Catherine Lindsey Satterwhite1, Valerie French2, Molly Allison3, Tanya Honderick4, Megha Ramaswamy5. 1. University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160; University of Kansas School of Medicine, Department of Obstetrics and Gynecology, 3901 Rainbow Blvd, MS: 2028, Kansas City, KS 66160. Electronic address: csatterwhite@kumc.edu. 2. University of Kansas School of Medicine, Department of Obstetrics and Gynecology, 3901 Rainbow Blvd, MS: 2028, Kansas City, KS 66160. Electronic address: vfrench@kumc.edu. 3. University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160. Electronic address: mallison2@kumc.edu. 4. University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160. Electronic address: thonderick@kumc.edu. 5. University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160. Electronic address: mramaswamy@kumc.edu.
Abstract
OBJECTIVE: Describe contraception availability at local health departments (LHDs) serving largely rural populations. STUDY DESIGN: We invited administrators at LHDs located in four Midwest states to participate in an online survey conducted from September 2017-April 2018. We collected data on clinic staffing, patient population, receipt of Title X funds, and services provided to assess the proportion of LHDs providing any prescription method of contraception; secondary outcomes included healthcare staff training level and other reproductive health services provided. RESULTS: Of 344 LHDs invited, 237 administrators completed the survey (68.9%). Three-quarters served rural populations. One-third (34.6%) provided short-acting hormonal contraception; however, availability varied by state (Kansas: 58.0%, 40/69; Missouri: 37.5%, 33/88; Nebraska: 16.7%, 3/18; Iowa: 9.7%, 6/62; p<.01). Only 8.4% of LHDs provided IUDs; 7.6% provided implants, and 5.9% provided both methods. LHDs in Nebraska and Kansas provided any long-acting method more frequently (Kansas: 17.4%, Nebraska: 16.7%, Iowa: 8.1%, Missouri: 4.6%; p=.04). LHDs receiving Title X funds (27.0%) were much more likely to provide any prescription contraception (85.1% vs. 14.2%, p<.01). Most LHDs relied on registered nurses (RNs) to provide medical care; 81.0% reported that RNs provided care≥20 days per month. Pregnancy testing was widely available in Missouri and Kansas (>87%) and less commonly available in Iowa and Nebraska (<18%) (p<.01). CONCLUSION: LHDs in these states are currently ill-equipped to offer comprehensive contraceptive services. Women seeking care at LHDs have limited, if any, contraceptive options. IMPLICATIONS: Local health departments in the Midwest, serving a largely rural population, rarely offer prescription contraception, especially long-acting reversible methods. Women residing in settings without broad access to publicly-funded healthcare providers may have limited access to comprehensive contraceptive services. Efforts to ensure rural access are needed.
OBJECTIVE: Describe contraception availability at local health departments (LHDs) serving largely rural populations. STUDY DESIGN: We invited administrators at LHDs located in four Midwest states to participate in an online survey conducted from September 2017-April 2018. We collected data on clinic staffing, patient population, receipt of Title X funds, and services provided to assess the proportion of LHDs providing any prescription method of contraception; secondary outcomes included healthcare staff training level and other reproductive health services provided. RESULTS: Of 344 LHDs invited, 237 administrators completed the survey (68.9%). Three-quarters served rural populations. One-third (34.6%) provided short-acting hormonal contraception; however, availability varied by state (Kansas: 58.0%, 40/69; Missouri: 37.5%, 33/88; Nebraska: 16.7%, 3/18; Iowa: 9.7%, 6/62; p<.01). Only 8.4% of LHDs provided IUDs; 7.6% provided implants, and 5.9% provided both methods. LHDs in Nebraska and Kansas provided any long-acting method more frequently (Kansas: 17.4%, Nebraska: 16.7%, Iowa: 8.1%, Missouri: 4.6%; p=.04). LHDs receiving Title X funds (27.0%) were much more likely to provide any prescription contraception (85.1% vs. 14.2%, p<.01). Most LHDs relied on registered nurses (RNs) to provide medical care; 81.0% reported that RNs provided care≥20 days per month. Pregnancy testing was widely available in Missouri and Kansas (>87%) and less commonly available in Iowa and Nebraska (<18%) (p<.01). CONCLUSION: LHDs in these states are currently ill-equipped to offer comprehensive contraceptive services. Women seeking care at LHDs have limited, if any, contraceptive options. IMPLICATIONS: Local health departments in the Midwest, serving a largely rural population, rarely offer prescription contraception, especially long-acting reversible methods. Women residing in settings without broad access to publicly-funded healthcare providers may have limited access to comprehensive contraceptive services. Efforts to ensure rural access are needed.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Karen B DeSalvo; Patrick W O'Carroll; Denise Koo; John M Auerbach; Judith A Monroe Journal: Am J Public Health Date: 2016-04 Impact factor: 9.308
Authors: James Trussell; Anjana M Lalla; Quan V Doan; Eileen Reyes; Lionel Pinto; Joseph Gricar Journal: Contraception Date: 2008-09-25 Impact factor: 3.375
Authors: Abigail Liberty; Kimberly Yee; Blair G Darney; Ana Lopez-Defede; Maria I Rodriguez Journal: Am J Obstet Gynecol Date: 2019-12-14 Impact factor: 8.661