Onsite provision of specialized contraceptive services: does Title X funding enhance access?

BACKGROUND: This article presents the extent to which providers enrolled in California's Family Planning, Access, Care, and Treatment (Family PACT) program offer contraceptive methods onsite, thus eliminating one important access barrier. Family PACT has a diverse provider network, including public-sector providers receiving Title X funding, public-sector providers not receiving Title X funding, and private-sector providers. We explored whether Title X funding enhances providers' ability to offer contraceptive methods that require specialized skills onsite. METHODS: Data were derived from 1,072 survey responses to a 2010 provider-capacity survey matched by unique identifier to administrative claims data. RESULTS: A significantly greater proportion of Title X-funded providers compared to non-Title X public and private providers offered onsite services for the following studied methods: intrauterine contraceptives (90% Title X, 51% public non-Title X, 38% private); contraceptive implants (58% Title X, 19% public non-Title X, 7% private); vasectomy (8% Title X, 4% public non-Title X, 1% private); and fertility-awareness methods (69% Title X, 55% public non-Title X, 49% private) (all p<0.0001). The association between onsite provision and Title X funding remained after stratifying individually by clinic specialty, facility capacity to provide reproductive health services (based on staffing), and rural/urban location. CONCLUSIONS: Extra funding for publicly funded family-planning programs, through mechanisms such as Title X, appears to be associated with increased onsite access to a wide range of contraceptive services, including those that require special skills and training.

Postpartum contraception in publicly-funded programs and interpregnancy intervals.

OBJECTIVE: To assess the extent to which women received contraceptive services within 90 days after birth at their first or subsequent visits and whether contraceptive provision was associated with optimal interpregnancy intervals. METHOD: We linked California's 2008 Birth Statistical Master File with Medicaid databases to build a cohort of women aged 15-44 years who had given birth in 2008 and received publicly-funded health care services in the 18 months after their previous live birth (N=117,644). We determined whether provision of contraception within 90 days after birth was associated with optimal interpregnancy intervals when controlling for covariates. RESULT: Only 41% (n=48,775) of women had a contraceptive claim within 90 days after birth. To avoid short interpregnancy intervals, 6 women would need to receive contraception to avoid one additional short interval (number needed to treat=6.38). Receipt of a contraceptive method, receiving contraception at the first clinic visit, and being seen by Medi-Cal and its family planning expansion program were significantly associated with avoidance of short interpregnancy intervals. Receiving contraception at the first postpartum clinic visit had an additional independent effect on avoiding short interpregnancy intervals when controlling for the other variables. Although foreign-born women had 47% higher odds of avoiding short interpregnancy intervals than U.S.-born women, women of Asian and Pacific Islander ethnicity had 24% lower odds of avoiding short interpregnancy intervals than white women. CONCLUSION: Findings of this study suggest that closer attention to provision of postpartum contraception in publicly-funded programs has the potential to improve optimal interpregnancy intervals among low-income women. LEVEL OF EVIDENCE: II.