For five decades, the nation’s publicly funded family planning effort, with Title X as its cornerstone, has helped millions of people achieve their reproductive goals, by providing funding and guidelines for high-quality, voluntary, equitable, and accessible sexual and reproductive health (SRH) services. Over the past decade, Title X has been in significant flux, expanding the range of services offered, centering health equity, navigating a shifting landscape shaped by the Affordable Care Act, and experiencing service disruptions due to the COVID-19 pandemic and shifting policies and priorities.
The Guttmacher Institute proposes a comprehensive package of research to generate actionable data and ensure that high-quality, equitable SRH services are available to all people. This work addresses three of OPA’s four priority areas: (A) innovative strategies to increase equitable access, (C) trends and current reach of family planning clinics, and (D) trends in client need and use of Title X services.
The proposed activities address individual-level, provider-level and systems-level questions of health equity, including access to and preferences for quality family planning care. Multiple, interrelated research foci, each responding to and informing the other, are designed to advance foundational resources to assess family planning care in the US. We also include innovative work to improve surveillance systems and will collaborate with partners to bring in expertise and center the needs of people seeking care. This work will result in data and findings readily available for policy makers, clinical providers, and program planners to leverage when designing programs and policies to increase equitable access, especially for those most in need of publicly funded SRH services. The information generated from this research will provide new insights and answers to four key research questions. Major activities planned for each research question include:
• Who needs SRH care? In collaboration with Dr. Anu Manchikanti Gómez, we will integrate a new metric of contraceptive need based on people’s own determination of that need into Guttmacher’s on-going surveillance work, producing population-level estimates of the numbers who may need care, and those who may need public funding for this care.
• Where, for whom, and how is care provided and received? We will provide data and information for assessing the adequacy of existing service providers in delivering equitable access to care and in meeting people’s needs using three data sources: the National Survey of Family Growth (NSFG), Guttmacher’s 2020 Census of Publicly Funded Clinics, and Guttmacher’s 2022 National Survey of Clinics Providing Publicly Funded Contraceptive Services.
• What care do people want? We will conduct new, secondary analyses of qualitative and quantitative data recently collected by Guttmacher that will draw on individuals’ self-reported experiences obtaining SRH care, preferences regarding this care, descriptions of quality SRH care, and trust in the health system. Findings from these analyses will arm clinicians, policy makers, and other decision-makers with the information needed to align SRH care delivery with patients’ needs and preferences.
• What difference does access to care make? In partnership with the Coalition to Expand Contraceptive Access (CECA) and informed by diverse stakeholder input through expert and patient lived experience panel convenings, we propose to develop new approaches to measure the impacts of receiving or not receiving desired SRH care so that these metrics are more equitable and person-centered.
We aim to disseminate data and findings from this work widely and effectively. State and county data will be made easily accessible using Guttmacher’s online Data Center; other reports and peer-reviewed journal articles will be posted on the Guttmacher website, and data will be incorporated into national and state-level Fact Sheets.
