Increasing Access to Contraception Toolkit

Assess clinic capacity to provide contraceptive access without barriers to care.

Create and communicate an organizational vision for contraceptive access that emphasizes client-centered care (focused on the client’s needs, values, and preferences) in line with Title X expectations.

Have a policy and procedures describing the process for ensuring quality service delivery for all consistent with nationally recognized standards of care.

See Provision of High-Quality Family Planning Services #5, #6: Clinical Protocols and Standards of Care.

Have a policy and procedures describing the process for ensuring that individuals are not pressured or coerced to receive contraceptive services or to use or not use any particular contraceptive method.

See Project Administration #1, #2, #3: Non-Coercive Services in Title X Policy Templates

Put systems in place to regularly gather client feedback on access to and experience with contraceptive services at your site.

Put systems in place to evaluate contraceptive access and implement quality improvement activities, including collecting, reporting, and using data.

Clearly and accurately promote contraceptive services through both mass communication (e.g., website, social media) and communication with individual clients (e.g., at check-in, over the phone, through the portal).

Participate in (and have a policy for) the 340B Drug Pricing Program, to obtain lower-cost contraceptives and supplies.

See Project Administration #13: 340B Program Enrollment in Title X Policy Templates

Develop and optimize inventory systems to maintain on-site stocking of a broad range of FDA-approved contraceptive methods.

Train and support staff responsible for billing and coding on accurate coding and how to promptly manage denials of reimbursement for contraceptive services.

Offer flexible clinic hours, including evenings and weekends.

Use an evidence-based, client-centered approach to screening for reproductive desires (e.g., PATH, OKQ, SINC, RHSSQ).

Provide information on a broad range of FDA-approved contraceptive methods, including methods not provided on site.

Provide client-centered contraceptive counseling to help each client select a contraceptive method that aligns with their needs, values, and preferences.

Recognize and support clients interested in using contraceptive methods for reasons other than contraception (e.g., STI/HIV prevention, menstrual regulation, acne).

Cultivate an awareness of how staff backgrounds and experiences influence the information they share, the language they use, and how they counsel clients.

Provide instructions and ensure client understanding about how to use their selected method correctly and consistently, including how to access it, optimize use, discontinue or switch methods, manage side effects, and anticipate problems (e.g., late dosing).

Train staff on contraceptive methods and method-specific eligibility criteria.

Train staff on client-centered contraceptive counseling approaches and skills.

Train staff on contraceptive method misinformation and myths and how to counsel clients.

Watch video 2 in series.

Put systems in place for same-visit (“quick start”) initiation for a broad range of contraceptive methods, including intrauterine devices (IUDs) and implants. (If unable to provide the client’s contraceptive method of choice on the same day they request it, offer a bridge method of contraception.)

Train clinicians on insertion and removal of long-acting reversible contraceptive (LARC) methods, such as IUDs and implants.

Offer an extended contraceptive supply (a 6 to 12 month supply of combined hormonal methods, like the pill, patch, or ring) at the time of the visit.

Provide information and counseling on self-care contraceptive options (DMPA-SC, over-the-counter progestin-only pills, fertility awareness-based methods) and information, as needed.

Offer emergency contraception (EC) to all clients, as appropriate, including offering an advance supply.

Offer contraceptive services via telehealth, as appropriate. The following contraceptive services are suitable for telehealth provision:

• Contraceptive counseling
• Prescription (initiation or continuation) of oral contraceptive pills, transdermal patch, or vaginal ring
• Discussion of EC options and provision of oral EC pill
• Prescription (initiation or continuation) and instruction on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC)
• Prescription of barrier and other peri-coital methods, including diaphragm, cervical cap, spermicides, external and internal condoms, and vaginal pH modulator gel
• Counseling prior to IUD and implant placement, removal, or replacement
• Evaluation and potential management of side effects (such as unexpected bleeding)
• Consultation for permanent contraception

Build a strong referral network for contraceptive methods not provided on site. For example:

• Have at least one local referral agency for each contraceptive method unavailable on site
• Have a mechanism for warm handoff to referral agencies when a contraceptive method is unavailable on site
• Track referrals and outcomes in the electronic medical record
• Have a protocol in place to track the availability of relevant contraceptive methods at referral agencies
• Have a protocol in place to monitor the cost of relevant contraceptive methods at referral agencies

Optimize clinic flexibility and efficiency:

• Adopt a team-based care model to strengthen collaboration, streamline workflows, and ensure that staff are operating at the top of their license
• Perform only the exams and tests needed to provide contraception safely, based on the client’s health status.
• Do not require appointments for routine methods refills.

Develop an income verification policy and monitor front desk practices in carrying it out.

See Financial Accountability #6: Income Verification in Title X Policy Templates

Train all front desk staff on income verification, sliding fee scales, and confidential billing.

Prepare front desk staff to inform clients about self-pay, sliding fee schedules, and insurance enrollment options, to ensure clients have access to services without delay and regardless of ability to pay.

Correctly apply your agency’s sliding fee scale to determine client fees for services based on their family size, income, and insurance coverage.

Screen for confidential billing needs by asking all clients if they have concerns with documentation being sent to their home.