From Vision to Initiative: A Toolkit for Building and Implementing Contraceptive Access Initiatives

Health care professional woman in scrubs smiling

At Power to Decide, we envision a world where everyone has control over their bodies and can decide if, when, and under what circumstances to get pregnant, including the right to access the full range of contraceptive methods, if and when someone chooses to do so.

Unfortunately, this right is continually at risk due to geographic barriers, economic barriers, policy changes such as reductions to federal funding, and more. 

Contraceptive access initiatives (CAIs) can play a critical role in reducing those barriers and expanding equitable access to free or low-cost contraception.

This toolkit provides information and resources for program staff and champions as they build new CAIs or strengthen existing initiatives. Each section includes white-labeled tools and resources adapted from existing CAIs, which you're welcome to copy and adapt for use within your CAI. 

Note: Because securing funding is a significant topic on its own, this toolkit assumes funds are already identified or in place.

How to use this toolkit: 
Every community and initiative is unique. As such, you can use this toolkit in any order. If you're building an initiative from the ground up,  reading in sequence may be helpful; otherwise,  feel free to jump to whatever section is most relevant for you. 

Contraceptive Access Initiatives have existed throughout the United States since at least 2007, emerging in response to persistent gaps in access to contraceptive care due to insufficient and/or inconsistent federal funding and limitations on programs like Medicaid and Title X. CAIs remain a vital part of this landscape, helping to ensure that all people can access the full range of contraceptive options in ways that align with their values and life circumstances.

Though each is unique, CAIs tend to share a common goal of expanding equitable access to low- or no-cost contraception, grounded in the reproductive health, rights, and/or justice movements.  They are led by a range of organizations, including government agencies, community-based organizations, foundations, and Title X administrators, and vary in focus across policy, funding, service delivery, and/or public education.

CAIs also tend to share common values, including but not limited to:

  • Reproductive and bodily autonomy
  • Health equity
  • Person-centered counseling and care
  • Robust community and stakeholder engagement
  • Reproductive rights, such as the right to comprehensive sexual and reproductive health care

According to In Our Own Voice: The National Black Women’s Reproductive Justice Agenda, reproductive justice “means the human right to control our sexuality, our gender, our work, and our reproduction. That right can only be achieved when all women and girls have the complete economic, social, and political power and resources to make healthy decisions about our bodies, our families, and our communities in all areas of our lives. At the core of Reproductive Justice is the belief that all women have the right to have children; the right to not have children, and the right to nurture the children we have in a safe and healthy environment.”

CAIs are also intentional about the broader ethos that shapes their work. Many CAIs have moved away from framing centered on “unplanned pregnancy” and “pregnancy intention,” recognizing that these population-level measures often fail to reflect reproductive autonomy or the complexity of people’s experiences. This shift is grounded in a reckoning with the reproductive health field’s history of coercion, racism, and disregard for bodily autonomy—especially toward Black, Indigenous, and other communities of color, people with disabilities, and those with low incomes. By learning from these harms, CAIs seek to advance equity and trust through high-quality, person-centered care rooted in a reproductive well-being framework.

CAIs work to increase contraceptive access, but there has not always been agreement in the field about what ‘contraceptive access’ is or how to measure it.

So, in 2022, Power to Decide worked with a group of expert advisors—including academics, providers, and behavioral scientists—to develop a comprehensive framework.

The Contraceptive Access Framework builds on existing frameworks of health care access, including the 5 As of access from Penchansky & Thomas, Saurman’s “6th A”, and the framework from Levesque et al., resulting in the six dimensions of access: 

  • Awareness
  • Availability
  • Accessibility
  • Accommodation/Adequacy
  • Acceptability
  • Affordability
     

 
The framework has four interacting components: 

Modification strategies are actionable interventions or approaches, such as provider training or insurance coverage policies, that can be used to drive change.  

Modifiable determinants are the underlying factors, such as the number of trained providers or the level of insurance coverage, that contribute to the conditions for access.

Access dimensions are the conditions that shape an individual’s pathways to seeking and obtaining their preferred contraceptive method or LARC removal services.

Individual level pathways describe how an individual may actually reach and obtain contraceptive care.

Each dimension influences each step of the individual-level pathways and outcomes. The framework serves as the organizing structure for this toolkit; proposed CAI activities are mapped to each of the six A’s to help initiatives identify and prioritize areas for action.

You can read more about the framework in this article in Contraception.

This toolkit was developed in partnership with members of Power to Decide’s Contraceptive Equity Initiative (CEI) Shared Learning Collaborative (SLC)—leaders from existing CAIs with experience establishing and scaling contraceptive access initiatives. The group met from 2023-2026 and contributed significantly to the ideation and development of the toolkit.
 

The Planning Period

A planning period of at least eight to twelve months can be especially helpful as a new CAI is being built. The key tasks outlined below are recommended by existing CAIs to set your CAI up for success, though this list is not all-encompassing and your planning period may include additional activities.

Assess the policy landscape

Take a close look at your state’s current policy and funding landscape using the Landscape Analysis tool. Understanding how programs like Medicaid, Title X, and other state or local funding streams operate—and who they’re reaching—can help you identify where gaps exist and where your initiative can have the greatest impact. This analysis will also inform key decisions about the structure, scope, and strategy of your CAI. 

Landscape Analysis

Establish a structure (if you don’t have one already)

Once you have a sense of the need you are trying to fill, you can select the organizational infrastructure within which your CAI will be housed. Will your CAI be part of a health department or larger academic institution, or will it be its own independent non-profit organization? This decision has implications for staffing, leadership buy-in, any income or donations your CAI may generate or receive, etc. There is no “right” answer—the choice will likely depend on several factors, including your funding source.

You will also want to determine whether your CAI will be a payor or non-payor model. In a payor model, like Choose Well, the CAI covers the cost of contraception (method and care), in part or in full, for participants who meet eligibility standards. In a non-payor model, like All Access EKY, the focus is on building awareness and increasing access to contraception, but the CAI does not cover the cost of contraception. 

CAI Structures and Considerations

Conduct a community and/or clinic needs assessment

In order to ensure your CAI centers the desires, needs, experiences, and voices of the community(ies) within which it functions, it is critical to begin with a community needs assessment. Ideally, this effort should be led by or conducted in partnership with community members, and may include an assessment of one or more clinics in the area to be served. In addition to the Clinic Assessment available from the Reproductive Health National Training Center (RHNTC), you can download and adapt sample assessments from The Right Time and All Access EKY.

Clinic Assessment Sample Clinic Services Administrative Assessment Sample Clinic Services Direct Services Assessment Sample

Identify your CAI goals, guiding principles, and purpose/approach

Once you understand the landscape and have a structure in place, get clear on what your CAI aims to achieve and how you'll approach the work. Define specific goals, mission, or vision statements that reflect community needs and align with your capacity and resources. Identify guiding principles—like equity, reproductive autonomy, or community collaboration—to inform decision-making and keep your work grounded. Then, craft an approach that fits your context, whether it's focused on policy change, funding, service delivery, or a mix. For examples, see PATH4You and the Reproductive Health Collaborative Nebraska.

Create a budget/forecast

Your budget will be shaped in part by the CAI model you selected earlier, as payor-based models are typically much more cost-intensive. During the planning period, we recommend developing a forecast for both the planning year and your first full year of implementation. Consider what your costs will include—will you cover a year’s worth of prescription contraception, or more? All methods or focus on a specific formulary? Higher-cost options like Slynd or Annovera, which are often not covered by insurance? Your budget will ultimately determine the scope and scale of your activities. 

Budget Template

Develop and share your brand

Your brand is more than just a logo—it’s how people understand your CAI’s purpose, values, and impact. Involve community members and partners early through conversations, focus groups, or surveys to ensure your brand is inclusive, accessible, and reflective of the people you serve. You can develop your brand internally using existing resources like the Agency Brand Worksheet from the RHNTC, or reach out to marketing professionals, particularly those with experience in the sexual and reproductive health space. Be thoughtful about language, go slow, and remain open to feedback—your brand may evolve over time, and that’s okay. Keep in mind that your initiative might benefit from multiple brand identities, such as one that is client-facing and another focused on policy or programmatic work.

Agency Brand Worksheet

Establish an advisory board

Advisory Boards provide an explicit path for meaningful community involvement and voice in a CAI, and can assist with a wide range of tasks, from identifying community needs and supporting program planning to evaluation, measurement, and continuous quality improvement. You should compensate community members for their time and expertise, as this demonstrates respect for their contributions and ensures equitable participation. The size and composition of an Advisory Board can vary, but when possible, should include representation from those with lived experience, youth, maternal health (e.g., doulas, post-partum support, etc.), medicine, public health, education, and community/non-governmental organizations.

Advisory Board Expectations Sample Sample Community Advisory Board (CAB) Application

Identify potential partners and establish partnerships

Most CAIs have clinic partners, community-based partners, or both. During the planning period, identify the types of partnerships you wish to establish, as well as the specific organizations you would like to bring on—guided by your CAI model (payor vs. non-payor), goals, and guiding principles. When establishing partnership agreements, clearly outline whether the relationship is funded or non-funded, as well as roles, responsibilities, and expectations for all parties, including the CAI. Sample partnership agreements from Trust Her are included here for reference. 

Clinic Contract with Method Payment Sample Telehealth Agreement Sample

Begin planning for sustainability

Start thinking about sustainability during the planning period, not in the final year. This includes securing leadership buy-in, identifying potential funding sources for short- and long-term support, and developing a plan for continuity of services in the event of a funding gap. This is particularly important for payor models, which may be forced to sunset portions of the program over time. For direct service models, be realistic about reimbursement challenges and the value of identifying varying and diverse funding streams to maximize available revenue.

If relevant to your CAI, advocacy or legislative work can also support long-term sustainability, such as leveraging State Plan Amendments and waivers to expand coverage, advocating for simpler insurance enrollment processes, or supporting upfront stocking. Additional strategies are outlined in the Advancing Contraceptive Access Toolkit from Power to Decide.

CAI Activities

Group of healthcare providers, two women and one man talking.

CAIs may engage in a broad range of activities to support and expand contraceptive access. In the Contraceptive Access Framework, these activities are referred to as Modification Strategies—activities that, when carried out, have the potential to positively impact awareness, availability, accessibility, accommodation/adequacy, acceptability, and/or affordability.

It's important to determine which activities your CAI will carry out, aligned with your model and goals. Below, you’ll find the activities that members of the CEI SLC identified as most relevant to CAIs broadly based on their experience, though this list is not exhaustive and does not include every modification strategy in the framework.  Additionally, keep in mind the“6 A’s” intersect and interact, so working to address one may influence others. 

CAIs may engage in a broad range of activities to support and expand contraceptive access. In the Contraceptive Access Framework, these activities are referred to as Modification Strategies—activities that, when carried out, have the potential to positively impact awareness, availability, accessibility, accommodation/adequacy, acceptability, and/or affordability.

It's important to determine which activities your CAI will carry out, aligned with your model and goals. Below, you’ll find the activities that members of the CEI SLC identified as most relevant to CAIs broadly based on their experience, though this list is not exhaustive and does not include every modification strategy in the framework.  Additionally, keep in mind the“6 A’s” intersect and interact, so working to address one may influence others. 

Activities to Increase Awareness

Awareness relates to individuals’ understanding of reproductive biology, the benefits of contraception beyond pregnancy prevention, and available contraceptive services. The activities below can help increase that awareness among those in your CAI service area.

Develop and share communications and marketing materials
Marketing Materials

Share how your CAI is making contraception more accessible through a variety of marketing tools—press releases, websites, op-eds, blogs, and physical materials like coasters, flyers, magnets, and stickers with QR codes linking to your website or information hub. A sample press release template from the New York Birth Control Access Project and news releases from the Contraceptive Access Initiative are provided below. 

Press Release Template CAI News Releases

 

Information Campaigns 

Conduct information campaigns to build awareness for your CAI, the importance of contraceptive access for those who want to use contraception, and the steps eligible community members can take to access care. Campaigns can also correct mis/disinformation about contraception, such as the examples shared here by PATH4You, and may include billboards, ads, flyers, and posters in community spaces. Work with trusted community partners to help distribute materials and amplify your message. Explore creative media opportunities, on college campuses, in local businesses, and at community events, to ensure your messaging reaches the people who need it most.

Myth-Busting Social Media Post Examples

Conduct education and outreach

Establish a presence for your CAI on social media channels. Social media is a critical tool for building awareness around contraception, as well as awareness of your initiative and the specific services that you offer. Social media toolkits from CAI’s in our SLC, such as those from All Access EKY, or from the RHNTC, may be helpful as you establish your identity and voice on social media.

Conduct messaging and outreach to non-traditional partners. Consider who in your community/region/state may be able to effectively contribute to or benefit from a CAI but is not currently at the table (e.g., home visiting programs, social workers, case managers, after-school programs, etc.).

Developing Promotional Content Overview for Title X Grantees

Engage (with) the community

It can be helpful to identify key partners who have a role in contraceptive access in the community currently, or who may have such a role in the future, in order to inform them about your CAI and to engage them in relevant CAI activities. To do so, you can use the Actor Mapping tools included here from Power to Decide or other similar tools to think about the various groups and individuals who are connected to contraceptive access.

Actor Mapping Instructions and Template

Community events are another powerful strategy for increasing awareness of your CAI and of contraceptive services broadly. Such events can be designed and hosted by the CAI, or you can attend events hosted by other community groups. Consider which events might be well-attended by those you are trying to reach. For example, if you are especially interested in reaching young adults, events hosted by community colleges or other academic institutions might be a good fit.

Your CAI will benefit from building strong connections with local healthcare and community-based organizations.  In the context of family planning, referrals are particularly important for meeting patients’ preferences for contraceptive methods, as some providers or clinics are limited in their ability to offer specific methods or to offer them the same day. While most CAIs do not provide direct clinical care, they often help connect people to the services and contraceptive methods that best meet their needs. In many communities, no single provider can offer every method or provide same-day access, so having an active network of clinics and organizations allows your CAI to guide people to the right care more effectively. Establishing clear pathways for information-sharing and warm handoffs between partners can increase the likelihood that individuals follow through and receive the services they want.

Distribute patient education materials

For those CAIs that focus on clinical services, offering patient education materials in clinics, during appointments or in exam rooms or waiting rooms is one strategy for increasing patient understanding of fundamental reproductive biology, as well as available contraceptive options. For example, Trust Her in Dallas developed this teen-friendly resource on contraceptive methods; the PATH4You team uses this birth control explorer; and ICAN developed this birth control quiz. Such resources can also be made available in relevant community settings, such as student health centers, health departments, or youth-serving organizations. CAIs can select from a wide variety of existing patient education materials, including but not limited to those linked here, or they can develop their own.

Bedsider Reproductive Health Access Project PICCK Patient Resources 

Activities to Increase Availability

Availability is specific to the health-systems level and includes clinic, provider, appointment, and method availability. The activities below are designed to increase availability of one or more of these categories.

Provide ongoing training/continuing education to clinic staff (e.g., clinicians, support staff, administrative staff)

As a first step, it can be helpful to use a training assessment matrix or similar tool to identify relevant training needs within and across clinics.

Once training needs have been identified, CAIs can provide training on relevant topics,  using various modalities (e.g., in-person training, one-on-one proctoring, webinars).  Your CAI may want to design trainings yourself, or you may make use of trainings that are available nationally. Two common training topics within CAIs include patient-centered contraceptive counseling and method provision.

There is increasing discussion about the limitations of pregnancy desire screening tools, such as One Key Question and/or the PATH framework. However, some CAIs still find them useful for guiding patient-centered conversations. Other CAIs, like PATH4You, are implementing their own birth control decision making tools. When these tools are used, appropriate provider training is important to ensure they are applied thoughtfully, respectfully, and in a patient-centered manner.

National Trainings on Method Provision:

  1. UCSF Beyond the Pill
  2. Clinical Nexplanon Training
  3. Bayer Healthcare Trainings
    1. Mirena
    2. Kyleena
    3. Skyla
  4. Cooper Surgical Paragard Training

  5. Clinical Training Center for Sexual and Reproductive Health

     

Birth Control Decision Tree and Option
 

Provide ongoing technical assistance (TA) to clinics

Some clinics may desire individualized, ongoing technical assistance (TA) to address specific challenges and ensure smooth integration of accessible contraceptive services. Unlike broader training, which is delivered to multiple people at once, TA is hands-on, problem-solving support tailored to the unique needs of each clinic. This type of support can range from operational guidance (e.g., optimizing workflows, scheduling, supply ordering, and inventory management) to enhancing patient interactions (e.g., counseling techniques, ensuring language inclusivity) and improving clinical practices (e.g., on-site stocking and dispensing, proctoring, and provider education). Successful TA involves customizing solutions to fit the specific context of each clinic, being responsive to their needs, and learning together with clinic partners. We’ve included a sample from a CAI partner of a TA tool they developed to share with their clinics.

Dispensing Manual Sample

Advocate for expanded authority to prescribe/dispense contraception

CAIs can support efforts to expand the range of providers who are authorized to prescribe or dispense contraception—such as pharmacists, nurses, or community health workers—through policy change or regulatory advocacy. This may include engaging with state boards, legislators, and professional associations; building coalitions; and sharing data or stories to demonstrate the impact of expanded access. CAIs can also develop advocacy materials, provide education to decision-makers, and support pilot programs that test alternative models of care. These efforts can help reduce provider bottlenecks and bring contraceptive access closer to where people live, work, and go to school.

Increase availability of emergency contraception (EC)

Emergency contraception (sometimes called the “morning after pill”) can stop a pregnancy before it starts by delaying ovulation. There are three different kinds of EC: an over-the-counter pill, a prescription-only pill (called ella), and certain IUDs. Although EC has been approved by the FDA in at least one form since 1998, numerous barriers to accessing EC remain, making it an important component of a CAI’s efforts to increase availability of contraception.

Access to Emergency Contraception

CAIs have used a range of strategies to increase availability of EC in their communities.

  • Some CAIs ship EC directly to individuals. For example, PATH4YOU has partnered with EC brand Julie to ship EC to Indiana residents who request it via the online order form. Similarly, the All Access EKY Program ships EC, pregnancy tests, and other SRH supplies that have been donated directly to individuals who request it via the online order form. The Right Time partners with a local clinic to ship free EC as well.
  • Some CAIs work with their clinic partners to train providers on advanced provision of EC (ella and Plan B) during appointments so that patients can have EC on hand as needed and at no cost through their insurance coverage (if applicable).
  • Some CAIs work to increase access points to EC in the community, such as on college campuses, in public buildings like libraries or community centers, in local businesses, or through outreach during community events. CAIs may do this either independently or through partners like the American Society for Emergency Contraception. ASEC’s EC4EC campaign works with student activists on campuses across the United States to promote EC access on campus through advocating for an EC vending machine and/or peer-to-peer distribution of EC.

Birth Control Pharmacist

If you would like to receive donations of EC for your CAI, you can request donations from Plan B or Julie using the links provided.
 

Activities to Increase Accessibility

Accessibility, at its crux, means that individuals can reach clinics and other service delivery settings and can access services once there. The activities below are designed to increase accessibility of service delivery settings and/or methods.

Work with clinics to improve their policies and/or protocols

CAIs can offer targeted support to help clinics implement best practices and refine internal policies. This may include providing training or TA (as described above) on strategies that may increase accessibility, like offering same-day access, expanding clinic hours, prescribing 12-month supplies of contraception, or setting up mobile or co-located services in community spaces. CAIs might also develop tools, templates, or resource guides that help clinics streamline workflows to make it easier for patients to access services. Additionally, CAIs can assist clinics in promoting their services—for example, by creating or linking to clinic/service finders like this one from Trust Her or this one from ICAN—so that individuals can easily locate accessible care options.

Clinical Training Center Resource Library

Increase over-the-counter (OTC) access to contraception

On July 13, 2023, the FDA approved Opill, one brand of progestin-only birth control pills for over-the-counter (OTC) access without an age restriction. Having the birth control pill OTC means people can buy it right off the shelf of a drug store or other retail location, without ever talking to a health care provider. OTC access is particularly important as restrictions on reproductive health services and barriers to access to contraception are on the rise.

Opill Resource List

Increase access to contraception via telehealth

Millions of people in the U.S. have difficulty accessing reproductive health care. For those who live in contraceptive deserts, counties that lack reasonable access to a health center offering the full range of methods, getting contraception may mean having to travel a long distance, take time off work, or find childcare. Telehealth is a viable option for many people to obtain birth control and can help overcome some of these common barriers to accessing contraception.

National Consortium of Telehealth Resource Centers

CAIs can support clinics to establish a telehealth system or to strengthen or expand existing telehealth services. This might include helping clinics select platforms, navigate billing and compliance, or train staff in virtual care delivery. Some CAIs go further by addressing infrastructure gaps—for example, Family Planning Elevated provided iPads to clinics and partnered with rural libraries to create private telehealth spaces equipped with devices for patients to use. Others, like PATH4You, hire part-time clinicians to deliver telehealth care directly through the program—including evenings and weekends—and provide them with a clinical care handbook and protocols to ensure consistent, high-quality care.

Telehealth Resource Guide

Activities to Increase Accommodations

Appropriate accommodations should be made for patients’ needs and/or adequacy of services. These are typically, though not always, made at the Health Systems level. The activities below are designed to support CAIs in working with health care systems to increase accommodations.

Support clinics (and health care systems broadly) to follow national guidelines and/or recommendations for care

One such set of guidelines is the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which includes “recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions.”

Another set of relevant guidelines is The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), which addresses a “selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods.”

If clinics are not aware of existing tools to support providers in implementing such guidelines, your CAI can help bridge that gap by identifying relevant resources, sharing them through provider trainings or learning collaboratives, and incorporating them into workflow tools such as electronic health record prompts, checklists, or counseling aids.
 

Ensure that clinics are providing appropriate accommodations for populations that historically do not have the same access
  • Many populations have historically experienced unequal access to sexual and reproductive health care, shaped by systemic inequities such as medical racism, contraceptive coercion, and implicit bias. The list below highlights a few specific groups, but it is not exhaustive. CAIs can help clinics assess and address their own implicit biases, build practices grounded in Reproductive Justice principles, and work in partnership with communities to ensure that all people—particularly those most marginalized—can access high-quality, person-centered care.
  • People with disabilities face inequitable access to reproductive health (RH) services. CAIs can support clinics in identifying and addressing barriers by providing training, technical assistance, and resources on disability inclusion and accessibility. This might include partnering with trusted experts on disability inclusion to offer accessibility assessments, guidance on materials adaptation and/or communication methods, or connecting clinics directly with disability rights organizations for consultation and partnership. CAIs can also help ensure that clinic workflows, appointment systems, and service delivery models are flexible enough to accommodate a range of physical, sensory, and cognitive needs.
  • Young people, including adolescents, face particular barriers to accessing high-quality sexual and reproductive health services, including contraceptive and sexually transmitted infections services. In particular, research shows that adolescents who are concerned about the confidentiality of their contraceptive care are unlikely to obtain care. CAIs can play an important role in increasing access to confidential care for minors, as well as increasing other youth-friendly practices for clinical settings, like the ability to make appointments online and flexible hours that work for young people’s academic and employment schedules.
  • People who identify as LGBTQ also face unique disparities in sexual and reproductive health care due, in part, to barriers such as “the fragmentation of health services, discrimination from providers, and insurance issues, all of which can be exacerbated by racism and intersecting oppressions.” CAIs can support clinics to use person-centered approaches that integrate the needs of those who identify as LGBTQ, and to integrate best practices, such as those identified by ACOG and the Society of Family Planning, for providing SRH care to this population.
  • CAIs can also assist clinics in their service area to provide services that are culturally and linguistically appropriate. It’s important for each CAI to work with the community to determine what that looks like in their area. This may include staff who can speak the languages that are commonly used in the community, access to translators, preparing materials at an appropriate reading level, and more. General resources on culturally and linguistically appropriate services, such as the National CLAS standards, may be helpful in identifying and implementing specific strategies to increase cultural and linguistic competency.

Activities to Increase Acceptability

Acceptability refers to the patients’ acceptability of services, methods, and providers. The strategies below are related to gathering and addressing patient acceptability.

Convey the importance of clinics gathering feedback from patients on a regular basis and support strategies to do so

Clinics consistently balance a multitude of tasks and responsibilities. Though most recognize the importance of gathering patient feedback, identifying implementable strategies to do so can be a time-consuming task. CAIs can support clinics by providing tools to collect patient feedback, like the one linked here from ICAN!, as well as identifying realistic processes and workflows to implement those tools.

Use a continuous quality improvement (CQI) approach

CAIs can adopt a CQI approach to ensure their strategies remain responsive to the needs and preferences of the communities they serve. This includes regularly collecting and reviewing feedback from patients and/or partners, analyzing outcomes, and making real-time adjustments to strengthen the initiative. For example, ICAN! uses the results from provider training surveys and from the patient satisfaction surveys that are administered in partner clinics to identify priority training needs, build provider buy-in by sharing feedback results, and guide marketing decisions—amplifying clinics committed to patient-centered care. PATH4You is developing site-partner "report cards" that compare PCCC scores across the program to encourage ongoing improvement. By embracing a learning mindset and adapting throughout implementation, CAIs can drive outcomes that align more closely with patient experiences and priorities.

Activities to Increase Affordability

Affordability includes how affordable family planning visits/encounters are, as well as how affordable methods are. CAIs can use the strategies below to increase the affordability of encounters and methods in their service area.

Serve as a payor to cover the cost of contraceptive care and methods

Some CAIs increase affordability by directly reimbursing clinics for contraceptive services and supplies (i.e., serving as a “payor”). This payor role can take different forms—some CAIs reimburse clinics at Medicaid rates, others provide upfront stocking grants, administrative fees, or per-patient or per-month payments to offset costs. The reimbursement model may vary depending on the clinic’s needs and the CAI’s resources, and often includes both visits and methods. The RHNTC has developed a useful tool for tracking billing and reimbursement for LARC devices and Depo. Regardless of the approach, clear contracts (see “Planning Period”), streamlined invoicing, and consistent communication are key to successfully implementing a payor model.

Support clinics in billing and coding for contraceptive services

CAIs can help increase the financial sustainability of contraceptive care by supporting clinics in correctly billing and coding for services and methods. This may include offering training, TA, or reference materials to help clinics navigate complex reimbursement requirements across payors like Medicaid, private insurance, or 340B programs, like the job aid sample shared by ICAN! Accurate billing and coding can help clinics maximize reimbursement, reduce claim denials, and avoid financial losses that might otherwise limit access to care. CAIs may also connect clinics with billing experts or create peer learning opportunities to share strategies and troubleshoot common issues.

Work with community health centers (CHCs) in your service area to determine whether they are eligible for the Section 330 program

Through Section 330 of the Public Health Service Act, the Bureau of Primary Health Care grants awards to eligible health centers to provide health care services. Health center grantees can also receive additional funds to provide for underserved populations in their areas as defined by 330, including migrant and seasonal agricultural workers and their families, people experiencing homelessness, residents of public housing, and people with limited English proficiency. Some CAIs, like Family Planning Elevated, have worked with CHCs to help them determine eligibility and compile application materials (e.g., population demographics/need, budget, etc.); however, this is not necessarily a common CAI activity.

Help clinics in your area secure discounted prices for contraceptive methods through the 340B Drug Pricing Program (if they are not already doing so)

The 340B Drug Pricing Program requires pharmaceutical manufacturers to sell outpatient drugs at a discount to eligible health organizations, such as Title X-funded Health Centers, CHCs and Federally Qualified Health Centers (FQHCs), hospitals, and more. Some clinics are not aware that they may be eligible for 340B pricing, while others may be aware of eligibility but unsure how to become a covered provider. CAIs can assist clinics in assessing eligibility and in registering for the program if they are eligible.

Leverage diverse funding sources to support contraceptive access

CAIs can help ensure the long-term affordability and sustainability of contraceptive services by identifying and coordinating multiple funding streams. This may include leveraging Title X, Medicaid, private insurance, 340B revenue, foundation grants, and other local or state funding opportunities. For example, ICAN! developed the linked memo on Medicaid state plan amendments for family planning. By helping clinics understand how to leverage these resources—while positioning CAI dollars as the payor of last resort—initiatives can stretch their impact and reduce gaps in access. CAIs can also support clinics in navigating eligibility, enrollment, and reporting requirements tied to each funding stream to maximize reimbursement and minimize administrative burden.

CAIs can help clinics improve their understanding of insurance coverage—including public, private, Medicaid, and self-pay—by training staff on verification and billing, addressing barriers such as prior authorization or confidentiality concerns, connecting patients to enrollment support, and ensuring uninsured or under-insured patients have access to sliding-fee or other safety-net options. For example, ICAN! developed the sample tools you see linked here.

Make clinics aware (if they are not already) of relevant patient assistance programs to reduce costs for contraceptive methods

There are many patient-assistance programs for contraceptive methods, including programs from pharmaceutical companies, Medicaid, and other organizations. CAIs can compile and share patient-facing information about relevant patient assistance programs with clinics in their area.

Measuring Impact

Tracking and understanding the impact of your CAI is essential to improving your work, demonstrating value to stakeholders, and advancing health equity. That being said, evaluating CAIs is a broad and complex topic—one that encompasses policy, public health, clinical outcomes, and community experiences. This section does not attempt to provide an exhaustive guide to the evaluation of CAIs, but instead offers a focused starting point for you to think strategically and practically about how to track progress, make real-time improvements, and communicate the value of your CAI. Here are some key principles and practical steps CAIs can take to measure impact in a way that is manageable, meaningful, and grounded in values of equity and accountability.

Define what success looks like

Start by identifying what success means for your CAI. Your impact measures should align with your initiative’s goals, activities, and values—many of which you may have outlined during your Planning Period. 

You can use the Contraceptive Access Framework to identify the dimensions of access (awareness, availability, accessibility, accommodation, acceptability, affordability) your initiative is targeting and the modifiable strategies (i.e., activities) you’re implementing to address those dimensions. The corresponding modifiable determinants can then serve as guides for what you might consider measuring. For example, if your initiative is targeting the Acceptability dimension by offering provider and staff training, you might consider measuring patient’s experiences when visiting your partner clinics. 

Consider tracking outcomes at multiple levels:

  • Individual-level outcomes, such as patient satisfaction, contraceptive method use if a method is desired, contraceptive continuation as aligned with patient goals, service utilization, changes in perceived access or autonomy; CAIs may also consider tracking outcomes beyond the immediate receipt of contraception—such as follow-up over time to assess continuation, satisfaction, or shifting needs—and ensuring that data collection methods (e.g., surveys or interviews) are available in multiple languages and capture the experiences of specific sub-groups that have historically faced inequities in care.
  • Clinic-level outcomes, such as same-day access rates, provider uptake of best practices, implementation of patient-centered counseling, insurance reimbursement rates.
  • System-level outcomes, such as policy changes, number of service delivery sites participating, funding secured or sustained.

You can also look at how other CAIs have defined and measured success. The AJPH Special Issue on Contraception, linked here, included several articles that referenced CAI metrics and evaluation, is linked here for easy reference.

Recognize that traditional data sources may be limited or delayed, and explore innovative ways to gather timely insights. This might include distributing short surveys via QR codes, collecting patient and community stories, or adapting data collection methods to align with the communication styles and access needs of the populations your CAI serves.

reference Links
To the extent possible, engage community partners in measurement efforts

Just as community voice is critical to planning and implementation, it should also guide what and how you measure. The use of participatory evaluation approaches—where community members help define questions and interpret data—has been shown to increase relevance and utilization of findings, especially in public health initiatives focused on equity.

Involve partners and people with lived experience in identifying what outcomes matter most. Share data back with them regularly to foster transparency and trust. You can do this through:

  • Your Advisory Board reviewing results and helping interpret findings
  • Focus groups or listening sessions to reflect on data and guide adaptations
  • Community report-backs or data “open houses”

  • And more!


     

Use tools that work for your CAI

There are several tools highlighted throughout the toolkit that can support your measurement efforts. These include but are not limited to the:

  • Person-Centered Contraceptive Counseling (PCCC) measure, a validated tool from UCSF that assesses whether patients feel respected, heard, and supported in their contraceptive decision-making.
  • RHNTC Patient Satisfaction Survey and Patient Experience Improvement Toolkit for Title X-funded clinics.
  • Clinic self-assessment tools (e.g., RHNTC’s Clinic Contraceptive Access Assessment) that focus on operational readiness and best practices.

Use tools that are feasible to implement in your context. If your CAI works with clinic partners, consider offering TA to help them embed data collection into their existing workflows.
 

Communicate what you learn

Think about how you’ll share findings—with funders, clinic partners, community members, and other partners. Consider using:

  • Brief impact snapshots or scorecards
  • Visual dashboards or infographics
  • Stories that pair patient experiences with supporting data

Some CAIs develop quarterly dashboards to track progress, while others create “Year in Review” summaries to showcase impact, celebrate milestones, and engage partners in planning for the future. The format matters less than making sure the information is clear, accessible, and tied to your goals.
 

Adopt a continuous quality improvement (CQI) approach

As noted in the Acceptability section, CAIs benefit from using a CQI approach—continuously collecting feedback, reviewing outcomes, and making real-time adjustments to strengthen the initiative. CQI emphasizes small, rapid-cycle tests of change (e.g., Plan-Do-Study-Act cycles) and encourages a learning mindset. Research suggests that CQI initiatives are more successful when they include leadership support, staff engagement, and structured feedback loops that turn data into actionable insights.

Consider external evaluation support

If your CAI has the resources, consider working with an external evaluation team. External partners can help ensure your measurement approach is both rigorous and aligned with your goals. Evaluators can support:

  • Data system design and management
  • Outcome analysis
  • Interpretation of findings
  • Communication strategies for multiple audiences
  • And more! 

Even a part-time or short-term evaluation partner can provide valuable insight and capacity—especially when you're trying to scale or refine your work. CAIs may also consider partnering with an academic researcher with expertise in evaluation, which can sometimes provide a lower-cost alternative to hiring consultants and may open opportunities to pursue joint funding as a research project.
 

Who we are

All Access EKY 

All Access EKY (AAEKY) has transformed contraceptive access across Kentucky—particularly in rural and underserved regions—by reducing barriers, elevating community voices, and ensuring Kentuckians have the information and resources to make informed reproductive health decisions. Launched in Appalachian Kentucky, this community-led initiative has expanded statewide to advance access to the full range of birth control methods through youth-centered, culturally responsive, and evidence-based strategies. AAEKY has trained hundreds of healthcare providers, partnered with clinics to improve same-day method availability and clinical practices, and, in 2020, launched Kentucky’s first and only free, locally led contraceptive mailing program. This program has distributed nearly 100,000 condoms, 15,000 doses of emergency contraception and pregnancy tests, and 1,000 units of Opill and menstrual products directly to individuals across the state. By centering community needs, AAEKY has established a resource-efficient model for reproductive health innovation—one that is both impactful and scalable across diverse settings.

Family Planning Elevated/ASCENT Center for Reproductive Health

The Family Planning Elevated (FPE) initiative has transformed contraceptive access and reproductive health care for thousands of Utah residents. Through a comprehensive and innovative approach, FPE provided no-cost contraception to 19,313 individuals within the contraceptive coverage gap. This initiative not only improved direct patient care but also strengthened health systems and influenced state policy to create sustainable change. From this initiative, the ASCENT Center for Reproductive Health was formed. The Center supports and promotes proactive sexual and reproductive health policy and service provision and acts as a regional resource on sexual and reproductive health in the Mountain West by focusing on expanding and improving local contraceptive access and sexual and reproductive health care for all.

Illinois Contraceptive Access Now!

Implementing Contraceptive Access Now (ICAN!) is an ambitious initiative to advance contraceptive equity by de-siloing, de-stigmatizing, and normalizing birth control as basic healthcare. ICAN!'s reproductive justice-informed, systems-change approach seeks to transform the way contraceptive care is delivered, accessed, and paid for with a focus on equity and sustainability. ICAN! works to effect lasting change at the policymaker, provider, patient, and payer levels. In 2021, ICAN! led the development and advancement of a model, reproductive justice-aligned Family Planning State Plan Amendment (SPA)—now known as the HFS Family Planning Program—in Illinois. Up to 1.2 million people are eligible for coverage under the new Medicaid family planning program,  including over 200,000 who are truly uninsured. You can learn more about ICAN!'s work advancing a model Family Planning SPA and how they are translating lessons learned to support other states with strengthening coverage for sexual and reproductive healthcare at icancoverall.org.

New Morning

New Morning focuses on ensuring equitable contraceptive access for all South Carolinians. Through their work, over 100 partnering clinics are provided technical assistance, training, and evaluation to support the delivery of person-centered, evidence-based contraceptive care. Their consumer education program, No Drama, provides information about contraceptives, links to local partnering clinics, and telehealth. Since 2017, the program has served over 600,000 people. New Morning is especially proud of leveraging strategy to make sure that everyone, even people living in rural, underserved areas, can access high-quality contraceptive care.

New York Birth Control Access Project (NYBCAP)

NYBCAP is shaping policy, increasing access, and building up activists with energy and know-how. NYBCAP has developed a unique model for social change through an Associate Board for advocates from public colleges across New York. Today over 400 young people have graduated from the Associate Board program. They  provide hands-on-training models to equip young people with the skills they need to bring real advocacy into the real world. Specifically, NYBCAP has trained advocates across New York State to lead our Campuses With Emergency Contraception Campaign on their own campuses. As a result of this effort, some advocates successfully convinced their campus to install the first vending machine stocked with emergency contraception on a City University of New York (CUNY) campus. They have also supported advocates’campaigns which have led to vending machines being placed on multiple State University of New York (SUNY) campuses. In all of the vending machines EC is currently being sold for $10.

PATH4YOU

Pregnancy At a Time that is Happy and Healthy 4 YOU was created with a person-centered contraceptive care framework and focuses on expanding access to high-quality pregnancy planning care in the state of Indiana. The program was launched with community engagement at the core and during the pandemic, which created a hybrid model of in-person and telehealth care that enables them to reach a large geographic area. In addition to offering clinical care, they have dedicated team members that provide liaison and navigator assistance to people that reach out to the program. This patient-facing work outside of clinical encounters helps them continuously iterate and improve our program delivery model. The free “EC” program also enables them to provide direct care to people in need of single-use contraceptive options. They continue to find ways to expand their reach and awareness of our program given the landscape for reproductive health access has only become more challenging in the state since their launch.

Reproductive Health Collaborative Nebraska 

The Sexual & Reproductive Health Initiative (SRHI) is a grant program designed to expand access to high-quality, affordable sexual and reproductive healthcare in Nebraska. It supports the provision of services to people who are low-income, uninsured or underinsured, or who face other barriers to access. Crucially, the program supports the implementation of education and outreach programming to promote healthy sexuality, increase awareness of available services, and deepen community networks. SRHI’s overall goal is to improve health outcomes, reduce barriers to care, and create stronger, more connected communities. SRHI supports ten organizations with 30 clinical service sites across the state. In 2024, staff at these clinics made contact with 23,637 community members through education and outreach programming.

The Right Time

Through The Right Time initiative, Beacon expands access to contraception throughout Missouri. They partner with health centers to offer same-day, free or low-cost birth control options, provide ongoing training and support, and deliver community education so people can make informed choices about their sexual and reproductive health. The initiative engages in policy and advocacy to build community power to address systemic barriers that impact peoples’ ability to receive and offer sexual and reproductive healthcare.  One of the things that they are most proud of is the way the initiative has evolved and responded to community needs.

Take Control Initiative (TCI)

The Take Control Initiative is a contraceptive access program based in Tulsa, OK. Since 2010, TCI has worked to break down barriers to access through education, outreach, policy change, and free clinical services for contraception. To achieve this, TCI partners with local clinics, three of which provide confidential teen-friendly services, across Tulsa County. TCI provides free access to all contraception methods, IUD and implant removals, Lyft rides to partner clinics, and morning-after pill kits for eligible individuals. They also offer education workshops for community members, referral trainings for partner organizations, and training opportunities for healthcare providers. In 2020, TCI launched a free emergency contraception (EC) program, also known as “Just in Case” kits, which contain EC, condoms, pregnancy tests, lube, and an information card. Since the launch, TCI has distributed over 70,000 kits via mail and through community partners across Oklahoma! With student support and advocacy, they implemented two wellness vending machines on college campuses that offer EC, condoms, lube, pregnancy tests, & menstrual products at no cost to students and staff. The wellness machines have been a successful point of access to resources for individuals, dispensing nearly 7,000 reproductive health products in 2024.

Trust Her

Trust Her, an initiative of the Child Poverty Action Lab (CPAL) in Dallas, Texas, removes barriers to birth control so all women and girls in Dallas County can plan for their families and their futures. Since 2020, Trust Her has partnered with over 25 local clinics to stock the full range of contraceptive methods, and serve as a payor for the under and uninsured so that women can receive same-day access to their preferred method of birth control. As an initiative of CPAL, an organization dedicated to using data to drive better outcomes for families, Trust Her has piloted and launched several initiatives to expand opportunities for contraceptive access. Examples of this innovation include a mobile family planning clinic that travels between 7 community college campuses serving over 120,000 students, a pop-up contraceptive counseling service created through human centered design techniques that engaged dozens of teens across Dallas, and a one-of-it’s kind LARC proctoring program that has expanded the capacity of family and primary care providers in the county to offer the full range of birth control methods.
 

From our partners

See what the CAIs from our Shared Learning Collaborative are up to now and connect with them on social!

Social Media Links

All Access EKY:

Instagram, Facebook, and TikTok

Take Control Initiative:

Instagram, TikTok, and Facebook

Trust Her:

Instagram, TikTok, and Facebook

ASCENT Center for Reproductive Health

Instagram, Facebook, and YouTube

Illinois Contraceptive Access Now

Instagram

Reproductive Health Collaborative Nebraska

Instagram and LinkedIn

PATH4YOU

Facebook, Instagram, LinkedIn, and TikTok

NY Birth Control Access Project

Instagram and Twitter

Research and resources

Below you’ll find relevant research and resources on contraceptive access. This is not an exhaustive list; instead, it aims to highlight materials that are particularly focused on contraceptive access initiatives.

The Coalition to Expand Contraceptive Access (CECA) is a convener of committed partners working to ensure access to contraception as part of a broader vision to achieve sexual and reproductive health equity for the U.S.

  • In 2022, CECA published a special supplement of the American Journal of Public Health entitled Reshaping Contraceptive Access Efforts By Centering Equity, Justice, and Autonomy. The issue highlights research and perspectives on contraceptive access efforts. It also features articles on telehealth, community connections, scaling up evidence-based practices, evaluating initiative methodologies, and more.
relevant links

 

The American College of Obstetricians and Gynecologists (ACOG) is the premier professional membership organization for obstetrician–gynecologists. The College produces practice guidelines for health care professionals and educational materials for patients, provides practice management and career support, facilitates programs and initiatives to improve women’s health, and advocates for members and patients.

  • ACOG’s Committee on Health Care for Underserved Women released a Committee Opinion on Access to Contraception in 2015, which was reaffirmed in 2022. The document reviews barriers to contraceptive access and offers strategies to improve access.
relevant links

The Reproductive Health National Training Center (RHNTC) works in collaboration with the Office of Population Affairs and the Office on Women’s Health in the Office of the Assistant Secretary for Health to address the needs of Title X family planning service delivery grantees and Teen Pregnancy Prevention grantees through training and technical assistance.

  • Their Increasing Access to Contraception Toolkit supports family planning providers in ensuring access to the full range of contraceptive methods for clients who could become pregnant, but who wish to avoid pregnancy at this time. The toolkit supports agency-level improvement on the contraceptive care measures developed by the Office of Population Affairs (OPA) and endorsed by the National Quality Forum.
relevant links

Reproductive Health National Training Center

Link: Increasing Access to Contraception Toolkit