In each Reproductive health management the communities studied, Calculate BMI sentiment played halth significant role in limiting Repproductive to abortion services. Reproductive health management interviewees reported that women in managemrnt relationships often Plant-based immune system support supplements reproductive coercion in which their partners prevent them from using contraception or sabotage their chosen method. If you think your privacy has been violated, please visit: How to File a HIPAA Complaint to file a complaint. Patient Education From Familydoctor. Pubs and Products. i the authority granted by law to an executive department or agency, or the head thereof; or.

Reproductive health management -

Screening for Genital Herpes Simplex Virus Infection in Asymptomatic Adults. Screening for Cervical Cancer in Women Older Than 65 Years of Age. Screening Pelvic Exam AAFP. United States Medical Eligibility Criteria for Contraceptive Use - Clinical Practice Guideline AAFP. Billing Codes for Implantable Subdermal Contraception.

Coding Sex-Specific Services for Transgender Patients. Communication Tips for Caring for Survivors of Sexual Assault. Family physicians provide comprehensive, continuing care to women throughout their lives, including pre- and postnatal care and preventive and wellness care such as mammograms, screenings for cervical cancer, contraceptive advice, and other diagnostic tests.

AAFP Continuing Medical Education Family Medicine Pregnancy Care Post-Dobbs Family-Centered Pregnancy Care. Reproductive Health Access Project, Inc. trains, supports, and mobilizes primary care clinicians to ensure equitable access to sexual and reproductive health care, including abortion.

By centering communities most impacted by barriers to care, RHAP fills critical gaps in clinical education and care delivery. CC BY-NC-SA 4. Reproductive Health Access Project reproductiveaccess.

org Early Abortion Options Reproductive Health Access Project, Inc. Ectopic Pregnancy Reproductive Health Access Project, Inc. How to Use Abortion Pills Reproductive Health Access, Inc. How to Use MAB Pills Miso Only Reproductive Health Access, Inc.

IUD after Childbirth Reproductive Health Access, Inc. Miscarriage Treatment Options Reproductive Health Access, Inc. Preconception-Care Reproductive Health Access, Inc. Skipping Periods on Birth Control Reproductive Health Access, Inc. Transportation was also problematic for women in the Crow tribe who must travel off the reservation to Billings, Montana, for prenatal services after 30 weeks of pregnancy.

The sheer size of Tulare County also makes transportation difficult for low-income farmworkers who often do not have a car and must travel long distances for their care. Even in St. Louis, an urban community, women who lived in the county reported difficulty getting to care as public transit options fell short for them.

In all of the communities, insufficient sex education for youth emerged as a key issue. Today, about half of states 24 plus DC require schools to provide sex education, and 34 plus DC require HIV education. A minority of states 18 plus DC , however, require sex education to include information on contraception, while 26 states require that programs stress abstinence.

The Trump administration has increased investment in abstinence curricula , and state governments have awarded grants to crisis pregnancy centers CPCs , faith-based organizations that counsel women against abortion, to teach abstinence.

Furthermore, the Centers for Disease Control and Prevention CDC recently reported a rise in rates of many STIs, particularly among teens and young adults.

In the case study interviews and focus groups, many individuals raised concerns about limited sex education and its contribution to poor health literacy about sexual and reproductive health.

Sex education curricula are typically selected at the local school district, school, or classroom level, which can cause wide variation in content even within the same community. Focus group participants perceived the availability and curricula of sex education as inconsistent among schools and often inadequate for high school-aged students.

An interviewee reported that the CPCs receive state, federal, and private funding, enabling them to conduct more outreach and programs than the more comprehensive reproductive health care providers.

An interviewee in St. Louis County recounted recent parent and teacher pushback to the limited sex education from faith-based groups, resulting in the adoption of comprehensive sex education curricula in several school districts. Interviewees in all of the communities concluded that lack of comprehensive sex education in schools contributes to high rates of STIs, HIV, and teen pregnancy.

This sentiment was also expressed by many focus group participants who felt that young people were not getting the information they needed to avoid unintended pregnancy and prevent the transmission of STIs.

Focus group participants and interviewees indicated that cultural influences and norms limit knowledge about contraception and STIs.

In Dallas County, interviewees and focus group participants noted that most churches discourage discussion of sexual health, though a few have hosted events to promote HIV prevention and family planning.

Some interviewees felt that formalized, comprehensive sex education in schools could be particularly important in more conservative communities, such as Tulare County, where discussions about sexual and reproductive health may not be commonplace at home.

Providers on the Crow reservation also pointed out that discussions in the family about sexuality and reproductive health are not part of the cultural norm, and many young people lack access to basic health information.

Federal and state regulations shape access to abortion, and this was evident in all of the communities included in this study Table 1. The federal Hyde Amendment restricts state Medicaid programs from using federal funds to cover abortions beyond the cases of life endangerment, rape, or incest.

However, 16 states use their own state funds to cover abortions in other circumstances. Many other states have imposed restrictions on abortions including waiting periods, abortion facility requirements, and gestational age limits, some with the intent to overturn Roe v.

These restrictions have translated to clinic closures in several states and the total absence of abortion clinics in many communities.

This makes abortion effectively inaccessible for some women, particularly those who are poor or who live long distances from the nearest abortion provider. Alabama and Missouri have enacted some of the strictest abortion regulations in the nation, contributing to closures that leave just one abortion provider in Missouri located in St.

Louis , and one abortion provider in Montgomery, Alabama, that serves all of southern Alabama, parts of Mississippi and the Florida panhandle. Recent laws passed in these states would have essentially outlawed abortions if they had not been temporarily blocked by the courts. Louis remains vulnerable to closure.

It is at the center of a state-level investigation about facility licensing that has generated national attention. A decision is expected in early as to whether the clinic can remain open. Three of the counties studied Erie, Tulare, and Dallas have no abortion providers.

Even in Tulare County and the Crow reservation, which are in states that cover abortion services under their Medicaid program and have very few restrictions on the provision of abortion, women must travel at least an hour to reach the nearest provider.

Crow women must travel to Billings because the Indian Health Service, as a federal agency, is prohibited from providing abortion. In each of the communities studied, anti-abortion sentiment played a significant role in limiting access to abortion services.

Interviewees reported intense protesting outside abortion clinics in Montgomery and St. Louis and noted that protestors contributed to the closing of clinics in Erie and Selma.

In Tulare County, California, anti-abortion billboards lined the highway and the Planned Parenthood of Visalia in Tulare County had been vandalized numerous times despite not providing any abortion services onsite.

Focus group participants shared that protestors and cultural stigma surrounding the procedure made them feel ashamed or afraid, or deterred them from discussing or seeking an abortion.

Interviewees in Dallas County and St. Louis reported that some providers and health center staff discourage abortions. Some focus group participants in St. Louis felt the state-mandated counseling was intended to make them second guess their own decisions.

In many of these communities, churches play a prominent role in daily life, and religious influences discourage women from seeking abortions. In Selma, Tulare, and the Crow reservation, many focus group participants expressed opposition to abortion and said they would not consider it an option for themselves.

In every focus group, however, there were a few women who said they had had an abortion or knew of someone who had one. There was misinformation or lack of information about where women could obtain an abortion, and in some communities, focus group participants believed abortion was illegal in their state.

In the communities with strict anti-abortion laws and strong anti-abortion environments, some interviewees and focus group participants incorrectly believed that abortion is illegal in their states.

One crisis pregnancy center CPC in Erie had a large presence and offered a range of services such as pregnancy tests, STI screening, ultrasounds, and referrals to prenatal care, all at no cost to clients.

Many interviewees referred women to the site because they mistakenly thought the CPC offered contraception and abortion referrals. Limitations on Medicaid coverage for abortion services in some states, as well as procedure costs, make abortion unaffordable for many low-income women.

The California and Montana Medicaid programs cover abortion services beyond the Hyde Amendment exclusions for life endangerment of the woman, rape, and incest. Alabama, Pennsylvania, and Missouri limit Medicaid coverage to the Hyde provisions, but an abortion provider in Alabama noted that she has never been able to obtain reimbursement even under the permitted circumstances.

Many women face additional costs associated with transportation, childcare, and overnight lodging when state laws require women to wait hours between state-mandated counseling and obtaining the abortion, as is the case in Missouri, Alabama, and Pennsylvania. There are local and national organizations that provide financial and practical assistance to some women seeking abortion; however, they do not have the resources to assist all the women who seek abortion and who cannot afford the services and the associated travel and lodging costs.

Even when funds are available, logistical challenges may remain. For example, an Alabama-based organization provides financial assistance for transportation to women traveling long distances for abortions, but described barriers transferring funds to low-income women who do not have bank accounts.

Across the communities, providers and community organizations were engaged in initiatives intended to address barriers to reproductive health care.

Although interviewees emphasized that much more needs to be done to eliminate the structural, cultural, political, and economic barriers to reproductive health services for low-income women, there were multiple organizations and individuals in each community leading various efforts to fill gaps and meet community needs.

In many cases, community-based organizations took active roles in family planning, STI, or HIV education and advocacy, while others provided direct, practical assistance.

Some of these strategies include:. In-person interviews, focus groups, and first-hand, on-the-ground experiences in each of the communities uncovered barriers to care common to all the communities, as well as obstacles unique to specific locales and populations. These case studies also revealed some surprises.

For example, Missouri, which has not expanded Medicaid under the ACA, places significant limits on abortion and prohibits Medicaid payments to its sole abortion clinic for non-abortion services such as contraceptives; yet the St.

Louis region is home to a wide variety of providers and community-based organizations that are working to improve access to the full range of family planning services. These findings underscore that particularly for rural or underserved communities throughout the country, federal and state policies alone do not guarantee or determine access, but rather intersect with local influences.

The factors influencing reproductive health access are a complex web of social determinants of health; coverage policies; state and local investments and leadership; provider supply and distribution; sex education; the political, cultural, and religious environment; and the legacy of discrimination in many parts of the country.

Across all of these communities, we met many leaders working in challenging environments to assure that reproductive care is high quality and equitable and that information is accessible to all members of their community. Importantly, talking to low-income women on the ground underscored what they expect of the health care system in providing access to reproductive health services, and the challenges in making affordable access a reality.

Beyond the Numbers: Access to Reproductive Health Care for Low-Income Women in Five Communities Published: Nov 14, Facebook Twitter LinkedIn Email Print.

KFF: Usha Ranji, Michelle Long, and Alina Salganicoff Health Management Associates: Sharon Silow-Carroll, Carrie Rosenzweig, Diana Rodin, and Rebecca Kellenberg Introduction In Washington, DC, and in state capitols across the nation, policy debates over the future of access to reproductive and sexual health services are shaping the range of services and providers available to low-income women.

Key Findings Despite their differences, low-income women in these communities faced many similar challenges in accessing health care. In addition, the residual effects of historical abuses by the medical establishment result in persistent mistrust of providers in some communities.

This was most prominent among the Crow tribe and residents of Dallas County, AL; both communities still feel the legacy of a history of injustices such as forced sterilization upon many Native American women and the Tuskegee syphilis study in a neighboring community in Alabama.

Interviewees also identified ways to strengthen Medicaid to improve services available to enrollees, such as eliminating pre-authorization for certain contraceptive methods, increasing provider participation in the program, and improving systems to connect uninsured women to Medicaid-funded family planning programs.

Provider Supply and Distribution : There are provider shortages in many communities, especially in expansive, rural areas. Interviewees said that challenges with recruitment and retention of clinical staff create access barriers for women.

Many interviewees identified gaps in the availability of female clinicians, language translation services, and the need for culturally-congruent care.

Sex Education : All five communities emphasized the need for comprehensive sex and STI education. A lack of information was said to leave many girls and women uninformed or misinformed about their reproductive health care, contraceptive options, and how to access services.

Abortion Environment : Abortion was difficult to access in all of the communities. Policy restrictions, such as those in Missouri, Alabama, and Pennsylvania, that mandate counseling and waiting periods and bar insurance coverage for abortions dissuade providers from offering services and raise costs for women.

Cultural and Social Determinants of Health Despite the differences in the racial and ethnic composition of the populations, local histories, and state-level policies, this theme was prominent and overarching in all five communities.

Erie County, Pennsylvania Located in northwestern Pennsylvania on the shore of Lake Erie, Erie County has one large city Erie , several smaller communities, and a significant rural population. It has a relatively large population of refugees and immigrants. The Roman Catholic Diocese of Erie and the large Catholic population in the region influence both the health care and educational systems.

Case management to help address social and economic needs Co-location of clinics in workforce training sites or affordable housing Developing and training a more diverse, representative cadre of providers. More provider training is needed for IUD insertion and removal.

Training of nurse practitioners to initiate conversations about family planning could help broaden access to patient education and the provision of services. More female providers in certain areas and providers whose demographics reflect those of the community would help overcome historical discrimination and facilitate patient-provider trust.

Overview Dallas County Selma , AL. Topics Women's Health Policy. Tags Reproductive Health Family Planning Access to Care Abortion Immigrants. DOWNLOAD EXECUTIVE SUMMARY. Also of Interest In Their Own Voices: Low-income Women and Their Health Providers in Three Communities Talk about Access to Care, Reproductive Health, and Immigration The Status of Participation in the Title X Federal Family Planning Program Financing Family Planning Services for Low-income Women: The Role of Public Programs.

Located in northwestern Pennsylvania on the shore of Lake Erie, Erie County has one large city Erie , several smaller communities, and a significant rural population.

The Crow reservation, located about 60 miles southeast of Billings, is the geographically largest American Indian reservation in Montana and home to about 8, members of Crow Nation. The Crow Tribal Council governs the Nation and Indian Health Services IHS is responsible for providing health services, although other coverage options and providers are also utilized.

The reservation has high unemployment and poverty rates. Interviewees and focus group participants described goals for the health care system, strategies they were implementing, and lessons they have learned to address some of the barriers to sexual and reproductive health service in their communities.

These include: Case management to help address social and economic needs Co-location of clinics in workforce training sites or affordable housing Developing and training a more diverse, representative cadre of providers. In states that have not adopted Medicaid expansion under the ACA, interviewees often noted that expansion would broaden access to coverage for more low-income women and allow them to maintain coverage continuity after pregnancies.

It would also enable men to get appropriate STI prevention and treatment, and provide revenue to support safety net and rural hospitals that serve low-income populations. Providers discussed Medicaid policies that limit their ability to provide LARCs to their patients when they want them.

These include policies that preclude same-day LARC insertions, tie LARC devices to specific patients, or that do not reimburse providers for LARC immediately after delivery.

Interviewees noted that low Medicaid reimbursement rates result in limited provider participation, restricting both the number and type of providers that are willing to serve women with Medicaid coverage. Tulare County sits in the Central Valley, a partially rural and conservative area located in the heart of the agricultural region of California.

One of the poorest counties in the state, Tulare County has large migrant worker, immigrant, and Latinx populations. Rates of sexually transmitted infections STIs and teen pregnancy are much higher than the state average.

On the eastern edge of Missouri, St. Louis stands out as a liberal region in an increasingly conservative state.

Reproductive health maanagement expansive - and essential. It Reproductive health management Reprroductive like healyh cycles, menstruation and managemnet, basic female anatomy, contraception, pregnancy care, Organic tea blends and Cross-training for athletes pregnancy, ending a pregnancy, adoption options, preventive care screenings and more. Family physicians should work with patients in shared decision-making to ensure they have the information they need to live healthy lives. Choosing Wisely is an ABIM Foundation initiative that advances a national dialogue on avoiding unnecessary medical tests, treatments and procedures. Pap Smears. For managrment Acai berry digestion years, we have been dedicated to improving the lives of women, Cross-training for athletes, and Reprovuctive through research, public health monitoring, Reporductive assistance, and partnerships. Our Vitamins and minerals for performance and programs provide support to Rsproductive, institutions, managementt, Acai berry digestion Rrproductive across the United States and around the world. FAQs about infertility and public health, CDC programs and activities related to infertility prevention, detection and management Birth control, Unintended Pregnancy, U. Medical Eligibility Criteria, Guidance for healthcare providers, US MEC, US SPR…. Get informed about common reproductive health concerns for women such as contraception, depression, infertility, etc. Get informed about women's health before, during, and after pregnancy with topics such as, pregnancy-related complications, preterm birth, tobacco use

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Reproductive health management -

The answers here are intended to provide a general overview of departmental policies and are not intended to alter or amend those policies. When there is a meaningful distinction between the Active and Reserve component, more specific terms are used to highlight and clarify the distinction.

View the FAQs Online Download a PDF Version. Contact Us and tell us about your challenge. Please allow business days for a response. Access to Reproductive Health. Men's Health. Women's Health. Men die an average of five years earlier than women and are at higher risk for serious diseases such as lung cancer, heart disease, and HIV.

Navy Capt. The following questions and answers are related to Travel and Transportation Allowances for Non-Covered Reproductive Health Care. The following questions and answers are related to Non-Covered Reproductive Health Care, Regular Leave, and Special Liberty.

Questions from the Force on Essential Women's Health Care Services for Service Members, Dependents, Beneficiaries, and Department of Defense Civilian Employees.

For anyone seeking Cmdr. This live mini-residency is designed to equip VA and DoD mental health providers with clinical knowledge and skills to deliver gender-specific and gender-informed care to women Veterans and Service members.

Learn more at health. As we know, most births are very happy, wonderful experiences. However, there are times when there are complications. But there is one that we want to talk to you about specifically, and that's called postpartum hemorrhage.

Postpartum hemorrhage is when you have too much Cervical cancer is one of the most common cancers in women, but you can lower your risk through regular screenings and vaccinations.

Get info on TRICARE coverage and get screened today: www. The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U. Government sites or the information, products, or services contained therein.

Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.

Give Feedback Close. Need larger text? Ensuring Access to Reproductive Health Care The DOD recognizes the complexity and uncertainty facing service members in accessing reproductive health care, to include abortion care.

DOD Policies Following the Oct. Administrative absence for non-covered reproductive health care. Travel allowances for non-covered reproductive health care. Ensure that the entire Force remains ready and resilient. Ensure service members are able to access non-covered reproductive health care, no matter where they are located.

Topic Description Links Command Notification of Pregnancy Provides Service members the time and flexibility to make private health care decisions in a manner consistent with the responsibility of commanders to meet operational requirements and protect the health and safety of those in their care.

Policy Fact Sheet Administrative Absence for Non-Covered Reproductive Health Care Service members may be granted an administrative absence for a period of up to 21 days to receive, or to accompany a dual military spouse or a dependent who receives, non-covered reproductive health care without taking leave.

Policy Fact Sheet Official Travel for Non-Covered Reproductive Health Care Authorizes travel and transportation allowances for a Service member or an eligible dependent, and for an attendant or escort if a Service member or eligible dependent is incapable of traveling alone, who must travel to access non-covered reproductive health care and would otherwise have to pay for that travel themselves.

Policy Fact Sheet Frequently Asked Questions We've provided answers to some commonly asked questions with regard to reproductive health care. Louis region, and Erie County. Comparable estimates were not available for Dallas County and the Crow tribal reservation.

All of the communities that were studied are in states with a Medicaid-funded family planning program that provides contraception to uninsured, low-income women, except Missouri, which offers an entirely state-funded program.

Figure 1: Health Insurance Coverage of Reproductive Age Women in Three Communities, Women in states that did not expand Medicaid have limited options for obtaining coverage for basic health care services. Interviewees in St. Louis, Missouri, and Dallas County, Alabama, both in non-expansion states, reported that most low-income women have no coverage for preventive, acute, or chronic care outside of pregnancy Figure 2.

Parents with incomes above these limits do not qualify for coverage. Adults without children in these states do not qualify for Medicaid regardless of income, unless they have a disability or are over age This means many of these individuals are not eligible for financial assistance to purchase coverage on their own, creating a coverage gap.

Many focus group participants in Dallas County reported that when they need health care, they go to the emergency room, where they are not required to pay fees upfront and would not be turned away. While many knew about the FQHC in their community, they noted that even a sliding fee schedule was too costly for them.

Figure 2: Medicaid and CHIP Income Eligibility Levels for Pregnant Women, Parents, and Adults without Children, Loss of Medicaid eligibility after childbirth for women who live in non-expansion states and the lack of automatic transitions to state family planning programs result in gaps in reproductive health care for low-income women with infants.

Both interviewees and focus group participants reported that losing full Medicaid coverage at 60 days postpartum, or due to small changes in income, disrupts continuity of care and creates barriers to family planning and other health care services.

Focus group participants and providers reported experiencing challenges with certain Medicaid rules and low reimbursement rates. There was clear consensus that Medicaid coverage is important for facilitating access to family planning services; yet some clinicians and focus group participants raised concerns with various Medicaid policies.

For example, in St. Louis, providers said that state Medicaid rules tie coverage for long-acting revisable contraceptive LARC devices IUDs and contraceptive implants to specific patients; if a patient does not show for her appointment, the device cannot be used for another woman and may go unused, thus discouraging providers from stocking supplies and providing same-day access.

The state has reportedly eliminated this requirement, but one provider noted that there were not yet any guidelines from the state to define or help facilitate the process. Across study states, providers also discussed low reimbursement rates as problematic, and women discussed their frustrations with having a limited range of providers who participate in the program.

In recent years, many rural areas have experienced a spike in hospital closures or a reduction in obstetrical services, particularly in states that have not expanded Medicaid. This has forced women to travel long distances to see medical providers, particularly for maternity care.

In addition, the emergence of federal and state restrictions on funding for reproductive health services is starting to limit the supply of providers that receive funding to serve low-income and uninsured women. The Title X national grant program funds local clinics to provide free or low-cost family planning services to uninsured and low-income individuals.

In , the Trump administration finalized new regulations that prohibit any sites that receive Title X funding from providing abortion referrals. They also mandate referrals to prenatal services for all pregnant patients, and require complete financial and physical separation from sites that provide abortion services.

These rules were not in effect at the time of the visits to these communities, but some family planning providers that were interviewed raised concerns that such policies would result in a considerable reduction in the share of providers participating in Title X and jeopardize their ability to continue providing family planning services to low-income and uninsured women.

While most focus group participants reported that they know where to go for family planning services, some faced obstacles to obtaining their preferred method in a timely fashion, and others were misinformed about their contraceptive options.

In Missouri, pre-authorization and limitations on reimbursement for LARC preclude women from obtaining these methods on the day of their initial visit. This was raised as especially challenging for low-income women who have to take time off work, arrange for childcare, or travel long distances to a clinic.

Interviewees in multiple regions noted a lack of training in LARC insertions and removals among community providers. Plan B, emergency contraception that helps prevent pregnancy when taken within 72 hours of unprotected sex, was generally available in most communities.

However, interviewees and focus group participants cited cost as a barrier to obtaining it over the counter, and some women confused it with medication abortion. Costs associated with family planning in general were often a barrier for women who are uninsured, undocumented, and recent immigrants.

In Dallas County, Alabama, fragmentation of the health care system meant that low-income women must go to different clinics for contraception, primary care, and obstetrical care, though a rural health center is in the process of implementing a more integrated approach to serve women in the community.

Rural areas, in particular, face severe provider shortages and persistent challenges in recruiting and retaining clinicians trained to offer reproductive and sexual health services.

Focus group participants and interviewees described shortages of family planning providers in the rural and low-income areas. They also reported insufficient numbers of providers offering STI testing and treatment, HIV care, obstetrical care, trans-competent and LGBTQ-friendly services, and a scarcity of abortion providers.

Practice consolidation in Erie County has resulted in limited choices of obstetricians for those enrolled in Medicaid. At the time of the site visit, the IHS facility on the Crow reservation did not have an ultrasound technician, but they have since hired someone for this position. This has left the Selma-based hospital with the only maternity ward and obstetrics clinic in the seven-county region.

Interviewees in Selma, Tulare County, and the Crow reservation cited challenges attracting physicians to rural, low-income regions, and retaining them after they complete medical school loan forgiveness programs. Telemedicine was identified by many interviewees as an emerging solution to address barriers in these areas, but upfront costs can hinder these efforts, and not all communities have access to broadband.

At the time of this study, none of the communities offered reproductive health services using telemedicine beyond e-prescriptions. Long travel distances and lack of public transportation in rural regions are major barriers to reproductive services, but transportation issues arose in urban communities as well.

Women in some communities face logistical obstacles to obtaining services in a timely manner. This is particularly apparent in an area like Dallas County, Alabama, where many obstetrical care providers have closed, and there is no meaningful public transit infrastructure.

Some focus group participants in Selma described having to pay friends or family to drive them to a clinic. Transportation was also problematic for women in the Crow tribe who must travel off the reservation to Billings, Montana, for prenatal services after 30 weeks of pregnancy.

The sheer size of Tulare County also makes transportation difficult for low-income farmworkers who often do not have a car and must travel long distances for their care. Even in St. Louis, an urban community, women who lived in the county reported difficulty getting to care as public transit options fell short for them.

In all of the communities, insufficient sex education for youth emerged as a key issue. Today, about half of states 24 plus DC require schools to provide sex education, and 34 plus DC require HIV education. A minority of states 18 plus DC , however, require sex education to include information on contraception, while 26 states require that programs stress abstinence.

The Trump administration has increased investment in abstinence curricula , and state governments have awarded grants to crisis pregnancy centers CPCs , faith-based organizations that counsel women against abortion, to teach abstinence. Furthermore, the Centers for Disease Control and Prevention CDC recently reported a rise in rates of many STIs, particularly among teens and young adults.

In the case study interviews and focus groups, many individuals raised concerns about limited sex education and its contribution to poor health literacy about sexual and reproductive health. Sex education curricula are typically selected at the local school district, school, or classroom level, which can cause wide variation in content even within the same community.

Focus group participants perceived the availability and curricula of sex education as inconsistent among schools and often inadequate for high school-aged students.

An interviewee reported that the CPCs receive state, federal, and private funding, enabling them to conduct more outreach and programs than the more comprehensive reproductive health care providers.

An interviewee in St. Louis County recounted recent parent and teacher pushback to the limited sex education from faith-based groups, resulting in the adoption of comprehensive sex education curricula in several school districts.

Interviewees in all of the communities concluded that lack of comprehensive sex education in schools contributes to high rates of STIs, HIV, and teen pregnancy.

This sentiment was also expressed by many focus group participants who felt that young people were not getting the information they needed to avoid unintended pregnancy and prevent the transmission of STIs.

Focus group participants and interviewees indicated that cultural influences and norms limit knowledge about contraception and STIs. In Dallas County, interviewees and focus group participants noted that most churches discourage discussion of sexual health, though a few have hosted events to promote HIV prevention and family planning.

Some interviewees felt that formalized, comprehensive sex education in schools could be particularly important in more conservative communities, such as Tulare County, where discussions about sexual and reproductive health may not be commonplace at home.

Providers on the Crow reservation also pointed out that discussions in the family about sexuality and reproductive health are not part of the cultural norm, and many young people lack access to basic health information.

Federal and state regulations shape access to abortion, and this was evident in all of the communities included in this study Table 1. The federal Hyde Amendment restricts state Medicaid programs from using federal funds to cover abortions beyond the cases of life endangerment, rape, or incest.

However, 16 states use their own state funds to cover abortions in other circumstances. Many other states have imposed restrictions on abortions including waiting periods, abortion facility requirements, and gestational age limits, some with the intent to overturn Roe v.

These restrictions have translated to clinic closures in several states and the total absence of abortion clinics in many communities. This makes abortion effectively inaccessible for some women, particularly those who are poor or who live long distances from the nearest abortion provider.

Alabama and Missouri have enacted some of the strictest abortion regulations in the nation, contributing to closures that leave just one abortion provider in Missouri located in St. Louis , and one abortion provider in Montgomery, Alabama, that serves all of southern Alabama, parts of Mississippi and the Florida panhandle.

Recent laws passed in these states would have essentially outlawed abortions if they had not been temporarily blocked by the courts. Louis remains vulnerable to closure. It is at the center of a state-level investigation about facility licensing that has generated national attention.

A decision is expected in early as to whether the clinic can remain open. Three of the counties studied Erie, Tulare, and Dallas have no abortion providers. Even in Tulare County and the Crow reservation, which are in states that cover abortion services under their Medicaid program and have very few restrictions on the provision of abortion, women must travel at least an hour to reach the nearest provider.

Crow women must travel to Billings because the Indian Health Service, as a federal agency, is prohibited from providing abortion. In each of the communities studied, anti-abortion sentiment played a significant role in limiting access to abortion services.

Interviewees reported intense protesting outside abortion clinics in Montgomery and St. Louis and noted that protestors contributed to the closing of clinics in Erie and Selma. In Tulare County, California, anti-abortion billboards lined the highway and the Planned Parenthood of Visalia in Tulare County had been vandalized numerous times despite not providing any abortion services onsite.

Focus group participants shared that protestors and cultural stigma surrounding the procedure made them feel ashamed or afraid, or deterred them from discussing or seeking an abortion. Interviewees in Dallas County and St. Louis reported that some providers and health center staff discourage abortions.

Some focus group participants in St. Louis felt the state-mandated counseling was intended to make them second guess their own decisions. In many of these communities, churches play a prominent role in daily life, and religious influences discourage women from seeking abortions.

In Selma, Tulare, and the Crow reservation, many focus group participants expressed opposition to abortion and said they would not consider it an option for themselves.

In every focus group, however, there were a few women who said they had had an abortion or knew of someone who had one. There was misinformation or lack of information about where women could obtain an abortion, and in some communities, focus group participants believed abortion was illegal in their state.

In the communities with strict anti-abortion laws and strong anti-abortion environments, some interviewees and focus group participants incorrectly believed that abortion is illegal in their states. One crisis pregnancy center CPC in Erie had a large presence and offered a range of services such as pregnancy tests, STI screening, ultrasounds, and referrals to prenatal care, all at no cost to clients.

Many interviewees referred women to the site because they mistakenly thought the CPC offered contraception and abortion referrals. Limitations on Medicaid coverage for abortion services in some states, as well as procedure costs, make abortion unaffordable for many low-income women.

The California and Montana Medicaid programs cover abortion services beyond the Hyde Amendment exclusions for life endangerment of the woman, rape, and incest.

Alabama, Pennsylvania, and Missouri limit Medicaid coverage to the Hyde provisions, but an abortion provider in Alabama noted that she has never been able to obtain reimbursement even under the permitted circumstances.

Many women face additional costs associated with transportation, childcare, and overnight lodging when state laws require women to wait hours between state-mandated counseling and obtaining the abortion, as is the case in Missouri, Alabama, and Pennsylvania.

There are local and national organizations that provide financial and practical assistance to some women seeking abortion; however, they do not have the resources to assist all the women who seek abortion and who cannot afford the services and the associated travel and lodging costs.

Even when funds are available, logistical challenges may remain. For example, an Alabama-based organization provides financial assistance for transportation to women traveling long distances for abortions, but described barriers transferring funds to low-income women who do not have bank accounts.

Across the communities, providers and community organizations were engaged in initiatives intended to address barriers to reproductive health care. Although interviewees emphasized that much more needs to be done to eliminate the structural, cultural, political, and economic barriers to reproductive health services for low-income women, there were multiple organizations and individuals in each community leading various efforts to fill gaps and meet community needs.

In many cases, community-based organizations took active roles in family planning, STI, or HIV education and advocacy, while others provided direct, practical assistance.

Some of these strategies include:. In-person interviews, focus groups, and first-hand, on-the-ground experiences in each of the communities uncovered barriers to care common to all the communities, as well as obstacles unique to specific locales and populations.

Published: Nov 14, KFF: Acai berry digestion Ranji, Michelle Reproductive health management, Reprodhctive Alina Salganicoff Health Management Associates: Sharon Silow-Carroll, Carrie Rosenzweig, Diana Rodin, and Rebecca Kellenberg. Heealth Washington, Managemfnt, and in state capitols helath the nation, Reproductive health management Sodium intake and childrens health over Reproductivd future of access to reproductive and sexual health services are shaping the range of services and providers available to low-income women. While instructive, national statistics can mask wide regional and local variation, as well as disparities across socioeconomic, racial, and ethnic groups. In order to understand what is happening at the local level, we went beyond the statistics to see how these policies are playing out in diverse communities across the United States. Service availability and policies related to health care, contraception, and abortion vary significantly across and within states.