Allying for Health Equity Blog

Melody Robles, Site Manager of the mobile unit at Project Vida Health Center, is a familiar face to the residents of Aliviane, a residential treatment facility in El Paso’s North Loop. Twice a week, Robles and Project Vida Deputy Medical Director Jessica Anne Romero, PA-C, are parked outside Aliviane in the blue and white mobile medical unit providing much-needed healthcare services and friendly conversation to this medically underserved community. From STD screenings and Pap smears to blood pressure checks and diabetes management, Robles and Romero provide patients with a range of services in their mobile unit, including one that they might not expect: same-day contraceptive care and education—including options supported by the State of Texas’s Family Planning Program and other initiatives—with the support of their partners at Upstream USA.

Increasing Maternal Mortality Rates and the Gap in Contraceptive Care

Experts in patient-centered contraceptive care, Upstream has partnered with over 130 healthcare organizations since 2014 to provide free training and technical assistance to increase access and education on the full range of contraceptive options (including a range of preventative measures such as condoms, intrauterine devices, elective sterilization, etc.) [1]. And as the maternal mortality rate in the U.S. continues to rise, the need for contraceptive care—a key driver of maternal health—is immense.

The numbers tell the story. There were 32.9 deaths per 100,000 live births in the U.S. in 2021, higher than the previous two years, and approximately 19 million women aged 13-44 live in a “contraceptive desert,” meaning that they live in a county where the number of health centers or providers offering access to and education on family planning and contraceptive methods is not adequate to meet the needs of those who qualify for publicly funded contraception. Not surprisingly, medically underserved communities, people of color, and low-income individuals bear the brunt of this ever-widening gap in access to contraceptive care.

Note: The family planning and contraceptive options provided by health centers are separate from and do not include abortion services. The Hyde Amendment prohibits the use of federal funding for abortion.

A Focus on Education and Communication

Education is a cornerstone of Upstream’s work—only 30% of women say they are getting enough information about their contraceptive options before making a choice. Robles shares that “a lot of people aren’t educated [about contraceptive care] . . . they just think that there’s the pill. They don’t know that there are other options out there.” Upstream is working to change this. Through patient-centered training and technical assistance, they’ve equipped Project Vida providers over the past year with strategies for effective patient communication and approaches to ensure that patients feel comfortable asking questions and interacting with healthcare providers. Upstream’s monthly interactive trainings for Project Vida staff took the form of role-playing as patients and providers, rousing Family Feud-esque games, and internal coaching within each clinic.

Project Vida’s mobile unit and staff: Jessica Romero, Melody Robles, and Elizabeth Hernandez

This tailored, patient-centered approach has proved invaluable to Project Vida’s work, adding to their ability to educate patients on a range of options available to them so that they can determine what decision is best for them. “Upstream provided us with a lot of educational tools, like visuals and resources showing the benefits and side effects of contraceptive options. We’re able to give [patients] education on birth control before they choose what they want. Upstream taught us how to talk to clients, how to make them feel comfortable,” Robles adds.

One specific tool implemented as a result of Project Vida’s work with Upstream is a reproductive health needs screening question. Asking patients about their reproductive health needs, including contraception, provides an opportunity for further conversation around supporting a future healthy pregnancy or desired preventative contraceptive care. Robles says these conversations leave a significant imprint on patients. “Every patient is asked at every visit if they’re interested in starting birth control, and we will provide it the same day . . . this opens the door for conversation and leads to them remembering on future visits that this is a service that is available to them from Project Vida.”

Making a Lasting Impact

Project Vida offers patients a variety of options for contraceptive care. Robles observes that “if patients didn’t have this available from Project Vida, they would find it very hard to go anywhere else to get this treatment, especially the same day. Patients do really appreciate the service and recommend us.”

One year into the collaboration with Upstream, Romero says the benefits of the relationship for providers and clients are obvious. “Partnerships are key. It’s hard to implement change without a plan, and our partnership with Upstream allowed us to focus on a plan and implement changes.”

Learn more about Upstream’s contraceptive care work with health centers across the U.S. and Project Vida’s programs and services for the communities in El Paso, TX.

[1] This partnership does not involve education on or provision of abortion but focuses entirely on family planning education and contraceptive options. The Hyde Amendment prevents the utilization of federal funds for abortion services.