Access to long-acting reversible contraceptives in community health centers

Community health centers (CHCs) represent the single largest primary care system in the U.S. with over 1,100 FQHCs providing primary care to approximately 20 million underserved patients across every state and territory. Women comprise 59 percent of health center patients, nearly half of whom are of childbearing age. In 2010, nearly 1.1 million patients received contraceptive management services (ICD-9 codes V25.xx) at FQHCs. Until recently, only limited data existed regarding the delivery of family planning and reproductive health services in CHC settings. In 2011, we surveyed 958 CHCs nationwide with a response rate of 44% (n = 423). We also conducted six in-depth case studies of health center organizations to explore challenges and barriers to providing family planning and reproductive health services in their respective communities. Results of the survey and case studies indicate that nearly all (9 out of 10) health centers provide some type of family planning services, but the scope of such services varies substantially. In particular, the provision of long-acting reversible contraceptives (LARCs) emerged as an area of need among health center populations. Our results demonstrate that while LARCs are often one of the more frequently requested forms of contraception by patients, health centers face significant barriers to providing these methods to their patients, such as the high cost of devices and inadequate reimbursement mechanisms. These findings have enormous implications for federal and state policy decisions regarding availability, funding, coverage of, and access to LARCs in community health center settings and among health center populations.