Overview of Contraception Access Through the Indianapolis Student-Run Free Clinic

Abstract

Background: Student-run free clinics (SRFCs) provide preventive and primary care services to populations who face significant socioeconomic barriers to accessing healthcare1. Contraceptive care is a critical component of women’s primary health services, but women of low socioeconomic status often experience limited access to contraceptive care due to cost, access, and systemic barriers2. This study aims to describe the demand for contraceptive services at an SRFC in Indianapolis; this clinic’s contraceptive services are limited to counseling, on-site prescription and refill of oral contraception and subdermal implants, as well as referrals to a partner community organization where patients can obtain contraception at no cost. Methods: This was a retrospective chart review of patients seen at the Indiana University Student Outreach Clinic (IUSOC) from January 1, 2021 to March 31, 2025. All encounters during the study period that addressed contraception were included for review. These included encounters for contraception counseling, those where a new prescription for contraception was provided or a prior one refilled, and those that included a contraception referral. Data were obtained from the clinic’s electronic medical records and appointment scheduling spreadsheets. Demographic data were collected to describe the study sample. The primary outcomes were (1) the demand for contraceptive services, measured by the proportion of contraception visits of the total number of encounters, and (2) the demand for contraception itself, measured by the encounters where contraception was prescribed, refilled, or referred of the total number of contraceptive service encounters. The secondary outcomes were the demand for each type of contraception prescribed and for referrals. Descriptive statistics were used to summarize the primary and secondary outcomes. This project was deemed exempt by the institutional review board. Results: During the period 2021-2025, there were 63 encounters in which contraception was addressed, representing 0.68% of the total encounters at the clinic. Of the total contraceptive service visits, 87.3% resulted in a refill, prescription, or referral. Most services requested were prescriptions (90.9%) and a minority were referrals (14.5%). Of prescriptions, oral contraception was in higher demand (96%) than Nexplanon (4.0%). The average patient age was 34 years. Self-reported race-ethnicity was 26% African American, 15% Hispanic, 2% White and 57% unknown. Conclusion: Though representing a small proportion of the total encounters, contraceptive care is an important service to provide at student run free clinics. Our data show that patients who present to the clinic for contraception want to receive a service and most want something they can leave with that day. This patient population preferred the pill to Nexplanon. The ability to refer increases the range of contraceptive options to which patients have access, but it is not a perfect solution. Although the partner organization also provides contraception at no cost, the requirement to set up and attend another appointment at a different location could represent a significant logistical barrier. Patients appear to prioritize immediate access to contraception services, which the clinic can provide with limitations.