Imagine a working graduate student who can’t afford to spend a lot of time waiting in line, but now it's time to replace her contraceptive ring. Fortunately, her clinic has a drive-up window that's convenient and quick. She swings by after work to pick up her new ring and makes it to class right on time. She doesn't experience any gaps in contraception, avoids unintended pregnancy, and gets an A on the next test. Score!
Imagine a woman who doesn't speak English living in a small, rural town. She visits her reproductive health care provider to discuss her contraceptive options, but when she arrives the translator isn't there. Within five minutes, she and her provider are engaged in a “Skype-like” conversation with another translator in a town over 40 miles away using a secure Open Source platform. She is able to review various options with her provider and leaves with a follow-up appointment to obtain an IUD – what she has chosen as the best contraceptive method for her. Score!
Imagine a mother of one who has been using condoms to space her next pregnancy. One breaks on Saturday evening but instead of waiting for the pharmacy to open on Sunday morning, she calls the emergency contraception hotline and is given a code to a key box within a 5-minute drive of her home. She visits the key box, enters the code, and obtains a packet containing the emergency contraception she needed along with sexual health information and a list of local resources. Score!
Okay, you can stop imagining now. These things aren’t happening in a time and galaxy far, far away. They are happening right now across the United States - most notably in Wisconsin.
With all the negative attention given to anti-choice legislation passed in Wisconsin recently and Senators saying silly things, it’s easy to look over the fact that Wisconsin is actually winning when it comes to innovation in contraceptive service delivery. Long before health care reform was even thought feasible the friendly professionals at Family Planning Health Services, Inc. have been working to expand women’s physical and financial access to contraceptive care, information, and products.
With the support of Congresswoman Tammy Baldwin and others, Wisconsin was the first to have a permanent State Plan Amendment from the Centers for Medicare and Medicaid Services for family planning services approved under the Patient Protection and Affordable Care Act and it’s the state with the highest income eligibility in the nation (300 percent of the Federal Poverty Level).
Not only has Wisconsin led in expanding financial access, they are the team captain when it comes to making sure women have physical access to birth control. When Family Planning Health Services, Inc. first opened their clinic’s drive-up window eight years ago on Valentine’s Day, the opposition said it made “sex as cheap as cheeseburgers” to which executive director Lon Newman replied “I enjoy a little humor in my work, but these are our patients are our wives, our sisters, our colleagues and there’s nothing cheap about them.”
While politicians and opponents have been busy making offensive move after move, some reproductive health service providers understand that it’s important for women to have both financial and physical access to contraceptives and have been carefully crafting ways to meet the needs of their patients.
It’s no secret that the United States has been a losing team when it comes to reproductive health. It’s great that 89 percent of U.S. women who do not want to become pregnant are using contraceptives, but gaps remain. Half of all pregnancies in the United States are mistimed or unwanted and though unintended pregnancy happens across all populations, low-income, young, and minority women are more likely to experience an unwanted or mistimed pregnancy than their counterparts. Despite a recent decline, the United States still has the highest teen birth rate compared to other developed countries. There’s clearly an unmet need.
The Affordable Care Act has made significant strides in making sure women can afford the health care they need and want, but there’s no guarantee that increased demand will be met with increased availability. Recent research indicates that physical access may continue to be a barrier even when women have financial access.
The life of every woman is different and ever-evolving, as are her contraceptive needs. Shouldn’t the way a woman accesses contraceptives match her lifestyle? Innovation in family planning service delivery is imperative to reaching the goals of the Affordable Care Act and ensuring women can obtain contraception when they need it.
Maybe if we actually meet women where they are, not where we insist they be, we can help them achieve their fertility goals. Family Planning Health Services, Inc. observed a 50 percent reduction in positive pregnancy tests among women who did not want to be pregnant after rolling out their new emergency contraception delivery methods and protocols.
We can be successful if we think outside of the box when it comes to service delivery by thinking about putting birth control and condoms in key boxes or in vending machines if that’s what works. We could even automatically ship contraceptives to women when they need a new prescription and a physical exam isn’t medically necessary. Now that’s outside of the box.
We have to teach decision-makers the value of new methods of service delivery and help them recognize that increased access to contraceptives only improves the health of women and their families. It’s inspiring to see that the U.S. Food and Drug Administration is considering innovation like using kiosks as teaching tools and a new non-prescription paradigm that could result in greater access to safe medical therapy, including hormonal contraceptives. The United States needs more of that.
Becoming a winner will require making creative moves, taking bold risks, and taking some not-so-unexpected hits, but we have to be willing to stand up to the opposition when they’re playing dirty.