Federally Qualified Health Centers: Vital Sources of Care, No Substitute for the Family Planning Safety Net
Federally qualified health centers (FQHCs) are an integral part of the publicly funded family planning effort in the United States, but it is unrealistic to expect these sites to serve the millions of women who currently rely on Planned Parenthood health centers for high-quality contraceptive care. Socially conservative policymakers are seeking to take public funding for family planning away from Planned Parenthood and other providers focused on reproductive health, suggesting that federally qualified health centers (FQHCs) could take their place. However, the Title X national family planning program’s ability to yield significant health and economic benefits for women, families and society relies on a diverse network of safety-net providers—a network that should include, but cannot be limited to, FQHC sites.
The Essential Role of FQHCs in the Health Care Safety Net
FQHCs are an essential part of the nation’s overall health care safety net, serving 25 million people annually, seven in 10 of whom live at or below the federal poverty level. Their role has been expanded by the Affordable Care Act (ACA), which invested billions of new dollars into FQHC infrastructure, driving considerable nationwide growth in the number of sites and their capacity. In conjunction with their overall growth, FQHC sites have become increasingly integral to the national publicly funded family planning effort.
According to the Department of Health and Human Services (HHS), "Health centers are community-based and patient-directed that deliver comprehensive, culturally competent, high-quality primary health care services." These centers often integrate access to pharmacy, mental health, substance abuse and oral health services in areas where economic, geographic or cultural barriers limit access to affordable health care services. For example, Neighborhood Health Centers of Lehigh Valley (NHCLV) offers medical care including prenatal, pediatrics, women’s health, physicals, immunizations, STD and HIV counseling and testing, pregnancy testing and group visits.
Contraceptive Care and Safety-Net Capacity
Nationwide, there are approximately 10,700 safety-net health centers providing family planning services. These service sites are operated by a diverse range of public and nonprofit entities, including FQHCs, Planned Parenthood affiliates, health departments, hospitals and other independent agencies. Together, these safety-net providers delivered contraceptive care to 6.2 million women nationwide in 2015.
However, not all individual service sites operated by FQHCs provide contraceptive care. Federal law requires FQHCs to offer comprehensive preventive and primary care—explicitly including family planning services—to their clients, but they can either do so directly or through contracts or cooperative agreements with other health care providers. In 2015, out of the over 9,600 total FQHC sites in the 50 states and the District of Columbia, 5,830 of them (60%) reported offering contraceptive care to at least 10 women each year.
National Safety-Net Statistics
| Service Metric | Data Point |
|---|---|
| Total safety-net family planning centers nationwide | 10,700 |
| Total FQHC sites (50 states and D.C.) | Over 9,600 |
| FQHC sites offering contraceptive care (to 10+ women/year) | 5,830 |
| Total people served by FQHCs annually | 25 million |
| Women receiving contraceptive care from safety-net providers (2015) | 6.2 million |
Challenges to Replacing Specialized Providers
Despite their growing importance to the family planning safety net—and policymakers’ assertions to the contrary—FQHCs could not readily replace Planned Parenthood health centers. A new Guttmacher Institute analysis finds that they cannot be expected to deliver contraceptive care to the large numbers of women who currently rely on Planned Parenthood or other Title X–supported providers. Policymakers are moving to exclude Planned Parenthood from various public funding streams, asserting that Planned Parenthood health centers are unnecessary because FQHC sites are plentiful and could easily meet women’s need for family planning care.
To suggest otherwise willfully oversimplifies the considerable challenges FQHCs would face in doing so, and ignores how these proposals put millions of U.S. women at very real risk of being unable to obtain the basic care they need. Furthermore, federal law imposes restrictions on the use of federal funding to provide or facilitate the provision of abortion services. These restrictions create complex regulatory compliance concerns for family planning agencies and federally qualified health centers that elect to offer abortion services using non-federal funds.