Linda Snyder at Adagio Health in Pennsylvania remembered a patient in her 40s who found a lump in one breast.
“Unfortunately, we were not her first call,” recalled Snyder, who is Adagio’s senior director of family planning programs. In fact, the woman had reached out to a series of health care providers, but “they would not see her, because she was uninsured.”
Adagio, a nonprofit health center, was able to offer care. The woman, it turned out, needed a double mastectomy to prevent her breast cancer from spreading any further.
“We should never have to see anything like that, and it unfortunately happens all too often,” Snyder said.
In the United States, where the Brookings Institution, among other sources, says that 45% of pregnancies are unintended, barriers to family planning, cancer screenings, and other reproductive health services are widespread and diverse.
Among them? Lack of transportation and child care that might keep a prospective patient from getting to a local clinic. A lack of insurance, which may mean being refused care. Stigma, which could prevent someone from seeking care in a reproductive health facility where they might run into someone they know. And a lack of education or awareness – whether it’s about family planning techniques, their own body, or the importance of screenings in preventing STIs, cancer, and other conditions.
These barriers – and how best to overcome them – were the subject of a March 8 webinar hosted by Direct Relief in honor of International Women’s Day.
Leslie Montgomery, the education manager for Planned Parenthood of Indiana and Kentucky (PPINK) and, like Snyder, one of the panelists, explained that while some of the barriers her patients face are practical – transportation, child care, finances – others are harder to address.
“People believe a lot of myths, or they just plain lack information about reproductive health services,” Montgomery said.
PPINK provides care to uninsured and low-income patients, and offers a number of resources to help remove those practical barriers. But the organization also focuses on education – both on doing it themselves, and on teaching other people how to do it.
Montgomery explained that the organization has only five educators in the state of Indiana. The rest is done by creating programs that teach community members how to act as effective, trusted resources about sexual and reproductive health.
“We know we can’t do it all,” Montgomery said. “That extends the reach of people having the availability of sexual health.”
A teen council turns young people into informed educators who can act as a reliable source of information for peers. An online course can turn teachers and other professionals into facilitators of effective reproductive health education.
PPINK also focuses on particularly at-risk populations, including youth who are incarcerated or otherwise outside of a home setting, people with substance use disorders, and those who have experienced intimate partner violence.
“What we are finding is adults are becoming more enlightened about the need for sexual health education,” Montgomery said. “Our sexuality is a big part of [our lives], and we have to take care of that and educate ourselves.”
For Adagio Health, which covers 25,000 square miles across three states, reaching a population that’s both urban and rural, and that may experience stigma in seeking out sexual health care, has been challenging.
But Snyder stressed that it’s necessary. Pennsylvania is one of 21 states that doesn’t mandate any form of sex education, and the area that Adagio serves sees high rates of pregnancy and STIs.
“Many of our young clients are not as well-equipped to make decisions about their health that can impact them for the rest of their lives” as others might be, Snyder said.
In many of the rural settings Adagio reaches, “everybody knows everything and everything that you do,” making it difficult to seek out sexual and reproductive health services, Snyder said.
Adagio reaches these patients through a combination of mobile health care and messaging. The organization has a mobile unit that has “all you can get in a stationary medical office. If a patient wants an IUD or an implant, she can get it in the mobile health unit,” even as a walk-in appointment, Snyder explained.
They’re also reaching patients through targeted messaging that’s designed to remove some of the stigma around seeking out reproductive health care and to stress the comfort and confidentiality that the mobile unit can provide – as opposed to an in-town provider where a teenager risks running into “your best friend’s mother,” Snyder said. “It’s safe, it’s welcoming, it’s nonjudgmental.”
Barriers in the Covid-19 world
Both Montgomery and Snyder said that Covid-19 had forced them to turn their focus to telehealth and other virtual services that, coincidentally, helped them address barriers like transportation and child care.
“It made us realize the importance of being able to function in a virtual world,” Montgomery said. “Virtual is here to stay.”
The change made it even more important to provide scholarships to PPINK’s Spark*ED, a virtual program that helps teachers and other people who work with youth to become effective sex educators.
Adagio pivoted to telehealth and telephone appointments, along with drive-up birth control injections.
But both organizations remain committed to education and outreach efforts designed to help their patients increase their health literacy, access necessary reproductive health services, and, they hope, enjoy healthier lives.
A recent award from Direct Relief in partnership with the pharmaceutical company Bayer funded education and messaging programs both at PPINK and Adagio Health.
“The ability to access contraception not only prevents unintended pregnancy, but is crucial to women’s social and economic advancement,” explained Paulina Ospina, Direct Relief’s associate director of maternal and child health. “The most disadvantaged women, particularly those who are uninsured, do not equally share in these benefits.”
Ospina explained that the United States’ high rate of unintended pregnancies is unusual for a wealthy nation.
“We clearly have some work to do,” she said.