Do you want to become pregnant in the next year?

A recent survey found that over 40% of women have changed their plans about having children in the coming year due to COVID-19, including roughly one-third who want to delay childbearing or have fewer children (Figure 1, from Guttmacher).

This new survey data affirms what we already know: healthcare providers should prioritize asking patients about their intentions of becoming pregnant as a regular and consistent part of primary care so that they can achieve their own goals about if and when to have a child.

In Delaware, asking if patients plan to get pregnant in the next year is now a standard screening question across the entire healthcare system, and patients can receive any contraceptive method they choose in just one convenient visit. Data showing Delaware’s abortion rate dropped 37% in just three years (the largest reduction of any state in the country, without reduction to access) and unplanned births declined 25% in the same time period are strong indicators that now more than ever, patients in Delaware are making their own decisions about when and if to become pregnant.

During the pandemic, we’ve been supporting health centers virtually across all the states we’re working in to help them deliver best-in-class contraceptive care. They are all facing enormous challenges, but despite this, many of our partners continue to prioritize contraceptive access.

In downtown Boston, one community health center partner that was not regularly asking patients about their reproductive health goals before working with Upstream has improved their workflow and increased the frequency in which they ask patients if and when they plan to become pregnant as a routine screening question, even during COVID:

GRAPH: Harvard Street Neighborhood Health Center Pregnancy Intention Response Rate
Percent of women of reproductive age with an Electronic Health Record documented response to a Pregnancy Intention Screening Question (PISQ) in the 12 months prior.

The Upstream training on March 7th helped to reinforce for our support staff and clinicians the importance of posing a PISQ [Pregnancy Intention Screening Question] to all patients of reproductive age at least once per year — it’s a matter of patient choice. Our PISQ reporting rates have continued to climb this spring, despite the challenges of the pandemic, and we have continued providing essential contraceptive care to our patients across the board.”
— Dr. Christopher Zimmerman, Medical Director, Harvard Street Neighborhood Health Center

Providing single visit access to the full range of contraceptive methods with patient-centered counseling is always important, but it’s essential during a pandemic, when patients may experience a surge in unplanned pregnancies.

In just two months, we’ve conceived, developed, and rolled out virtual training options for our partners, including live training sessions via Zoom, and self-directed e-learning work. As with our live trainings, virtual training sessions are followed by technical assistance and coaching work with a dedicated Upstream Quality Assurance team. We’re measuring changes in knowledge of contraceptive care among clinicians and support staff, pre- and post-trainings. And, we’ll be comparing these scores to the data from our in-person trainings pre-COVID to improve the curriculum and make it as effective as possible.

Upstream Washington training via Zoom
Lead Training Event Coordinator, Danielle Samuel, virtually discusses contraceptive counseling best practices with two Family Health Centers sites in North Central Washington.

We are proud that our health center partners continue to prioritize contraceptive care during COVID-19 – and we are working hard to provide flexible, comprehensive trainings that meet our partners where they are. Now more than ever, women are saying they do not want to become pregnant, and we have a moral imperative to make sure they have access to the support they need.

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