With controversy surrounding recent attempts to make the HPV vaccine mandatory for school entry, public health advocates increasingly are turning their attention to other avenues for distributing the vaccine and educating the public about its importance. By virtue of both their expertise and the composition of their clientele, the 7,500 publicly funded family planning clinics located in almost every county in the United States are well positioned to play an important role in this effort, according to a new analysis published in the Guttmacher Policy Review.
"Clinics are an especially important source of health information and services for low-income women and minority women, who are at particularly great risk of developing and dying from cervical cancer," says Rachel Benson Gold, author of "Challenges and Opportunities for U.S. Family Planning Clinics in Providing the HPV Vaccine." "And because a majority of their clients are already parents, the clinics provide a natural venue for educating parents with school-age daughters about the vaccine."
Family planning clinics also serve four million young women between the ages of 15 and 24 annually (about half of their total caseload), making them a major source of care for individuals in the designated "catch-up" population for the vaccine—women 13–26, who are not in the primary age range for the vaccine but could still benefit, according to the CDC’s Advisory Committee on Immunization Practices.
"By providing information about the HPV vaccine and the vaccine itself to women at increased risk of cervical cancer, family planning clinics are poised to play a key role in reducing the stark disparities in cervical cancer that we see in our country today. But these clinics face many challenges, especially when it comes to the question of cost," says Gold. The maze of possible funding sources for the $300, three-shot regimen that clinics will have to navigate—often based on factors like the patient’s age and income level—ranges from the Vaccines for Children program and Medicaid to private insurance plans and the pharmaceutical industry’s patient assistance programs.
In addition to administering the vaccine, clinics can also play a pivotal role in educating the public about its benefits and risks, especially when it comes to addressing widespread concerns about the vaccine in communities of color, Gold suggests. "As an established and trusted source of health care information and counseling, family planning clinics could make a significant down payment toward the broad-based public education effort that the American Academy of Pediatrics and other public health advocates have called for about cervical cancer and the importance of the HPV vaccine."
More information on family planning clinics and their potential to provide the HPV vaccine to women in need
For many young, minority and low-income women, a periodic family planning visit may be their only interface with the health care system:
- In 2002, over one in four (28%) black women who received any reproductive health service did so from a family planning clinic; cervical cancer incidence among black women is nearly 1.5 times that among white women, and mortality is more than twice as high.
- Four in 10 Hispanic women who received any reproductive health service did so from a family planning clinic; Hispanic women have the highest levels of cervical cancer in the United States.
- One-third of all women aged 15–24 who received any reproductive health service at all did so at a family planning clinic.
- Among women with incomes below 250% of the federal poverty level, nearly four in 10 who received any reproductive health service did so at a family planning clinic.
Family planning clinics are also well-positioned to reach out to older women and parents with cervical cancer–related information and services:
- Just over half (53%) of women served by family planning clinics are aged 25 or older.
- Almost six in 10 (57%) family planning clinic clients have at least one child.
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Achieving universal vaccination against cervical cancer in the United States