DOVER — Delaware has gone from having the nation’s highest rate of unintended pregnancies to one of the state’s with the largest improvement in this rate over the last decade, according to data from the Guttmacher Institute.
A Guttmacher report from September found a 28% decline in unwanted pregnancies from 2012 to 2017 — the fourth biggest change out of the 50 states. The report showed an 18% decline in 2014 to 2017 which was more than double the national average of 8%.
The latter statistic overlaps with the launch of the Delaware Contraceptive Access Now program which began in January 2015 under Gov. Jack Markell. DE-CAN is a public-private partnership among the Delaware Division of Public Health, Upstream USA, health centers and community organizations across the state.
Upstream USA provided free birth control which was an idea from discussions with Planned Parenthood of Delaware and sought to increase access to long-acting reversible contraceptives such as intrauterine contraceptives and implants.
The estimated unintended pregnancy rate dropped 24% among Delaware’s Title X patients through the first few years of DE-CAN, compared to 3% nationally. Title X is a federal grant program dedicated to providing low-income or uninsured individuals with comprehensive family planning and related preventive health services.
“It’s not surprising that when you open up access and give people the tools that they need that they often can’t afford, that you end up with fewer unintended pregnancies,” said Ruth Lytle-Barnaby, president and CEO of Planned Parenthood of Delaware. “That’s what we want. We want people to get pregnant when they want to, not when they don’t.”
In 2010, 57% of all pregnancies in Delaware were unintended, according to Guttmacher.
Recent studies from DPH have found an improvement in this number as well, using DPH’s Behavior Risk Factor Surveillance System and Pregnancy Risk Assessment Monitoring System for women of childbearing ages 15 to 44 years old.
During 2012 to 2018, there was a 17% increase in the percent of Delaware women with a recent live birth indicating that their pregnancy as “wanted then or sooner.” During the same time-frame, there was an approximately 29% decrease in the percent of women indicating that their pregnancy as “wanted later or unwanted.”
This decrease is good news for the state, said Leah Woodall, DPH’s Family Health Systems section chief.
“A lot of the research shows that when women have an unintended pregnancy it leads to a significant increase for the chance of poorer outcomes for the woman and the baby,” Ms. Woodall said. “So we want to see that unintended pregnancy rate go down.”
Research has also shown fewer unintended pregnancies can also lead to a declining poverty rate, which is what Upstream USA set out to do when it created DE-CAN.
“When you have control over when you have kids and how many kids you have, it makes a huge difference in your ability to live a more economically stable life,” Ms. Lytle-Barnaby said.
Upstream USA turned over DE-CAN to the state and its partners in April 2020, after it built the capacity with staff and training officers to look at data and best practices, Ms. Woodall said. Several partners are involved in DE-CAN such as DPH, the state’s OBGYNs, numerous health providers, Title X family planning, the state’s Federally Qualified Health Centers and Medicaid.
Prior DE-CAN, patients were not regularly asked about their pregnancy intentions, but Upstream USA stressed the importance of asking this question, Ms. Woodall said. She said this helps to start a dialogue with women and their provider.
If women answer yes, the provider will look to help with nutrition and ensure the patient is quiting habits such as smoking and alcohol as they attempt to become pregnant. If the answer is no, the provider will discuss birth control options.
“That’s what’s important to us is women connecting with their provider and talking things through and the options they have available to them,” Ms. Woodall said.
More than 180 health centers and social service agencies participated in DE-CAN’s training and technical assistance programs. The program also helped train more than 600 Delaware clinicians in contraceptive counseling on all methods, as well as technical training and support on device placement, medical management and removal of IUDs and the implant.
Upstream USA has used DE-CAN as a model for programs in other states.
“They felt like they could wrap their program around the whole state,” Ms. Lytle-Barnaby said. “They could use us as a pilot to figure out how to make this work so when they go to other states they have that figured out.”
“I think as long as the supports are there we can continue to do really well in this area,” Ms. Lytle-Barnaby added. “Will we be at 100%? No because we don’t see every single person and nor does any physician or medical practice. But the more you provide easy access and low costs, the better your outcomes will be and I think this project proves that.”