The quality of contraceptive care is a crucial component of contraceptive access and reproductive health services overall. Contraceptive counseling and related services should be comprehensive and person-centered, advising women of the full range of contraceptive methods in a nonjudgmental, noncoercive way that affirms their autonomy and reproductive decision-making. For nearly 30 years, advocates have uplifted the importance of high-quality care services, including the use of standardized performance measures to assess effectiveness.1 To improve the quality of contraceptive care, states should adopt and implement these contraceptive quality measures, which provide consistency and accountability to ensure that family planning services adhere to recognized standards and guidelines.2 Such measures can be used to drive improvement and make adjustments to care, inform consumers, and drive payment and reimbursement to providers.
However, because contraceptive quality measures are relatively new—and include both measures of use of certain types of contraceptives as well as the quality of contraceptive counseling offered, as reported by the patient—and our understanding of the concept of quality is evolving, there is still a gap in understanding how to implement these measures at the state level, making it challenging to know exactly what barriers states may face.
Below are some common challenges to implementation that policymakers must be aware of and work to address. This is not an exhaustive list and is meant to create an informative foundation that states can build on to plan and create new programs and improve existing programs.
Challenge: Optimizing the use of quality measures
In an effort to optimize the use of quality measures and better assess the quality of contraceptive care, states should explore using more than one quality measure concurrently. This approach may provide a more holistic picture of service provision and help states identify and assess issues in care. Indeed, as recommended by the Coalition to Expand Contraceptive Access, using existing measures in tandem can help expound on the complex and “multi-dimensional nature of quality as it relates to contraceptive care [and counseling].”3
States can explore the following options:
- Use existing measures, such as the use of certain types of contraceptives, in tandem with new contraceptive measures, such as patient-reported experience during contraceptive counseling.
- Explore both patient and provider aspects of quality of care, with the goal of ensuring that patients are able to access the full range of contraceptive methods while not being coerced into choosing any specific method.
Challenge: Provider training, education, and awareness
The implementation of contraceptive quality measures relies partly on providers being informed and educated on contraceptive quality measures as well as being incentivized to adopt them into practice.
Specifically, states can take the following steps to ensure that providers are adequately trained on quality measures:
- Collaborate with training and technical assistance providers. Partnering with a technical assistance provider may help states anticipate common questions and give providers a direct source of information to lean on during implementation.
- Require ongoing training for providers and staff to help them meet the standards of the measures. Not all health care providers receive extensive formal training on contraceptive care. Having regular training sessions can help equip providers with the tools and information they need to provide high-quality contraceptive care and stay up to date with changing guidelines and standards.
Challenge: Patient awareness and empowerment
In quality of care, the importance of the patient’s perspective and experience cannot be understated. Patient agency should be the foundation with which care decisions are made, and importantly, patient experiences should inform and drive changes in our health care system. All too often, patients are not centered in their own care nor provided resources that support their autonomy and agency.
Moving forward, states should:
- Invest in decision support tools to improve quality of care and affirm patients’ autonomy in their contraceptive care. One way to do this is to incentivize health care facilities to adopt and use these tools regularly in their practices.4
- Partner with providers to implement electronic health record measures that ensure patients receive comprehensive, patient-centered resources on contraceptive options available to them.5
Challenge: Integrating quality measures into existing programs and practices
There is an opportunity for states to explore how to integrate contraceptive quality measures into other commonly used programs and services to both broaden their reach and meet statewide family planning goals to reduce unintended pregnancies and support women to plan their pregnancies if, when, and how they choose.
Accordingly, states must:
- Investigate ways to integrate quality measures into existing reproductive health services, programs, and practices. Postpartum and post-abortion access to contraception are often overlooked areas of family planning need. Integrating contraceptive quality measures into these and other pregnancy-related services may help to mitigate this issue and ensure that people are able to achieve their family planning goals.
Additionally, common state programs, such as home visiting programs,6 provide a great opportunity to connect women to contraceptive care and counseling as well as other family planning and reproductive health services overall.
Contraceptive quality measures have the potential to exponentially improve the way that women access and experience contraceptive care and counseling. Contraceptive care should be affirmative of women’s agency and personal needs, and providers must be supported in adopting these complex measures. Implementing quality measures is one way to ensure patients’ family planning needs are being met and to incentivize providers to offer quality care by focusing on the whole person.