Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:
“Are you planning to become pregnant in the next year?”
If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.
“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education that I got that I’m able to pass on to them.”
That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the health center’s perinatal services manager.
“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”
The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)
The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.
“If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”
So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?
For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.
Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.
“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.
“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”
Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers. Continue reading