Do Community Health Centers Offer Full Range of Family Planning?

GW researchers surveyed and studied hundreds of centers across the country to find out.

susan wood professor community health centers study
Susan Wood, associate professor of health policy and executive director of the Jacobs Institute of Women’s Health.
March 13, 2013

Nearly all of the nation’s community health centers provide family planning services but just 1 in 5 offers access to a full range of contraceptive services, such as birth control, condoms and sexually transmitted infection screening and treatment, finds a new report from the George Washington University’s School of Public Health and Health Services.

The report—Health Centers and Family Planning: Results of a Nationwide Study—is the result of a survey of 423 health centers that receive federal grants, and in-depth case studies of six of those centers. Researchers from GW included Susan Wood, associate professor of health policy and executive director of the Jacobs Institute of Women’s Health, and Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy.

Researchers found 87 percent of all health centers provide a “typical” package of family planning methods, defined as dispensing birth control pills plus one other contraceptive method such as condoms, implants or intrauterine devices, along with offering sexually transmitted infection screening and treatment.

But it isn’t all good news: The study also found wide variation in the scope and quality of care, reporting that half of all health centers lack the ability to dispense birth control pills onsite, despite their high effectiveness and low cost.

“This report breaks new ground in our understanding of health centers’ role in family planning,” said Dr. Wood, the study’s lead author. “Our findings underscore the opportunities and challenges in strengthening access to this vital service.”

The findings are particularly important because of the vast number of patients—women in particular—community health centers see each year. In 2011, they saw more than 20 million patients; 60 percent were women and 25 percent were women of childbearing age. And with the implementation of the Affordable Care Act, the number of patients these centers serve is expected to double by 2019.

“Community health centers play a key role in delivering primary care, and family planning services always have been a core primary care service,” said Julio Bellber, president and CEO of the RCHN Community Health Foundation, which also contributed to the study. “Strengthening capacity and performance is essential.”

The report also found:

  • Family planning services are more likely to be comprehensive at larger health centers operating in urban or suburban neighborhoods, as well as those in Western states.
  • Participation in Title X—a federal grant program aimed at providing individuals with family planning and other preventative health services—is the strongest predictor of health center performance and onsite access to care, including counseling and education and a number of contraceptive options. Roughly 26 percent of all health centers participate in Title X.
  • The most comprehensive health center family planning programs tend to be located in states with more generous Medicaid adult coverage levels, as well as in states with policy environments that support women’s health.
  • Barriers like poverty and competing demands of patients threaten the scope and quality of family planning services at health centers.

The study authors also made a series of recommendations to improve care, including: developing clear practice guidelines for family planning; identifying areas in need of improvement in family planning practice and providing training for them; and fostering collaborations among community health centers, regardless of whether they participate in Title X.