Abstract
Objectives
Federally Qualified Health Centers (FQHCs) are a major and growing source of primary
care for low-income women of reproductive age; however, only limited knowledge exists
on the scope of family planning care they provide and the mechanisms for delivery
of these essential reproductive health services, including family planning. In this
paper, we report on the scope of services provided at FQHCs including on-site provision,
prescription only and referral options for the range of contraceptive methods.
Study Design
An original survey of 423 FQHC organizations was fielded in 2011.
Results
Virtually all FQHCs reported that they provide at least one contraceptive method (99.8%)
at one or more clinical sites. A large majority (87%) of FQHCs report that their largest
primary care site prescribes oral contraceptives plus one additional method category
of contraception, with oral contraception and injectables being the most commonly
available methods. Substantial variation is seen among other methods such as intrauterine
devices (IUDs), contraceptive implants, the patch, vaginal ring and barrier methods.
For all method categories, Title-X-funded sites are more likely to provide the method,
though, even in these sites, IUDs and implants are much less likely to be provided
than other methods.
Conclusion
There is clearly wide variability in the delivery of family planning services at FQHCs
in terms of methods available, level of counseling, and provision of services on-site
or through prescription or referral. Barriers to provision likely include cost to
patients and/or additional training to providers for some methods, such as IUDs and
implants, but these barriers should not limit on-site availability of inexpensive
methods such as oral contraceptives.
Implications
With the expansion of contraceptive coverage under private insurance as part of preventive
health services for women, along with expanded coverage for the currently uninsured,
and the growth of FQHCs as the source of care for women of reproductive age, it is
critical that women seeking family planning services at FQHCs have access to a wide
range of contraceptive options. Our study both highlights the essential role of FQHCs
in providing family planning services and also identifies remaining gaps in the provision
of contraception in FQHC settings.
Keywords
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Article info
Publication history
Published online: October 03, 2013
Accepted:
September 24,
2013
Received in revised form:
September 24,
2013
Received:
April 29,
2013
Footnotes
☆Conflicts of Interest: The authors report no conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
