University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd, MS: 1008, Kansas City, KS 66160; University of Kansas School of Medicine, Department of Obstetrics and Gynecology, 3901 Rainbow Blvd, MS: 2028, Kansas City, KS 66160.
University of Kansas School of Medicine, Department of Obstetrics and Gynecology, 3901 Rainbow Blvd, MS: 2028, Kansas City, KS 66160.
Contraception. 2019 Jun;99(6):363-367. doi: 10.1016/j.contraception.2019.02.009. Epub 2019 Mar 11.
Describe contraception availability at local health departments (LHDs) serving largely rural populations.
We invited administrators at LHDs located in four Midwest states to participate in an online survey conducted from September 2017-April 2018. We collected data on clinic staffing, patient population, receipt of Title X funds, and services provided to assess the proportion of LHDs providing any prescription method of contraception; secondary outcomes included healthcare staff training level and other reproductive health services provided.
Of 344 LHDs invited, 237 administrators completed the survey (68.9%). Three-quarters served rural populations. One-third (34.6%) provided short-acting hormonal contraception; however, availability varied by state (Kansas: 58.0%, 40/69; Missouri: 37.5%, 33/88; Nebraska: 16.7%, 3/18; Iowa: 9.7%, 6/62; p<.01). Only 8.4% of LHDs provided IUDs; 7.6% provided implants, and 5.9% provided both methods. LHDs in Nebraska and Kansas provided any long-acting method more frequently (Kansas: 17.4%, Nebraska: 16.7%, Iowa: 8.1%, Missouri: 4.6%; p=.04). LHDs receiving Title X funds (27.0%) were much more likely to provide any prescription contraception (85.1% vs. 14.2%, p<.01). Most LHDs relied on registered nurses (RNs) to provide medical care; 81.0% reported that RNs provided care≥20 days per month. Pregnancy testing was widely available in Missouri and Kansas (>87%) and less commonly available in Iowa and Nebraska (<18%) (p<.01).
LHDs in these states are currently ill-equipped to offer comprehensive contraceptive services. Women seeking care at LHDs have limited, if any, contraceptive options.
Local health departments in the Midwest, serving a largely rural population, rarely offer prescription contraception, especially long-acting reversible methods. Women residing in settings without broad access to publicly-funded healthcare providers may have limited access to comprehensive contraceptive services. Efforts to ensure rural access are needed.
描述主要为农村人口服务的地方卫生部门（LHD）提供避孕措施的情况。
我们邀请了位于四个中西部州的 LHD 管理人员参加 2017 年 9 月至 2018 年 4 月进行的在线调查。我们收集了有关诊所人员配备、患者人群、获得 Title X 资金以及提供服务的数据，以评估提供任何处方避孕方法的 LHD 的比例；次要结果包括医疗保健人员的培训水平和提供的其他生殖健康服务。
在邀请的 344 个 LHD 中，有 237 名管理人员完成了调查（68.9%）。三分之二的 LHD 服务于农村人群。三分之一（34.6%）提供短期激素避孕措施；然而，可用性因州而异（堪萨斯州：58.0%，40/69；密苏里州：37.5%，33/88；内布拉斯加州：16.7%，3/18；爱荷华州：9.7%，6/62；p<.01）。只有 8.4%的 LHD 提供宫内节育器；7.6%提供植入物，5.9%提供这两种方法。内布拉斯加州和堪萨斯州的 LHD 更频繁地提供任何长效方法（堪萨斯州：17.4%，内布拉斯加州：16.7%，爱荷华州：8.1%，密苏里州：4.6%；p=.04）。获得 Title X 资金的 LHD（27.0%）更有可能提供任何处方避孕措施（85.1%比 14.2%，p<.01）。大多数 LHD 依赖注册护士（RN）提供医疗服务；81.0%的人报告说，RN 每月提供护理≥20 天。在密苏里州和堪萨斯州，妊娠测试的应用非常广泛（>87%），而在爱荷华州和内布拉斯加州则不太常见（<18%）（p<.01）。
这些州的 LHD 目前提供全面避孕服务的能力不足。在 LHD 寻求护理的女性避孕选择有限，如果有的话。居住在公共卫生提供者广泛服务不足的环境中的女性可能获得全面避孕服务的机会有限。需要努力确保农村地区获得服务。
服务于主要为农村人口的中西部地区的地方卫生部门很少提供处方避孕药具，尤其是长效可逆方法。居住在没有广泛获得公共资助医疗服务提供者的环境中的女性可能获得全面避孕服务的机会有限。需要努力确保农村地区获得服务。
