Access to Contraceptive Care Can Help Build Healthier Families
It’s a story that happens too often. Nurse practitioner Dacey Stratton had referred a patient to another clinic for birth control, but there was an issue with the patient’s ID. “Maybe three months later, I was seeing her for prenatal care because she got turned away for not having the right ID,” says Stratton, medical director at Puentes de Salud, a medical clinic serving Philadelphia’s low-income Latinx population.
Nearly half of all pregnancies in the U.S. are unintended, according to the CDC.1 Having an unwanted or mistimed pregnancy can have a substantial impact on the lives of the women it affects and their families. Still, access to contraceptive care is often a challenge for women in underserved communities.1 The barriers are wide-ranging but can include lack of education, language, economic stability, transportation and the health care system itself. And that’s before factoring in a global pandemic.
Yet all across the nation, health care clinics have stepped up to help bridge these barriers so that women can plan their families. Studies show that family planning and contraceptive care actually help create healthier families by making mothers healthier as well as their children.2 And since women are the backbone of many communities, these efforts can also serve to help strengthen those communities.
Helping Bridge the Barriers
Steering past barriers often means starting with something simple, like communication. “Sometimes, we put up barriers that are too hard to overcome for someone who doesn’t speak fluent English,” Stratton explains. “A lot of it is that patients are just not quite understanding what they’re being asked, so, they might give the wrong answer because no one bothered to use an interpreter.”
Interpreters are essential to serving clients at Puentes de Salud, which means “Health Bridges.” Puentes de Salud was launched in 2003 by two Philadelphia doctors who realized that traditional health care delivery was not meeting the complex needs of the city’s vulnerable Latinx immigrant population. The clinic provides education, health and social services with the goal of empowering both individuals and their communities. Since 2008, it has served 9,000-plus people. Many are restaurant and labor industry workers currently laid off and experiencing severe food insecurity due to the COVID-19 pandemic. The clinic has stepped up to offer emergency food relief as well.
Moving Care into the Neighborhood
Economic issues can be another barrier to access. Women in underserved communities may not have health insurance, or, if they do, may have other financial issues that impact their options. “If you have other expenses that need to be addressed, you tend to de-prioritize your health,” says Yesmean Wahdan, MD, U.S. Medical Affairs at Bayer. “This is particularly true for women. They tend to prioritize their family, their spouses and their children over their own health.
For example, “If I had to make the choice between taking a bus to the family health clinic or paying for my kids’ lunch that day, I’m probably going to pay for my kids’ lunch,” Wahdan explains.
The pandemic has only heightened economic concerns for many families, with job losses often leading to loss of health insurance as well as a sudden gap in the family budget. The Santa Barbara Neighborhood Clinics serve as a critical health care safety net, providing care to more than 21,000 patients each year, many of them service employees hard-hit by the pandemic as well as college students.
“We have tons of patients who were on monthly prescription plans, covered by insurance,” says Nicole Martinez, family nurse practitioner at the Clinics. “For those who have lost their jobs … they’re losing their health care benefits. They’re finding that the medications they were on, the birth control that was working wonderfully, is no longer covered and they’re in a bind.”
To ensure that women in these communities can still get the health care they need, the Santa Barbara Clinics hosted pop-up clinics on the college campus, offered telemedicine visits and even instituted home visits to cross transportation and economic barriers, says Martinez. “We’re doing a lot more telemedicine for contraceptive planning,” she adds.
In addition, the clinic has a whole department of “access navigators” who raise awareness of all the services available to patients. “Seventy percent of the patients we see are women,” Martinez explains. “Access navigators help plant the seeds, so people will come in and talk about family planning.”
Navigating New Roads to Health Care
Another barrier to access is having to travel a long distance to find health care. “We have a number of counties in our region that have a very limited number of [family planning] providers,” says Linda Snyder, senior director of Family Planning at Adagio Health. “You might have a single OB-GYN provider in a county. And a family practice physician that can do IUDs or implants might not be trained to do so.”
Adagio and its provider network offer reproductive health care and family planning services to 120,000-plus clients in western Pennsylvania and parts of West Virginia and New York. In addition, it offers prenatal care, STI testing and prevention, breast and cervical cancer screening, community education and nutrition services.
In July 2020, Adagio christened a 36-foot mobile unit that now travels with a nurse practitioner Monday to Friday through a dozen rural counties north and west of Pittsburgh. In addition, Adagio sends gas cards to supplement clients’ transportation. “We have plenty of money to cover the cost [of birth control], but if women can’t access the care, that’s of no use to them,” Snyder says. “The mobile unit will help us get that service out right around the corner from where people are living.
“Our region here has a lot of unemployment, low-income families and a lot of other factors that create so many barriers to access of care,” she says. “With COVID, people are losing their jobs, losing their insurance, and that’s exacerbated the entire situation.”
Solutions that Help Meet Women’s Needs
Earlier this year, Bayer launched We’re for Her, an initiative to provide low-cost or no-cost IUDs to women who qualify. The effort includes a partnership with the humanitarian organization Direct Relief. Over the next three years, this partnership will help impact the lives of thousands of women by helping to address the challenge of access through product donations, grants provided by Direct Relief to health clinics around the country, and educational materials to healthcare facilities. Since 2001, Bayer has donated more than 277,000 IUDs for women in need globally.
Family Planning May Impact Generations to Come
So, what does it look like when this goes right? “I had a woman who unexpectedly got pregnant every year for four years until we counseled her about the different [birth control] methods and found one that she was happy with,” says Stratton. “Now she’s using a method and hasn’t been pregnant for three or four years at this point.”
Helping women (and men) plan the number, timing and spacing of their children may have an impact on people’s lives that could play out not just over years but generations.
“Contraceptive care is so much more than just preventing a pregnancy,” says Martinez. “It impacts not only the person but the community by changing the opportunities that people have for increased access to education, career opportunities and even the socio-economic determinants of health, which allow them to have food security versus insecurity, home stability versus instability, relationship choices, and overall safety and wellness. And that’s for both men and women.”
“Birth control is a huge piece of women’s lives,” adds Wahdan. “When a woman has preconception counseling, when she goes into her pregnancy healthier, at the end of the day, what we have is a healthy mama and a healthy baby. Which then translates to a healthy family,2 which is what we want.”