Empowering all patients to make their own choices about birth control

We train staff and providers to offer voluntary contraceptive counseling and care that is centered around the patient.

Core to our mission at Upstream is true patient choice. During Upstream’s training and technical assistance, staff learn how to provide patient-centered contraceptive counseling that respects a patient’s time, goals and decision-making abilities.

Staff members learn how to use shared decision making, a model for care that is associated with higher patient satisfaction with method choice and contraceptive counseling overall. Equipped with this model and questions to help guide the session (such as “do you want to get pregnant in the next year?” and “what do you hope to get out of your method?”), staff members use their knowledge of contraceptive options to support the patient in choosing a method that best aligns with their stated preferences and goals.

Centering counseling around the patient’s stated goals is essential to quality contraceptive counseling and is designed to reduce bias and avoid coercion. There is no “one size fits all” contraceptive method, and some patients are seeking contraception for benefits in addition to, or other than, pregnancy prevention. 

We train staff to provide counseling that is:

  • rooted in best practice
  • efficient yet effective
  • free from coercion
  • tailored to the patient’s goals
  • respectful and responsive

"After working with Upstream, we saw more women actively participating in their birth control decisions. Upstream changed our practice significantly by training all of our staff. When patients have questions, everyone on our staff is able to provide accurate information to them."

– Ruth Lytle-Barnaby, President and CEO, Planned Parenthood of Delaware

We support health centers in expanding choice and access to the full range of contraceptive options.

We partner with health centers to ensure their patients have access to their desired method on the day they want it. To enable this, Upstream works with partner agencies to stock the full range of methods, integrate contraceptive access policies and medical protocols, and eliminate any other administrative or structural barriers to single-visit access.

Long Acting Reversible Contraception (LARC) such as IUDs and the implant are the most effective forms of birth control at preventing unplanned pregnancy. However, they are also often the most difficult method for healthcare providers to offer in a single visit. There are complex stocking, billing and coding, workflow, and training logistical barriers; it is simply harder to place an IUD or implant same day than write a prescription for the pill. Upstream provides in-depth support on all of these areas and more because IUDs and the implant are great options for many women – and everyone should have the right to access them, not just a select few. Research published in the Journal of the American Board of Family Medicine found that only 11% of primary care providers regularly provide IUDs and implants.

“Upstream offers a rare opportunity to concretely change the way patients are served. Upstream has had an impact beyond contraceptive care. Its enabled our staff to think in a more patient-centered way."

– Frances Anthes, Former CEO, Family Health Center of Worcester

We reinforce our patient-centered approach.

Upstream conducts patient surveys at Upstream-trained health centers to measure adherence to a patient-centered approach. Patient survey results to date indicate that over 99% of patients either made their own decisions about contraceptive methods or shared decision-making with their provider. Over 98% of patients responded that they felt listened to by their provider and did not feel pressured to choose any specific method of birth control.

Post-training, our Quality Improvement Advisors provide on-site support for continuous improvement to healthcare providers and staff throughout the course of our typical engagement, and our Implementation Coaches work elbow-to-elbow with staff as they implement quality contraceptive care practices.

Finally, we train providers and staff to understand that some patients don’t want or need contraception. The choice is always the patient’s, and it must be respected. There is an ugly, and recent history of forced sterilization and reproductive coercion in this country, targeted towards people of color and low-income individuals; a chapter we abhor. Upstream’s work gives all patients access to quality education and choice around contraception when they visit their healthcare provider.

“That was the most important thing to me when it came to birth control was having something that worked for me.”

“My choice works for me.”

“I feel in control. I feel empowered.”

— Delaware patients describe their experiences choosing a birth control method that works best for them.