The Strategies to Improve Family Planning Service Delivery project aimed to develop actionable recommendations for those who work to improve clients’ experiences of care at Title X-funded health centers.
The project, funded through a grant from the Office of Populations Affairs (OPA) of the U.S. Department of Health and Human Services (HHS), helped publicly funded family planning providers identify innovative, effective strategies to improve clients’ experiences.
This project built on research conducted under the Trends in Family Planning Service Provision project.
Background
The Title X Family Planning Program, administered by OPA, is the only federal program designed to support comprehensive family planning and related preventive health services for individuals with low incomes. Title X services can include contraceptive methods and counseling, assistance to achieve pregnancy, care for sexually transmitted infections (STI), and more. In 2022, more than 2.6 million family planning clients received care at over 4,000 Title X-supported service sites in the United States.
The context within which Title X clinics operate has changed dramatically in recent years. Program policy changes have led a significant number of clinics to leave and return to the program, the COVID-19 pandemic transformed how services were provided, and new state-level policies have limited access to sexual and reproductive health services for many.
This context underscores the critical need to help publicly funded family planning centers improve access to high-quality services and ensure that everyone who visits a Title X clinic receives client-centered care.
Research Approach
To identify strategies for improving family planning services, the research team collected and analyzed in-depth data from family planning clients (via surveys and interviews) and providers (via interviews with clinic staff) and analyzed existing data sources such as the National Survey of Family Growth.
The study team:
- Surveyed more than 1,000 recent family planning clients about their sexual and reproductive health care experiences, barriers to accessing services, and contraceptive use and preferences.
- Interviewed staff at 32 Title X-funded health centers about factors that influence client experience, including interactions between providers and patients, social and structural factors related to the clinic (e.g., procedures to ensure confidentiality, clinic environment and location), and barriers and facilitators to implementing person-centered and equitable care.
- Interviewed 17 family planning clients from across the country to collect information on clients’ experiences at Title X clinics, identify clinic- and provider-level factors that shape their experiences, and gather insights on how providers can improve clients’ visits.
Timeline
Our study began in August 2022 and ended in February 2026.
- June-October 2023: Interviewed family planning providers
- September-November 2023: Collected client survey data
- July-October 2024: Interviewed family planning clients
- 2023-2025: Analyzed provider and client data, as well as national survey data
- 2023-2026: Disseminated findings through peer-review publications, conference presentations, and Child Trends products
Publications
Broadly, publications from this project highlighted insights from family planning clients, insights from family planning providers, or the study team’s research methods.
Insights from clients
- Understanding What Contributes to a Positive Family Planning Visit. September 2025. Using findings from interviews with family planning clients, this brief summarizes the key interpersonal elements and clinic characteristics that made a sexual and reproductive health care visit positive or negative.
- Patients Value Family Planning Providers Who Understand Their Religion or Culture. September 2025. This data point highlights client survey data on patient preferences for providers who are knowledgeable about their religious and cultural background.
- Many Young Family Planning Clients Took Reproductive Health Actions Following Dobbs. August 2025. Using data from our client survey, this data point describes the reproductive actions that family planning clients took following the Dobbs decision and highlights differences by age.
- Unmet Contraceptive Preferences Among Family Planning Clients With Low Incomes. January 2025. This brief draws on client survey data to highlight family planning clients’ preferences for birth control methods. It outlines rates of unmet contraceptive preference (using a method that one does not prefer) and methods most frequently preferred instead.
- Desire for Sterilization Reversal: Differences by Rural/Urban Area, Method of Payment, and Facility Type. October 2025.This article, published in the Journal of Women’s Health, uses data from the National Survey of Family Growth to examine the desire for sterilization reversal.
- Improving Service Delivery by Understanding Family Planning Clients’ Experiences With Unfair Treatment. December 2024. This brief summarizes clients' experiences with unfair treatment at their last family planning visit, based on client survey data.
- Person-centered Care Elicits More Positive Responses From Family Planning Clients. September 2024. This data point describes the key aspects that make family planning clients’ experiences positive or negative, based on client survey data.
Insights from providers
- Family Planning Providers Share Respectful Care Strategies to Improve Client Experience. November 2024. This brief highlights strategies for achieving respectful care in family planning settings, based on qualitative interviews with 32 Title X family planning providers.
- Discovering and Elevating Respectful Care Strategies: Providers Share their Strategies to Improve Equitable Delivery of Sexual + Reproductive Health Services. September 2024. This poster, presented at the National Reproductive Health Conference in 2024, presents strategies to promote respectful care based on interviews with 32 Title X family planning providers.
Research methods
- Developing a Measure to Assess Patient-Centered Sexual and Reproductive Health Care. September 2025. This brief describes the development and testing of an eight-item scale measuring patient-centered sexual and reproductive health care, based on our client survey data.
- A Case Study on Using AI to Analyze Qualitative Interview Transcripts. August 2025. This short brief describes how the team used AI to help analyze interview transcripts from family planning clients and highlights lessons learned.
- Methodological Approach to Fielding a Family Planning Client Survey and Resulting Sample Characteristics. September 2024. This brief explains our approach to conducting the family planning client survey and describes the sample characteristics.
Child Trends Team
Jennifer Manlove
Senior Research Scholar, Sexual and Reproductive Health
Kate Welti
Senior Research Scientist
Jane Finocharo
Senior Research Analyst
Emma Pliskin
Research Scientist I
Ria Shelton
Research Assistant
Kylee Novak
Research Assistant
Asari Offiong
Senior Research Scientist I
Deja Logan
Senior Research Analyst
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This project was supported by the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $1,548,353 with 100 percent funded by OPA/OASH/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, OPA/OASH/HHS, or the U.S. government. For more information, visit https://opa.hhs.gov/.