Patient choice is our priority

Core to our mission at Upstream is true patient choice. During Upstream’s training and technical assistance, health center staff learn how to provide patient-centered, evidence-based contraceptive counseling and care that respects a patient’s time, goals and decision-making abilities. Upstream and our partners are working towards the same goal: that all patients are empowered to become pregnant only if and when they want to.

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Patients surveyed feel empowered to make their own decisions about which birth control method is right for them

Upstream conducts patient surveys at Upstream-trained health centers to assess whether patients feel they were in charge of choosing their own method, that they feel listened to by their providers and that they feel no pressure to choose any method of birth control.  


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


of Delaware patients made their own choices about birth control.


of Delaware patients feel that health center staff listen to them and their preferences. 

I want to be a mom when I'm ready

Morgan learned about increased birth control access throughout Delaware. She made her first-ever OB-GYN appointment. She reviewed all the options with her provider and decided on the pill. She has alarms on her phone to remind her to take her pill, and her boyfriend helps her remember as well. He said he hopes they can make a male birth control option soon, so he can use it.   

I was constantly worried about getting pregnant. I would spend so much money on Plan B pills and condoms. It’s nice to wake up not feeling like I could be pregnant. I have reminders on my phone, and my boyfriend has them on his phone. It’s a relief. I don’t want to have kids anytime soon.”

Morgan patient

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


The opportunity to have a choice

Mia wasn’t good at remembering her birth control pill, but her OB-GYN never discussed other contraceptive options with her. Through Upstream’s work, she learned about different methods available at low or no cost. She contacted her health care provider and got an appointment where she chose a method that worked best for her. 

Birth control means the opportunity to have a choice. I feel empowered. It’s been amazing for me to be able to succeed at my career and do the things that I want to do without worrying about an unplanned pregnancy.”

Mia Patient

of Delaware patients made their own choices about birth control.


How we support patient choice

All patients deserve the opportunity to make their own choices about birth control.

Staff members learn how to use shared decision making, a model for care that is associated with higher patient satisfaction with method choice and contraceptive counseling overall. Equipped with this model and questions to help guide the session (such as “do you want to get pregnant in the next year?” and “what do you hope to get out of your method?”), staff members use their knowledge of contraceptive options to support the patient in choosing a method that best aligns with their stated preferences and goals.

Centering counseling around the patient’s stated goals is essential to quality contraceptive counseling and is designed to reduce bias and avoid coercion. There is no “one size fits all” contraceptive method, and some patients are seeking contraception for benefits in addition to, or other than, pregnancy prevention.

Upstream USA has endorsed the LARC Statement of Principles created by SisterSong and the National Women’s Health Network and we are proud to live into these principles through our program and in every interaction we have with health care agencies.

We partner with health centers to ensure their patients have access to their desired method on the day they want it. Upstream works with partner agencies to stock the full range of methods, integrate contraceptive access policies and medical protocols and eliminate any other administrative or structural barriers to single-visit access.

Long-Acting Reversible Contraception (LARCs) such as IUDs and the implant are the most effective forms of birth control at preventing unplanned pregnancy. However, they are also often the most difficult methods for healthcare providers to offer in a single visit. There are complex stocking, billing and coding, workflow, training, and logistical barriers; it is simply harder to place an IUD or implant the same day than write a prescription for the pill. Upstream provides in-depth support on all of these areas and more because IUDs and the implant are great options for many patients—and everyone should have the right to access them, not just a select few. Research published in the Journal of the American Board of Family Medicine found that only 11% of primary care providers regularly provide IUDs and implants.

The choice is always the patient’s, and it must be respected. There is an ugly and recent history of forced sterilization and reproductive coercion in this country, targeted towards people of color and people with low-income; a chapter we abhor. We’re committed to changing these harmful patterns by trusting patients, improving the culture of healthcare to include contraceptive care as a normal part of primary care, and providing full access to the full range of birth control options—including the option to not use contraception.

Upstream’s work gives all patients access to quality counseling and choice around contraception when they visit their healthcare provider.

Upstream conducts patient surveys at Upstream-trained health centers to measure adherence to a patient-centered approach. Patient survey results to date indicate that over 99% of patients either made their own decisions about contraceptive methods or shared decision-making with their provider. Over 98% of patients responded that they felt listened to by their provider and did not feel pressured to choose any specific method of birth control.

Post-training, our Quality Improvement Advisors provide support for continuous improvement to healthcare providers and staff throughout the course of our typical engagement, and our Implementation Coaches work elbow-to-elbow with staff as they implement quality contraceptive care practices.

Upstream shares the commitment of Reproductive Justice organizations to equity and justice. Upstream is a reproductive health organization and, as such, we aim to be supportive of, amplify, and be in solidarity with Reproductive Justice organizations.

We acknowledge the history of bias, coercion, oppression, and violence in contraceptive care and management—particularly directed at people of color, members of the LGBTQIA+ community, individuals with disabilities, and other groups that have been targeted by reproductive oppression and/or left out of reproductive health conversations—and highlight these injustices in our training content.

We require all new staff to receive specific training on our patient-centered approach, the history of reproductive coercion and racism in reproductive healthcare, and recognizing bias.