Regular monitoring and evaluation is central to achieving lasting change


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. 


Patients surveyed say that they 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 confirm that patients are 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. Our results affirm one of our central goals: patients should be empowered to make their own choices about the birth control method that is right for them.

Source: Survey of 554 patients at Upstream-trained Delaware health centers conducted July–September 2017. Patients who discussed birth control were asked (1) and (3); patients who started a contraceptive method were asked (2). Learn more about our commitment to patient choice.

Simulated unintended pregnancy rates dropped 24% among Title X family planning clients aged 20–39 in Delaware compared with 3% nationally

Child Trends issued a report using available contraceptive data from 2014 to 2017 in Delaware among Delaware Title X family planning clients aged 20–39. The observed movement from moderately effective contraception to highly effective Long-Acting Reversible Contraception (LARCs), paired with a small decrease in no method, was linked to a substantial simulated decrease (24.2 percent) in the unintended pregnancy rate among this population. The complete report, including methodology and limitations, was commissioned by Upstream and can be found at Child Trends.

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.

Study limited to women at risk of unintended pregnancy (sexually active and not pregnant or seeking pregnancy). Complete methodology and limitations can be found at Child Trends.

FamilyScape simulations using state-level Title X data from Delaware and from the U.S. Title X data, 2014-2017. 

Patients are asked about their reproductive health goals by their providers as a standard screening question for their primary care visit

Upstream provides technical assistance so that healthcare agencies can integrate questions to guide each contraceptive counseling session into clinical staff workflow and the Electronic Health Record (EHR) system. Questions such as “Do you want to get pregnant in the next year?” and “What do you hope to get out of your birth control method?” are an effective and efficient way to begin a conversation about the patient’s reproductive health goals, whether they are interested in contraception or preconception counseling. Before Upstream in Delaware, very few women at health centers had a documented response to a pregnancy intention screening question in their EHR. At health centers where data are available, that has since changed dramatically.

PISQ adoption chart

Percentage of unduplicated patients age 15-44 with a documented response to a pregnancy intention screening question in a dedicated Electronic Health Record (EHR) field over a 12-month period prior to and following Upstream engagement.

Because reporting varied slightly by agency, results are not comparable across agencies. 

Before our work patients had no access to IUDs and implants. 3+ years after work concluded patients continue to have access to the full range of methods

Prior to working with us, The Door was not offering a full range of contraceptive methods. We are committed to ensuring patients have convenient access and choice to the birth control method that they want. The data for the Door shows that before our work together, patients had access to some methods, but they could not choose IUDs and implants. After our work, it is clear that patients now have the ability to choose from a range of methods to find one that suits their needs.

We review a number of indicators with our health center partners, including which birth control methods that patients are choosing, if the patient chose the method voluntarily, if the patient felt pressured, and whether the patient was asked a pregnancy intention screening question. There is no “right” level of contraceptive use.

All contraceptive clients for The Door receive condoms at every visit, and condoms are readily available in the waiting room and patient bathrooms. Monitoring the percentage of patients choosing natural family planning coaching (<2%) began in Q1 2019. Other barrier methods available to patients include diaphragms (0%) and cervical caps (0%).

Self-reported data on the percentage of clients ages 13-45 choosing and receiving a method of contraception provided by The Door, a healthcare provider in New York City. 

Clinician and support staff knowledge improved after Upstream's training

We monitor several indicators to ensure that patients are receiving excellent, patient-centered care. Since the biggest gap for many healthcare providers is their inability to offer LARC methods in a single visit—and since one of the reasons for this is the education for providers and support staff—we conduct pre- and post-training surveys to assess provider and staff knowledge on this and a range of other indicators.

Table shows large gains from pre- to post-survey in survey respondents’ average scores on a set of LARC-related knowledge items. 

Data represent group-level averages for attendees at over 30 Upstream trainings held in Delaware from mid-2017 to early 2019. Pre-survey data were collected up to 2 weeks before trainings, and post-survey data were collected immediately following trainings.