Taking Family Planning Services To Hard-to-Reach Populations. (SPECIAL REPORT).

In a 1995 survey of the nation's 3,119 family planning agencies, three-quarters of those questioned reported that they provide contraceptive services to such hard-to-reach populations as substance abusers, incarcerated men and women, the disabled, the homeless and non-English-speaking minorities. (1) However, the survey results left unclear the scope of these services, and did not indicate whether agencies specifically target these populations through outreach, education and specialized services, or simply provide standard services to individuals from these groups when they seek care.

Recent interviews with roughly 100 administrators, program supervisors and clinicians in family planning agencies that make special efforts to serve hard-to-reach groups provide insight into the range of services offered. Some of these efforts are large, collaborative undertakings involving several agencies and substantial public funding, while others are small programs that may reach no more than 10-15 people a year and receive little or no outside support. Some programs are multiyear demonstration projects, others are short-term or even one-time events. Organizations may target education and counseling or provide direct medical services. Some agencies provide services at their clinics, while others conduct outreach and provide education and family planning services in substance-abuse treatment centers, homeless shelters, prisons and other nontraditional sites where hard-to-reach populations live or congregate.

Family planning providers generally agree that these hard-to-reach populations are desperately in need of services. Many report that it is not uncommon for homeless, incarcerated or substance-abusing women to have gone 10 years or more without a Pap test; some have never had a pelvic examination. Kay Armstrong, research director at the Family Planning Council of Southeastern Pennsylvania in Philadelphia notes that "many [drug abusers] don't have homes, they're constantly changing relationships, they don't have money. Health care is often at the bottom of their priority list." (2)

Karen Andrade, director of community services at Planned Parenthood Association of the Mercer Area, Trenton, N.J., which has special programs for Hispanic women and homeless women, agrees: "There are so many issues in the lives [of these women] that health care for themselves is not a priority." (3) Consequently, many women who are homeless or drug-involved have more health problems, and more serious ones, than clients usually seen by family planning providers.

This article provides a sampling of the kinds of programs family planning agencies offer for hard-to-reach populations and examines some of the problems that agencies encounter in their efforts to serve these groups. The contacted agencies were selected in a variety of ways: Some were respondents to the 1995 survey; some were identified by state or regional health department officials; and others were suggested by fellow providers of services for hard-to-reach groups. The interviews on which the article is based were conducted between December 1995 and March 1996.

Special Programs

Substance Abusers