Onsite provision of long-acting contraception: A comparison of Title X and non-Title X providers in California

Use of long-acting contraception (LAC) is recommended to reduce unintended pregnancy. Provision of LAC methods requires extra skill and training and clients are often referred elsewhere to obtain these services, presenting a barrier to accessing services. Family PACT, California's Medicaid family planning expansion, has a diverse provider network comprised of public sector providers receiving Title X funding, non-Title X funded public sector providers and private providers. This analysis explores the extent to which these three provider groups differ in their onsite provision of LAC, by using Family PACT claims data matched to results from a provider survey. A significantly greater proportion of providers from Title X-funded clinics provided onsite services for reversible methods and vasectomies: implants (58% Title X, 19% non-Title X, 7% private providers); intrauterine contraceptives (90% Title X, 51% non-Title X, 38% private); and vasectomies (8% Title X, 4% non-Title X, 1% private). The higher proportions among Title X providers were found regardless of clinic size, specialty or rural/urban location. A higher proportion of private providers (24%) had claims for tubal ligations which need to be provided at surgi-centers (4% Title X, 6% non-Title X); whereas there was no difference among the provider groups in offering tubal occlusions. Title X funding appears to play an important role in increasing access to LAC and enabling access to a wider range of contraceptive services. This data will be used to estimate averted births and saved costs that result from the increased likelihood of LAC use at Title X clinics.