Family planning service provision among providers in the WWAMI region

Abstract

University of Washington Abstract Family planning service provision among providers in the WWAMI region Krista M Stephens Chair of the Supervisory Committee: Kelly Gilmore Department of Health Services Family planning is a crucial component to comprehensive reproductive health care and access to full spectrum family planning services has been shown to help mitigate poor women’s health outcomes. Geographic disparities in family planning service provision exist, especially between rural and urban practice settings; however, family planning service disparities in the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region are unknown. This study aimed to assess for provider knowledge, practices, and perceived barriers in providing evidence-based family planning services in the WWAMI region, in addition to comparing service provision in rural and urban practice settings, as well as religiously affiliated with non religiously affiliated practices. Forty-six out of one hundred and sixty-eight obstetrician gynecologists and family medicine physicians were surveyed between March and April 2019. Proportions in various family planning practices, with an emphasis on contraception, abortion, and early miscarriage management, were calculated and reported. Notable findings included almost all providers were able to provide long acting reversible contraception (LARC), fewer were able to provide immediate postpartum LARC, and about half of providers reported prescribing ullipristal acetate (Ella) for emergency contraception. Only about 20-25% of providers reported personally performing either medical or surgical abortion. Half of providers offered manual vacuum aspiration (MVA) for early pregnancy loss (EPL) management and only about a 1/3 offered EPL management in an outpatient setting. Differences in family planning practices between providers in rural and urban practice settings were assessed using Fisher exact tests due to small sample size. Using a p<0.05 for significance, the difference in surgical abortion provision was statistically significant with a greater proportion of urban providers providing surgical abortion compared to rural. We did not evaluate for practice differences based on religious affiliation due to a low proportion of responding providers who practice in such a setting. These results highlight the wide variation in family planning practices across a single geographic region, the potential for ongoing disparities between rural and urban practice settings, and the need for further studies with better provider recruitment, as well as recruitment that involves providers who work in a religiously affiliated practices.