Using Learning Collaboratives to Increase Access to Contraception to Achieve the Healthy People 2020 Goal for Contraceptive Use

Everyone, regardless of life circumstances or ability to pay, should be able to make informed choices about their reproductive health based on accurate information and have access to the full range of contraceptive methods.  

With this goal in mind, in 2016, JSI worked with 12 publicly-funded family planning sites to increase access to most and moderately effective methods of contraception among patients who could become pregnant, but wished to avoid pregnancy at the time. (Most effective methods include female sterilization, implant, and intrauterine device [IUD], while moderately effective methods include the injectable, pill, patch, ring, or diaphragm.) 

This was accomplished through an eight-month national learning collaborative adapted from the Institute for Healthcare Improvement Breakthrough Series model. The learning collaborative included monthly online learning sessions with peer-to-peer sharing of challenges and successes, monthly data monitoring and reporting, improvement planning, and evaluation. The learning collaborative focused on strengthening participants’ quality improvement practices and implementing strategies related to four best practices outlined in the Contraceptive Access Change Package, developed by JSI as the Family Planning National Training Center (FPNTC):

• Stock and dispense a broad range of contraceptive methods, including all provider-dependent FDA-approved contraceptive methods.
• Discuss pregnancy intention and support patients through evidence-informed, patient-centered counseling.
• Develop systems for the option of same-day initiation of all contraceptive methods. 
• Utilize diverse payment options to reduce cost as a barrier for the facility and the patient.

During the learning collaborative, the percent of female patients using a most or moderately effective method of contraception increased from 70% to 79% among participating sites.

The learning collaborative emphasized that services should be provided on a purely voluntary basis and that patients should not be coerced to use, or not use, any particular contraceptive methods. JSI also observed increased access to IUDs and implants due to increased availability of the methods on site and in the same visit requested by the client, as well as training of staff to use a patient-centered, shared-decision-making approach to contraceptive counseling.

Coinciding with increased access, nine of twelve teams observed increases in the percent of women choosing to use LARC methods. The group average percentage increased from 9.6% to 12.9%.

Since 2016, JSI has worked to disseminate these lessons learned and materials. The findings were published in the literature, From theory to application: using performance measures for contraceptive care in the Title X family planning program. Anyone can replicate the learning collaborative with the Increasing Access to Contraception Toolkit that JSI developed as the FPNTC.

More recently, JSI as the FPNTC hosted a webinar, Contraceptive Performance Measures: Striving for Patient-Centered Contraceptive Access Webinar for Title X providers. This webinar profiled the work of the University of California, San Francisco to develop a Person-Centered Contraceptive Counseling (PCCC) measure. The PCCC is a patient-reported outcome measure that assesses the patient-centeredness of contraceptive counseling. The PCCC is designed to be used in tandem with the contraceptive utilization measures discussed previously to ensure counseling is high-quality and sensitive to individual patient needs.

JSI is proud of our work supporting service providers who are breaking down barriers to health care and helping patients achieve their reproductive goals. Since 2016, JSI has served as the FPNTC for the Title X Family Planning Program, a project awarded by the Department of Health and Human Services Office of Population Affairs. Through the Training Center, as well as our past work with private foundations, non-profits, and health departments, we continue our partnership with family planning clinics around the US.

Written by Jennifer Kawatu, Katie Quimby, and Katie Saul