About eight years ago, I met a young woman.
I'll call her Sophia.
And she showed me her newborn in her lap.
And she said to me, "This wasn't my plan."
She described how her unplanned pregnancy
forced her to drop out of community college,
how she then lost her job
and was now living with her mother in Texas.
Sophia had already had two unplanned children
before this third child was born.
All three of Sofia's pregnancies occurred while she was on the pill.
It was a birth control method that just didn't work for her,
but it was the only method she'd ever been offered.
Sophia's pregnancies weren't just unplanned.
She actively planned not to become pregnant
and took precautions against it.
But the only method she was ever offered failed her.
In the US each year,
nearly half of all pregnancies are unplanned.
I know it's an astonishing number to get your head around.
And over the span of ten years,
it's been estimated that six out of ten typical birth-control pill users
will become accidentally pregnant.
This is not just about uninformed teens.
Most unplanned pregnancies occur to women who are in their 20s.
In fact, about half of all unplanned pregnancies occur to women
who are actually using birth control, like Sophia.
Most people know about pills and condoms.
There are actually 18 FDA-approved methods of birth control,
each with different efficacy and side effect profiles,
some of which are 20 times more effective than others.
The reason you don't know about this is simple.
Outside of specialty family planning clinics that are few and far between,
health care organizations don't educate people
about all their birth control options
and don't make them easily available.
But this is what Upstream, the nonprofit I cofounded, does.
We train community health centers, hospital practices,
primary care facilities,
the places where the vast majority of people get their health care,
to put patient centered needs first
and provide best in class contraceptive care
as a part of basic primary health care.
(Applause)
You know, when I first met Sophia,
I'd been listening for years to what young people were saying
about the challenges they were facing achieving their goals.
And I was struck by how many of their stories
began with some version of,
“Well, I found myself pregnant and I had to drop out of school.”
Or, “I got my girlfriend pregnant and I had to quit my job.”
I just kept hearing these stories, I wasn't looking for it.
And I came away from those conversations utterly convinced
that lack of equitable access to contraception,
the inability to get the birth control method you want, when you want it,
with full information,
was a critical factor derailing the life trajectories
of many young people in this country.
It's obviously not the only structural barrier they face, of course,
but I really have come to believe that it is a major cause of inequality,
and it's one we can actually do something about.
Back to Sophia.
She told me she faced countless barriers
trying to get another method of birth control that was more effective.
After hearing from a friend about the IUD,
one of the most effective methods of birth control,
she decided she wanted that method.
So she ended up getting a day off from work,
borrowing a car
and driving the three hours to her health center to get one.
But when she got there,
they told her that they had to order one for her
and the sole provider they had who could place that method
was only available on Tuesdays.
They told her to come back two weeks later.
Even holding down two jobs,
she managed to borrow that car and make that three-hour journey
and get the day off,
but was told once again they couldn't place it that day.
They told her to come back a third time,
but this time, she couldn't get the time off.
Five months later, she did come back,
this time unintentionally pregnant.
Sophia's story demonstrates how unplanned pregnancy
is rooted in inequitable access to birth control.
Sophia didn't know that many providers
aren't trained to offer contraception beyond the pill.
Many health centers don't even stock the full range of methods,
so it can take multiple visits and referrals
to get one of the more effective methods of birth control.
Sophia didn't have the privilege of that kind of time for birth control,
so she ended up settling for the only option she had.
Now instead of that experience,
imagine a regular doctor's visit in primary care like this.
First, no matter why a patient comes in for care,
they're asked a deceptively simple, standard screening question.
"Do you plan to become pregnant in the next year?"
The answer to that question opens up a whole dialogue
about what they care about and what they want.
Second, if the answer is no,
patients should be offered the full range of contraceptive methods
with full information,
so they can really choose the method that works best for them.
And most importantly,
they should be able to leave that visit
with the birth control method of their choice,
not be asked to come back two or three more times.
This is really about shifting the system of primary care to empower patients.
Well, you don't have to imagine it, we actually did this.
We trained up the entire health care system in Delaware
to work this way.
We worked there because patient surveys showed, when we started,
that more than half of all pregnancies were unplanned.
Three years later,
the percentage of births from unplanned pregnancies
dropped 23 percent.
The abortion rate dropped 37 percent,
the largest decline of any state in the country.
And within six years, infant mortality dropped 24 percent.
(Cheers and applause)
Upstream is now working in 14 states with plans to go national.
(Cheers and applause)
It is unconscionable, unconscionable, that Sophia,
and millions like her in this country,
don't have access to birth control like this.
Especially in a post-Roe world.
I think we can all agree
that ensuring people have access to the birth control they need
so they can plan their families
or decide if they want to have one or not,
isn't a blue, red or a purple-state idea.
It's a smart, just, empowering idea for everyone.
If we care about giving young people the best start at their dreams,
let's make sure they have access to fully equitable, fully informed,
patient-centered contraceptive care as a part of basic primary health care.
We can empower patients like Sophia with the choices and tools they need
to become the intentional parents they want to be.
Access to best-in-class health care
and best-in-class contraceptive care is a health equity issue,
but it is so much more than that.
It's also a foundation of equal opportunity.
Thank you.
(Cheers and applause)