Providing General and Preconception Health Care to Low Income Women in Family Planning Settings: Perception of Providers and Clients
This study examines both provider and client perceptions of the extent to which general health concerns are addressed in the context of publicly supported family planning care. A mail survey of family planning providers (n = 459) accepting Medicaid-covered clients in Arkansas and Alabama gathered data on reported actions and resource referral availability for ten categories of non-contraceptive health concerns. A telephone survey of recent family planning clients of these providers (n = 1991) gathered data on the presence of 16 health concerns and whether and how they were addressed by the family planning provider. Data were collected in 2006–2007. More than half (56%) of clients reported having one or more general health concerns. While 43% of those concerns had been discussed with the family planning providers, only 8% had been originally identified by these providers. Women with higher trust in physicians and usual sources of general health care were more likely to discuss their concerns. Of those concerns discussed, 39% were reportedly treated by the family planning provider. Similarly, over half of responding providers reported providing treatment for acute and chronic health conditions and counseling on health behaviors during family planning visits. Lack of familiarity with referral resources for uninsured clients was identified as a significant concern in the provision of care to these clients. Greater engagement by providers in identifying client health concerns and better integration of publicly supported family planning with other sources of health care for low income women could expand the existing potential for delivering preconception or general health care in these settings.
KeywordsFamily planning Primary care Preconception care Medicaid Chronic disease screening
This research was sponsored by the Office of Population Affairs, U.S. Public Health Service, DHHS, as a Family Planning Service Delivery Improvement Project. David Rickard, Christine Pino and Thomas Creger provided valuable research assistance. Earlier versions of this work were presented at the 2008 Academy Health Meetings and at the Centers for Disease Control Best Practices for Screening Women of Reproductive Age for Chronic Conditions 2009 conference.
- 1.D’Angelo, D.,Williams, L., Morrow, B., Cox, S., Harris, N., Harrison, L., Posner, S. F., Hood, J. R., & Zapata, L. (2007). Preconception and interconception health status of women who recently gave birth to a live-born infant—pregnancy risk assessment monitoring system (PRAMS), United States, 26 Reporting Areas, 2004. MMWR 56(SS10), 1–35. http://www.cdc.gov/mmwR/preview/mmwrhtml/ss5610a1.htm#tab2. Accessed 22 Oct 09.
- 3.Moos, M. K., Dunlop, A. L., Jack, B. W., Nelson, L., Coonrod, D. V., Long, R., et al. (2008). Healthier women, healthier reproductive outcomes: Recommendations for routine care for all women of reproductive age. American Journal of Obestrics and Gynecology, 199(6 Suppl 2), S280–S289.CrossRefGoogle Scholar
- 4.Bloom, B. B., Simpson, G., Cohen, R. A., & Parsons, P. E. (1997). Access to health care, Part 2: Working age adults. Vital and health statistics, Series 10. Data from the National Health Survey, pp. 1–47.Google Scholar
- 7.Salganicoff, A., Ranji, U. R., & Wyn, R. (2005). Women and health care: A national profile key findings from the Kaiser Women’s Health Survey. http://www.kff.org/womenshealth/7336.cfm. Accessed 21 Dec 09.
- 8.Guttmacher Institute. Contraceptive Needs and Services, 2006. Available at http://www.guttmacher.org/pubs/win/index.html. Accessed 14 Oct 2009.
- 9.Gold, R. B., & Alrich, C. (2009). Role of Medicaid family planning waivers and Title X in enhancing access to preconception care. Women’s Health Issues, 18S, S47–S51.Google Scholar
- 11.Gold, R. (2007). Stronger together: Medicaid, title X bring different strengths to family planning effort. Guttmacher Policy Review, 10(2), 13–18.Google Scholar
- 13.Atrash, H., Jack, B. W., Johnson, K., Coonrod, D. V., Moos, M. K., Stubblefield, P. G., et al. (2008). Where is the “W”oman in MCH? American Journal of Obestrics and Gyneocology, 199(6S2), S257–S396.Google Scholar
- 15.Dillman, D. (2000). Mail and internet surveys: The tailored design method (2nd ed.). New York: Wiley.Google Scholar
- 16.Felix, H. C., Bronstein, J., Bursac, Z., Stewart, K. M., Foushee, R., Klapow, J. (forthcoming). Referral and referral facilitation behavior of family planning providers for women with human immunodeficiency virus (HIV) infection in the Southern US. Journal of Women’s Health. Google Scholar