Role of Family Planning Providers in Mediating Challenges

Our research suggests that the care offered by family planning providers is critical not only to ensure that low-income women have access to family planning services but also to mitigate health reform-related problems that may affect women's overall health. Several features of the Massachusetts family planning care model contribute to this, including affordability, willingness to offer services regardless of a client's insurance status, comprehensiveness of services offered, and provider expertise in reproductive health.

Because of their service provision model, family planning providers can offer services free or at reduced cost regardless of whether a woman has insurance. As one administrator said, “We are a community health center. The services that we have offered have been offered all along, and we serve insured and uninsured folks .... the services that are available have always been available and have always been provided regardless of someone's insurance status.”

Women in focus groups consistently described turning to family planning providers when they needed urgent and moderately priced care. One Boston-based participant described seeking emergency contraception and stated: “I was very scared .... They told me that in the pharmacy [emergency contraception pills] cost $50, I don't know if this is true, and that in the clinic they cost about $20. But when I went to the clinic they didn't charge me, they gave them to me. Thank God I didn't become pregnant.”

Family planning providers also mitigated the impact of women moving on and off plans both by helping women understand their insurance plans and by directly providing services. Specifically, for women whose insurance coverage has lapsed, family planning clinics might be the only way to obtain health care during their “off-plan” periods, since it takes time for plans to get reactivated.

Many women reported that they consistently and frequently rely on family planning clinics or that the clinics are the “first place I would go.” The majority of comments about family planning providers involve the benefits of providers educating them about contraception, generally positive experiences in obtaining contraception because of the staff's positive attitudes, and women's ability to get multiple months of contraceptives for free or at deeply discounted prices at family planning clinics. As one Boston-based participant stated, “Honestly, for something like that I would just go right to [the clinic] because I know [it] a lot better at this point than I know my own insurance.”

Because of the strong network of family planning providers, many participants felt that access to family planning was easier in Massachusetts than in other states. In one focus group, participants called for more family planning providers to help facilitate contraceptive access.