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Increasing Access to Contraception Toolkit

Toolkit/Guide
Contraceptive Services

Welcome to the Toolkit

Every woman has a right to have the information and resources she needs to make personal decisions about her own life, including when or if she wants to be pregnant, and to choose if and when she wants a family. The goal of this toolkit is to support family planning providers in ensuring access to the full range of contraceptive methods for clients who could become pregnant, but wish to avoid pregnancy at this time. This toolkit supports improvement on the contraceptive care measures, which have been endorsed by the National Quality Forum.

This toolkit includes a series of training guides and complementary resources that support facilitation of interactive learning sessions about how to implement best practice recommendations outlined in the Contraceptive Access Change Package. Each training guide consists of a PowerPoint slide deck with talking points and an accompanying discussion guide. The resources in this toolkit can be used in any order according to a site’s needs and priorities. Training guides can be adapted and revised as needed, and may be used to:

  • Convene staff from one or more family planning clinics for a standing meeting (e.g., monthly) to discuss each Best Practice (in order or as needed) from the Contraceptive Access Change Package.
  • Convene a one-time meeting with clinic staff about this topic.

The toolkit walks sites through a process to increase contraceptive access, organized around the four best practice recommendations of the Contraceptive Access Change Package.

  • Assess baseline contraceptive access
  • Develop an improvement plan
  • Best Practice 1: Stock a broad range of contraceptive methods
  • Best Practice 2: Discuss pregnancy intention and provide patient-centered counseling
  • Best Practice 3: Develop systems for same-visit provision of all contraceptive methods
  • Best Practice 4: Utilize diverse payment options to reduce cost as a barrier
  • Sustain and spread improvements

Find more implementation strategies, tools, and resources for increasing contraceptive access in Same-Visit Contraception: A Toolkit for Family Planning Providers.

This toolkit was adapted from a contraceptive access learning collaborative for increasing contraceptive access facilitated by the FPNTC in 2017.

Sites should begin by assessing the current level of client access to contraception by comparing site-level practices to established best practice recommendations, and looking at Family Planning Annual Report (FPAR) data.

Action Steps Supportive Resources

Review the best practice recommendations outlined in the Contraceptive Access Change Package.

Contraceptive Access Change Package

Assess clients’ baseline access to the full range of contraceptive methods.

Contraceptive Access Assessment

Calculate baseline contraceptive care measures using site FPAR data.

Contraceptive Care Performance Measure Calculator

Undertaking a participatory process for developing an improvement plan ensures staff have ownership and understand their respective roles in achieving change.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about the need for expanding access to contraception.

Contraceptive Access in Family Planning Settings Training Guide

Facilitate a discussion with clinic staff to develop a site-level plan for increasing access to contraception.

Develop a Site-Level Improvement Plan Training Guide

Title X clinics must provide a “broad range” of Food and Drug Administration (FDA)-approved contraceptive methods and services. Although some methods can be obtained by prescription, the provider-dependent methods need to be stocked on-site in order to ensure clients can access them without delays. At a minimum, at least one type of each FDA-approved provider-dependent method (i.e., hormonal IUD, copper IUD, implant, and injectable) should be stocked on-site. Other methods should also be readily available, either stocked on-site or through a pharmacy.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to increase, if necessary, the number of types of contraceptive methods available on-site.

Stock a Broad Range of Contraceptive Methods (Best Practice 1) Training Guide

The Office of Population Affairs (OPA) recommends discussing a reproductive life plan with all family planning clients. Asking the question, “Do you think you would like to have (more) children someday?” is an introduction to the conversation that opens the door for further discussion of reproductive health needs—including contraception. Adhering to patient-centered counseling principles outlined in QFP can help clients identify the most appropriate contraceptive methods.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to consistently assess pregnancy intention and support patients through patient-centered counseling.

Discuss Pregnancy Intention and Support Patients through Evidence-Informed, Patient-Centered Counseling (Best Practice 2) Training Guide

Facilitate a discussion with clinic staff to address common concerns providers may have about providing the full range of methods, including long-acting reversible contraception (LARC) to adolescents.

Address Common Concerns for Providing Long-Acting Reversible Contraception (LARC) to Adolescents Training Guide

According to the Centers for Disease Control and Prevention (CDC) and OPA, clients should have access to their contraceptive method of choice without unnecessary delays. “Same-visit” provision of contraception means providing immediate access to contraceptive methods using Quick Start, and not requiring clients to return for a separate appointment on another day or even later the same day to initiate contraception.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to implement or streamline same-visit provision of the full range of methods, including IUDs and implants.

Develop Systems for Same-Visit Provision of All Contraceptive Methods (Best Practice 3) Training Guide

Learn more about the rationale for offering same-visit contraception, watch case study videos, and access tools and resources to support implementation.

Same-Visit Contraception: A Toolkit for Family Planning Providers

The Title X Family Planning Program provides services and information to all clients who want and need them, with priority given to persons from low-income families. Removing cost barriers ensures clients can choose a method that is most appropriate and desirable.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about strategies for ensuring cost is not a barrier for the facility or the client.

Utilize Diverse Payment Options to Reduce Cost as a Barrier for the Facility and the Patient (Best Practice 4) Training Guide

Facilitate a discussion with clinic staff about financial management best practices.

Introduction to Financial Management in Family Planning Settings Training Guide

Implementation is not a one-time activity and does not end after initial improvement plan changes are made. Using a quality improvement approach, staff should prepare for how changes will be sustained at the site, and, once successful, how to spread them to other sites in the network.

Action Steps Supportive Resources

Learn more about quality improvement approaches.

Introduction to Quality Improvement for Family Planning eLearning (Module 1)

Facilitate a discussion with clinic staff about how to sustain and spread changes made to increase access to contraception.

Sustain and Spread Improvements Training Guide