Family planning quality improvement projects in Healthy Start communities

Background: Federally funded Healthy Start infant mortality reduction projects now operate in 102 communities. Each is required to have an interconception care component focused on higher-risk women for the 24 months following an index pregnancy. Healthy Start participants are more likely than the general population to be low-income and/or women of color and to be at higher risk for unplanned pregnancies. Evidence shows that adequately spacing pregnancies leads to better outcomes. Healthy Start projects offer family planning counseling, if desired, and refer women participants to community providers.

Methodology: The Interconception Care Learning Community (or “ICC LC”) adapted the Institute of Healthcare Improvement (IHI) model for quality improvement to Healthy Start community-based efforts. Teams from 102 projects are organized into 16 learning collaboratives which bring together geographically disparate teams to achieve common goals. Three learning collaboratives selected “family planning/reproductive health” for the first of three action periods. Change concepts are: Community Linkages and Partnerships, Implementation of Evidence-Based Tools and Protocols, and finally, Staff Training and Skill Development.

Results: Each team implemented a Plan-Do-Study-Act (PDSA) cycle and collected data to measure its change. Initiation of linkages with family planning providers, use of “Reproductive Life Plan” tools, intensive family planning education integrated with case management, provision of birth control after delivery, and training on contraceptive methods for community health workers have been reported.

Discussion: This presentation will describe several innovative community-based strategies aimed at reducing unplanned pregnancy during the interconception period; highlighting barriers and opportunities encountered. Implications for public health will be discussed.