Friday, October 25, 2019

Mobile clinic brings better contraception to South Texas

The UT Health Rio Grande Valley mobile health clinic (Undark photo by Charlotte Huff)
A mobile clinic is bringing more effective contraception to rural areas in South Texas, Charlotte Huff reports for Undark, a nonprofit news organization that writes about scientific issues that intersect with policy and society.

The clinic is the brainchild of two professors and a hospital executive. It started with Joseph Potter, a sociology professor at the University of Texas at Austin who studied postpartum access to contraception in 2016, Huff reports. Of the 1,700 new mothers studied at eight Texas hospitals, almost all were Medicaid patients, and over three-fourths were interested in sterilization or a long-acting reversible contraception (LARC) such as an intrauterine device or implant after childbirth. But six months later almost half were using cheaper, less reliable methods like condoms or withdrawal.

Though LARCs are the most effective form of birth control on the market, only about 11 percent of U.S. women use them. Texas Medicaid does not cover them unless they're inserted immediately after childbirth, and new mothers must pay a separate fee for the insertion. Since the devices alone cost about $750, most low-income women can't afford them unless they get one right after childbirth, and the high cost keeps many hospitals and clinics from stocking them even if the mothers did want them, Huff reports. Texas did not begin covering postpartum intrauterine devices until 2016.

Tony Ogburn, obstetrics and gynecology chair at the University of Texas Rio Grande Valley's medical school, wanted to improve women's health in the area, especially after reading Potter's research. They teamed with Aida Gonzales, vice president of DHR Health Women's Hospital in Edinburg, near the southern tip of the state, and came up with the idea of the mobile clinic. "By cobbling together several grants, and teaming up with Women’s Hospital, they’ve so far been able to provide the devices at little to no cost through the medical school’s outpatient obstetrics/gynecology clinic, a mobile outreach effort, and at the hospital immediately after delivery," Huff reports.

The trio have tried to expand area access to intrauterine devices in ways besides the mobile clinic. Ogburn has ensured that his medical students learn how to insert the devices and how to counsel women interested in a LARC while being sensitive to their opinions about childbearing and religion (most of the women are Catholic, a denomination that discourages some birth control methods). Women's Hospital has also been stocking IUDs; over two-thirds have been paid for by an anonymous donor, and the hospital has been able to get insurance or Medicaid to pay for the rest, Huff reports.

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