Upstream Massachusetts: Progress During the Pandemic

A national report from The Guttmacher Institute revealed that one-third of women want to delay pregnancy due to the pandemic and the financial and social insecurity it has bought into their lives. The same proportion of women (one-third) also had trouble accessing birth control and other sexual and reproductive health services because of the pandemic. In this context, access to contraceptive care feels more essential than ever.

Throughout the pandemic, we all have adapted how we work, how we serve patients, and how we care for our communities. Our health center partners have worked hard to continue seeing patients and ensuring access to care. At Upstream, we too have shifted how we deliver our program.

Currently, all of our training and technical assistance is conducted virtually. We know that virtual programming is incredibly hard to do well. We also know that our partners need a program model that is both nimble and effective — and we’re committed to delivering both. Today I’m pleased to share some early results that demonstrate the impact we’re having amidst the pandemic.


As noted above, pregnancy desires and intentions have been evolving rapidly as a result of the pandemic. This context reinforces the importance of screening for pregnancy intention. Integrating a Pregnancy Intention Screening Question [PISQ] is a key component of our work – it unlocks a patient-centered discussion between the patient and provider and opens the door for contraceptive counseling in a primary care setting.

Two of our health center partners have been able to increase their screening for pregnancy intention during the pandemic. With the help of Upstream trainings that occurred just before quarantine started, the Community Health Center of Franklin County and Harvard Street Neighborhood Health Center were able to improve their workflows and increase the frequency with which they ask patients if and when they plan to become pregnant as a routine part of patient care. Notably, the changes they made early in 2020 have been sustained throughout the last several months:

GRAPH: Pregnancy Intention Screening During COVID-19

The Upstream training helped to reinforce for our support staff and clinicians the importance of posing a Pregnancy Intention Screening Question [PISQ] 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

These encouraging early results reinforce the power of centering pregnancy intention on a patient’s choice and desires. We are thrilled to see the sustained commitment of these partners and so many others working to support contraceptive access in these challenging times.


Earlier this year, we pivoted to a virtual training model. Since Upstream’s start, our high-touch, in-person training has been a key component of our program, and we were concerned about how a pivot to virtual delivery during the pandemic would affect our work. Would our partners find the virtual training as effective? Would they remain as engaged?

Relying on data about our trainings has provided us with real time insights into what’s working, and where we can do better. When Upstream examined data across 24 in-person and virtual trainings, we found comparable increases in knowledge scores for both clinicians and support staff.

Chart: Virtual Training - Average Knowledge Score
The Average Knowledge Score is an aggregate value commonly used as a quick assessment of training. This score covers three knowledge areas: contraceptive methods, patient eligibility for IUD placements, and best practices in contraceptive counseling.

The virtual trainings also resulted in the same or increased levels of self-reported understanding and confidence for clinicians across two additional measures: providing contraceptive counseling, and asking and responding to pregnancy intention screening questions (PISQ).

GRAPH: Clinician Understanding

Even with these promising results, challenges remain – for example, currently there are no effective replacements for hands-on clinical training on placing IUDs and implants. Still, we’re pleased that our initial efforts to provide flexible and effective virtual trainings are achieving the desired results, and we’re committed to continuing to improve.

During the pandemic, we’ve worked hard to develop a virtual program model effective for both training and technical assistance, and we’re delighted to see these early signs of progress. Ultimately, this transition to virtual programming means our work is more flexible than before, and we hope it means we can work with even more partners to support patients achieving their own goals of becoming pregnant only if and when they want to.

Our team is grateful to have partners working diligently to provide the best patient-centered care possible, and we will continue to support them every way we can.

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