,” she explains. “I wanted to see if one year was available on site at health centers.”

Researchers found that half of health centers provide any supply of contraceptives on site, and about 30% of the one-half offer patients a one-year supply of oral contraceptives.

“The majority of health centers do not provide a one-year supply on site,” Strasser says. “We wanted to understand policy- and practice-related barriers to doing so.”

Investigators conducted interviews and studied survey answers to learn about potential barriers, including Medicaid reimbursement. “We did a state-by-state policy analysis of both Medicaid and private insurance for one-year’s supply at a time,” Strasser says. “We did interviews with healthcare staff to understand their practices.”

On the policy side, only three states require coverage for a one-year supply for contraception under all Medicaid and private insurance coverage mechanisms. On the practice side, barriers include clinicians’ preferences for prescribing contraceptives.

“I looked at the way healthcare organizations, leadership, and pharmacists approach this practice,” Strasser explains. “Through conversations with them, I learned that clinicians and pharmacists might have preferences or beliefs about patients losing pills or failing to return to the clinic or other challenges related to primary care.”

Since they worry about patients’ ability to maintain a year’s supply of contraceptives, this could be a barrier to their providing a one-year supply on site, Strasser says.

Health centers with better reproductive health integration or that focus on quality improvement practices related to planning services were better able to provide a one-year supply on site. “Where family planning is more integrated into overall practices, it seems there was more emphasis on meeting quality improvement indicators, like meeting a one-year supply,” Strasser says. “Those that don’t have as robust a focus on family planning would usually have a lower supply.”

When Strasser interviewed members of community health center leadership teams, one person said, “I tell patients to go to Planned Parenthood because they can get [contraceptives] faster than we could get it here.”

If clinicians at a health center were unable to give patients a one-year supply of oral contraceptives, they might give them the three-month supply and recommend they visit a family planning center for an additional nine months of pills.

Research shows women who receive a one-year supply experience better health outcomes and lower costs to the state because of fewer unintended pregnancies and more gynecological screening check-ups than when they do not receive the one-year supply.

“If you have one or two packs of pills at a time, and you run out of them and can’t get to a pharmacy, you have to go somewhere to find it,” Strasser explains. “If that takes a couple of days, then you’re no longer taking it continuously, and you run the risk of pregnancies.”

One solution is to address provider knowledge and preferences to help change health center practices. For instance, researchers could note that people are not less likely to return for follow-up appointments if they receive a year’s supply of contraceptives. This is because the women who ask for a year’s supply are not first-time users of the pill. They already know about side effects.

“If it’s someone’s first time with the pill, then you will want them to come back in a couple of months to discuss side effects,” Strasser adds.

Another potential avenue for change at the policy level is to lobby states to require a one-year supply of oral contraceptives — particularly for Medicaid services.

“Recognize that it’s a slow process because it’s a change that would have to take place in 48 states,” Strasser says.

REFERENCE

  1. Strasser J, Markus A, Wood S. Community health centers’ practices, barriers, and facilitators for providing a one-year supply of oral contraception on site. Womens Health Issues 2021;31:440-447.