Trends in contraceptive and preconception care in United States ambulatory practices.

BACKGROUND AND OBJECTIVES Since 2005, the Centers for Disease Control and Prevention (CDC), American Academy of Family Physicians (AAFP), and American College of Obstetricians and Gynecologists (ACOG) have recommended incorporating family planning and preconception counseling into routine primary care visits. We compared rates of reproductive health service provision to women aged 15--44 years before and after these guidelines were issued and identified patient, physician, and visit characteristics associated with the likelihood of provision of preconception or contraceptive services. METHODS The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected nationally representative data on provision of preconception and contraceptive services in 1998--2000 and 2009--2010. We used multivariable logistic regression with appropriate survey weights to assess changes over time in provision of these services, while controlling for patient demographics, medical comorbidities, and physician or clinic specialty. RESULTS Among ambulatory encounters with women of reproductive age, provision of reproductive health services increased from 9.5% to 14% between 1998--2000 and 2009--2010, largely due to increased provision of prescription contraception. CONCLUSIONS Despite CDC recommendations, a minority of ambulatory visits made by US women of reproductive age currently include either preconception or contraceptive services. Future work should focus on understanding barriers and developing interventions to facilitate incorporation of recommended services into primary care.