Enhancing Statewide Contraceptive Access Initiatives

Learn about recommendations to enhance Statewide Contraceptive Access Initiatives (SCAI)

CECA, in collaboration with the Center for Reproductive Health Research in the Southeast (RISE) at Emory University, led an effort with SCAI leaders to document and share lessons learned and help identify opportunities to advance SCAI. Grounded in the Sexual and Reproductive Health Equity (SRHE) framework, this work resulted in the development of priority recommendations that have the potential to build on lessons learned, address challenges, and fulfill opportunities for SCAI. Read our blog and scroll down to learn more about our approach and available resources.

What are SCAI?

Statewide Contraceptive Access Initiatives (SCAI) are projects implemented across all or multiple regions of a state that involve a coalition of key stakeholders from public, private, and non-profit sectors who undertake coordinated efforts to increase access to contraception. Efforts focus on mobilizing interest in expanding access to contraception, providing contraceptive products at no or low cost, providing training and capacity building, and removing other structural barriers to enhanced contraceptive access.

Background

SCAI seek to expand access to contraception by bringing together key partners committed to advancing access, increasing health center capacity to provide services, and removing structural barriers to contraceptive access, such as cost. Since the early 2000s, more than 30 SCAI have been implemented in the U.S.

SCAI have continued to evolve from a primary or sole focus on Long-Acting Reversible Contraception (LARC) uptake or unintended pregnancy and toward a focus on equity, person-centeredness, and autonomy, for example, ensuring that more people have access to high-quality contraceptive care and the method(s) of their choice. As some of the legacy SCAI end and a new generation of SCAI emerge, there is a critical need to build on the work that has already begun to further expand the potential of these initiatives.

Approach

To generate the priority recommendations, CECA:

Vision for SCAI

The vision of SCAI is to achieve universal, equitable contraceptive access. This means that all people can access comprehensive contraceptive information, products, methods, and/or services that work best for them – if, when, how, and where they want it, free of barriers and bias. Equitable contraceptive access also means that people who do not want contraception, or who want to discontinue contraception, should be free to make and realize that decision for any reason, without pressure, judgment, or coercion.  

SCAI help achieve this vision by:  

  • Integrating strategies that advance equity, reproductive autonomy and agency, and wellbeing throughout the SCAI planning, implementation, and evaluation processes.   

  • Removing barriers across the system, provider, and individual levels to sustainably increase access to and provision of high quality, nonjudgmental, and person-centered care.  

  • Adopting and tailoring/adapting best practices, responding to local and community needs, and pursuing innovative approaches. 

Recommendations to Advance SCAI

The recommendations are designed to encourage funders, SCAI implementers and evaluators, national organizations and conveners, and the broader field to:

  • Identify, document, and share learnings, best practices, and innovations from SCAI.

  • Convene stakeholders in diverse forums to facilitate continuous learning and knowledge sharing.

  • Support SCAI in making the case for the value of these initiatives.

  • One Icon

    Center Communities

    Meaningfully center the needs, values, priorities, experiences, and voice of local communities related to sexual and reproductive healthcare

    Require and adequately fund community engagement activities in SCAI grants

    Dedicate adequate money, time, and effort to building new and maintaining established relationships after the project ends

  • Two Icon

    Foster Flexibility and Responsiveness

    Enable more flexible timelines and use of funds, particularly as the project is underway

    Prioritize approaches that provide benefit to, rather than place an additional burden on, clinical and community partners

    Create explicit opportunities for SCAI to test innovative approaches

  • Three Icon

    Align Goals with Comprehensive Measures

    Change the expectations and narrative around SCAI goals, measures, and intended outcomes to align with equity-centered principles

    Define what equity means for SCAI and how to measure it

    Identify and advance efforts to improve measures, measurement approaches, and documentation of best practices

  • Four Icon

    Sustain the Work

    View SCAI as a starting point to addressing access barriers, and incorporate strategies to extend the work beyond the period of the funded project

    Maximize support from diverse funding and payment sources

    Identify aspects of the work that are scalable and leverage resources for expansion

Recommendations and Resources

Recommendations Report

Building on the project findings related to challenges, opportunities, and lessons learned, this report documents and shares the vision for SCAI, priority recommendations to move SCAI toward the vision, and ideas for fostering action.

Listening Session Report

This report summarizes the findings of six “listening sessions” with representatives from nine SCAI to gather insights on promising practices, challenges, and opportunities related to the initiatives. The listening sessions focused on implementation, evaluation, and SRHE in SCAI.

Environmental Scan

This scan explores the published and grey literature related to the implementation and evaluation of SCAI from 2005 to January 2024. Sixty-one relevant resources were identified, describing implementation approaches and evaluation findings across 30 states and territories that have implemented, or are currently implementing, contraceptive access initiatives.