Upstream believes regular monitoring and evaluation is central to achieve lasting change. Using data to learn and to refine our approach is vital to delivering our intervention effectively and efficiently.

Our Approach to Data

Upstream employs a comprehensive, graduated approach to Monitoring, Evaluation and Learning (MEL). Our MEL efforts build on what we learn from robust monitoring and evaluation of each phase of our work to inform the next phase of evidence-building. We systematically track critical pre-, mid- and post-intervention implementation and outcomes data for each Upstream-trained health center. We assess changes in health center clinician and support staff knowledge, confidence, and behaviors associated with Upstream training; implementation progress and fidelity to model components; and change over a 12-month baseline in the contraceptive method mix during implementation and for at least 12 months following training.

Progress in Delaware

In a report released by Child Trends, use of IUDs and implants has increased substantially among Title X clients since the start of our Delaware initiative; almost doubling from 14 percent to 27 percent between 2014 and 2016. The percentage of Title X clients using “no method” decreased by nearly 2%.

In this same two-year period, unplanned pregnancies have decreased by a simulated 15% among Delaware Title X patients, compared to just 1.3% nationally.

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Estimated unintended pregnancy rates, Title X family planning clients aged 20-39* in Delaware and the United States, 2014-2016

Source: FamilyScape simulations using state-level Title X data from Delaware and from U.S. Title X data, 2014-2016
*Study limited to women at risk of unintended pregnancy (sexually active and not pregnant or seeking pregnancy)

“In all my years as a medical professional, I’ve never encountered a public health initiative that has made such a dramatic impact on practice change in such a short period of time.”

– Dr. Karyl Rattay, Director, Delaware Division of Public Health

Patient Choice

Patient surveys in Delaware, Ohio, and Massachusetts indicated that over 99% of patients either made their own decisions about contraceptive methods or shared decision-making with their providers. Over 98% of patients confirmed that they felt listened to by their providers and did not feel pressured to choose any specific method of birth control.

This strongly affirms one of our central goals: Upstream-trained providers are empowering patients to make their own decisions about their contraception.

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“Effective birth control means opportunity – it creates the chance for a young woman to finish her education, start her career, space out her children, and decide if and when she wants children. An unplanned pregnancy can really alter a young woman’s life and a young man’s life as well. Upstream has successfully partnered with us to create a zone of opportunity here in New York City.”

– Renee McConey, Director of Adolescent Health Services, The Door

Engaging the whole health center

The Door — New York City

The Door’s contraceptive patients choosing and receiving IUDs/Implants rose from 0% to 25% after Upstream’s training.


New York City’s The Door provided self-reported data on the contraceptive method mix of their patients, indicating that following Upstream’s intervention, women now have access to and are choosing the most effective methods.

Before our work together, The Door did not provide patients with IUDs or implants – also known as Long-Acting Reversible Contraceptives (LARCs). Upstream trained The Door’s staff to provide patient-centered counseling on the full range of methods; clinicians to place and remove LARCs; and administrative staff how to improve billing and coding.

“Since working with Upstream, our staff is feeling empowered by educating our patients on up- to-date, accurate, comprehensive contraceptive options.”

—Anne Marie Caswell, CNP, Family Nurse Practitioner

Empowering support staff

Haven Health — Amarillo, Texas

After Upstream training, 10x as many Haven Health contraceptive patients chose and received IUDs or Implants.

Haven Health in Amarillo, Texas serves 26 counties and is the only health center within a four-hour radius to prescribe contraception for patients under 21. Before our training, only a few of the clinicians at Haven Health had been trained to place IUDs or implants, and support staff members were not providing counseling.

Post-training, the number of women choosing IUDs or implants has increased dramatically. Central to the improvement was the embrace of our model, which empowers support staff members to provide contraceptive counseling. Additionally, word of mouth about the center’s ability to provide all methods of contraception has driven a noticeable increase in the number of patients.