Abstract
BackgroundAccess to high-quality, comprehensive contraceptive care is an inherent component of reproductive human rights. However, hindrances to specific aspects of contraceptive provision, including availability, accessibility, acceptability, and quality, continue to perpetuate unmet needs. The state of Utah has recently passed a series of contraceptive policies intended to improve contraceptive access. Despite these positive changes to theoretical access, fiscal appropriations to support the implementation of these policies have been minimal, and many individuals still struggle to access contraception.ObjectiveThe Family Planning Elevated Contraceptive Access Program (FPE CAP), part of a larger statewide contraceptive initiative, specifically aims to improve contraceptive access within health clinics. This paper describes the study protocol for evaluating the success of FPE CAP.MethodsHealth clinics apply for membership in the FPE CAP. On acceptance in the program, they receive a cash grant for clinical supplies, equipment, and personnel expenses; reimbursement for contraceptive services and methods for eligible clients; technical support, training, and proctoring on counseling and providing all methods of contraception; method stocking of intrauterine devices and implants; and demand generation activities, including local media campaigns, to inform community members about the FPE CAP and possible eligibility. FPE collects monthly service delivery reports from participating clinics for evaluation purposes. The primary outcomes of FPE CAP are level and trend changes in contraceptive service delivery among individuals earning ≤138% federal poverty level (FPL) following membership in FPE CAP and among FPE CAP clients earning between 139% and 250% FPL (including those ineligible for Medicaid) compared with historical data and control clinics. To assess this, we will conduct comparative interrupted time series analyses assessing the level and trend changes in intervention and control clinics 12 months before the intervention, for the 2-year duration of the intervention, and for the subsequent 12 months following the intervention.ResultsWe found that the study is adequately powered (>80% power) with our planned number of clinics and the number of months of data available in the study. To date, we have successfully completed the recruitment and enrollment of 8 of the expected 9 health organizations and 4 of the control clinics. Completed health organization enrollment for both intervention and control organizations is expected to be completed in December 2020.ConclusionsThe study aims to provide insight into a new approach to contraceptive initiatives by addressing comprehensive aspects of contraceptive care at the health system level. Ongoing state policy changes and implementation components may affect the evaluation outcomes.International Registered Report Identifier (IRRID)DERR1-10.2196/18308
Highlights
BackgroundContraception has been a primary tool to achieve reproductive justice, allowing people to plan their families as they see fit [1]
The primary outcomes of Family Planning Elevated (FPE) Family Planning Elevated Contraceptive Access Program FPL (CAP) are level and trend changes in contraceptive service delivery among individuals earning ≤138% federal poverty level (FPL) following membership in Family Planning Elevated Contraceptive Access Program (FPE CAP) and among FPE CAP clients earning between 139% and 250% FPL compared with historical data and control clinics
In the United States, there have been a number of proactive family planning–friendly policies, including mandated contraceptive coverage by insurers, telehealth contraceptive counseling, web-based provision of short-acting hormonal methods such as oral contraception, over-the-counter availability of emergency contraception, and pharmacy dispensing authorization of hormonal contraception without prescriptions [2,3,4]
Summary
BackgroundContraception has been a primary tool to achieve reproductive justice, allowing people to plan their families as they see fit [1]. In the United States, there have been a number of proactive family planning–friendly policies, including mandated contraceptive coverage by insurers, telehealth contraceptive counseling, web-based provision of short-acting hormonal methods such as oral contraception, over-the-counter availability of emergency contraception, and pharmacy dispensing authorization of hormonal contraception without prescriptions [2,3,4]. Despite these advances, obstacles to comprehensive contraceptive access remain. Despite these positive changes to theoretical access, fiscal appropriations to support the implementation of these policies have been minimal, and many individuals still struggle to access contraception
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