Reproductive Health Family Planning Services in Arkansas

1. Reproductive Health(Family Planning) Services in Arkansas Women’s Health Course UAMS – College of Public Health MPH Program April 22, 2005

2. Presented By Dianne Campbell, MNSc, RN Nurse Coordinator/Women’s Health Liaison Women’s Health Work Unit Arkansas Department of Health

3. Reproductive Health/Family Planningthrough theArkansas Department of Health Overview of Family Planning National Level State Level Population Served Adolescents Women Males Community Clinical Services Provided Sources of Revenue Program Evaluation

4. Overview of Family Planning National Level

5. Important Dates in Family Planning 1961- President Kennedy addressed the foreign policy issue relative to overpopulation 1963 – the Department of of Health, Education and Welfare (DHEW) issued a report listing 758 projects on human reproduction and contraception 1964 – the Office of Economic Opportunity funded the first federal family planning program

6. Important Dates continued 1966 – President Johnson and Congress declared family planning a “special emphasis” program in the War on Poverty 1970 – Title X (Family Planning Services and Population Research Act) enacted

7. The Origins of Title X “…no American woman should be denied access to family planning assistance because of her economic condition.” President Nixon, 1969

8. Title X Mission To provide “the educational, comprehensive medical, and social services necessary to aid individuals to determine freely the number and spacing of their children.”

10. Title X Program Principles Affordable - sliding scale fees - teenagers charged based on their own income Method Choice - range of options to help each individual select the right method Voluntary - never a condition for participation in another program Confidential - especially essential to teenagers seeking care Broad Package of Services - includes related preventive health care: pelvic exams, blood pressure checks, Pap smears, breast exams

11. Overview of Family Planning State Level

12. Important Dates in Family Planning in Arkansas 1964 – 1965 - ADH offered limit number of family planning clinics 1966 – Office of Economic Opportunity (OEO) granted award to Pulaski County to organize countywide family planning program 1971 – Arkansas Family Planning Council (AFPC) was funded by Office of Economic Opportunity and DHEW to organize a statewide family planning program

13. Important Dates in AR continued 1982 – ADH became the sole grantee for Arkansas and AFPC became a delegate/contractor under ADH 1988 – ADH and AFPC merged

14. Introduction of Family Planning in Arkansas Reproductive health services are provided in accordance with the “Arkansas Family Planning Act” (235) of the State of Arkansas 69th General Assembly legislative session.

15. Act 235 of 1973 States: “all medically acceptable contraceptive procedures, supplies, and information shall be available through legally recognized channels to each and every person desirous of same, regardless of sex, race, age, income, number of children, marital status, citizenship or motive.”

16. Goal of Reproductive Health Program Provide Reproductive Health services to women, men and couples, enabling them to choose freely and responsibly the number and spacing of their children, and thereby prevent unwanted pregnancies.

17. Reproductive Health Services Offered Health History Assessment Laboratory Tests Physical Assessment Contraceptive Methods Health Education Treatment and/or Referral

18. Health History Completed on all patients according to a schedule (initial, annual visit and subsequent visit) Includes, but is not limited to: - Medical History - Pregnancy History - Menstrual History - Sexual History - Contraceptive History - Medication History - Immunization History

20. Family Planning Annual Report2002

21. Family Planning Program Demographic Profile (2004) American Indian or Alaska Native 0 males; 170 females Asian 1 males; 386 females Black or African American 193 males; 21,521 females Native Hawaiian or Other Pacific Islander - 0 males; 26 females White 314 males; 54,430 females Unknown or Not Reported 17 males; 902 females

22. Users By Hispanic/Latino Origin Hispanic/Latino (all races) 40 males; 8,227 females Non-Hispanic/Non-Latino (all races) 482 males; 69,086 females Unknown/Not Reported 3 males; 122 females Total Users 77,960 525 males; 77,435 females

23. Income Status

24. Contraceptive Methods for Female Users Sterilization 3,603 Oral Contraceptives 29,067 Injection 14,042 IUD 1,160 Hormone Implant 65 Diaphragm 68 Condom 7,589 Spermicidal foam, jelly 635 or cream; or contraceptive film

25. Selected Services Delivered During Family Planning Visits Pap Smear - 62,040 Breast Exam - 51,084 STD tests (excluding HIV) - 77,253 HIV tests - 31,330

26. NOTE The total number of Family Planning clients served increased by 2464 for calendar year 2004.

27. Population Served ADOLESCENTS WOMEN MALES COMMUNITY

28. Adolescent Services All unmarried teens, 17 years and younger are informed on the following issues: - Review the human reproductive system - Review their understanding of fertility and contraception - Stress that Abstinence is the surest method - Encourage discussion of decisions - Ask if teen has discussed or will discuss with family, the discussion to seek services

30. Women Services General Description of Methods Specific Methods Routine Physical Examination and Laboratory Test Family History How to Prevent Common Vaginal Infections Douching HIV/AIDS and STD Smoking Folic Acid Awareness

32. Male Services Male Responsibility Pregnancy Prevention Sexually Transmitted Disease Prevention Testicular Self-Exam Sterilization Services

33. Access ADH provides Family Planning Services in all 75 counties throughout the state Arkansas is a rural state and outside of the Greater Little Rock area, access to care is limited and the Local Health Unit may be the only provider of care. ADH offers services Monday – Friday between 8:00 a.m. – 4:30 p.m. 92 clinic sites provide Reproductive Health services 91 Local Health Units; 1 Community Agency Program

35. Service Delivery All clinical services are in accordance with Title X required program guidelines ADH Medical Providers - Maternal and Child Health Medical Director - Women’s Health Chief Physician Consultant - 50 Women’s Health Registered Nurse Practitioners, 75% are Advanced Practice Nurses (APN) and have Prescriptive Authority - 20 Contract Physicians

36. Contraceptive Information The Public Health Nurse (PHN) assesses and provides Client Centered Counseling to each patients that desires a method of contraception

37. Contraceptive Methods Abstinence Condoms Depo-Provera Contraceptive Injection Diaphragms IUD/IUS Natural Family Planning Oral Contraceptives Sterilization Vaginal Spermicides Transdermal Contraceptive System

38. Reproductive Health Counseling Standards Other Health Department Services Plan for Emergency Care Breast Self – Examination Immunization General Description of Methods

39. Pamphlets Offered All adolescents should receive (3) pamphlets available “Abstinence and Self-Esteem” “Am I Ready to Be A Dad?” “Am I Ready to Be A Mom?” All women receive Reproductive packet All males may receive (4) pamphlets available “A Man’s Guide to Sexuality” “10 Best Reason to Use A Condom” “Birth Control- 10 Things A Man Can Do” “Male Self Exam”

40. COMMUNITY SERVICES

41. Community Education Approximately eight-four community educational presentation were made to civic, youth and community groups totaling 875 unduplicated participant and eleven faith-based organizations serving 286 participants

42. Family Planning (Inside Project) Family Planning on the Inside (FPI) is a collaborative effort between Arkansas Department of Health, Women's Health Work Group and Arkansas Department of Community Correction (DOCC) in Pine Bluff and Newport Arkansas Provide bi-weekly reproductive health educational classes to residents 30 days prior to their release Provide inmates access to three non-prescription methods of contraception at the time of their release Link inmates with Reproductive Health Services in their community after their release

43. Unwed Birth Prevention Project The Unwed Birth Prevention Project is a statewide comprehensive program established to reduce the number of unwed births and teenage pregnancies in Arkansas. The 1997 Arkansas General Assembly passed Act 1159 (which established the Arkansas Department of Health as the lead Agency in addressing Unwed Birth Prevention) and funding legislation, Act 1101 (which provided funding to support the initiative), was signed into law by Governor Mike Huckabee. Legislative oversight of activities supported by this legislation was established in HCR 1010. Fourteen counties with the highest teen pregnancy rates in the State are targeted and selected County Coalitions focus on a variety of activities that have been demonstrated as effective in delaying the initiation of sexual activity by teens, in reducing the rates of pregnancy, and in reducing the occurrence of sexually transmitted diseases.

44. Summary The Title X Program was design to provide low income individuals access to Family Planning Services For 35 years it has successfully provided services to millions each year and prevented millions of unintended pregnancies It has become a standard for the provision of Family Planning and Reproductive Health Services