Senior Research Scientist, Guttmacher Institute, New York, NY, USA.
Research Associate, Guttmacher Institute, New York, NY, USA.
Sex Reprod Health Matters. 2022 Dec;30(1):2089322. doi: 10.1080/26410397.2022.2089322.
In recent years, there have been several state and federal policies that have disrupted access to publicly supported family planning care in the United States, including the 2019 rule that altered the federal Title X family planning program. In late 2020, we conducted in-depth interviews with health care providers from 55 facilities providing family planning care in Arizona, Iowa, and Wisconsin with the aim of learning how sites were affected by policy changes. We identified perceived effects on clinic finances, patient confidentiality, contraceptive counselling and service provision, and options counselling resulting from state and federal policy changes. Some clinics lost funding and had to pass some of the cost of services on to patients, raising new confidentiality concerns and creating new burdens on staff to carry out financial counselling with patients. Other sites had to grapple with restrictions on the pregnancy options counselling that they could provide, concentrate counselling on fertility awareness-based methods, and increase efforts to include parents/guardians in the care of adolescent patients. State and federal policies impact how publicly supported family planning care is provided, and compromise efforts to provide patient-centred care.
近年来，美国有几项州和联邦政策扰乱了公众支持的计划生育保健服务的获取，包括 2019 年改变联邦计划生育 X 标题项目的规定。2020 年底，我们对亚利桑那州、爱荷华州和威斯康星州 55 家提供计划生育服务的医疗机构的医疗服务提供者进行了深入访谈，旨在了解这些机构如何受到政策变化的影响。我们确定了州和联邦政策变化对诊所财务、患者保密性、避孕咨询和服务提供以及选择咨询的影响。一些诊所失去了资金，不得不将部分服务费用转嫁给患者，这引发了新的保密性问题，并给工作人员带来了新的负担，需要与患者一起进行财务咨询。其他诊所则不得不应对提供的妊娠选择咨询的限制，专注于生育意识为基础的方法的咨询，并增加努力，让父母/监护人参与青少年患者的护理。州和联邦政策影响着公众支持的计划生育保健服务的提供方式，并损害了以患者为中心的护理服务。
