Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program

Abstract

Objectives: Nearly one-third of low-income women of reproductive age in the U.S. receive care in federally qualified community health centers, but comprehensive reproductive care is not consistently provided. Illinois Contraceptive Access Now (ICAN!) is an initiative addressing the access gap to high-quality contraceptive care with a focus on normalizing reproductive health screening for patients in federally qualified community health centers (FQHCs).

Study design: This multi-method program evaluation used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with retrospective and prospective data collection from three Illinois FQHCs who participated as Quality Hubs, and from a Community Advisory Board. We conducted descriptive analysis of patient surveys using the Person-Centered Contraceptive Counseling (PCCC) measure (n = 142); clinician and staff pre-and post-training surveys (n = 210); and Community Advisory Board surveys (n = 8) collecting quantitative and qualitative feedback. We ran logistic regression on claims data from 15- to 49-year-old patients identified as female at birth (n = 103,756).

Results: Reach assessment showed patients receiving contraceptive or preconception care increased from 1063 per month in 2020 to 1236 per month in 2021 (16% increase), while general volume increased 2%. Effectiveness showed most patients (78%) described the quality of contraceptive counseling as "excellent" on the PCCC. Adoption assessment showed knowledge increases after clinical training on Modern Contraception (85% pre-training, 95% post-training) and Reproductive Justice (RJ) (58% pre-training, 70% post-training). Implementation assessment found that most Community Advisory Board members felt ICAN! was responsive to community needs.

Conclusions: The ICAN! demonstration year increased provider knowledge and volume of reproductive care at three Illinois FQHCs.

Implications: Contraceptive access initiatives that operationalize same day access to birth control methods while training FQHC providers on RJ and modern contraception, show promise on several measures. Early evidence from ICAN! indicates increased reproductive health service provision, as well as increases in provider knowledge of RJ and modern contraceptive care.

Keywords: Community health center; Contraceptive care; Federally qualified health center; Reproductive justice; Reproductive wellbeing.