Advertisement

Patient opinions on sexual and reproductive health services in primary care in rural and urban clinics

      Abstract

      Objectives

      Primary care providers are a major source of sexual and reproductive health care in the United States, particularly in rural areas, and not all providers offer the same services. This study aimed to understand patient preferences and expectations around reproductive health services including abortion care in a primary care setting and if those expectations differed by urban or rural setting.

      Study Design

      An anonymous survey was distributed to all patients 18 years or older in 4 primary care clinics in Idaho, Washington, and Wyoming over a 2-week period. The survey asked patients about which reproductive health services should be available in primary care.

      Results

      The overall response rate was 69% (745/1086). For all queried reproductive health services except for aspiration abortion, the majority of respondents reported that primary care clinics should have that service available. Forty-two percent of respondents reported that aspiration abortion should be available in primary care. Overall, most respondents reported that medication abortion (58%) and miscarriage management (65%) should be available in primary care. More respondents in urban clinics thought IUD services (84% vs 71%), medication abortion (74% vs 37%), and aspiration abortion (52% vs 28%) should be accessible in primary care compared to those in rural-serving clinics.

      Conclusions

      This study of 4 primary care clinics in Idaho, Washington, and Wyoming, spanning urban and rural settings, highlights that most patients desire contraception services and miscarriage management to be available in primary care.

      Implications

      Increasing training may help meet patient desires for access to reproductive services in primary care, however, further exploration of barriers to this care is warranted. High rates of respondents desiring miscarriage management access highlights the need to train more primary care clinicians to provide full spectrum miscarriage management options.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women
        Committee opinion no. 654: reproductive life planning to reduce unintended pregnancy.
        Obstet Gynecol. 2016; 127: e66-e69
      1. Department of Health and Human Services. Healthy People 2020 topics and objectives: family planning. Available at: http://www.healthypeople.gov/2020/topics-objectives/topic/family-planning.

        • Johnson K
        • Posner SF
        • Biermann J
        • Cordero JF
        • Atrash HK
        • Parker CS
        • et al.
        Recommendations to improve preconception health and health care – United States. A report of the CDC/ATSDR preconception care work group and the select panel on preconception care.
        MMWR Recomm Rep. 2006; 55: 1-23
        • Dunlop AL
        • Logue KM
        • Miranda MC
        • Narayan DA
        Integrating reproductive planning with primary health care: an exploration among low-income, minority women and men.
        Sexual Reproduct Healthcare. 2010; 1: 37-43https://doi.org/10.1016/j.srhc.2010.01.001
        • Jones HE
        • Calixte C
        • Manze M
        • Perlman M
        • Rubin S
        • Roberts L
        • et al.
        Primary care patients’ preferences for reproductive health service needs assessment and service availability in New York Federally Qualified Health Centers.
        Contraception. 2020; 101: 226-230https://doi.org/10.1016/j.contraception.2019.12.003
        • Goldberg D
        • Sahgal B
        • Beeson T
        • Wood SF
        • Mead H
        • Abdul-Wakil A
        • et al.
        Patient perspectives on quality family planning services in underserved areas.
        Patient Exp J. 2017; 4: 54-65
        • Summit AK
        • Casey LMJ
        • Bennett AH
        • Karasz A
        • Gold M
        I don’t want to go anywhere else”: patient experiences of abortion in family medicine.
        Fam Med. 2016; 48: 30-34
        • Sochet T
        • Trussell J.
        Determinants of demand: method selection and provider preference among US women seeking abortion services.
        Contraception. 2008; 77: 397-404https://doi.org/10.1016/j.contraception.2008.02.003
        • Rayburn WF
        • Klagholz JC
        • Murray-Krezan C
        • Dowell LE
        • Strunk AL.
        Distribution of American congress of obstetricians and gynecologists fellows and junior fellows in practice in the United States.
        Obstet Gynecol. 2012; 199: 1017-1022https://doi.org/10.1097/AOG.0b013e31824cfe50
        • Cohen D
        • Coco A.
        Trends in the provision of preventative women's health services by family physicians.
        Fam Med. 2011; 43: 166-171
        • Lunde B
        • Smith P
        • Grewal M
        • Kumaraswami T
        • Cowett A
        • Harwood B.
        Long acting contraception provision by rural primary care physicians.
        J Women's Health. 2014; 23: 519-524https://doi.org/10.1089/jwh.2013.4286
        • Coffman M
        • Wilkinson E
        • Jabbarpour Y.
        Despite adequate training, only half of family physicians provide women's health care services.
        J Am Board Fam Med. 2020; 33: 186-188https://doi.org/10.3122/jabfm.2020.02.190293
      2. ACGME. ACGME Program Requirements for Graduate Medical Education in Family Medicine. 2020 . Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/120_FamilyMedicine_2020.pdf?ver=2020-06-29-161615-367 [accessed 5.3.21]

      3. ACGME. ACGME Program Requirements for Graduate Medical Educationin Internal Medicine. 2020. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/140_InternalMedicine_2020.pdf?ver=2020-06-29-161610-040 [accessed 5.3.21]

      4. ACGME. ACGME Program Requirements for Graduate Medical Education in Pediatrics. 2020. Available at: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/320_Pediatrics_2020.pdf?ver=2020-06-29-162726-647&ver=2020-06-29-162726-647 [accessed 2.24.22]

        • Davis SA
        • Braykov NP
        • Lathrop E
        • Haddad LB.
        Familiarity with long-acting reversible contraceptives among obstetrics and gynecology, family medicine, and pediatrics residents: results of a 2015 national survey and implications for contraceptive provision for adolescents.
        J Pediatr Adolescent Gynecol. 2018; 31: 40-44https://doi.org/10.1016/j.jpag.2017.09.007
        • Ostrowski KA
        • Holt SK
        • Haynes B
        • Davies BJ
        • Fuchs EF
        • Walsh TJ.
        Evaluation of vasectomy trends in the United States.
        Urology. 2018; 118: 76-79https://doi.org/10.1016/j.urology.2018.03.016
        • Saunders EC
        • Moore SK
        • Gardner T
        • Farkas S
        • Marsch LA
        • McLeman B
        • et al.
        Screening for substance use in rural primary care: a qualitative study of providers and patients.
        J Gen Intern Med. 2019; 34: 2824-2832https://doi.org/10.1007/s11606-019-05232-y
        • Jones RK
        • Jerman J.
        How far did US women travel for abortion services in 2008?.
        J Womens Health (Larchmt). 2013; 22: 706-713
      5. ACOG. Increasing Access to Abortion. Obstetrics & Gynecology. 2020;136(6):e107-e115. https://doi.org/10.1097/AOG.0000000000004176

        • Upadhyay UD
        • Schroeder R
        • Roberts SCM.
        Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19.
        Contracept X. 2020; 2 (PMID: 33305255; PMCID: PMC7718446)100049https://doi.org/10.1016/j.conx.2020.100049
        • Early pregnancy loss
        ACOG Practice bulletin no. 200. american college of obstetricians and gynecologists.
        Obstet Gynecol. 2018; 132: e197-e207
        • Vermeir E
        • Jackson LA
        • Marshall EG.
        Barriers to primary and emergency health care for trans adults.
        Culture, Health & Sexuality. 2017; 20: 232-246https://doi.org/10.1080/13691058.2017.1338757
        • Fix L
        • Durden M
        • Obedin-Maliver J
        • Moseson H
        • Hastings J
        • Stoeffler A
        • et al.
        Stakeholder perceptions and experiences regarding access to contraception and abortion for transgender, non-binary, and gender-expansive individuals assigned female at birth in the U.S.
        Archives of Sexual Behavior. 2020; 49: 2683-2702https://doi.org/10.1007/s10508-020-01707-w
        • Schreiber CA
        • Creinin MD
        • Atrio J
        • Sonalkar S
        • Ratcliffe SJ
        • Barnhart KT.
        Mifepristone pretreatment for the medical management of early pregnancy loss.
        N Engl J Med. 2018; 378: 2161-2170https://doi.org/10.1056/NEJMoa1715726