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5.7.1 Access to traditional family planning services
Overall, P4HB® focus group participants were pleased with the family planning services they received and were thankful these services were provided at no-cost. When P4HB® enrollees were asked what health care services they have accessed since
enrollment in the program, most reported seeking traditional family planning services. Women received contraception, annual exams (Pap smears), STD testing, and pregnant testing through P4HB®. In a few cases, women accessed other related services, including the HPV vaccine, ultrasound, and diagnostic MRI. One participant, “Tracy,” 22, Atlanta, was diagnosed and treated for cervical cancer while on the P4HB® program. After
enrolling in P4HB® in December 2011, “Tracy” was diagnosed with Stage 1 cervical cancer by a private OBGYN, who then treated her via a Loop Electrosurgical Excision Procedure (LEEP). She has also received follow-up care since being treated.
5.7.2 Services from public health clinics after P4HB® enrollment
Another important finding from the focus groups is that most of the P4HB® participants seek family planning services from public health providers. A majority of the P4HB® enrollees sought family planning services from local public health clinics prior to their enrollment in the program, and once enrolled, preferred to continue using their usual health care providers. These participants expressed preference for their providers because they were conveniently located, familiar to them, and because the participants had been seeking services from them for a long time.
As mentioned previously, there were a few P4HB® participants who changed providers after enrolling in the program. A couple of women changed from public health
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clinics to private doctors because they thought these providers could give them better care for their family planning needs. Several other P4HB® participants, however, switched providers because the health clinics did not accept their health plan. One participant, “Dena,” 30, Atlanta, had to switch from a public health clinic to a private OBGYN to get her birth control, because the clinic did not accept her CMO (Peach State) and made her pay for her contraception. Since switching to the private provider, she had not experienced any problems. Another P4HB® enrollee experienced a similar situation, when her local health clinic stopped accepting Well Care. This enrollee, “Candice,” 23, Atlanta, initially received her birth control through a community-based primary care center. However, when this center stopped accepting her health plan, she switched to a nearby federally qualified health center that accepted all Medicaid health plans. A third P4HB® enrollee, “Yasmine,” 30, Atlanta, needs fibroid surgery (myomectomy), but can’t find a doctor to perform the procedure. “A lot of them are saying that they don’t take Medicaid as well anymore because I have to get like a myomectomy because I have fibroids. So, I’ve been having a really hard time trying to find a doctor that actually does the surgery. “
5.7.3 Remaining barriers to P4HB® services
Despite the overall findings that P4HB® enrollees are utilizing family planning services through the program, some barriers to services were identified. The first barrier is the lack of available family planning-related services. Several women reported that they were not able to access services such as HIV testing, ultrasounds, and gynecological procedures, such as myomectomy. One woman, “Wendy,” 19, Atlanta, sought HIV
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testing from her private family practitioner, who accepts P4HB® clients. However, she was told by the doctor that HIV tests were not covered under the program and could only receive the test at a public health clinic. For another participant, “Gabrielle,” who was told she needed an ultrasound due to a cyst on her ovary, the procedure was not covered by P4HB® but eventually, the provider paid for it. Yet, for “Rachel,” 19, Atlanta, she received a bill for $75 for an ultrasound that she received at an Atlanta hospital, where she had received pap smears and other P4HB® covered services. In all of these instances, women were confused about the scope of coverage under P4HB® and where they could access such services free of cost.
A second barrier that was revealed during the focus groups was the low utilization of family planning services among post-partum P4HB® clients. Several women who had young children reported not yet seeking birth control or other family planning services since delivering their children. In our southeast Georgia focus group, two of the four participants had not started back on birth control since delivering their children. When asked why she was not using birth control, one participant, “Carmen,” 25, who has 3 children under the age of 4, replied, “Well I’ve been pregnant for the past 5 years (laughing).. I don’t know. We haven’t got really back on schedule yet.” Another participant from this focus group, “Anna,” 22, claimed she had not been back to the family planning clinic since her daughter was born, which was one year ago. Likewise, two of the four participants in one of the northwest Georgia focus groups have not
initiated birth control since delivering their children. For one of these participants, “Ilena, 19, she did not use birth control prior to her pregnancy and has not sought family
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stated she was going to “get on birth control soon..since now I know I have it “(meaning coverage for contraception). A P4HB® enrollee in one of the Atlanta focus groups explained she hadn’t used any family planning services since delivering her daughter seven month ago because she was not sure what services were covered under the program. This enrollee, “Quinn,” 29, asked, "Well my question was do you think, you know, because I haven’t utilized the program, do you think it’s worth it to utilize the program for pap smears or whatever ?”
Both types of barriers to P4HB® service indicate a lack of awareness about the types of services that are covered under the program as well as the lack of understanding of where they can access family planning services. The findings from the postpartum P4HB® enrollees is especially troubling as the women seem to be unaware of the coverage available to them but also of the need to utilize contraception and other family planning services after delivery.