Alabama has one of the highest proportions of pregnant people who do not want to be pregnant, many of whom are low-income and live in contraceptive deserts. A new study revealed that a public health commitment to providing intrauterine devices (IUDs) at Title X clinics helped increase access to long-acting reversible contraception (LARC) across the state.1
Researchers surveyed clinic administrators at Alabama Department of Public Health (ADPH) Title X clinics in 2017 and 2020, asking them about their clinic’s contraceptive care practices and protocols in 2016 and 2019.
“Almost all of the Title X clinics completed the survey, so we had strong data at two different time points,” says Michael G. Smith, DrPH, MSPH, lead study author and an associate professor in the department of health services management and policy at the East Tennessee State University College of Public Health.
The surveys captured information about contraceptive access both before and after the ADPH began allocating Title X funding to IUD provision in 2019. Before 2019, IUDs were not provided, Smith notes.
“From a contraceptive equity and reproductive justice standpoint, providing that full range of contraceptive options was important to the folks in the department of public health,” Smith says. “They wanted to provide IUDs and a full range of methods but did not have new resources to do it.”
The solution was to use existing resources through Title X. “They used Title X programs to train nurse practitioners to provide IUDs and to remove IUDs for patients when it was not working out well as their method of contraception,” Smith explains. “This was implemented statewide. Our surveys showed that IUD provision increased from 7% to 69% of clinics.”
As a result of training nurse practitioners, physician assistants, and certified nurse midwives on IUD placements and removals, the percentage of sites with trained non-physician providers able to place IUDs increased from 4% to 75%. The percentage of clinics that stockpiled IUDs onsite increased from 3% to 89%. The number of providers trained in same-visit IUD placements/removals increased from 2% to 66%.
“We had been working with the Alabama Department of Public Health for a few years. Based on that collaborative relationship, we knew they would make a change, and we worked with them to collect data to evaluate the impact of this policy change they would be making,” Smith explains. “That’s what led to conducting this study — the existing relationship and knowing they would work to improve access within Title X clinics.”
Alabama was behind the times in improving access to IUDs through Title X programs, Smith notes. It is an example of a state health department improving contraception access without any new influx of funds to support it.
“They were reallocating existing funds and developing training protocols and a train-the-trainer system within their network,” he says.
Training includes showing practitioners how to counsel on the full range of contraceptive methods in an equitable and non-coercive way.
“There also are confidentiality concerns, which is something that’s been a recent issue with Title X that, traditionally, has provided contraceptive services for everyone,” Smith says. “But there was a recent federal ruling in Texas about whether or not Title X should be able to provide contraceptive care to individuals less than 18 years of age without parental permission.”
Full access to contraception through Title X and other programs is important since the overturn of Roe v. Wade. “It’s especially important in the policy environment right now,” Smith says. “Alabama passed a total abortion ban that went into effect after the Supreme Court’s Dobbs decision.”
Patients in every county in the state should have access to a full range of contraceptive options, Smith adds.
REFERENCE
- Smith MG, Beatty KE, Khoury AJ, et al. Increases in IUD provision at Alabama Department of Public Health Clinics from 2016 to 2019. J Public Health Manag Pract 2023;29:E176-E180.
Alabama has one of the highest proportions of pregnant people who do not want to be pregnant, many of whom are low-income and live in contraceptive deserts. A new study revealed that a public health commitment to providing intrauterine devices at Title X clinics helped increase access to long-acting reversible contraception across the state.
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