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Title X clinics offer same quality of contraceptive counseling as private health care

Federal health programs that provide services to economic and racial minorities may have a reputation for providing less empathetic or patient-centered care than private health care institutions, but a new study shows that—at least in contraceptive counseling¬—that’s not the case.

Funding for Title X clinics was officially established in 1970 to offer federal family planning services. Starting with a $6 million allocation in 1971 that increased to more than $100 million by 1973 and now sits around $280 million per year, the program has demonstrated success in expanding access to quality contraceptives and other family planning services—especially for low-income Americans.1,2

The true measure of health care quality isn’t just the fact that a service is offered. A new study, published in Contraception, aimed to investigate how well Title X funds support patient-centered care when it comes to contraceptive counseling compared to private clinics.

Past contraceptive coercion and forced sterilization practices highlight the need for transparent and personal contraceptive planning that takes into consideration the best evidence-based practices as well as personal preferences and values, according to the report.2

Researchers from Oregon and Mexico used information from the 2017 to 2019 national Survey of Family Growth to gauge the experiences of women aged 15 to 49 who received contraceptive services in the US. Almost 7% of the women polled received these services at a Title X clinic while nearly 85% were seen at a private clinic, the report states.

Despite the large difference in the division of care locations, there was little discrepancy when it came to perceptions of care, the study team found. According to the report, 51.3% of the women who received services at Title X clinics reported personalized contraceptive counseling based on their individual needs. In comparison, 50.6% of women who went to private clinics and 52.4% of women who went to non-Title X public clinics also reported receiving patient-centered contraceptive counseling.

The study went on to reveal, however, that patient-centered contraceptive counseling was more common in people with incomes at or above 300% of the federal poverty limit compared to people whose incomes were below 100% of the federal poverty limit. Additionally, non-Latina Black women reported lower rates of person-centered contraceptive counseling in comparison to what was reported by non-Latina white women.

Still, the study concluded that Title X clinics did a good job in providing patient-centered contraceptive counseling when compared to the private sector.

In terms of efficacy and the contraceptive methods chosen, the study also found that people who received care at Title X clinics were more likely to use long-acting reversible contraception like an intrauterine device or implant. According to the report, almost 24% of patients at Title X clinics used these devices compared to 16% at other public or private clinics.

There was little difference, the authors noted, in how people felt after visiting Title X clinics compared to private and other public clinics. Overall, women tracked in the study rated providers at all type of clinics as “excellent” when it came to making them feel respected as a person. Ratings dropped a bit, however, in regard to how much education was provided on how to make the best decision about birth control methods across all the clinic types.

Overall, the research team concluded that Title X clinics were just as likely to provide patient-centered contraceptive counseling as other public or private clinics, even though Title X clinics most often serve racial and economic minority groups that most often report lower levels of patient-centered care.

References

  1. HHS Office of Population Affairs. hhs.gov. Published 2021. Accessed October 20, 2022. https://opa.hhs.gov/grant-programs/archive/title-x-program-archive/title-x-program-funding-history
  2. Hansen K, Boniface ER, Darney BG. Association of Title X clinic status with receipt of person-centered contraception counseling: A population-based study. Contraception. August 19, 2022. Accessed October 20, 2022. 115:36-43. https://www.contraceptionjournal.org/article/S0010-7824(22)00222-0/fulltext