Self-identified barriers to providing comprehensive family planning services in Community Health Centers

Community health centers (also called federally qualified health centers under Medicaid and Medicare) serve nearly 20 million medically underserved patients annually, in every state and territory in the U.S. Women comprise 59 percent of health center patients, nearly half (47%) of whom are of childbearing age. While community health centers (CHCs) are required to provide family planning services and virtually all (99 percent) report provision contraceptive management/birth control or infertility treatment and counseling and education, either on-site or through referral arrangement, limited information exists on the challenges and barriers encountered in providing these services in a CHC setting.

GW undertook a national survey in 2011 of approximately 1,000 CHCs nationwide with a response rate of approximately 44%. The survey contained qualitative questions to understand the barriers CHCs face meeting the family planning needs of their patients. Thematic analysis of qualitative data revealed the most prominent barrier is financial; the high costs of devices and services such as IUDs, implants, and fertility treatments impact both CHCs ability to provide access to such services and patient ability to pay. CHCs also face difficulties providing confidential care to adolescent populations. State political climates, such as the defunding of certain types of clinics, and protests by community members opposed to family planning are also a barrier. CHCs have a continued commitment to provide comprehensive primary care, including family planning services, however, many barriers still exist to providing optimal access. Understanding these barriers presents an opportunity to address them.