Program Evaluation of a County Reproductive Health Program

Abstract

Northern Arizona women of childbearing age are at disproportionately higher risk for poverty and persistent health disparities in maternal risk factors and maternal child health outcomes. Preconception care is a lifespan and population-based approach to providing health promotion activities to women of childbearing age to improve the health of women, their families, and communities. The county's Reproductive Health Program offers comprehensive reproductive and preconception healthcare to underserved women and men throughout the county without regard for ability to pay, serving as a critical safety net for this vulnerable population. A formative evaluation was performed using the CDC's Framework for Program Evaluation in Public Health and retrospective chart review to assess program implementation. In 2010, 1,561 patients received care over 2,575 visits; the majority of patients (69.4%) were women of childbearing age (females 15-44). Most patients (92.9%) were ≤ 150% FPL, and uninsured (77.8%). Program patients were racially/ethnically diverse, with nearly half identifying themselves as White (48.8%), followed by Hispanic (35.3%), and American Indian/Alaskan Native (11.6%). Program reach was limited. Comprehensive medical and social risk assessment and health promotion activities were consistent with evidence-based recommendations. More than 3,400 STI and pap screenings were performed, with identification of 178 abnormal results at the primary program site. One hundred forty-five females had a positive pregnancy test at the primary program site, one-third (33.1%) to teens. For women of childbearing age not trying to become pregnant (98%), a range of family planning methods were provided, which most commonly included oral contraception (36.9%), followed by condoms (15.4%), and Depo-Provera injection (12.6%). More than 10% of low-income females 15-44 received referrals for further medical care not provided with program. Logistic regression analysis revealed program visits associated with a decreased risk of unplanned pregnancy, though this was not significant (OR 0.87, 95% CI 0.59-1.29, p>0.05). In conclusion, this program provided evidence-based preconception care to underserved women of childbearing age, though reach was limited. Additional studies are recommended to explore patient needs and barriers to improve reach and tailor services. Development of a community advisory council is recommended to guide program activities.