Access in Texas during COVID and beyond

Accessing birth control in Texas is difficult in the best of times – it has one of the nation’s highest rates of unplanned pregnancy – so we remain deeply inspired by the commitment of the first health center we ever trained, Haven Health, located in Amarillo, Texas, for their ability to offer the full range of contraceptive options in a single visit with great, patient-centered counseling, particularly in times like these. Haven’s CEO, Carolena Cogdill, knows that many of her patients drive upwards of three hours for an appointment, so it is essential that they can receive the birth control method of their choice in just one visit.

Seven years ago Upstream came to Haven Health to improve contraceptive care; when we got there, very few providers were trained, they didn’t stock all the methods on their shelves (as a result, many patients required a second visit), and the availability of the most effective contraceptive methods, IUDs and implants, was almost non-existent. A few short months later, Haven Health was able to meet significant demand for IUDs and implants in their patient population, and they’ve been offering best in class care ever since, even though we’ve never been back to refresh our work – it’s embedded in their care.

Graph - Sustained access to the most effective methods of birth control at Haven Health

COVID presented a whole new set of challenges to Carolena, because approximately 40% of all women of reproductive age nationwide changed their minds about their desire to have a child, yet in-person visits to health centers for contraceptive care declined significantly.

“The pandemic has made a tough situation even worse,” Carolena says. “Other health centers stopped offering birth control as they focused entirely on COVID response, and we became the only destination within hundreds of miles where patients could receive high quality contraceptive care.”

When the pandemic hit, the local Department of Public Health facilities stopped offering reproductive health care in order to focus on COVID response. As a result, Haven Health saw a significant increase in patients. Compounding the challenges of the pandemic, Texas Public Radio reported that birth control access became even more difficult as a result of the state’s restrictive SB8 law – but not at Haven Health. A full seven years after our work there – and without any additional investment of time and resources from Upstream – Haven Health is still able to offer patients the full range of contraceptive methods even while operating under the constraints of COVID and within an increasingly complex reproductive health landscape.

“Providing best-in-class contraceptive care is just what we do. This isn’t a moment to say that we’re not going to do this. In the middle of the pandemic, many patients did not think it was a good time to have a baby. And it is never a good time for an unplanned pregnancy. We are so grateful to Upstream for providing the tools and expertise so many years ago that have allowed us to continue to meet our patients’ needs, even in the midst of the pandemic.”

Haven Health was our beta site – seven years later, Upstream is on a path to train health centers that serve well over 1 million patients every year. Their ongoing commitment to patients in need of high-quality, same-day contraceptive care, even in the face of significant barriers, inspires our work each day.

Carolena continued, “If not for Upstream, we would not be here today. I always get very emotional about that. We have patients who have nowhere else to go, who have traveled hundreds of miles to see us. When you see their gratitude, and the control they now have over their lives so they can pursue their dreams, it makes it all worthwhile. Everything changed for the better after Upstream – we just need more of you down here.”

Carolena and her team are the true healthcare heroes – their continued ability to provide best in class care all through the biggest shock the healthcare system has experienced in a hundred years is remarkable. We are so honored and proud to be their partner, and just last week we were mentioned in the New York Times Opinion’s Holiday Giving Guide in a dialogue between two liberal and conservative Opinion writers who were asked “to name some of the charitable causes we admire and that might also appeal to our readers.” Both applauded our efforts in this moment to expand access to contraception. Thank you for following along with our efforts in support of this mission!

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