Family planning service provision in rural areas: a survey in Washington State

Abstract

Context: Women in rural areas are highly dependent on public clinics for family planning services, yet little information has been collected on rural family planning providers, especially on their funding and operation.

Methods: All 31 family planning clinic sites in rural Washington State were surveyed about their sponsorship, staffing, service provision and population coverage.

Results: Clinic sites were located in 25 of the 53 discrete rural health service areas of Washington State. While the three wealthiest areas had clinics, eight of the poorest areas had no clinics. Eight clinics were Planned Parenthood affiliates, eight were private freestanding clinics and 15 were local health department sites. Clinic sites were small (with the equivalent of 2.4 full-time staff members, on average) and offered a mean of 18 of 43 potential reproductive and women's health care services; general primary care services were rarely provided. Only one clinic offered abortions.

Conclusion: Family planning clinics in rural Washington State offer an important but limited number of services. Many rural areas have no local family planning clinic. Given these clinics' reliance on federal and state funding, decreased public support might seriously impair family planning provision in rural areas.

PIP: This study explored the range of services available in 3 types of family planning (FP) clinic centers in rural Washington state: Planned Parenthood clinics (8), private freestanding clinics (8), and local health department clinics (15). Comparisons were made of staffing, funding, patient volume, range of services, service area, and availability of abortion services. All 31 FP clinics completed the questionnaire in 1995. Most providers were nurse practitioners, physician assistants, or registered nurses who were supervised by a medical physician. Local health departments had the largest staffs (3.5 full-time staff). Private clinics averaged 1.8 staff, and Planned Parenthood clinics averaged 1.2 staff. 25 clinics reported a mean of 809 clients, or 131 clients/1000 women aged 15-44 years. 9 of 43 possible reproductive health services were unavailable. Of a designated total of 34 core, discretionary, and rare services, clinics provided a mean of 18 services. Only 1 clinic provided abortions. Availability of services did not vary by type of clinic. Cost and lack of trained providers were reasons for lack of service expansion. Local community opposition and lack of trained providers were the most common reasons for absence of abortion services. Women were referred to abortion services 20-200 miles away. 36% would prescribe mifepristone if it were available. Federal funds and state funds, which comprised almost 50% of funding, varied by clinic type. Areas with the lowest socioeconomic status were less likely to have FP clinics. Findings demonstrate that FP clinics provide an important but limited scope of services to rural women.