Increases in IUD Provision at Alabama Department of Public Health Clinics From 2016 to 2019

Abstract

The Alabama Department of Public Health (ADPH) began allocating Title X funding to intrauterine device (IUD) provision at family planning clinics in 2019, instated more training opportunities, and expanded nurse practitioner scope of practice to include IUD placements. We assessed IUD provision and protocols at ADPH Title X clinics in 2016 and 2019 before and after ADPH policy changes. Generalized binomial regression models assessed differences between years. The proportion of ADPH clinics reporting offering any IUD on-site increased by 61.6 percentage points (P < .001), stockpiling IUDs on-site increased by 85.9 percentage points (P < .001), IUD placement/removal training increased by 71.4 percentage points (P < .001), and same-visit IUD placement trainings increased by 64.1 percentage points (P < .001). Advanced practice nurses were significantly more likely to place IUDs in 2019 compared with 2016 (P < .001). These findings highlight the positive impact of policy changes related to Title X funding allocation and scope of practice on provision of a full range of contraceptive methods. These changes in policies and practices at the state and local levels within ADPH have expanded the availability of the full range of contraceptive options across the state of Alabama. This expanded access to contraceptive options is especially important given the rapid changes in reproductive health policies occurring in Alabama and across the United States.