Delaware CAN

Delaware Contraceptive Access Now (DE CAN) is a public-private partnership among the state of Delaware, Upstream USA, health centers and community organizations across Delaware. We provide training and technical assistance to our health center partners, ensuring all patients have access to the full range of birth control methods in a single visit.

Patient Centered Counseling

We build strong partnerships with Delaware healthcare providers to make all contraceptive options accessible to their patients

Delaware CAN is, frankly, one of the most exciting things that I have been involved in since I started in medicine because of the fact that it truly addresses a significant problem at its source, empowers those affected, and has such a significant impact downstream.”

Tom Stephens, MD Chief Medical Officer, Westside Health, FQHC

Health centers and social service agencies across Delaware received training and technical assistance


In 2010, Delaware had the highest rate of unintended pregnancies in the nation

57% of all pregnancies in Delaware were unintended in 2010, according to the Guttmacher Institute.  In 2014, Upstream USA partnered with then-Governor Jack Markell to lead a state-wide intervention with the Division of Public Health aimed at reducing unplanned pregnancy through system-wide improvements in contraceptive care and access across the entire state.


  • Christiana Care, Delaware’s largest healthcare system with two hospitals that serve over 29,520 women of reproductive age, has integrated a Pregnancy Intention Screening Question and family planning services into 17 of their outpatient primary care practices to ensure that patients have access to the full range of contraceptive methods as a routine part of primary care.
  • Nemours Children’s Health System is an internationally recognized children’s health system, delivering pediatric primary, specialty and urgent care. Nemours implemented a contraceptive screening model for providers serving adolescent patients.
  • Five of the six birthing hospitals ensure that all patients are able to receive the contraceptive method of their choice immediately after giving birth.
  • Federally Qualified Health Centers, public health centers and private practices ensure patients have access to a full range of contraceptive options, regardless of their insurance status.
  • Delaware social service organizations provide patient-centered contraceptive counseling for their clients experiencing challenges including substance use disorder, mental health issues, homelessness and domestic violence.

Though Upstream’s training has ended, Delaware CAN lives on to continue to improve public health by empowering women to become pregnant only if and when they want to.

Progress in Delaware

In September, 2021 Guttmacher Institute released new data showing trends in unintended pregnancy from 2012 to 2017. Additional tabulations of these data show that unintended pregnancy decreased by nearly 20% in Delaware from 2014 to 2017. This decline is more than twice the average for all states included in the report.

GRAPH: Unintended pregnancy rates have fallen 2x more in Delaware as compared to all available states combined

 “Pregnancies and Pregnancy Desires at the State Level: Estimates for 2017 and Trends Since 2012” and additional Upstream tabulations. Guttmacher data sources, methodology and limitations can be found in their report.

Estimated unintended pregnancy rates dropped 24% among Delaware Title X patients, compared to 3% nationally

After the first three years of Upstream’s partnership with the state of Delaware, there was a simulated 24 percent decrease in unplanned pregnancies among Title X patients ages 20-39.

Graph comparing the simulated 24% reduction in unplanned pregnancies in Delaware among Title X patients to the simulated 3% reduction in unplanned pregnancies among Title X patients across the U.S.

FamilyScape simulations using state-level Title X data from Delaware and from the U.S. 

Title X data, 2014-2017. Study limited to women at risk of unintended pregnancy (sexually active and not pregnant or seeking pregnancy).

Empowering the women of Delaware

Prior to our work in Delaware, patients were not regularly asked about their pregnancy intentions. Dr. Janice Tildon-Burton, an OB-GYN and the former head of the Delaware section of the American College of OB-GYNs tells a moving story about the transformative power of asking this simple question.

It just sums up the reason why I’m here and why I do what I do. For many women that come in to the office, nobody in their life talks to them as a person and sees that they have worth and value. They have aspirations that just haven’t been exposed.”

Dr. Janice Tildon-Burton Delaware-based OB-GYN

of Delaware patients did not feel pressured to choose a specific method of birth control.


Statewide reach since 2014

180+ health centers & social service agencies

Participated in Delaware CAN training and technical assistance programs.

600+ clinicians

Trained in contraceptive counseling on all methods, and provided with technical training and support on device placement, medical management and removal of IUDs and the implant.

2200+ support staff

Learned patient-centered contraceptive counseling techniques on all methods of birth control.

For our partners

Delaware CAN partner health centers have access to resources and ongoing help. The Partner Resources Portal has videos, toolkits and more to help train new employees or provide a refresher for current staff on our model.