Community Health Centers’ Response to Family Planning Needs in the Era of Health Reform

BACKGROUND Community health centers represent the nation’s largest delivery system for low-income individuals and families, including six million women of reproductive age. However, the changing landscape of health policy over the last several years has made health centers’ capacity to respond to women’s health needs unclear. This study aims to explore the challenges, barriers, opportunities, and successful models of family planning service delivery in health center settings in the context of rapidly shifting state and federal policy. METHODS Using a comparative case study approach, we conducted in-depth site visits at four community health centers from distinct geographic regions in different policy climates. We conducted semi-structured interviews with clinical, administrative, and executive staff members. Two investigators conducted thematic content analysis of interview transcripts until consensus on key themes emerged. RESULTS Within-case and cross-case themes encompass: perceptions of and responses to community-based reproductive health needs; models of family planning care; and the impact of federal and state policies on health center operations. Staff at all health centers described patient preferences as influencing the scope of family planning services and supplies available at their health centers. Although all health centers provided some level of family planning care, staffing patterns differed; some sites created a family planning team or employed dedicated reproductive healthcare staff, while others incorporated family planning into the same processes as their general primary care practice. Some health center staff considered family planning a portal of entry into primary care, while others perceived primary care as an entry point for family planning. All health centers described challenges related to uncertainty and instability in state and federal policy, including the Affordable Care Act, and a need for flexibility in response to continuing policy changes. Finally, leadership staff who are invested in family planning and see its value serve as a facilitator for high performance and as a key component of a health center’s ability to navigate the current policy climate. IMPLICATIONS Community health centers provide essential health services for women of reproductive age. This study identifies commonalities and differences in health centers’ approaches to family planning in a time of policy uncertainty. It also identifies barriers to and facilitators of providing family planning care that is responsive to community needs. As federal and state policies continue to shift, the findings from this study provide emerging models of care and best practices that can be implemented in health centers around the country