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Upstream training brings same-day contraceptive services to First State

Photo Courtesy: Christiana Care

In 2010, 57% of all pregnancies in Delaware were unintended, the highest rate in the nation. That year, the federal and state governments spent over $94 million on unintended pregnancies in the First State.


With more than $10 million in private funds, the group Upstream USA set out early last year to change those numbers. Through a program called Delaware CAN – which stands for contraceptive access now – health professionals have begun training pediatric, primary care and OB/GYN practices on how to deliver same-day contraceptive care: including how to insert long-acting reversible contraception, called LARC. They’ve also deployed marketing campaigns to reach out to women in potential need of contraception.


While there isn’t data yet to show if there’s been a definite decrease in unplanned pregnancies, over 500 First State healthcare providers have been trained.


Delaware Public Media’s Megan Pauly spoke to one Delaware woman about how the program has helped her. Her name has been changed to protect her privacy.

For 26-year-old Tori Burt, birth control is crucial.


“Since my early teens I had irregular menstrual cycles so I knew that I needed to be on birth control to help regulate that,” Burt said. “In addition, I was fluctuating with my weight and was like…oh, I’m just trying to be a normal woman!”


But on her most recent birthday, her healthcare situation changed.


“I turned 26, and no one prepared me for that to say ‘hey, by the way, when you turn 26 you’ve gotta get your own health care.’ So when I got to that point I was like, oh man I need birth control,” she said.


Without insurance, she couldn’t afford to pay for it.


“The type of birth control I had at the time was the nuvaring which is certainly great,” she said. “No acne, no weird weight gain – it was perfect. When I found out it was going to be $200-$250 just for one, it was kind of like a panic that I went into.”


Working as a server at a local restaurant – and earning minimum wage – she realized she needed to apply for Medicaid.


“It’s so taboo for me to say –I’m an educated person – I went to college, I have a degree. To go and have to apply for Medicaid is something where I’m like: this is crazy. I never thought I’d be in a predicament where I’d have to apply for Medicaid, but I had to. I didn’t have a choice: I needed healthcare.”


And even with healthcare through Medicaid, she was still in need of immediate birth control.


“I was at the gym and I was listening to Pandora, and it has different ads that come through. I didn’t realize that Pandora was geographically linked – it knew where I was. This announcer’s voice came on and was like ‘do you need birth control?’ And I said yes to myself, I was on the treadmill saying yes to myself…and it said ‘do you know you can get free birth control in your area’?


“I just stopped right there – mid-stride – and said yes what is this, I need this? The entire announcement went through and it started to play another song. I had to stop the song and go back so I could hear it again. I clicked on it and it took me to a website that had the listing of places that give free birth control. I kept staring at it and was like, wow – I can’t believe that this is something that is available in my area. Not only that, but it was available in multiple locations at a bunch of different clinics. Where I went was West Side Health Center on 16th St.”


Westside is Delaware’s largest federally qualified health center. The center’s chief medical officer Dr. Tom Stephens says that contraception services were offered before their partnership with Upstream, but not same day implantation of the long lasting devices.


He says that was problematic. Some women would ask for it while in the delivery room, but by the time she’d come back to the doctor’s office, she’d be pregnant again. And for others, having to make a second or third appointment was also a significant barrier. It could mean the difference between getting pregnant or not.


But through the health center’s partnership with Upstream, Westside now has the capability to provide that same day care for patients like Burt.


“It was awesome because literally I called, set everything up, and before I knew it I was there. The nurse practitioner was very, very informed, education. She didn’t make me feel like she was rushing me out. At first she told me, yes we can get you the nuvaring. It’s a mail in rebate. She said yeah, you have to pay $150 - $50 for each, but then we’d mail it back. I was like aw man, the pockets are a little tight right now.  But she said the Mirena is free.”


Still, Burt was a little skeptical.


“I was a little nervous because I knew it was an implantation, and I didn’t know much about it,” she said. “Some of my friends who experienced it gave me horror stories about it. I was like…err, I don’t know. But the nurse practitioner said that she had one, the medical aid said she also had one, and they said that they loved it. After calling my mom and sister, saying I don’t know if I want to do it….both of them said it’s a guaranteed bet and it’s going to be safe for you, and it covers you for five years. So I said yes and I’m so glad I said yes.”


Another aspect of Upstream’s training is focusing on the safety of contraceptive devices like the Mirena, and debunking myths that suggested they were scary or unreliable.


Understanding the science behind the device was also important to Burt’s decision.


“Your body doesn’t necessarily have to continuously have a releasing of eggs. Sometimes your body doesn’t even release eggs – it’s more about the uterine line shedding,” she said. “And basically what the Mirena does – the chemicals in the Mirena help to thin your uterine lining so you don’t have as much of a period per se. You don’t have as much of the extreme cramping and all of that because it already thins your lining. And the Marina lasts for five years. Five years without a period: I’m ok with that!”


Burt has had her Mirea since July, and is happy with it so far.


“Which I thoroughly enjoy – because tampons and women’s products are so expensive…they call it the pink tax, which is ridiculous. But it is, it’s so ridiculous. Something that we can’t control, we have to pay so much money. A box of tampons – good ones – ones that perfectly fit and are $18, $20 – and you go through that in a week…it’s like a membership that you don’t want.”


Burt hopes Upstream – and devices like the Mirena – can help other women like herself. She also hopes it’ll help others – like one of her friends – who became a mom before she was really ready to be a parent.

“She tells me the same thing over and over: I love my son, but he could have waited. He could have waited. That’s the theme that I hear a lot of my friends who are going through co-parenting or being a single mom. They’re saying, if I would have had access to proper birth control – or have been educated on what options are out there, if I would have gotten it for free, I wouldn’t have been in this predicament.”


And Burt – who turns 27 on Halloween – isn’t in a rush to have kids herself, either.


“27 is like the sweetheart year, because all of my friends who are my age are getting married, are settling down. And I’m like oh my goodness – when’s the next happy hour? And that’s awesome because I want to be able to say, five years from now I’ll be 32. I think that’s a good age to say, yeah I want to be a mom.”


But if she changes her mind, no problem. The Mirena doesn’t have to stay in for five years.


“If I decided…if I met the love of my life tomorrow and we’re like: yes, let’s get married, let’s have babies. I can go and have it removed and if I want to get pregnant I can get pregnant almost immediately.


“That’s the beauty of Upstream. It allows you to dictate when you want to have a child. It’s women empowerment. It’s being able to say, I take control of my life. I take control of when I want to have a child and not on someone else’s timetable. Because having a child is expensive as all get out.”


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