PRP100: How does policy impact reproductive health care delivery in your community health center setting?

Jee Oakley; Erika Cottrell, PhD, MPP; Brigit Hatch, MD, MPH; Anna Templeton, DNP


Context: Evidence-based reproductive and sexual health care are essential women’s health services but disparities in access, utilization, and outcomes persist. Community health centers (CHCs) provide care to 20% of reproductive age (15-44 years) women in the US and reproductive age women are one of the largest (29.5%) user populations. As the largest primary care system for low-income, uninsured, and publicly insured individuals, the impact of policies including the Affordable Care Act (ACA), and Medicaid expansion on women’s reproductive care is of particular interest in CHC settings.

Objective: Understand provider and CHC leader perceptions of how the ACA and state level policies have impacted women’s reproductive health care.

Study design: Semi-structured telephone interviews with providers and health system leaders. Findings will be integrated with a larger mixed-methods study evaluating the impact of federal and state policies on women’s health care utilization and outcomes.

Setting: CHCs and public health departments from the OCHIN practice-based research network of 131 health care organizations across 26 states.
Participants: Up to 30 providers or clinic staff, and 12 health systems leaders from CHCs or CHC lookalikes across a mix of: Medicaid expansion/non-expansion states; rural/urban sites; and primary care/family planning/prenatal care sites.

Outcomes: Provider and health system leader perspectives on contraceptive, preventive, prenatal and postpartum care provision, access, and utilization in CHC settings in the post-ACA environment.

Results: We are identifying federal (e.g. ACA, Title X, Public Charge rule) and state (e.g. Medicaid expansion, 1115 waivers, reproductive health programs) policies as well as provider, clinic, and community factors providers perceive as contributing availability, accessibility, and acceptability of women’s reproductive health care. Participants are recommending priority areas to focus development of strategies and approaches to improve, expand, or otherwise modify care in relation to evolving community and policy landscapes of women’s reproductive care in CHCs.

Conclusions: Understanding individual, CHC, community, and policy factors affecting the provision and utilization of women’s reproductive care will contribute to ongoing interventions to improve equitable evidence-based reproductive health care delivery and outcomes in CHC settings.

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