6 million pregnancies occur in the US each year. Nearly 3 million of these are unplanned.

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1 6 million pregnancies occur in the US each year. Nearly 3 million of these are unplanned. Upstream USA is a nonprofit organization that helps health centers across the country eliminate barriers that prevent women from obtaining the most effective contraceptive methods so that all women are empowered to become pregnant only when they want to.

2 THE PROBLEM Unplanned pregnancy is not just a healthcare issue. It also limits economic opportunity, educational attainment and upward mobility for both parents and their children. 5x Rate of unplanned pregnancy among poor women compared with wealthy women. Unplanned pregnancies contribute to negative health outcomes for women and their babies, including: delayed prenatal care premature birth poor physical and mental health All of which we spend billions of healthcare dollars to treat, but far less to prevent. Sources:

3 Unplanned pregnancy is a leading reason that women drop out of high school and community college. Some unplanned pregnancies occur to women who are using no contraception at all, but most occur to women who are using a birth control method that isn t working for them. A woman s chance of becoming pregnant over 10 years on the Pill with typical use

4 BARRIERS WOMEN FACE Health centers rarely offer women the most effective methods of contraception. The Pill and condoms are the most common birth control options available to women, but women should always have access to the full range of contraception, including the new IUDs (intrauterine devices) and implant (collectively referred to as LARCs, Long-Acting Reversible Contraceptives) because: They are 20x more effective than the Pill. They can be used between 3 10 years. They are easily removed. 4 The major medical governing groups, including the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, recommend them. A choice without barriers. In a groundbreaking research study by Washington University in St. Louis, 10,000 women were offered a choice of all contraceptive options with no barriers all clinic services and methods were free and provided in a single visit. Women overwhelmingly chose IUDs and the implant

5 However, fewer than 12% of women in the US use IUDs or the implant because of barriers and lack of access: Lack of trained providers Must make multiple appointments Cost perceptions Led to 75% decrease in teen pregnancy and a 75% decrease in abortion Misinformation Outdated billing and coding Poor patient counseling Patients using IUDs and the implant had higher satisfaction rates We did not have the necessary systems in place to offer IUDs and the implant. We needed help developing protocols, improving our billing and coding, and working on other systems issues. In addition, the clinicians needed hands-on training and direct support from a clinical expert. Once Upstream USA helped us with on-site clinical training and operational support, we were able to offer these methods immediately. Renee McConey, Director of Adolescent Health Services, The Door

6 BARRIERS WOMEN FACE I had to go to 4 separate clinics on 6 different days to obtain the IUD. I ve never been good at remembering to take a pill... I ended up with two unplanned pregnancies. The soonest appointment I could get was in three weeks and was a 45 minute drive for me. I have a four-year-old and couldn t find childcare... Quotes excerpted from Vox.com. These women asked their doctors for better birth control. Their responses were infuriating.

7 UPSTREAM USA APPROACH Upstream USA provides customized training and technical assistance to health centers so they can offer their patients same-day access to the full range of contraceptive methods, including IUDs and the implant. 1 2 We train clinicians how to place IUDs and implants. We train support staff on patient-centered counseling that covers the full range of contraceptive methods. 3 4 We improve administrative systems to ensure that health centers are able to properly bill and code for IUDs and implants efficiently and effectively. We provide ongoing support and conduct rigorous pre- and post-training evaluations.

8 IMPACT In just a short period of time, Upstream USA s efforts have shown a significant, measurable impact. Women who indicated that they either made their own choices about contraception or they shared decision-making with their provider (Source: Survey at the Family Planning Association of Northeast Ohio). This strongly affirms that Upstream USA-trained providers are helping patients to guide their own contraceptive decision making. Percentage of contraceptive clients choosing IUDs/Implants 0% Upstream Project Start 0% 2% 4% 8% 10% Jan May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr 13% 16% 14% 18% 19% 21% The Door, NYC Before Upstream USA, The Door did not provide IUDs or the implant. Post-training, the percentage of women choosing IUDs and the implant continues to increase. Percentage of contraceptive clients choosing IUDs/Implants 0% 3% 2% Upstream Project Start 1% 4% June July Aug Sept Oct Nov Dec Jan Feb Mar 5% 10% 15% 14% 17% Haven Health, TX In the months since Upstream USA s project with Haven Health in Amarillo, TX, as many as 17% of women seeking contraception selected an IUD or implant, compared with fewer than 4% before the project.

9 STATEWIDE APPROACH Upstream USA is leading a statewide intervention in Delaware in partnership with Governor Jack Markell and the Division of Public Health. Delaware has a 57% unplanned pregnancy rate. This groundbreaking, public/private partnership strives to give all Delaware women same-day access to the full range of contraceptive methods at low or no cost. I ve come to believe that helping women achieve their own goals of becoming pregnant only when they want to may be one of the most important things we can do to expand opportunity. Delaware Governor Jack Markell, State of the State Address

10 LOOKING AHEAD Upstream USA s work shows that reducing unplanned pregnancy nationwide is possible within the next decade. Downstream, Upstream USA will make a significant impact on intergenerational poverty. Unlike so many challenging social issues, the goals are aligned for everyone involved: Access to effective contraception, which is what women want for themselves. Dramatically improved health and educational outcomes for children, men and women. Billions of dollars in health care costs saved. For example, every $1 invested in Colorado s contraceptive access initiative saved nearly $6 in Medicaid costs. Source: Cost of Upstream USA training per woman served at a health center.

11 Upstream USA dramatically changed the way we provide contraceptive counseling and care. Carolena Cogdill, Chief Executive Officer, Haven Health Clinics, Amarillo, TX Health centers trained by Upstream USA see more than 50,000 women of reproductive age each year.

12 If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to. I applaud Upstream USA for addressing this important issue so comprehensively. Isabel Sawhill, Senior Fellow, The Brookings Institution / info@upstream.org