A priority population of the Title X Family Planning Program is low-income women. In fact, the unintended pregnancy rate for females living below the federal poverty level (FPL) is greater than five times as high as that among women at or above 200% of the FPL.1 Despite this apparent need for services, Title X service utilization among low-income women in New York State and nationwide has decreased in recent years.
Studies indicate that women are using effective and highly effective contraception (i.e., long-acting reversible contraception, or LARC methods) at unprecedented rates, leading some public health officials to suggest that recent declines in Title X service utilization among low-income women are attributed to greater uptake of LARC methods and changes in reproductive health guidelines. At the same time, rates of unintended pregnancy in New York State and nationwide remain persistently high and continue to exceed those of other developed nations. There is no doubt that there are underserved populations who struggle to access the quality reproductive health services in communities served by New York State Department of Health’s family planning provider network. As we celebrate the successes of increased insurance coverage for reproductive health services made available through the Affordable Care Act, it is critical for family planning providers to shift their efforts toward reaching and engaging those priority populations that remain underserved. Doing this requires a reassessment of current community engagement strategies and the adoption of new approaches for understanding the needs and desires of priority populations.
For years, the success of outreach efforts has been measured by the number of community events that take place or number of brochures were distributed to community members. While some agencies have mastered strategies to meet the most vulnerable where they are by offering late hours, conducting outreach through mobile vans, and establishing innovative community partnerships, it can be truly challenging to meet the needs of priority populations. This challenge was addressed during a presentation by Tom Klaus, PhD, at the 2015 NYS Family Planning Provider Meeting.
According to Dr. Klaus, one of the reasons we struggle to understand the needs and desires of priority populations—for example, low-income individuals—is that they are not a uniform group with the same needs. Just as developing a “teen-friendly” clinic does not ensure that all the adolescents at risk for unintended pregnancies will walk through the doors of a health center between the hours of 4:00pm and 8:00pm on a Wednesday night, nor does providing low- or no-cost contraception meet the sexual and reproductive health care needs of all low-income individuals in a community. There are unique nuances to individuals’ needs, desires, and the motivating factors that drive them to seek services. Which raises the question: How do we identify and better understand the needs of our priority populations? The answer, Dr. Klaus would suggest, is bringing members of these priority populations to the table and ask them.
Community engagement refers to a sincere and bidirectional relationship between the service provider and community members. It requires a shift from relying heavily on content experts like public health officials and academics, to including the insight of context experts who have first-hand knowledge of the desires and challenges that a target population faces by virtue of experience. Community engagement is not about finding a solution to the problem and strategizing ways to get the community on-board with an approach, but, rather, involving its members genuinely in the conversation and encouraging community ownership of the solution.
This message truly resonated with Michelle Gerka, Vice President of Family and Community Education Programs at CAI, who states that community engagement and reaching-out to context experts “cannot be just an item that we check off” as part of a program requirement. Community engagement requires inviting context experts to the table in a genuine attempt to understand their needs and desires.
Can we do a better job at engaging our context experts and allowing them to guide the way we offer services? The answer likely is yes. In order to achieve this, it is essential to:
1. Identify your priority populations: Identify who you need to hear from. What populations and sub-populations are you struggling to reach? Are there community-based organizations or local agencies with which partnership potentially could open lines of communication between your agency and your priority population?
2. Be sincere: Acknowledge that your community members are the experts. Let them know that you value the fact that they’re engaging in conversation with you and that you plan to act on the insights they provide.
3. Keep the doors of communication open: Develop multiple ways for your context experts to contact to you, and encourage them to share ideas and additional feedback throughout the year.
4. Communicate any changes you plan to implement: By keeping community members apprised of the changes you implement as a result of their feedback, you show them you sincerely value their recommendations.
What would it look like to shift the paradigm and rely more heavily on a bidirectional conversation with our context experts? The future of effective outreach strategies will require that family planning providers step-out of our public health circles and engage those with lived experiences who can provide unique insights into the needs and desires of the women and men we aim to serve.
1Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the United States, 2001-2008. AJPH, 2014; 104(S1):S43-8.