Abstract
Objective
Describe contraception availability at local health departments (LHDs) serving largely
rural populations.
Study design
We invited administrators at LHDs located in four Midwest states to participate in
an online survey conducted from September 2017–April 2018. We collected data on clinic
staffing, patient population, receipt of Title X funds, and services provided to assess
the proportion of LHDs providing any prescription method of contraception; secondary
outcomes included healthcare staff training level and other reproductive health services
provided.
Results
Of 344 LHDs invited, 237 administrators completed the survey (68.9%). Three-quarters
served rural populations. One-third (34.6%) provided short-acting hormonal contraception;
however, availability varied by state (Kansas: 58.0%, 40/69; Missouri: 37.5%, 33/88;
Nebraska: 16.7%, 3/18; Iowa: 9.7%, 6/62; p<.01). Only 8.4% of LHDs provided IUDs;
7.6% provided implants, and 5.9% provided both methods. LHDs in Nebraska and Kansas
provided any long-acting method more frequently (Kansas: 17.4%, Nebraska: 16.7%, Iowa:
8.1%, Missouri: 4.6%; p=.04). LHDs receiving Title X funds (27.0%) were much more
likely to provide any prescription contraception (85.1% vs. 14.2%, p<.01). Most LHDs
relied on registered nurses (RNs) to provide medical care; 81.0% reported that RNs
provided care≥20 days per month. Pregnancy testing was widely available in Missouri
and Kansas (>87%) and less commonly available in Iowa and Nebraska (<18%) (p<.01).
Conclusion
LHDs in these states are currently ill-equipped to offer comprehensive contraceptive
services. Women seeking care at LHDs have limited, if any, contraceptive options.
Implications
Local health departments in the Midwest, serving a largely rural population, rarely
offer prescription contraception, especially long-acting reversible methods. Women
residing in settings without broad access to publicly-funded healthcare providers
may have limited access to comprehensive contraceptive services. Efforts to ensure
rural access are needed.
Keywords
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Article info
Publication history
Published online: March 11, 2019
Accepted:
February 20,
2019
Received in revised form:
February 19,
2019
Received:
December 1,
2018
Footnotes
☆Declarations of interest: none.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
