In a refurbished bank building in Wilmington, Delaware, there’s a small classroom. It has a projector, neon posters on the wall, and several tables with pairs of plastic model uteruses scattered across them.
A dozen or so clinicians have come here to learn how best to insert IUDs into these uteruses. Once they’ve practiced on the low-tech models at their desks, they can try out a more high-tech model in the back. It’s a robotic replica of the female pelvic area, complete with a vagina, cervix, and uterus, that groans in pain when an IUD is inserted incorrectly. The staff has named it “Joan.”
The goal is to let the clinicians refine their technique on models like Joan instead of on real humans.
All of this — the classroom, the models, the training — is provided by Upstream USA, a nonprofit that launched in 2014 to help health clinics provide their patients with a wide range of birth control options. And they work with the whole clinic staff. While clinicians brush up on insertion, everyone else, from technicians to receptionists, learns how to answer questions about the various birth control methods, including IUDs.
IUDs are a type of LARC, or “long acting reversible contraceptives.” These are forms of birth control that you can put in once and leave in for months or even years. Research shows LARCs are way more effective at preventing pregnancy than birth control pills: 18 of every 100 sexually active women who rely on the pill become pregnant within a year. For women who use IUDs, fewer than one in 100 will become pregnant over the same time frame.
The work Upstream is doing, paired with a number of state and federal policies designed to make these LARCs more accessible, has helped to drive down abortion rates and teen pregnancy rates in several states. In Colorado, for example, a similar program led to a 42 percent drop in the teen abortion rate, and a 40 percent drop in the teen birth rate between 2009 and 2013.
But the policies that made these dramatic changes possible are under siege right now, and Upstream’s work will be impacted by them.
Sarah Kliff’s written about Upstream’s efforts before, but on this episode of Weeds in the Wild, we’ll give you an audio introduction to their work, and then we’ll talk about the policies that determine access to birth control: how they came to be, why they’ve been working so well, and what might happen if we change them.
If you have thoughts on this episode, please send them to us! Our address is weeds@vox.com
