This is the first post in a series of three. Stay tuned for the next two that further unpack the purpose of this work.
By Andrea Estes
Sexual and reproductive health programs innovation manager
Washington State Health Care Authority
Why person-centered family planning policy matters
Family planning policy shapes how people access reproductive health care. It sets the rules for services like birth control, education, and related services. These policies are meant to support people when deciding if and when to have children, and how many children to have.
In the United States, family planning policy is largely implemented through public programs like Medicaid (known in Washington as Apple Health) and the Affordable Care Act, determining which services—such as birth control, sexually transmitted infection (STI) screening, and counseling—are covered and who can access them. These decisions have a direct impact on underserved communities and play a critical role in preventing unintended pregnancies, improving health outcomes, and supporting people to achieve their reproductive goals.
The history of family planning policy in the U.S. is long and complex, has wins, and deep harms. It has evolved from an era when contraceptive information was suppressed to one that now supports federally funded, voluntary programs working toward centering on informed patient choice. Guidance from organizations like the World Health Organization and the U.S. Office of Population Affairs states that people should receive clear, unbiased information about all available options. This means patients should be able to choose the contraceptive method that best fits their personal values, reproductive goals, and health needs. This includes having access to clear, unbiased information about all available options.
Many current federal quality measures for contraception focus on if people have access to “most” or “moderately” effective prescription methods. While useful for accountability, these measures can unintentionally prioritize certain methods over patient preferences or lived experiences. Access alone does not tell the full story of whether care is truly person-centered. Access alone does not show if care feels respectful, meets a person’s individual needs, or if they feel supported when making decisions about their care.
To better understand patient experience, the Washington State Health Care Authority’s (HCA) 1115 Family Planning Only (FPO) program implemented the Person-Centered Contraceptive Counseling Survey (PCCC). This survey focuses on clients and captures whether contraceptive counseling and method selection reflect patients’ own needs, values, and preferences.
There are two versions of the PCCC: visit/site specific survey or retrospective survey (RS). The retrospective survey, called the PCCC-RS, is designed for use by states, health plans, managed care organizations, and federal accountability programs that collect population-level patient surveys. In 2024, HCA piloted the PCCC-RS with FPO enrollees who had received services within the prior six months, collecting 150 responses. The pilot helped HCA learn how the survey could be used at the state level. Starting in 2026, HCA plans to implement the PCCC-RS in the FPO program for three years. The results will help establish a baseline for patient experience, track changes over time, and support program evaluation and quality improvement.
Early results are encouraging. PCCC-RS scores are reported as the percentage of respondents who rated all four survey items as “excellent.” Washington’s FPO clients scored 48 percent in this ‘top score’ method, with many others selecting “very good” or “good.” These findings show generally positive experience, with much of the credit due to the providers who deliver care.
At the same time, the data highlight opportunities for improvement. Statistically significant differences emerged by socioeconomic status, age, ethnicity, and provider type. The lowest-scoring item related to whether patients felt they received enough information to make the best decision about their birth control method. These findings reinforce an important reality: while policy can set expectations, achieving truly person-centered care requires sustained, well-resourced partnerships among state agencies, providers, and communities.
Person-centered data like the PCCC-RS moves family planning policy beyond access alone—toward care that genuinely reflects the voices and choices of the people it serves.
To learn more, please visit the Person-Centered Reproductive Health Program site through University of California San Francisco or the HCA Family Planning Only client webpage.