Emergency Contraception Provision at Safety‐Net Clinics in the Southeastern United States

INTRODUCTION: Emergency contraception (EC) is essential for full-spectrum contraceptive care, preventing unintended pregnancies and promoting reproductive autonomy. Little is known about EC provision at safety-net clinics serving low-income people. This study examines EC provision at health department and federally qualified health center (FQHC) clinics in two United States (US) southeastern states at multiple points in time. METHODOLOGY: We analyzed data from statewide surveys of publicly funded family planning clinics assessing the years 2016, 2019, and 2022 in Alabama and South Carolina and key informant interviews with staff at surveyed clinics to assess patterns of EC provision by clinic type over time. RESULTS: Almost all health departments across both states provided EC on-site compared to less than half of FQHCs. Advance provision of EC was less common, with health departments reporting significantly higher rates (2016 = 15.8%; 2019 = 28.7%; 2022 = 15.5%) than FQHCs (2016 = 0%; 2019 = 2.8%; 2022 = 4.3%) (2016, 2019 = p < 0.0001; 2022 p = 0.01). In 2022, 20% of health departments reported providing EC via telehealth compared to 5.1% of FQHCs (p = 0.002). Health department staff noted an increase in advance provision, and FQHC staff noted challenges to provision due to limitations in on-site stocking. EC provision did not change significantly across years. DISCUSSION: Access to EC varies across safety-net clinics in the US South and has not improved over time. Addressing barriers to EC access and providing accurate information about contraceptive methods is essential to empower informed family planning decisions. As reproductive health legislation continues to evolve, expanding access to EC remains critical for safeguarding reproductive health and autonomy.