Context: Nearly one-quarter of women who obtain medical contraceptive services receive care from clinics operated by publicly funded agencies. In light of changes in government policy and funding and in the structure of health care financing, an assessment of agency policies and programs is essential for monitoring women's access to contraceptive care and services.
Methods: In 1999, 637 of a nationally representative sample of 1,016 U.S. agencies that receive public funding to provide contraceptive services responded to a 12-page survey. Responses were analyzed according to agency type, receipt of Title X funding and main focus.
Results: More than nine in 10 agencies offer the pill, the male condom and the injectable; 80% offer emergency contraceptive pills, compared with 38% in 1995. Some agencies allow clients to delay a pelvic exam when beginning use of oral contraceptives (56%), the injectable (42%) or the implant (23%). On average, agencies receive funding for contraceptive services from 4.9 sources; the proportion relying on private insurance and contributions has risen since 1995. Virtually all family planning agencies provide screening and testing for sexually transmitted diseases (STDs), and at least two-thirds offer treatment for most STDs. The vast majority of agencies offer general health care and perinatal or pediatric services; half offer general gynecologic care or infertility services. Services provided, costs and clinic policies vary according to agency type.
Conclusions: Agencies offering contraceptive services also offer a wide range of reproductive health and related services. There remain services for which provision could be increased and policies that need to be modified to facilitate clients' access to contraceptive care.
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