Maryland, by some measures, has some of the highest rates of unplanned pregnancies and is home to hundreds of thousands of women without easy access to comprehensive contraceptive care.
The new effort aims to fill the gaps by focusing on training and equipping primary care providers who are not already offering a full range of options. Starting with a single health care provider in Montgomery and Prince George’s counties, officials hope to expand it in the future across the state.
“We must do a better job of ensuring that when a Marylander walks into any doctor’s office, that they can get connected to contraceptive care,” Democratic Gov. Wes Moore said Tuesday, in Annapolis.
Moore and others described the move as the next phase in Maryland’s multifaceted effort to protect and expand reproductive health care in the wake of national pressures on long-standing abortion rights.
Both before and after the U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade, Democrats who control the Maryland General Assembly have pushed to expand abortion access and rights — including a ballot referendum that will ask voters next November whether abortion access should be enshrined in the state constitution.
The new focus on contraceptive care, Moore said, is about investing in health care for women and girls “before abortion even needs to be an option.”
The governor referred to data compiled by the nonprofit organization Power to Decide that shows about 285,000 women in Maryland live in “contraceptive deserts” — areas where the number of health centers offering a full range of contraceptive services is not enough to meet the needs of women who rely on publicly funded contraception.
Maryland also has one of the highest rates of pregnancies that are unwanted or wanted later, according to a 2017 Guttmacher Institute study that found 44 percent of pregnancies in the state fit that category. That was tied with New York and New Jersey for the highest, the study found.
The partnership announced Tuesday is between Upstream USA, a national nonprofit working to reduce unplanned pregnancies, and CCI Health Services, a nonprofit federally qualified health center that operates in Prince George’s and Montgomery counties.
The nonprofit’s staff will train and provide technical assistance to primary care providers who aren’t fully equipped to handle patients’ contraceptive needs. Maryland law requires most contraceptive care to be offered for free, and officials said Tuesday the care offered through the partnership would not be charged to patients.
Training will include instructions as straightforward as making sure providers know to ask questions like, “Do you plan to become pregnant in the next year?” and then, if the answer is no, to offer a full range of options, said Upstream USA CEO Mark Edwards.
Depending on the provider, those options may currently be limited. For example, a primary care doctor may only have immediate access to prescribe oral contraceptive pills, but if the patient wants something like an intrauterine device (IUD), they may have to travel to a family planning center, which could be more inaccessible, said Maryland Health Secretary Laura Herrera Scott.
Offering those options where people are, Herrera Scott and others said, is a more equitable solution.
“We see integrated contraceptive conversations in the fabric of all of our business as a vital step toward achieving equity,” said Dr. Sonya Bruton, CEO and president of CCI Health Services.
Bruton said CCI serves about 65,000 patients in Montgomery and Prince George’s counties, two of the most diverse counties in the state.
The centers have been offering contraceptive services for 14 years under Title X, a federal program that provides family planning for people with lower incomes. But coordinating with Upstream will help to “more seamlessly integrate family planning at every touchpoint,” Bruton said alongside the governor and other officials.
From educating the person at the front desk on how to have a conversation with a patient, to filling the knowledge gaps for clinicians who might not know all of the contraceptive options, the training has already helped CCI with a new “systemwide” approach, she said in an interview.
“Is it rocket science? No. Is it even hard? No. But when you’ve got a busy practice that’s dealing with a million things — and for us with populations that have needs that go well beyond even health — it’s the difference between having an effective conversation that meets the needs and allows them to have a little bit more choice about what happens in their life, or not,” Bruton said.
No state funding is going toward the collaboration and Upstream is not seeking public investment, Edwards said in an interview. He described the state’s involvement as critical in setting up the connection earlier this year when Upstream began working with CCI.
The state’s role in connecting the nonprofit with other community health centers beyond CCI, and potentially larger health systems and hospitals, will also be important as it plans to expand the work across the state, said Upstream Vice President Seville Meli.
Meli and others involved did not specify where in Maryland the contraception deserts have the most severe impact or which areas might be targeted for future collaborations.
“It will take time to roll this out. We’ll do it incrementally and we’ll really try to have a broad impact,” said Meli, noting it takes 12 to 15 months of training for each individual health center.
State Sen. Ariana Kelly, a Montgomery County Democrat who sponsored the law that required insurance plans to cover most contraceptive care for free starting in 2018, said she was excited about the collaboration as a way of actually getting contraceptives to the areas where they’re needed.
“This partnership is the next step,” Kelly said. “The cost is not a barrier. But … if you’re going to a regular primary care provider, are they going to be able to provide you with the multiple different methods that we already required under Maryland law with no cost sharing?”
Kelly, who has also helped pass several bills expanding abortion access, said she’s introducing legislation in the annual 90-day session that begins in January to require community colleges to offer 24-hour access to contraception. Without larger health services on those campuses, the care could come in the form of vending machines that offer condoms or even the Opill, which the FDA recently approved as the first over-the-counter birth control pill.
“There’s a really cool emergence in innovative contraceptive methods and delivery mechanisms that we’re seeing,” Kelly said.
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