Reproductive health is often separated from primary care. Most people visit stand-alone clinics to meet their reproductive health needs. When Roe v. Wade was overturned in June, an access crisis was created. Abortion services are now entirely unavailable in 14 states, eliminating access not only to abortion services but also to other services that these clinics used to provide: cancer screenings, maternity care, and childcare. Though some clinics still offer reproductive health services, an influx of persons from other states where clinics closed down has caused extended wait times and staff shortages. Perhaps the first step toward widespread access to quality reproductive health care would be through its integration into primary care settings.
When Roe v. Wade was overturned in June, an access crisis was created. Abortion services are now entirely unavailable in 14 states. Eliminating access not only to abortion services, but also to other services that these clinics used to provide: cancer screenings, maternity care, and childcare.
The burden of limited reproductive care access is especially felt by those with low access to health care: minority groups, low-income individuals, and homeless individuals. Primary care settings could be a potential access point for reproductive health services, which are more time-sensitive than other health care services. Primary care clinics and community health centers (CHCs) provide an opportunity to build upon a pre-established relationship with a patient and discover what their support team can offer. There is value in a primary care physician being able to help a patient with all of their needs, not just their basic health care needs.
Swiss Army Approach
Some CHCs take a “Swiss army knife” approach to health care. Instead of referring a patient to another organization that offers food, financial assistance, or childcare services, CHCs offer all of these services together. CHC clinicians and support staff rely on their long-standing relationships with patients to understand every part of their patients’ needs and offer them the best possible care.
Instead of referring a patient to another organization that offers food, financial assistance, or childcare services, Community Health Centers offer all of these services together in a Swiss army approach.
Due to the trust built in a CHC, providers can offer patients reproductive care services in addition to their primary care needs. Patients have a trusted environment in a CHC where they can discuss sexual health with people they can rely on to meet their needs. Many people may feel uncomfortable going to primary or specialty clinics for their sexual health needs because they may feel that providers can’t help them or that clinicians may have inherent biases that keep their needs from being met. Building a trusting relationship and understanding what is important to the patient is critical to a patient’s reproductive health.
Needs
To successfully integrate reproductive health into primary care, providers must ensure that all support staff are trained in the full range of services needed to meet a patient’s reproductive needs. Staff must be prepared to provide patient-centered counseling, contraceptive information, and other reproductive health care services. Providers must also be educated on the full range of options a patient can pursue, including their desires to have children, their knowledge of contraceptives, and their level of sexual activity, to provide the best recommendations for care.
Team-based thinking is also critical to the success of reproductive health care integration. Patients may only want to continue visiting a clinic if the entire care team is on board for offering reproductive care services. Everyone must buy in and fully support this integration. Getting the whole team involved also means eliminating biases that stem from individual experiences and values. In initiating new services for patients, support staff must think about their biases and how they affect the care they provide. A care team should come together and identify concerns, opinions, and individual barriers to find a way to eradicate these biases and differing opinions and meet common ground. Sometimes, providers may have a hard time pushing past their own biases. They may feel that contraceptives are against their religious beliefs or that abortion is against their moral values. When this is the case, it is important to acknowledge that difference in opinion as valid but to articulate that that provider may not be a good fit in a setting where those services are accepted.
Money and reimbursement continue to be significant challenges in health care. If providers aren’t reimbursed for their services, they will not want to continue providing them. Mission-based organizations, like CHCs, whose goals are to provide widespread health care services, cannot do so without proper reimbursement. State programs and grants can provide the necessary funding for proper integration. Proper coding can also help providers be reimbursed for their services. However, proper coding can be time-consuming, and providers may not have the time to go through and correct their coding themselves.
Finally, providers and health care professionals must make implementing services beyond health care a standard practice. There must be more access to services beyond health care within a primary care setting. Training, educating, and informing staff on delivering a full range of reproductive health services is the best way to establish a standard of care. If clinical staff learn best practices for addressing patients’ reproductive health needs, they create a culture of support where patients feel safe to share their sexual health needs.
While integrating reproductive care into primary care settings is not a solution to the problem of limited access, it is a step in the right direction. Since Roe v. Wade was overturned in June, there has been an increased need for clinics and centers that can provide maternal and childcare services. If providers and their care teams work together to establish standards of practice for reproductive health and cultivate a culture of acceptance, patients would have more options at their disposal, and maternal and infant mortality rates would begin to decrease across the country.
