What does reproductive healthcare look like for patients of North Carolina?

In January 2020, Upstream convened over 100 leaders at the McKimmon Center in Raleigh for The North Carolina Reproductive Life Planning (RLP) Summit. Leaders met to discuss the current status, needs, and future direction of reproductive life planning. The goal of the Summit was to examine how to improve the delivery of high-quality, equitable, non-coercive and patient-centered reproductive life planning care. North Carolina Secretary of Health and Human Services, Dr. Mandy Cohen, served as the keynote speaker.

Upstream planned this Summit as an opportunity to showcase and learn from our North Carolina agency and stakeholder partners. These leading institutions, agencies and individuals have welcomed Upstream into the RLP space and supported our mission to promote equitable access to family planning services. By highlighting the work and of the guests and speakers we can collectively work to mitigate the barriers to best-in-class contraceptive care.

Our original plan was to combine information and feedback gleaned from the Summit into a white paper. However, COVID-19 quickly added an unanticipated layer of concerns and complications to the RLP landscape. Given these complexities, we have pivoted and instead created a summary of key discussion topics that can serve as a RLP resource for our stakeholders.

The summary provides a high-level overview of the state of reproductive health care in North Carolina and takes into consideration the barriers many patients still face when attempting to access this care. While it does not address the complete list of barriers, specifically those that the pandemic has newly created or exacerbated, it does incorporate the most prominent barriers discussed during the Summit, including:

  • Distrust in the state. The North Carolina Eugenics Board weaponized sterilization against minority and underserved communities for decades, creating a legacy of distrust in the state‚Äôs involvement in reproductive life planning.
  • Coverage gaps. North Carolina is one of 12 states that has not adopted Medicaid expansion. Expansion has been linked to better reproductive health outcomes, especially for Black women.
  • Provider training and bias. Effective contraceptive counseling is proven to reduce unintended pregnancy. Gaps in provider knowledge can perpetuate inaccurate information and reproductive coercion.
  • Health care deserts. While the physician to patient ratio has increased in North Carolina, the growth is mostly in urban areas. Over 42,000 women of reproductive age reside in a county that does not have access to a single health center that provides the full range of family planning methods.

Upstream would like to thank our Summit partners: The Duke Center for Global Reproductive Health, The Duke Endowment, Foundation For The Carolinas, the North Carolina Affiliate of the American College of Nurse-Midwives, the North Carolina Department of Health and Human Services, the North Carolina Institute of Medicine, the North Carolina Obstetrical and Gynecological Society, and United Way of Central Carolinas.

To learn more about the barriers listed and read more about the way forward, download the Summit Summary here.

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