IMPACT OF THE CHOOSE WELL INITIATIVE ON CONTRACEPTIVE COUNSELING AND SUBSEQUENT USE

Objectives

Choose Well is South Carolina’s statewide contraceptive access initiative implemented from 2017 to 2022 to promote equitable access to contraception without judgment or coercion. We examined this program’s impact on patients’ experiences with contraceptive counseling and subsequent contraceptive use.

Methods

A quasi-experimental design was employed to recruit patients from program-participating clinics across South Carolina, including health department and federally qualified health center clinics, and matched comparison clinics in a peer state. Patients visiting the clinics for a contraceptive appointment were recruited and followed over 24 months. Data were collected about contraceptive experiences (using the validated Person-Centered Contraceptive Counseling scale) and contraceptive use. Generalized estimating equations measured Choose Well’s impact on 1) counseling experiences immediately post-appointment and 2) contraceptive use prior to the appointment and three months later.

Results

A total of 1,086 participants in Choose Well clinics and 1,136 in comparison clinics aged 16-44 were recruited. After we adjusted for differences between the populations, significantly more Choose Well clinic patients reported person-centered contraceptive counseling (60%) than comparison clinic patients (53%; p=0.04). The proportion of Choose Well clinic patients using intrauterine devices (IUDs) increased from 7.6% at pre-counseling to 11.8% at three months post counseling. In contrast, the proportion of comparison clinic patients using IUDs increased from 4.4% to 4.8%. The resulting 3.8 percentage-point difference was statistically significant (p=0.02).

Conclusions

Choose Well clinic patients reported more person-centered counseling and higher rates of IUD use than comparison clinic patients. This program likely increased access to desired contraceptive methods without coercive counseling, highlighting the important role of statewide contraceptive access initiatives.