Forty-five percent of all pregnancies in the U.S. are unintended1. Increasing access to contraception is a proven strategy for reducing unintended pregnancy and achieving healthy spacing of births. Currently, an estimated 37.9 million women are in need of contraceptive services in the United States2. Women who wish to delay or prevent pregnancy should have access to a broad range of contraceptive methods, preferably on a same-day, on-site basis. It is important that these contraceptive services are provided in a client-centered manner that treats each person as a unique individual with respect, empathy, and understanding, providing accurate, easy-to-understand information based on the needs and goals identified by the client and reflecting the client’s preferences and values.3 Efforts to provide client-centered contraceptive services as described above may be strengthened by quality improvement processes based on standardized measurement of the delivery of contraceptive care.
Previously, there have been no validated clinical performance measures for contraceptive care. To address this gap, the Office of Population Affairs (OPA) developed contraceptive care measures, endorsed by the National Quality Forum, that assess the provision of contraception to all women in need of contraceptive services. This is a significant step towards prioritizing and improving the quality of family planning care provided to women and men of reproductive age. In addition, OPA funded projects to develop electronic clinical quality measures (eCQM) as well as to develop a patient-reported outcome performance measure, which will focus on filling another critical gap in performance measures (i.e., the need for validated measures of client experience with contraceptive services). These measures will complement the contraceptive care measures.
This website provides information about how the contraceptive care measures are calculated, and how to use them in an appropriate manner.
There are four measures:
- Contraceptive Care – Most & Moderately Effective Methods: The percentage of women aged 15-44 at risk of unintended pregnancy that is provided a most effective (i.e. sterilization, implants, intrauterine devices or systems (IUD/IUD)) or moderately effective (i.e., injectables, oral pills, patch, ring, or diaphragm) contraceptive method
- Contraceptive Care – Access to LARC: The percentage of women aged 15-44 years at risk of unintended pregnancy that is provided a long-acting reversible contraceptive (LARC) method (i.e. implants or IUD/IUS)
- Contraceptive Care – Postpartum Most & Moderately Effective Methods; Among women aged 15-44 years who had a live birth, the percentage that is provided a most effective (i.e., sterilization, implants, IUD/IUS) or moderately effective (i.e., injectables, oral pills, patch, ring, or diaphragm) contraceptive methods within 3 and 60 days of delivery
- Contraceptive Care – Postpartum Access to LARC: Among women aged 15-44 years who had a live birth, the percentage that is provided a LARC method (i.e. implants or IUD/IUS) within 3 and 60 days of delivery
Rationale for Contraceptive Care Measures
Contraception is a highly effective clinical preventive service that can help women achieve their personal reproductive health goals, including preventing teen and unintended pregnancy and achieving healthy spacing of births. The type of contraceptive method used by a woman is strongly associated with her risk of unintended pregnancy and there is no single method that is right for everyone. Each woman and teen needs to have access to the full range of contraceptive methods in order to choose the method that is right for her and with which she can be successful in delaying or preventing pregnancy.
These performance measures for contraceptive care reflect the fact that some contraceptive methods are more effective than others at preventing unintended pregnancy and are designed to encourage providers to offer the range of most and moderately effective methods.
Effectiveness is only one of many important aspects to consider in comparing contraceptive methods, but it has been shown to be of great important to women who use contraception. A 2016 study asked 1,783 women in family planning and abortion clinics across the United States what characteristics of contraceptive methods were “extremely important” to them. Of 23 total items, the method’s effectiveness at preventing pregnancy was the item that most (89%) women said was “extremely important.” The next most important characteristics were the method is easy to get (81%), affordable (81%), and easy to use (80%).4 Many women also consider other characteristics, such as a method’s potential side effects and non-contraceptive benefits, as well as partner preferences and peer experiences, during selection.
The use of these performance measures will increase women’s access to contraception in two main ways:
- More providers will start asking women and men about their pregnancy intention in order to determine their need for services to meet their reproductive goals, whether those goals be preventing, delaying, or achieving pregnancy.
- For clients who wish to delay or prevent pregnancy, more providers will follow Centers for Disease Control and Prevention (CDC)/OPA recommendations to inform women about the availability of a wide range of contraceptive methods, conduct a brief assessment to identify those contraceptive methods that are safe for the client, offer client-centered counseling in a way that respects the client’s preferences, and provide the client with her chosen contraceptive method(s), ensuring that a wide range of methods are readily available to the client, preferably on a same-day on-site basis.
CDC and OPA recommendations describe how to provide contraceptive services in a safe, effective and client-centered manner.
- Providing Quality Family Planning Services (QFP)
- United States Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2016
- U.S. Selected Practice Recommendations (US SPR) for Contraceptive Use, 2016
How the Measure Should be Used
A specific benchmark has NOT been set for the Contraceptive Care - Most & Moderately Effective Methods measure, and OPA does not expect it to reach 100%, as some women will make informed decisions to choose methods in the lower tier of efficacy even when offered the full range of methods. The goal of providing contraception should never be to promote any one method or class of methods over women’s individual choices.
The Contraceptive Care – Access to LARC measure should be used to identify women who have very limited or no access to LARC methods, which are more commonly inaccessible than other methods. For example, reporting units with less than 1-2% use or rates well below the mean may signal the presence of barriers to LARC provision. The Contraceptive Care – Access to LARC measure should NOT be used to encourage high rates of use, as this could lead to coercive practices related to contraception and sterilization, especially practices targeting racial/ethnic minorities and low-income individuals. For this same reason, it is not appropriate to use the Contraceptive Care – Access to LARC measure in a pay-for-performance context.
1 Finer, L.B. and Zolna, M.R. (2016). Declines in unintended pregnancy in the United States, 2008-2011. New Engl J Med, 374(9), 843-52.
2 Frost, J.J., Frohwirth, L., and Zolna, M.R. (2015). Contraceptive needs and services, 2013 update. New York: Guttmacher Institute.
3 Gavin, L., Moskosky, S., Carter, M., Curtis, K., Glass, E., Godfrey, E., Marcell, A., Mautone Smith, N., Pazol, K., Tepper, N., Zapata, L. Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014; 63(RR-04):1-54.
4 Jackson, A.V., Karasek, D., Dehlendorf, C., and Foster, D.G. (2016). Racial and ethnic differences in women’s preferences for features of contraceptive methods. Contraception, 93(5), 406-11.