Sophia's Story - Systemic Barriers to Birth Control Access

• Young woman with 3 unplanned pregnancies despite using birth control pill
• Forced to drop out of community college, lost job, living with mother in Texas
• All 3 pregnancies occurred while on pill - only method ever offered
• Actively planned not to become pregnant but method failed repeatedly
• Attempted to get IUD after friend's recommendation
  • Required day off work, borrowed car, 3-hour drive to health center
  • First visit: told to return in 2 weeks (had to order device, provider only available Tuesdays)
  • Second visit: still couldn't place device, told to return third time
  • Third visit: couldn't get time off work
  • Fifth month: returned unintentionally pregnant

National Unplanned Pregnancy Crisis

• Nearly half of all US pregnancies are unplanned annually
• 6 out of 10 typical birth control pill users become accidentally pregnant over 10 years
• Most unplanned pregnancies occur to women in their 20s (not just teens)
• Half of all unplanned pregnancies occur to women already using birth control
• 18 FDA-approved birth control methods exist with different efficacy/side effects
• Some methods 20x more effective than others
• Most people only know about pills and condoms

Healthcare System Failures

• Outside specialty family planning clinics (few and far between):
  • Healthcare organizations don't educate about all birth control options
  • Don't make methods easily available
• Many providers not trained to offer contraception beyond pill
• Health centers don't stock full range of methods
• Requires multiple visits and referrals for effective methods
• Patients lack privilege of time for proper birth control access

Upstream's Solution Model

• Nonprofit cofounded by speaker
• Trains community health centers, hospital practices, primary care facilities
• Focus: patient-centered needs first, best-in-class contraceptive care as basic primary healthcare
• Three-step approach:
  1. Standard screening question: "Do you plan to become pregnant in the next year?"
  2. If no: offer full range of contraceptive methods with complete information
  3. Patient leaves same visit with chosen birth control method (no return visits required)
• Shifts primary care system to empower patients

Delaware Implementation Results

• Trained entire Delaware healthcare system
• Starting point: >50% of pregnancies unplanned (patient surveys)
• 3-year results:
  • Unplanned pregnancy births dropped 23%
  • Abortion rate dropped 37% (largest decline of any US state)
• 6-year results:
  • Infant mortality dropped 24%

Current Expansion and Call to Action

• Upstream now operating in 14 states with national expansion plans
• Post-Roe world makes access more critical
• Framed as bipartisan issue: "smart, just, empowering idea for everyone"
• Contraceptive access as foundation of equal opportunity
• Health equity issue beyond healthcare - enables intentional parenthood