ICAN! Project Improved Reproductive Care at Several Illinois FQHCs
Train providers in reproductive justice
December 1, 2023 6 minutes read
EXECUTIVE SUMMARY
Less access to traditional family planning clinics in many states has created a greater need for public and private primary care providers to offer comprehensive contraceptive care.
- Research into a demonstration project by the Illinois Contraceptive Access Now (ICAN!) project found a 16% improvement in contraceptive care access after providers received training.
- The ICAN! project also works on community outreach and changing state policies to enable effective contraceptive access.
- Provider training focuses on the principles of reproductive justice and modern forms of contraception.
More than 19 million women of reproductive age in the United States live in a contraception desert. With many of these located in states that ban abortion, there is an even greater need for access to high-quality contraceptive care.1
“Access to high-quality reproductive healthcare is a human right, and everybody deserves to have access,” says Debra Stulberg, MD, professor and chair in the department of family medicine at the University of Chicago.
People deserve to visit a clinic or physician’s office near their home, where contraceptive care is affordable, and clinicians and providers are respectful, responsive, and provide high-quality care.
“In a setting where people’s ability to exercise their bodily autonomy is already restricted by abortion restrictions and criminalizing pregnancy, the ability to prevent an unwanted pregnancy comes into even sharper relief,” Stulberg adds. “It can be lifesaving for women.”
Even in states with pro-contraception and abortion access laws, such as Illinois, birth control can be out of reach for many women. For instance, about half a million people in Illinois do not have coverage for birth control. Only one out of five women who receive care at community health centers receive contraceptive counseling, according to Illinois Contraceptive Access Now (ICAN!).2
ICAN! Fills Gaps in Care
With the rapidly changing and regressing reproductive healthcare environment in the United States, there is less access to traditional family planning clinics, OB/GYNs, and reproductive healthcare providers in large swaths of the nation, including the South. An emerging solution is to train more primary care physicians, clinicians, and others to provide full contraceptive care and counseling. One solution is the ICAN! demonstration program. (For more information, see the story in this issue on how ICAN! works to improve acccess to contraception.) Researchers found this program to increase provider training in reproductive care at Federally Qualified Health Centers (FQHCs) could improve provider knowledge of reproductive justice and contraceptives and increase access to high-quality contraceptive care.3
Before the intervention, 24.9% of women ages 15 to 49 years received reproductive care. After the demonstration project, this increased by 16%, although the patient population only increased 2%.
FQHCs and other community health centers and primary care provider services are readily available in most communities nationwide. They meet people where they live and need healthcare services.
“A lot of families, especially lower-income families, adolescents, and adults seek care at community health centers for a number of reasons,” Stulberg explains. “They’re more accessible cost-wise, and they’re designed to be accessible from the standpoint of geography and community. They’re usually in people’s neighborhoods, so it’s important that people receive comprehensive care.”
Community health centers often offer contraceptive care, but not as comprehensively as is needed. “They should be offering all contraceptive methods and have well-trained staff and clinicians who can provide high-quality contraceptive care,” Stulberg says.
Contraceptive care is covered at no cost by most insurance plans, so clinics need to be able to help uninsured or underinsured patients obtain coverage that will cover their contraceptive choice.
“There is a policy arm of ICAN! that is working with the state [of Illinois] to get better coverage and easier processes for getting people enrolled for coverage of reproductive care,” Stulberg explains. “ICAN! also has a public education component that lets the community know they have a right to access high-quality [reproductive] care.”
ICAN! has expanded its reach since the demonstration project ended. Funded mostly through private foundations, the project’s goal is to expand to at least 20 of Illinois’ largest FQHCs and include other large ambulatory clinics, says Kai Tao, ND, MPH, FACNM, a principal and co-founder of Impacting Innovation for ICAN! in Chicago.
The reason for the goal is to help primary care facilities expand their reach throughout the state, enabling patients to access quality contraceptive care, says Katie Thiede, executive director and co-founder of ICAN!
“We want it to work for communities facing the greatest need and where disparities are most striking,” Thiede says. “That’s been a priority as we think about who to prioritize in partnerships.”
ICAN! also is working to advance new legislation that would expand Illinois’ Family Planning Presumptive Eligibility (FPPE), which provides immediate temporary coverage for contraceptive care, Thiede says.4,5 People who apply for FPPE have a short period to obtain free family planning and contraceptive services, including Pap smears, testing for sexually transmitted infections (STIs), and birth control. The goal is to make FPPE available to those in need of coverage throughout the year.4
The Illinois Department of Healthcare and Family Services (HFS) launched the HFS Family Planning Program in November 2022.5 It is one of the most comprehensive and generous programs of its kind in the country, Thiede says.
“It expands — under Medicaid — for folks who make less than $3,500 a month, based on the threshold of the federal poverty level as an individual,” Thiede explains.
The change would need state funding, but it could have a great return on investment since it will help women prevent unintended pregnancies. It also could result in more women achieving their educational and professional goals.
Illinois, like other states, already has expanded access for pregnancy care through Medicaid. Providing funding for expanded access to contraceptive care is similar.
Stulberg and co-investigators studied an ICAN! demonstration project that involved three community health centers in the greater Chicago area. One of the centers ran nine clinic sites, and the other two ran 13 sites each. Together, they served a large population of reproductive-age people capable of pregnancy.2
Reproductive Justice
The health centers received various forms of support to improve access to reproductive health and contraceptive services. “There were two core trainings for clinicians and staff,” Stulberg says. “One was the principles of reproductive justice and applying those in clinical practice, and the other was about modern forms of contraception.”
Reproductive justice training focuses on providers respecting each person’s bodily autonomy and desires regarding whether and when to have children.
“They’re not in any way coercing patients to receive contraception but are addressing their desires,” Stulberg says. “Those are the key principles.”
The program also gave clinicians technical support for billing and coding. Providers were shown how they could offer same-day contraception for procedural methods like intrauterine devices (IUDs) and implants.
“If a patient comes in to discuss diabetes and is talking about her health and it comes up that she would like to start a new birth control method, then you could talk about her options,” Stulberg explains. “If she brings up the IUD, there previously were concerns about billing for an IUD on the same visit and how to comply with all the legal and financial requirements.”
ICAN! helped resolve some of those issues. For instance, ICAN! provides technical assistance for signing patients up for insurance coverage that includes family planning services.
Other barriers to same-day contraception are the cost of stocking the devices and staff time during administration. “Some clinics were not keeping Depo-Provera [injection] and condoms in stock,” Stulberg notes. “It’s about figuring out how to have as many methods as possible right there on site and setting up workflows to provide them.”
Inserting IUDs and contraceptive implants can be time-consuming. Clinics often provided contraceptive counseling at one visit and inserted devices during a different visit. Others incorrectly thought that patients needed to be tested for STIs before receiving an IUD. Clinician training and workflow changes could resolve both barriers.
“To set up the workflow, let’s set aside one visit per clinic session for same-day procedures so we can add someone on that day, if they need it,” Stulberg explains. “If someone needs a method, there’s no reason to send them out the door without one.”
Comprehensive services also include permanent contraception services. Creating a workflow for sterilization was included in the training.
“That was intended to be included in the scope of services that ICAN! wanted to make sure is available to patients,” Stulberg says. “If they don’t have a provider on site who can do sterilization, do they have a timely referral process? Can they make sure the other clinic takes the same insurance?”
The goal is for community clinics to be all-inclusive, to meet each patient where they are, and to reduce barriers to the reproductive care they need, Stulberg says.
REFERENCES
- Power to Decide. Contraceptive deserts. 2023.
- ICAN! What is ICAN!? 2023.
- Wolff H, McHugh A, Qadir S, et al. Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program. Contraception 2023:110305.
- Illinois Department of Healthcare and Family Services. Provider notice issued 08/02/2023. Aug. 2, 2023.
- Illinois Department of Healthcare and Family Services. HFS Family Planning Program. 2023.
Less access to traditional family planning clinics in many states has created a greater need for public and private primary care providers to offer comprehensive contraceptive care. Research into a demonstration project by the Illinois Contraceptive Access Now project found a 16% improvement in contraceptive care access after providers received training.
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