Study Examines Reasons Women Choose Specialized Family Planning Clinics

November 29, 2012 — "Specialized Family Planning Clinics in the United States: Why Women Choose Them and Their Role in Meeting Women's Health Care Needs," Frost et al., Women's Health Issues, Nov. 9, 2012.

Publicly funded family planning clinics in the U.S. provide contraceptive services to more than seven million women annually, many of whom have no other regular source of medical care, according to Jennifer Frost and colleagues from the Guttmacher Institute.

Publicly funded family planning clinics can be divided into those that specialize in reproductive health care services and those that provide contraceptive services in a broader primary care context. The specialized clinics include health departments, hospital clinics, Planned Parenthood clinics and other community women's health clinics. Most of the primary care clinics are federally qualified health centers, and some are at hospitals and health departments.

Although much is known about the importance of publicly funded family planning clinics, "little is known about the reasons that are important to women when choosing one family planning clinic over another," the researchers wrote. They conducted a survey of women who attended specialized family planning clinics to discover their reasons for obtaining care at the facilities and what types of care they received.

Methods

The study included responses from 2,094 women who obtained health care services at a nationally representative sample of 22 family planning clinics in 13 states from October 2011 through January 2012. Participating clinics were reproductive health-focused and located in communities that also had comprehensive primary care providers.

Participants responded to a four-page questionnaire that asked about their reason for their visit, why they chose the specific facility, what medical care they received in the past year and where they had received health care services in the past year.

Results

Most of the women were younger than age 25, with 22% in their teens and 34% between ages 20 and 24. More than half had no children, and nearly two-thirds were not married or living with a partner. About 51% were white, 21% were black and 23% were Latina. Twenty-five percent had incomes between 100% and 200% of the federal poverty level and 61% had incomes below 100% of the poverty level. One-third of participants had some type of public health insurance, such as Medicaid, while 22% were enrolled in private health insurance and 42% were uninsured. Forty-eight percent of respondents said their main reason for visiting the clinic was related to contraception, such as choosing a new method or discussing their current method. Twenty-seven percent said they visited the clinic for an annual gynecological exam, 10% visited for a pregnancy test, 8% were there for STI care and 7% needed other services.

About 64% of the women had obtained an annual gynecological exam within the past year, and nearly half had received an STI test or treatment in the past year. Only 12% had not visited a medical provider within the past year.

Out of 18 options for why they chose the family planning clinic instead of another provider, at least 80% of the women said they chose it because the staff is respectful, care is confidential, low- or no-cost services are available, and staff members are knowledgeable about women's health care. Among teens, the availability of confidential services was the top reason (86%), while low- or no-cost services was the most common choice among uninsured women (90%). Eighty-nine percent of women said they chose a family planning clinic because of its location, hours or wait time. "Accessible, affordable, confidential care, delivered by respectful staff who are knowledgeable about contraceptive and reproductive health, was considered very important by the vast majority of respondents from all major demographic subgroups," the researchers wrote.

Discussion

The findings illustrate the role of specialized family planning clinics in the U.S. health care safety net, the researchers wrote, noting that the surveyed women chose to obtain care at these clinics, even when other providers were available. Although the women gave several reasons for choosing specialized family planning clinics, a common theme across all demographic subgroups was the "desire to be accorded respect."

Many women also cited the clinics' knowledgeable staff and the availability of several contraceptive methods on location, without having to make a separate trip to the pharmacy. The authors noted that other research has found that specialized family planning clinics offer a larger range of contraceptive methods and "are more likely to have implemented streamlined method dispensing protocols," compared with primary care clinics.

Confidentiality also was important to women, particularly teens. Notably, one in five insured women did not plan to use their insurance to pay for their care because of confidentiality concerns. The researchers noted that insurance companies' procedures, particularly the practice of sending an explanation of benefits to the policyholder "make it virtually impossible for someone insured as a dependent," such as a child or spouse, "to access confidential care."

About six in 10 of the women had received some health care from another provider over the past year, while the remaining four in 10 said the family planning clinic was their only source of health care. For these women, the clinics serve "as an entry point to the health care system," which impose on the clinics "a vital obligation." Family planning clinics must be prepared to connect women with insurance programs or other health care. Almost all of the specialized clinics regularly refer patients to local primary care providers.

The findings "point to possible strategies for restructuring family planning clinic services in the new health care environment," as the Affordable Care Act is implemented. For instance, clinics could collaborate with comprehensive health care providers, such as FQHCs, which could help alleviate some of the pressure on the centers to respond to the increased demand for care expected under the ACA. This would take some of the pressure off of FQHCs, while also allowing women to get contraceptive services from their preferred provider.