No wrong door for birth control in Delaware

Helping women who have just delivered a baby achieve their own future pregnancy goals is an essential part of any strategy to reduce unplanned pregnancy. The American College of Obstetricians and Gynecologists recommends counseling pregnant women on contraception and offering Long-Acting Reversible Contraception (LARCs) such as IUDs and implants for all women immediately after giving birth. Yet, too often this doesn’t happen.

In Delaware, the major maternity hospitals are now prioritizing contraceptive care in the immediate postpartum setting. We’ve provided training and technical assistance to providers, worked with the state government to change Medicaid reimbursement policies, and lobbied private insurance providers, breaking down these barriers. As a result, women are able to leave the hospital with the birth control method of their choice, including the most effective ones, IUDs and implants.

“We’re now able to ensure that new mothers leave the in-patient setting with the contraceptive method of their choice, including IUDs and implants. Before Upstream, women didn’t have these options. Best-in-class care means that we discuss their birth control options before delivery and they can leave the hospital, immediately postpartum, with the method of their choice. This is now true for ALL women – privately insured, publicly insured, uninsured – we’re now able to make it work.”

– Robert Monaghan III, Director of Maternal Child Health, Nanticoke Health System

At one hospital, women weren’t able to leave the hospital with a birth control method following birth, let alone a long-acting reversible method of birth control. Women typically had to wait for their 6-week postpartum visit to discuss birth control options. Now they can receive the method of their choice right after delivery, and the number of women choosing IUDs and implants continues to grow.

This is what’s happening in one hospital, and we’re working with nearly every maternity hospital across the state. It’s a massive shift in the availability of high-quality contraceptive care. Across Delaware, we’re focused on ensuring that women themselves are in charge of choosing the method of birth control that’s right for them. Surveys show that over 99% of patients either made their own decisions about their contraceptive method or shared decision-making with their providers. Over 98% of patients confirmed that they felt listened to by their providers and did not feel pressured to choose any specific method of birth control.

I recently co-authored a piece in Modern Healthcare with Dr. Janice Nevin, CEO of Christiana Care Health System about their prioritization of contraception across their healthcare delivery system. Christiana Care is Delaware’s largest hospital system, where around 60% of Delaware’s annual births occur.

“Ensuring that women can plan when and if they want to become pregnant can help break the cycle of economic inequality… This approach can be replicated nationally…Imagine a nation with the highest rate of healthy women and babies in the world. That is a nation with women and communities ready to achieve their full potential. It can be ours.”

We’ve been working in community health centers, Federally Qualified Health Centers, private practice groups, family planning clinics, and now hospitals: there should be no wrong door for women to receive excellent contraceptive care. By aligning systems and creating protocols in hospitals so that women who have just delivered a baby have the tools to make the choices they want to make, on their own timelines, we’re empowering them to choose when and if to have children, improving outcomes for them and generations to come.

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