“A Mobile Health Clinic is Bringing Contraception to the Rio Grande Valley”
by Charlotte Huff
Undark, October 16, 2019
(Note from the writer: The below pitch was sent to Undark‘s general submission box in April of 2019, and I got a response a few days later. After a bit of back and forth refining the pitch and exploring the reproductive justice angle, I was assigned a 3,000-word feature.)
Tackling the Rio Grande Poverty Cycle with Long-Acting Contraception
Poverty and unplanned pregnancies are linked in the Rio Grande Valley, potentially sabotaging an expectant mother’s education, her ability to work or to adequately care for other children at home.
To try to break this cycle, obstetricians/gynecologists at the new Rio Grande Valley medical school have made it their mission to improve access to implants and IUDs for underserved women, reaching more than 1,000 to date. Along with tackling financial barriers, and retrofitting a broken down van to serve as a mobile clinic, they’ve also trained physician residents to overcome some of their own biases that the predominantly Hispanic and Catholic women might be unwilling to give contraception a chance.
The valley’s teen pregnancy rate is one of the highest in the U.S., about 35 births per 1,000 women, more than double the national rate of 15.4 births. Nearly one-third of the population lives below the federal poverty line, with a median annual income of less than $38,000 compared with $58,000 nationally.
“From a socioeconomic standpoint, the more kids you have, the more stress that can put on a family,” said Dr. Tony Ogburn, department chair of obstetrics/gynecology at the University of Texas School of Medicine Rio Grande Valley.
To be sure, the ACLU and some other groups have raised concerns about the potential for long-acting reversible contraception to be abused, if lower-income women are coerced or incentivized in some way. But Ogburn said that their goal is simply to offer women more reliable control over their reproductive destiny, whether that’s having no children or many more, “it’s up to you.”
Ogburn, who worked for years in New Mexico on women’s health issues, was recruited to join the new medical school when it wasn’t much more than a steel frame rising on a construction site. To reduce unplanned pregnancies, he believes that implants and IUDs offer two primary benefits: they don’t require repeat office visits for uninsured women and they’re as much as 20 times more effective than the birth control pill. In 2015, the American College of Obstetricians and Gynecologists issued a statement, encouraging doctors to more frequently offer the devices to reduce the nation’s “unacceptably high rate” of unplanned pregnancies, roughly half of all births.
Before the medical school opened in 2016, valley access was scant. For instance, clinicians are required to get training from a certified trainer before they can insert the hormone-releasing implant into a patient’s arm. When Ogburn arrived, there weren’t any other trainers.
In the last several years, Ogburn has taught more than 100 clinicians, including nurse practitioners, how to insert the implants. He and his colleague Dr. Saul Rivas have launched a pilot program at one of the local for-profit hospitals to offer long-acting reversible contraception to women on Medicaid immediately after delivery. And last year, they remodeled a broken-down van and are now using it to go out monthly, and soon twice a month, to underserved areas including the colonias, to conduct STD screening and insert the devices.
The medical school’s efforts have required some creativity to cover the cost of the devices, which can run close to $1,000. In 2016, Texas joined other states that pay for them through their Medicaid program. But in order to be covered, the devices must be inserted before the mother and her newborn go home.
To reach undocumented women and others who don’t qualify for Medicaid, the medical school landed a grant that foots the bill, as long as the devices are implanted by physician residents as part of their training.
Another barrier, Rivas said, can be the health providers themselves. When he started teaching at the medical school, he noticed that some residents were reluctant to bring up birth control. “The thought was that the patient really didn’t want to talk about that because she was Hispanic or she was Catholic, all of these barriers,” he said. “I think our own biases as providers sometimes get in the way.” (Of course, there’s also been an understandable mistrust among some racial and ethnic groups against the medical system, rooted in prior abuses, and my article could incorporate that element as well.)
I’m proposing a feature (2,500-3,000 words) to look at how a new medical school in one of the most underserved regions of the country is trying to make a difference in the health and economic trajectory of its community. As part of the article, I’d be illustrating the effectiveness of long-acting contraception along with the financial, ethical and logistical challenges of getting this most reliable form of contraception to those women who might most benefit.
Ogburn and Rivas have offered to introduce me to patients and, if I can travel there, to shadow them and ride along when the mobile van is out in the colonias. My travel plan would include a Southwest flight (Fort Worth to Harlingen), no more than two hotel nights and a rental car. I can provide a more detailed budget.
My background: I’ve been a medical journalist since the 1990s, starting my career on the metro staff of several daily newspapers, including the Las Vegas Review Journal and the Fort Worth Star-Telegram. For more than a decade, I’ve been freelancing full time, writing primarily long-form features and trend pieces. My articles have been published in some three dozen consumer and trade publications, including Kaiser Health News, STAT, Mosaic Science, Health Affairs, Slate and Texas Monthly.
My website (http://www.charlottehuff.com) features a sampling of my articles, some recent examples below: (I linked to four below.)
I’ll also be attending the AHCJ conference later this week and can discuss this story concept in Baltimore.
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