Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences

Abstract

Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Materials and Methods: Interviews were conducted with FQHC staff ( n = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded via at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Results: Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. Conclusions: The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.

Increases in IUD Provision at Alabama Department of Public Health Clinics From 2016 to 2019

“…These changes have resulted in large, statistically significant increases in in-clinic provision of IUDs and provider training for device placements/removals. Sustainability of funding has been found to be a driver of both IUD provision and provider training 13. Therefore, reallocating funds from an existing funding source should make these changes easier to sustain.…”

“…Sustainability of funding has been found to be a driver of both IUD provision and provider training. 13 Therefore, reallocating funds from an existing funding source should make these changes easier to sustain.…”

Barriers and Facilitators to Implementing Immediate Postpartum Contraceptive Implant Programs: A Formative Implementation Research

“…This finding is consistent with a recent qualitative study conducted with staff involved in the Postpartum Contraceptive Access Initiative in the US. 21 Hofler et al 13 also described the financial concerns regarding the reimbursement system and providers perceived that insurers should proceed first. Allowing for reimbursement would improve access to hormonal contraceptives.…”

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

“…6,7 Although safety-net clinics provide an important point of access for reproductive health care for people with lower incomes in the state, the range of services and contraceptive methods available vary widely among clinics. [8][9][10][11] In 2016, fewer than 1 in 10 FQHCs in South Carolina offered the full range of contraceptive methods (intrauterine devices [IUDs], implants, pills, patch, ring, hormonal injection, diaphragm, and condoms), and IUDs were the least available method, with only 37% of the 19 Choose Well participating FQHCs surveyed offering any IUD on site. 9,10 At midline of the formal implementation period (2019), significant increases in provision of the full range of contraceptive methods among Choose Well participating FQHCs in South Carolina were noted, with 85% of 48 Choose Well participating FQHCs offering IUDs on site.…”

“…Although safety-net clinics provide an important point of access for reproductive health care for people with lower incomes in the state, the range of services and contraceptive methods available vary widely among clinics . In 2016, fewer than 1 in 10 FQHCs in South Carolina offered the full range of contraceptive methods (intrauterine devices [IUDs], implants, pills, patch, ring, hormonal injection, diaphragm, and condoms), and IUDs were the least available method, with only 37% of the 19 Choose Well participating FQHCs surveyed offering any IUD on site .…”