Optimizing Access to Preventive Reproductive Health Care: Meeting Patients Where They Are At

ABSTRACT

PREVENTIVE REPRODUCTIVE HEALTH CARE BARRIERS Today, we hear ourselves repeating this wise attending's words while working in our hospital's family planning clinic in response to a question we sometimes hear from learners "Why do you think she waited so long to have her abortion?" Patients seeking abortion care and those pursuing preventive reproductive health care describe many of the same psychosocial, interpersonal, and structural barriers to obtaining care.1,2 Notable psychosocial challenges to obtaining care include medical mistrust and not prioritizing one's personal health amid competing demands;interpersonal barriers include parenting and caregiving for adult family members;and structural barriers include instability around insurance, transportation, and childcare.1 Although many barriers to seeking abortion and preventive reproductive health care coincide, those seeking abortion care face additional challenges, including stigma and antiabortion legal restrictions. The Turnaway Study was a landmark five-year longitudinal study that followed individuals who presented for abortion just before or after the gestational age limits at 30 abortion clinics across the United States.2 Participants who presented after the clinics' gestational age limits and were unable to obtain a desired abortion were more likely to experience economic hardship and report being in fair or poor health years later, compared with those who presented in time to obtain their desired abortion.2,3 Furthermore, what is often called the "wellwoman visit," which we refer to as the "preventive reproductive health visit" in recognition that not all individuals assigned female at birth identify as women, is an important opportunity to provide health screening, counseling, immunizations, contraception, and preconception care to help address individual and population-level reproductive health disparities.1 INNOVATIVE APPROACHES TO OVERCOMING BARRIERS Given the myriad interacting barriers individuals face in obtaining reproductive health care, innovative strategies to engage people in reproductive health care must prioritize meeting people where they are, figuratively and sometimes literally, to help them overcome their own context-specific barriers. [...]they implemented a program offering colocation of contraceptive services to mothers presenting for their young infants' well-baby visits. Importantly, preventive reproductive health care offers many potential health benefits but remains a downstream intervention that cannot fully mitigate long-standing, underlying structural and environmental factors that negatively affect individuals' reproductive health and contribute to population-level reproductive health disparities.