Upstream USA was founded in 2014 by co-founders, Mark Edwards and Peter Belden. Mark and Peter were united by their shared vision to empower all women to achieve their own goals of becoming pregnant only if and when they want to, ultimately reducing the high rate of unplanned pregnancy in the United States.
Prior to co-founding Upstream, Mark was the founder and executive director of Opportunity Nation, a national bipartisan campaign made up of 300 national nonprofits focused on expanding economic mobility through bipartisan federal policy reform. Over the past thirty years, Mark played a leadership role in launching Horizons for Homeless Children, now one of the nation’s largest organizations providing care for homeless children and their families. Through his work, and as a board member of one of the nation’s leading reproductive health organizations, Mark began exploring the connection between reducing unplanned pregnancy and expanding access to opportunity.
Prior to co-founding Upstream, Peter led the William and Flora Hewlett Foundation’s grantmaking for family planning and reproductive rights in the US managing roughly $100 million in grants. Over the course of two decades, Peter has worked in family planning in many roles including at the US Agency for International Development and in two different roles at Planned Parenthood, including managing the San Mateo, CA health center. While managing the health center, Peter saw the daily challenges faced by most health center staff. This had a powerful effect on the type of intervention Upstream now delivers, including recognizing the role of the whole health care team and the many systems that must be in place to deliver a new service.
During his time at the Hewlett Foundation, Peter’s grantmaking supported a number of projects that were critical in inspiring the creation of Upstream. First among them was a national randomized controlled trial led by UCSF’s Cynthia Harper which showed that a training for health centers could significantly reduce unintended pregnancy. Additional research projects in St. Louis and Colorado provided more evidence to support the idea that a health center-wide approach to improving access to all contraceptive methods was needed. Together Peter and Mark began exploring what it would take to enable all of the large health centers across the country to use the best practices identified in the research projects in order to dramatically reduce unplanned pregnancy nationwide.
Upstream launched its first pilot project at a community health center in Amarillo, Texas. The goal was to train all staff members so that the health center could offer the full range of contraceptive methods in a single visit, without barriers. This health center was one of the very few places low-income women could access any form of prescription birth control in the region, and prior to working with Upstream, they offered very few patients access to IUDs and implants. Following Upstream’s work, they were able to provide patients access to all methods, and saw a large increase in the number of patients choosing IUDs and the implant.
After hiring Siobhan Shand, Partner and Vice President of Programs, who created transformational trainings and a robust technical assistance program, additional regional pilot projects were conducted at community health centers in Ohio, New York City, Arizona and Massachusetts. In late 2014, Mark and Peter met with Governor Jack Markell of Delaware, the state with the highest rate of unplanned pregnancy in the US. They proposed a bold idea – Upstream would train nearly every healthcare provider in the state so that there was no wrong door for patients to access the birth control method of their choice. Governor Markell enthusiastically endorsed this idea and Upstream’s first statewide initiative, Delaware Contraceptive Access Now (CAN), was created. In the first three years of Delaware CAN, a simulation conducted by researchers at Child Trends estimated a 24% reduction in unplanned pregnancy among Delaware Title X patients ages 20-39, compared to an estimated 3% reduction nationwide. Importantly, 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.
Upstream continues to work towards impact at scale, growing rapidly across the US with statewide initiatives in Washington, Massachusetts, and North Carolina. By increasing access to the full range of contraceptive options for all, Upstream is changing healthcare and opportunity across the US for millions of individuals and families.