Multiyear initiative Upstream Washington is working to decrease the number of unwanted pregnancies by increasing same-day access to birth control, and has turned its attention to Eastern Washington, which has a higher-than-average rate of unintended pregnancies.

“We really believe that there should be no wrong door in terms of where women can go to get access to contraception,” says Chelsea Waliser, Seattle-based executive director of Upstream Washington. “Our goal over the next five years is to work with 40 different health care agencies across the state that provide health care at about 300 different sites.”

Upstream Washington already has signed with the Community Health Association of Spokane, Planned Parenthood of Greater Washington, and the Columbia Basin Health Association, all of which will begin training this summer, Waliser says. 

Waliser says, “Eastern Washington is a really important place for us in terms of just thinking about barriers to access. There’s a lot of rural parts of the state where it’s really hard to get into a health center quickly and easily, so it’s really important in rural parts of the state to be able to get access to birth control in a single visit.” 

Upstream Washington opened an office in Spokane last week, Waliser says. Zoe Hopkins-Ward, a spokeswoman for Upstream Washington, said via email it plans to hire more than a dozen staff members for Eastern Washington. 

Data compiled by the Spokane Regional Health District show teens aged 15 to 17 in Spokane County had a pregnancy rate of 10.7 per 1,000 people in 2016; data from the Washington state Department of Health show the pregnancy rate of teens aged 15 to 17 statewide was 10.8 per 1,000 in the same year. For ages 18 to 19, the rate in Spokane County was 36.9 per 1,000; statewide, it was 44.7.

From 2012-2014, data compiled by the SRHD show Spokane County had an unintended pregnancy rate of 23.3 per 1,000 people; statewide it was 24.1. 

Dr. Deb Wiser, chief medical officer with CHAS, says it was approached by Upstream Washington last summer about a partnership to expand contraception services at the organization.

CHAS already offers all methods of contraception, Wiser says, but Upstream offers an innovative model that trains all staff members, from the front desk to providers, on contraception methods.

“In the past year, CHAS has served about 74,000 patients in the Spokane area, and over 26,000 of those are reproductive-age women,” Wiser says.  

Waliser says women face several barriers to receiving effective contraception, as most forms require multiple doctor appointments and pharmacy visits. About 50 percent of women who seek contraceptives don’t return for a second doctor visit, she says.

On top of that, 40 percent of women who experience an unplanned pregnancy are using contraception, Waliser says, but they’re not using a method that is effective for them.

Data compiled by New York-based sexual and reproductive rights research organization Guttmacher Institute show publicly supported family planning centers met only 26 percent of Washington women’s need for contraceptive services and supplies in 2014.

Organizations that partner with Upstream will receive technical training that will allow them to provide all methods of contraception, including the pill, injections, and placement of an intrauterine device or implant. IUDs and implants require a minor invasive procedure done in the clinic.

Currently, Waliser says, only a third of clinics across the state are able to offer same-day access to IUDs and implants.

IUDs are recognized across the health community as the most effective form of birth control, Waliser says. However, they are also among the most expensive and can cost up to $1,000.

Upstream also will provide grants to participating organizations to allow them to stock all methods of contraception. She says the expense to keep a variety of birth control options on the shelves is a large barrier for clinics that want to do so.

Data compiled by the Guttmacher Institute show that 34 percent of all pregnancies in 2014 in Washington state were unwanted or wanted at a later date. Data from 2011 show that 45 percent, or 2.8 million, of the 6.1 million pregnancies in the U.S. each year were unintended.

Unintended pregnancies in Washington cost the state and federal governments $468 million in 2010, according to the Guttmacher Institute. Nationwide, the federal and state government spent $21 billion. 

Upstream also will train clinic staff in how to counsel women about the varying methods of birth control to ensure patients are aware of all available options.

“A lot of women … end up getting on whatever method their provider tells them they should have, or they’re never actually given the option to choose from a variety of different methods,” says Waliser. “It’s really important that women are given all of the information about all of the methods, and then they have the power to choose what’s best for them.”

Other support includes administrative restructuring to streamline scheduling and billing services.

“We work with health centers to help them take care of the whole life cycle of what is going to help women get access,” says Waliser. “That is from the person who makes the appointment … all the way to how the health center does its billing, so are they making sure that they’re coding everything right.”

Upstream Washington wants to reach 540,000 women of reproductive age across Washington by the end of the project, she says. 

Upstream Washington is a five-year effort launched by nationwide nonprofit Upstream USA that has partnered with Gov. Jay Inslee’s administration and the Washington state Department of Health to provide training and administrative support in community health centers, family planning organizations, and county public health departments.

Upstream USA was launched in 2014 as a nonprofit organization to reduce barriers to contraceptive access, integrate reproductive health and primary care, and reduce poverty levels associated with unintended pregnancies. 

It has initiatives in progress in Washington, Delaware, and Massachusetts, as well as offering training in health centers across Texas, Arizona, and New York.