Community Health Centers' Role in Family Planning

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Community Health Centers' Role in Family Planning Ruth Lesnewski, MD (bio), Lisa Maldonado, MA, MPH (bio), and Linda Prine, MD (bio) Whenever I see a woman who has an unintended pregnancy, I make a point of looking through her chart to see if she had a recent office visit. About 75% of the time, I find she did have a visit within the previous three months, but contraception was not addressed. —Family physician and medical director of a federally qualified health center Federally qualified health centers, also known as community health centers (CHCs), care for our nation's neediest populations. By latest count, 1,128 federally qualified health centers operate more than 8,500 sites serving 20.2 million men, women, and children.1 These numbers are expected to grow with expanded funding via the Patient Protection and Affordable Care Act. Community health centers are charged with providing a wide scope of preventive health services to people of all ages—including prenatal care, immunizations, cancer screening, and family planning.2 Community health centers form an integral part of the communities they serve. In some areas, these health centers offer the only medical resources available for miles around. Community health centers have demonstrated excellent outcomes in reproductive health. Community health center patients are less likely to have pre-term births or low-birthweight babies,3 and are more likely to obtain Pap tests and mammograms than other low-income patients.4 However, CHCs' effectiveness at providing family planning services is unclear. A 2001 study5 by the Guttmacher Institute found that only 60% of CHC sites provided contraception. Community health centers provided contraception to about 28% of their female patients of reproductive age. More recent studies by Guttmacher and others found that while most publicly funded clinics offered oral contraceptives, CHCs were less likely to provide the most effective contraceptive methods (namely the IUD and implant) and were not as likely to follow evidence-based contraceptive practices such as quick start (that is, same-day initiation of contraception).6 The role of CHCs in caring for our nation's most underserved populations is unquestioned. Community health centers serve one in five low-income women7 and are also more likely than other publicly funded family planning providers to serve men, special [End Page 429] needs groups, minorities, and patients with limited English proficiency.6 Yet, CHCs can do more to prevent unintended pregnancy in the United States. The Impact of Unintended Pregnancy We know a lot about unintended pregnancy in the United States. We know that most families in the United States want two children. We know that most people want to plan childbearing and avoid unintended pregnancies.8 One way of looking at this is that most women spend about 75% of their reproductive years trying to avoid pregnancy.9 We also know that nearly half of all pregnancies in the United States are unintended.10 Our rate of unintended pregnancy is far higher than that of most other developed nations. We know that poor and low-income women, the very women CHCs serve, are much more likely to experience an unintended pregnancy than other women.11 Unintended pregnancy can have lasting consequences. In 2001, the latest year of available data, 3.1 million unintended pregnancies in the U.S. resulted in 1.3 million abortions, 400,000 miscarriages, and 1.4 million births. Women with unintended pregnancies are less likely than women with intended pregnancies to initiate prenatal care promptly,12 to quit smoking cigarettes,2,13 to consume adequate amounts of folic acid,14 and to breastfeed their infants.15 Teens who have a child are less likely than others to graduate from high school or complete college.16 Children born of unintended pregnancies are more likely to have a premature birth, to die in the first year of life, to suffer abuse, and to fail in school.17 Consistent use of effective contraception can make a difference. Most women who experience unintended pregnancies are not using contraception at all or are using it inconsistently during the month of their conception.18 Teen pregnancy rates have dropped to all-time lows as a result of increased access to...