Title X Improved Access To Most Effective And Moderately Effective Contraception In US Safety-Net Clinics, 2016–18

Darney, Blair G.; Biel, Frances M.; Hoopes, Megan; Rodríguez, María I.; Hatch, Brigit; Templeton, Anna; Oakley, Jee; Schmidt, Teresa; Cottrell, Erika

doi:10.1377/hlthaff.2021.01483

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…Furthermore, many studies primarily focused on barriers experienced by adolescents rather than all individuals of reproductive age. Still fewer focused on a broad spectrum of reproductive health services, such as Papanicolaou tests or sexually transmitted infection testing and treatment, with most focusing on contraceptive access . Of the studies that focused on policy changes, some evaluated outcomes associated with delivery of services from the perspective of clinics and clinicians rather than the experiences of patients accessing care .…”

Section: Introductionmentioning

confidence: 99%

“…Still fewer focused on a broad spectrum of reproductive health services, such as Papanicolaou tests or sexually transmitted infection testing and treatment, 9 with most focusing on contraceptive access. 12 Of the studies that focused on policy changes, some evaluated outcomes associated with delivery of services from the perspective of clinics and clinicians rather than the experiences of patients accessing care. 13 No studies have been published to our knowledge that were nationally representative or compared similarly representative study populations over 2 periods.…”

Section: Introductionmentioning

confidence: 99%

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Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021

Adler

Biggs²,

Kaller³

et al. 2023

JAMA Netw Open

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ImportancePrevious research has documented individual-level barriers to reproductive health services, but few studies have examined national trends.ObjectiveTo determine whether the number and type of barriers to reproductive health care experienced by US women of reproductive age changed from 2017 to 2021.Design, Setting, and ParticipantsThis cross-sectional study used serial survey data, weighted to be nationally representative, collected in August 2017 and December 2021 from members of Ipsos’s KnowledgePanel who were aged 18 to 49 years and assigned female at birth.ExposuresHaving experienced barriers to reproductive health care over the past 3 years.Main Outcomes and MeasuresThe primary outcome was number and type of barriers to reproductive health care services, including Papanicolaou tests or birth control, experienced in the past 3 years. Increases in barriers to reproductive health care were measured using multivariable linear regressions adjusted for age, race and ethnicity, education level, employment status, metropolitan area, geographic region, household income, and language (English vs Spanish).ResultsOf 29 496 KnowledgePanel members invited, 7022 (mean [SD] age, 33.9 [9.0] years) and 6841 (mean [SD] age, 34.2 [8.6] years) completed the 2017 and 2021 surveys (50% and 45% response rates, respectively). Among 12 351 participants who indicated that they had ever tried accessing reproductive health services, 35.9% (95% CI, 34.8%-37.0%) were aged 30 to 39 years; 5.5% (95% CI, 4.9%-6.2%) were Asian or Pacific Islander, 13.7% (95% CI, 12.8%-14.6%) were Black, 19.1% (95% CI, 18.1%-20.1%) were Hispanic, 58.2% (95% CI, 57.0%-59.5%) were White, and 3.5% (95% CI, 3.1%-4.0%) were multiracial or of other race or ethnicity; and 11.7% (95% CI, 11.0%-12.5%) were living below 100% of the federal poverty level. Covariate distribution was similar across years. In bivariable analyses, participants were more likely to report experiencing a given barrier in the past 3 years in 2021 than in 2017 for all but 2 barriers. More people experienced 3 or more barriers in 2021 (18.6%; 95% CI, 17.3%-20.0%) than in 2017 (16.1%; 95% CI, 14.9%-17.4%) (P = .008). In multivariable analyses, the mean number of barriers increased significantly from 1.09 (95% CI, 1.02-1.14) in 2017 to 1.29 (95% CI, 1.22-1.37) (P &lt; .001) in 2021. Participants who were aged 25 to 29 years (0.42; 95% CI, 0.37-0.47), identified as Hispanic (0.41; 95% CI, 0.38-0.45), had no high school diploma or General Educational Development test (0.62; 95% CI, 0.53-0.72), lived below 100% of the federal poverty level (0.65; 95% CI, 0.55-0.73), and took the survey in Spanish (0.87; 95% CI, 0.73-1.01) saw the greatest increases in mean number of barriers between 2017 and 2021.Conclusions and RelevanceThe study findings suggest that barriers to reproductive health care increased between 2017 and 2021, with the largest increases observed among individuals from historically disadvantaged populations. Efforts are needed to ensure that reproductive health care access remains a priority.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021

Adler

Biggs²,

Kaller³

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…Title X grantees must also provide appropriate and adequate training to ensure that providers deliver services in accordance with Title X policies. Title X clinics are known to expand access to contraception and especially most effective methods using current quality metrics, but it is less clear how Title X clinics perform on delivering patient-centered care [22][23][24][25][26]. The purpose of this study is to describe receipt of person-centered contraceptive counseling, using the PCCC measure, among a nationallyrepresentative U.S. sample of reproductive-aged women who sought family planning services at Title X clinics, non-Title X public clinics, and private clinics.…”

Section: Introductionmentioning

confidence: 99%

Association of Title X clinic status with receipt of person-centered contraceptive counseling: A population-based study

Hansen

Boniface²,

Darney³

2022

Contraception

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“…This study adds to a body of evidence about the important role that community health centers play in providing access to contraceptive services, 18–20 including switching methods and LARC removal, in the United States. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.…”

Section: Discussionmentioning

confidence: 94%

“…7,9,15,16 Community health centers, which include Federally Qualified Health Centers and Federally Qualified Health Center look-alikes, 17 are an important access point for contraceptive services for people with low incomes 18,19 regardless of insurance status or ability to pay. 18,20 Furthermore, some community health centers participate in the federal Title X program, which provides greater access to the most effective reversible methods than community health centers without Title X funding. 20 However, less is known about real-world patterns of method switching and access to LARC removal in the population served by community health centers; this study fills this gap with a large, diverse sample of patients seeking contraceptive services in community health centers.…”

mentioning

confidence: 99%

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016–2021

Darney

Biel

Oakley

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To describe patterns of contraceptive method switching and long-acting reversible contraception (LARC) removal in a large network of community health centers. METHODS: We conducted a retrospective cohort study using individual-level electronic health record data from 489 clinics in 20 states from 2016 to 2021. We used logistic regression models, including individual-, clinic-, and state-level covariates, to calculate adjusted odds ratios and predicted probabilities of any observed contraceptive method switching and LARC removal among those with baseline incident LARC, both over 4-year time periods. RESULTS: Among 151,786 patients with 513,753 contraceptive encounters, 22.1% switched to another method at least once over the 4-year observation period, and switching patterns were varied. In patients with baseline LARC, the adjusted predicted probability of switching was 19.0% (95% CI 18.0–20.0%) compared with patients with baseline moderately effective methods (16.2%, 95% CI 15.1–17.3%). The adjusted predicted probability of switching was highest among the youngest group (28.6%, 95% CI 25.8–31.6% in patients aged 12–14 years) and decreased in a dose–response relationship by age to 8.4% (95% CI 7.4–9.4%) among patients aged 45–49 years. Latina and Black race and ethnicity, public or no insurance, and baseline Title X clinic status were all associated with higher odds of switching at least once. Among baseline LARC users, 19.4% had a removal (to switch or discontinue) within 1 year and 30.1% within 4 years; 97.6% of clinics that provided LARC also had evidence of a removal. CONCLUSION: Community health centers provide access to method switching and LARC removal. Contraceptive switching and LARC removal are common, and clinicians should normalize switching and LARC removal among patients.

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Title X Improved Access To Most Effective And Moderately Effective Contraception In US Safety-Net Clinics, 2016–18

Cited by 14 publications

References 35 publications

Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021

Changes in the Frequency and Type of Barriers to Reproductive Health Care Between 2017 and 2021

Association of Title X clinic status with receipt of person-centered contraceptive counseling: A population-based study

Contraceptive Method Switching and Long-Acting Reversible Contraception Removal in U.S. Safety Net Clinics, 2016–2021

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