Improving contraceptive access and use among women on teratogenic medications in a community-based psychiatry clinic.

Valproic acid (VPA) is an effective treatment and a mainstay for managing serious mental illness but possesses serious teratogenic risks. As a community psychiatry clinic that receives referrals from local inpatient hospitals, we recognized that women of childbearing potential were being initiated on VPA without adequate contraceptive counseling or access to highly effective contraceptive methods. In response, we implemented a targeted initiative to assess and address contraceptive needs, offering psychoeducation and injectable contraception within the clinic. Our goal was to address undermet/unmet contraceptive needs and thereby reduce the frequency of unintended pregnancy in our female patients. We met our specific aim in this quality improvement project by reducing the risk of pregnancy from 37 % to 27 %. We will continue offering this intervention in our psychiatric clinic moving forward.