Upstream USA | 2023

Upstream USA

Increasing equitable access to high-quality contraceptive care

Nearly half of all pregnancies in the United States are unplanned. Upstream USA empowers patients to decide when and if they want to become pregnant, by integrating contraceptive care into more healthcare settings — an approach that could be a critical step towards bridging health inequities.

Relevant Stats

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All 50 states in the US have high rates of unplanned pregnancy. While planned pregnancies are associated with all kinds of positive outcomes for women’s and children’s health and a family’s future, unplanned pregnancies are associated with premature birth, disrupted education, and poor physical and mental health for women. Unplanned pregnancy is a fundamental health equity issue. Black women experience it at twice the rate of white women, exacerbating the risks around pregnancy and birth that they already face. Today, only 20% of federally funded healthcare centers available to patients from underserved communities provide a full range of contraceptive options. Lack of trained staff and providers, biased or coercive counseling and unnecessary follow-up appointments create an environment where unplanned pregnancies are prevalent. With the end of Roe v. Wade, there is an urgent need to quickly and equitably expand access to high-quality, patient-centered contraceptive care.

Big Idea

Closing gaps in contraceptive access by breaking down long-standing healthcare silos will help reduce unplanned pregnancy and ensure that all people have equitable access to the full range of birth control options​​​​. To achieve this, contraceptive care must become a standard part of primary care, where a majority of patients in the US receive medical attention. By delivering evidence-based training and wraparound services to all types of healthcare organizations, Upstream USA is expanding the contraceptive care offered to patients across the continuum, with an intentional focus on communities who have historically been let down by the healthcare system. Their Audacious idea is to transform contraceptive care in healthcare organizations that collectively serve 5 million women of reproductive age every year by 2030. Over the next eight years, they will scale up exponentially across the country, reaching the women who face the greatest risk of unplanned pregnancy, especially in states where access to abortion is restricted..


Upstream USA prepares healthcare organizations to seamlessly provide high-quality, patient-centered contraceptive care by working with the entire team. Their intervention is free of cost to the center, implemented over 12-18 months and designed for sustainability long after Upstream’s partnership concludes. The model centers on three key aspects: women are asked whether they are trying to become pregnant as a routine part of care; patients receive bias-free counseling about all options and use a shared decision-making model that places patients’ needs at the center of the process; and patients are given same-day access to the full range of methods in a single appointment, without the need for multiple visits. To date, Upstream has partnered with 130 healthcare organizations — but with this project, they will bring their intervention to 700, serving the populations with the greatest barriers to care. By expanding into new geographies, partnering with municipalities and executing their evidence-based model , they’ll achieve a sea change in care

Why will it Succeed?

Through statewide initiatives in Delaware, Washington, Massachusetts, North Carolina and Rhode Island, Upstream USA partners with healthcare organizations that see more than half a million women annually. They are well-positioned to scale, as access to contraceptive care has broad bipartisan support at both the state and federal levels, even in a highly politicized climate. There is already rigorous, independent evidence that Upstream’s program works. Following the launch of their initiative in Delaware, there was a 23% reduction in births from unplanned pregnancies — in a span of just three years. With this strong proof point, Upstream can pursue partnerships with organizations serving women at highest risk for unplanned pregnancy.

Project Impact

Recent Updates

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How one clinic in Texas explains the threat to contraception

How one clinic in Texas explains the threat to contraception

n a small one-story clinic with peeling white paint, Community Health Services provides health care, including family planning, to low-income, mostly Latina, women in this city a 45-minute drive south of booming Austin.

May 12, 2022
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This local health initiative has expanded birth control access

This local health initiative has expanded birth control access

Governors often say their most important job is expanding economic opportunity for all. This year, 36 states will hold gubernatorial elections, and you can be sure every single candidate will run on their plans to make the American dream attainable.

May 18, 2018

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