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Community Health Centers’ Practices, Barriers, and Facilitators for Providing a 1-Year Supply of Oral Contraception on Site

  • Julia Strasser
    Correspondence
    Correspondence to: Julia Strasser, DrPH, MPH, Department of Health Policy and Management, The George Washington University Milken Institute School of Public Health, 2175 K St NW, Washington, DC 20036. Phone: 202-431-9728.
    Affiliations
    Department of Health Policy and Management, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia
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  • Anne Markus
    Affiliations
    Department of Health Policy and Management, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia
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  • Susan F. Wood
    Affiliations
    Department of Health Policy and Management, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia
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      Abstract

      Introduction

      High-quality family planning services help women to achieve their preferred family size and birth spacing, which in turn leads to improved health outcomes and better quality of life. This study investigates whether women have access to a 1-year supply of oral contraceptives (OCs) on site when they receive care at community health centers and whether states require coverage for a 1-year supply.

      Methods

      This study used a concurrent, mixed-methods approach, with a single phase of quantitative research (survey of health centers) and two phases of qualitative research (50-state policy environment scan and in-depth interviews).

      Results

      Only three states require coverage for a 1-year supply of OCs under all Medicaid and private insurance coverage mechanisms; the majority of states limit it through at least one mechanism. The survey found that 50.9% of health centers provided OCs on site, and of these, only 29.9% offered up to a 1-year supply at a time. An analysis of interviews revealed that clinician and pharmacist preferences and the organization's overall approach to family planning played a role in these practices.

      Conclusion

      This study finds that that only a minority of health centers provide a 1-year supply on site and that a minority of states have rules requiring coverage for a 1-year supply of OCs. To remedy these gaps, change is needed at multiple levels, including health center practices, clinician knowledge and beliefs, federal agency guidance, and state-level insurance policy.
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      Biography

      Julia Strasser, DrPH, MPH, is a Senior Research Scientist in the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University Milken Institute School of Public Health. Her research interests include reproductive health, Medicaid, and community health centers.

      Biography

      Anne Rossier Markus, PhD, MHS, JD, is Professor and Chair, Department of Health Policy and Management, The George Washington University Milken Institute School of Public Health. Her research focuses on the financing and organization of health care and access to quality care.

      Biography

      Susan F. Wood, PhD, is Research Professor of Health Policy and Management and Director, Jacobs Institute of Women's Health, The George Washington University Milken Institute School of Public Health. Her research focuses on women's health and the use of science in health policy making.