A Bridge to Contraceptive Care in Rural Washington

Accessing contraceptive services is challenging for many, but particularly for those living in rural communities, where medical centers can be few and far between. Often classified as “contraceptive deserts,” these are areas where the number of health centers or providers offering the full range of methods does not meet the needs of women who qualify for publicly funded contraception.

Patients often find themselves driving several hours to reach their nearest health center. Once they arrive, their visit rarely delves into conversations about their reproductive health goals. Jefferson Healthcare , a critical-access hospital healthcare system located on the peninsula of Washington State, is trying to change that reality.

“Part of the problem in primary care—and medicine anywhere—is people come in with an urgent need and that’s the fire for the day,” explains Dr. Molly Parker, Jefferson’s Chief Medical Officer of Population Health. “That’s what you focus on. And if that’s the only reason they keep coming in, we don’t get a chance to do preventive work or talk about big picture goals.”

Jefferson’s partnership with Upstream began in 2022 and is an important component of their Population Health program, which focuses on solutions that improve the health of the entire community. The small rural county is home to 30,000 people and Jefferson Healthcare is the only medical service in the area. It comprises seven sites throughout the region, including primary-care clinics, a hospital-based OB/GYN clinic, and a birthing center. Of these locations, six are currently supported by Upstream.

The team at Jefferson dove headfirst into Upstream’s training on topics such as the full range of contraceptive services, reproductive bias and coercion, and the utilization of patient education materials. Since then, they’ve broken down barriers to contraceptive care by implementing an array of services, including:

  1. Patient-centered contraceptive counseling and expanded capacity to prescribe all methods.
  2. Trained providers on site who are able to place or remove an IUD or implant.
  3. Immediate Postpartum Contraceptive Care (IPCC), which offers patients who’ve just given birth contraceptive care options before they leave the hospital.

Patients’ response to the program has been overwhelmingly positive. In a recent patient survey, a majority of respondents described the care as “excellent,” adding that they were “feeling respected,” “sufficiently educated,” and “empowered” by providers.

Jefferson staff, many of whom were new to providing contraceptive care, also welcomed the program. “It was fun to see staff get excited about something new and feel some pride in the new responsibilities they had owning this education and sharing it with their patients,” says Dr. Parker. “Our medical assistants, for example, don’t get to do that very often. They know a lot, but they don’t get to share it. To be given that role of being the first one to explore what someone may be interested in in terms of contraception and then sharing their knowledge—that’s really empowering for them.”

Dr. Parker and the team at Jefferson Healthcare take pride in their role as the county’s whole health community provider. They understand that contraceptive care is basic healthcare and a person’s access shouldn’t be dictated by their zip code.

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