Statewide Contraceptive Access Initiatives:
Documenting Lessons Learned and Discovering Opportunities
Recommendations Report Overview
June 2024
https://www.contraceptionaccess.org/scai-11Understanding theContext: Rationale andProject Approach2What is an 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 inexpanding access to contraception; providingcontraceptive products at no or low cost;providing training and capacity building; andremoving other structural barriers toenhanced contraceptive access.
Malcolm N, Danaux J, Parikh A, et al. Statewide Contraceptive Access
Initiatives: Updated Environmental Scan Report. Coalition to Expand
Contraceptive Access; 2024.
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How have SCAI evolved?
●Since the early 2000s, more than 30 SCAI have been implemented in the U.S●State and funder interest in the outcomes of the Contraceptive CHOICE Project,
implemented in St. Louis, Missouri in 2006, prompted the implementation ofseveral contraceptive access initiatives focused on addressing barriers specificto LARC access, including cost and logistical barriers●The reproductive health, rights, and justice community voiced concern thatLARC-first or LARC-centered approaches ignore the:○ Many factors beyond method effectiveness that may shape a person’s○●contraceptive preferences and decision-making across the lifespanLong history of reproductive coercion in the US

Based on these concerns, initiatives have generally shifted over time. The
majority of SCAI implemented in the past ten years:○ Focus on access to all contraceptive methods○ Employ strategies to ensure that all methods are available for individuals tochoose the method that will work best for them4

What is the purpose of this project?
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,with an eye toward advancing Sexual and Reproductive Health
Equity (SRHE).
The work of CECA and RISE to identify lessons learned andopportunities across SCAI serves two initial key purposes:
1. Inform the implementation and evaluation of current andfuture projects

2. Identify opportunities to generate and disseminate evidence

on SCAI

This project reiterates boththe need and opportunity for
all work on contraceptive
access to be committed to:• Integrating equity,
reproductive autonomy andagency, and wellbeing• Removing barriers across alllevels and sustainably
increasing access• Adopting andtailoring/adapting bestpractices to adapt to local
and community needs

5What is SRHE?

Sexual and Reproductive Health Equity (SRHE)
means that systems ensure that all people,
across the range of age, gender, race, and otherintersectional identities, have what they need
to attain their highest level of sexual andreproductive health.
This includes self-determining and achieving
their reproductive goals.
Government policy, healthcare systems, andother structures must value and support
everyone fairly.
Hart J, Stern L. Why CECA Focuses on SRHW and SRHE. Coalition to
Expand Contraceptive Access. Published December 26, 2021. Accessed
February 5, 2024. https://www.contraceptionaccess.org/blog/whyceca-focuses-on-srhw-and-srhe6

How did CECA gather input and develop recommendations?
Activity

PurposeConducted scoping and developed an
American Journal of Public Health (AJPH)
special issue

Document the work of SCAI and share articles on SCAI conceptualization,
implementation, evaluation, and initial findings. (Developed inpartnership with the Association of State and Territorial Health Officials)

Hosted listening sessions with SCAI
representatives and funders

Gather insights on the promising practice, challenges, and opportunities
related to implementation, evaluation, and SRHE

Developed an updated environmentalscan

Explore the existing evidence related to the implementation andevaluation of SCAI from 2005 to January 2024. (Developed in partnershipwith RISE)

Hosted a summit of SCAI representatives
and partners

Reflect on and confirm the key findings from the information gathering
activities, develop a shared vision, generate priority actions, and discuss
the needs and next steps for SCAI

Developed the SCAI Recommendations
ReportDocument and share the vision for SCAI, priority recommendations tomove SCAI toward the vision, and ideas for fostering action. (Developedin partnership with RISE)
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Translating Opportunities
into Action: TheRecommendations
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What is the vision of SCAI?
The vision of SCAI is to achieve universal, equitable
contraceptive access. This means that all people can accesscomprehensive contraceptive information, products, methods,
and/or services that work best for them – when, how, andwhere 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.

9How do SCAI help achieve this vision?
●●●

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, community,and individual levels to sustainably increase access to andprovision of high quality, nonjudgmental, and person-centeredcare.
Adopting and tailoring/adapting best practices, responding tolocal and community needs, and pursuing innovative
approaches.

10Priority Strategies

VisionHow can SCAI translate this vision into action?

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Center Community VoiceWhat?
• Center community voice in all aspects of SCAI

Why?
• Prioritizing and integrating community engagement strategies throughout planning, implementation, andevaluation activities helps SCAI center the needs, values, and priorities of local communities, yet doing so inan equitable way can be resource intensive, requiring dedicated time, staffing, and fundingHow?
• Meaningfully center the needs, values, priorities, experiences, and voice of local communities related tosexual 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 oncethe project ends

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Foster Flexibility and Responsiveness
What?
• Create space and flexibility for SCAI to adapt best practices, respond to local needs, and pursue
innovative approaches

Why?
• Evolving state and local contexts may require SCAI to adapt the planned approach to a particularintervention activity or delay the implementation of a particular activity while prioritizing progress onothersHow?
• Enable more flexible timelines and use of funds• Prioritize approaches that provide benefit to clinical and community partners• Create explicit opportunities for SCAI to test innovative approaches

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Align Goals with Comprehensive Measures
What?
• Ensure values-driven goals align with measures and intended outcomes that provide a more complete story ofpeople’s access to contraception and experiences

Why?
• Misalignment among key SCAI stakeholders between goals and measures creates discordance and confusion
around how success is defined and assessed, and can, for example, hamper progress toward equity-centeredgoals

How?
• Change the expectations and narrative around SCAI goals, measures, and intended outcomes to align withequity-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 bestpractices

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Sustain the WorkWhat?
• Explore various approaches to sustain efforts to improve contraception accessWhy?
• SCAI are necessary efforts to expand access to contraceptive care across states, but given their fixed
timelines and budgets, these projects alone are not a sufficient solution for ongoing advancement ofcontraceptive access and equityHow?
• View SCAI as a starting point to addressing access barriers, and incorporate strategies to extend thework 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

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What can funders do?
●

Create funding opportunities that support:○○

SCAI’s work to center equity- and justice-informed approaches
A range of comprehensive measures and best practices and allow
communities to choose and adapt approaches for their context●

Work collaboratively to ensure alignment between funderand SCAI leaders’ views, expectations, and approaches●

Support collaboration and idea sharing to facilitate thesynthesis and adoption of best practices and innovations●

Build understanding of what sustainability means for each
SCAI and help identify and support sustainable funding andpayment options“Our focus being predominantly
on contraception access gives us
the ability to be constant whensome of our larger healthproviders cannot be as nimble. I
think about the pandemic, when
SRH was deemed not essential,
and the attacks on birth control,
and we are willing to push
contraception forward.”- SCAI Representative16

What can implementers do?
●Tailor SCAI activities to local contexts while building on documented bestpractices to, for example, center equity- and justice-informed programmingand explore innovative strategies to expand SCAI reach●

Value and build on work of clinical and community partners by assessing
and integrating their strengths, needs, and gaps into the project design●

Set and communicate realistic expectations to key stakeholders about theinitiative’s primary goal(s) and how activities and corresponding measuresalign●Continue to build healthcare system capacity, foster practice change, andincrease the workforce, by building technical skill and changing the way
partners value contraception●

Integrate sustainability from the start of the project, establish responsibility
and accountability among key stakeholders, and maximize all available public
and private funding and payment sources"I don't want anyone to ever go toa doctor or interact with theirpartners thinking they can't have
input and direction in theirreproductive choices andaspirations, whatever they may
be. At the end of the day, that's
why I work for an SCAI--to be apart of the forces that keep
reproductive agency a salient
cultural norm.”- SCAI Representative17

What can evaluators do?
●Develop comprehensive, mixed-methods evaluations that incorporate
equity-informed principles, prioritize expansive community
engagement and data collection, and include a range of outcomes●

Tailor engagement approaches across different clinical partners toboth support the collection of consistent and comparable data andreduce burden●

Remain flexible and responsive to evaluation needs that may emerge,based on community needs, adapted implementation approaches, orchanging political landscapes●Share the impact of SCAI to help gain broad support by aligningevaluation conclusions with initiative goals and principles of equity,
providing context around findings, and being responsible for andthoughtful about when and how findings are shared“It is so important to understandwhat is working well and/or what
we are learning to better makeprogress toward the types ofaccess that SCAI are trying toachieve. So much work withinpublic health and reproductive
health does not have the luxury ofprioritizing evaluation in the waythat many of the SCAI have.”- SCAI Representative18

What can national partners do?
●

Identify the aspects of the work that are scalable, andopportunities to collaborate and leverage resources●

Integrate SCAI findings into their work, including
stakeholder convenings, trainings, patient engagement
strategies, evaluation support, funding and sustainability
resources, and other innovations●

Convene and proactively connect stakeholders,innovations, and lessons learned between the national,state, and local levels“As states, we need a place tocome and talk to one another.
SRH is going to be managed on
the state level instead of throughfederal protections. We now havestate by state initiatives. Thework conveners are doing to bringvoices of states together is very
important.”- SCAI Representative

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Moving Forward:
Potential Next Steps

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What are some potential next steps?
Funders, SCAI implementers and evaluators, national organizations
and conveners, and the broader field can:Inform and Strengthen Contraceptive Access Initiatives*•Disseminate project findings to amplify the reach of this effort to new andexisting partners•

Support ongoing conversations and collective action•

oIdentify, document, and share learnings, best practices, and innovations

oDevelop resources to support implementation and evaluation activities

oSupport leaders in making the case for the value of contraceptive access initiatives

oPromote the culture shift in the SRH field toward principles of equity, reproductive
agency and autonomy, and patient-centeredness

Build SCAI capacity to overcome barriers related to implementation, evaluation,and broader contextual factors*At any level – state, local, regional, etc.

21What are some potential next steps?
Funders, SCAI implementers and evaluators, national organizations
and conveners, and the broader field can:Generate and Disseminate Evidence on Contraceptive Access Initiatives*•Work toward developing a Community Preventive Services Task Force(CPSTF) Community Guide Recommendation on SCAI

•Conduct a range of studies, including:•oRigorous SCAI-focused studies, informed by implementation science and withan eye toward SRHE

oContextual and policy-focused studies to provide current dataoA comparative analysis of contraceptive access efforts in other countriesDevelop, test, and implement more comprehensive measures related tocontraceptive access and use*At any level – state, local, regional, etc.
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Thank you.
CECA@contraceptionaccess.org
contraceptionaccess.org