Improved access to contraception in the United States
The study results were published in the Journal of Women’s Health.1
The learning community, which ran from October 2016 to May 2018, was implemented by the Association of State and Territorial Health Officials (ASTHO) in partnership with the Centers for Disease Control and Prevention (CDC); the Department of Health & Human Services Office of Population Affairs; and the Center for Medicaid and Children’s Health Insurance Program Services of the Centers for Medicare & Medicaid Services.
The learning community spanned 27 state and territorial jurisdictions, with teams from each jurisdiction comprised of state health officials, program staff, and service providers.
“The original contraception-focused learning community began in 2014 to share strategies and best practices in developing and implementing a government-led protocol for long-acting reversible contraception (LARC) immediately after birth,” said lead author Carla DeSisto, PhD, MPH, an epidemiologist in the CDC’s Reproductive Health Division in Atlanta, Georgia. “This learning community, known as the Immediate Postpartum LARC Learning Community, expanded from 6 states in 2014 to 13 states in 2015.”
Despite the progress, the CDC and ASTHO heard from participating and non-participating states that there was a need to go beyond the immediate postpartum LARC and adopt policies and programs that improve access to all contraception.
In 2016, the learning community expanded to 27 jurisdictions to improve access to the full spectrum of contraception.
The University of Illinois Chicago evaluation team contacted the jurisdictions in May and June 2019 to re-evaluate target achievement and retention through semi-structured interviews by phone or email.
The 26 responding jurisdictions (96% participation rate) had created a total of 79 goals. At the final meeting of the learning community, 35 goals (44%) were achieved. Three jurisdictions have all achieved their goals by the end of the learning community.
At one year follow-up, jurisdictions maintained efforts for 69 (87%) of the overall targets. In each jurisdiction, work was carried out on at least one goal that originated in the learning community.
Many of the goals achieved by the jurisdictions related to logistical barriers, supplier awareness and training, consumer awareness, and reimbursement and financial sustainability. An example of a goal to remove logistical barriers has been to reduce the number of clinics that require 2 visits for intrauterine device (IUD) placement.
“These findings underline [the fact] that the jurisdictions have worked extremely hard to achieve their goals, ”said DeSisto Contemporary OB / GYN®. “They have … put in place detailed action plans to achieve them. They were also able to leverage the multidisciplinary nature of their teams to get their jobs done, often through different agencies within their jurisdiction. It was really impressive to witness that. “
Nonetheless, in the interviews, jurisdictions mentioned a number of barriers to achieving goals: lack of resources such as staff and funding, staff turnover, political concerns about contraception, and disagreements about priorities and interdependent goals.
“Some of the key factors in achieving goals are funding, engagement and support from leaders, champions, partnerships with stakeholders, and the actual meetings and activities of the learning community,” said DeSisto. “Building a multidisciplinary team, creating a plan of action, regular meetings for work, and learning from other jurisdictions and national experts helped the teams achieve and maintain their goals.”
Future learning communities may find it beneficial to partner with legal systems to develop robust, well-defined goals that are tied to implementation strategies, DeSisto said.
“It can also be beneficial for jurisdictions to consider how to measure success in achieving their goals before work even begins, and to think about how to maintain their work beyond the learning community,” she said.
DeSisto does not report any relevant financial information.
DeSisto CL, Estrich CG, Kroelinger CD et al. Improving Access to Contraception in the United States: Assessing Performance and Sustainability. J Women’s Health (Larchmt). 2021; 30 (9): 1217-1224. doi: 10.1089 / jwh / 2021.0414