PROJECT SUMMARY
ACCESS: Advancing Contraceptive Equity and Service Uptake through Telemedicine in the US
Safety-Net, 2019-2025
Unintended pregnancy is a key indicator of health inequity in the US. Unintended pregnancy rates are
decreasing overall in the US, but disparities are widening, with unintended pregnancy becoming more
concentrated among adolescents, women of color, and women living in poverty. Access to contraceptive
services for low-income and other marginalized identities is central to reducing inequities in
unintended pregnancy. Telemedicine (TM), has the potential to expand access to care, but widespread
use of TM for contraceptive care was limited prior to the COVID19 pandemic. The publicly funded family
planning “safety net” system of Community Health Centers (CHCs) is a critical provider of family planning
services to historically marginalized populations; however, existing evidence about use of TM for
contraceptive services in the US safety net system is limited. This proposal directly addresses this gap.
We leverage individual-level clinical data - real world health IT - from a common electronic health record
across a national network of CHCS and rigorous multilevel analytic methods to document use of TM compared
with face-to-face visits for contraceptive services. Aim 1. Assess whether there is a differential uptake of
the use of TM for contraceptive services across community health centers (CHCs). We will focus on key
populations (e.g., adolescents, uninsured, Latinas, Black women, rural), clinic characteristics (e.g., Title X
status), community-level SDH factors (e.g., social and economic conditions, computer and broadband access),
and state factors (e.g., Medicaid expansion) to identify differential uptake in the use of TM (versus face-to-face
visits) for contraceptive services for low-income populations. Aim 2. Quantify inequities or unintended
consequences of TM utilization for individuals and the health system. We will identify disparities in use of
long-acting reversible contraception (LARC) methods (which require an in-clinic visit), method switching at one
year, and no-show rates and cancellations by visit modality (TM versus in-person). Aim 3. Understand patient
experience of care and preferences for contraceptive services via TM versus in-person. We will conduct
semi-structured interviews with patients who receive contraceptive care at CHCs to understand their
experiences with TM, barriers and facilitators to receiving contraceptive services through TM versus in-person
care, and contextual factors that impact their ability to access contraception through TM versus in-person care.
