PATH4YOU is a non-profit based in Indianapolis working to bring free and patient-centered reproductive healthcare, including accessible birth control, to all of Indiana's counties. Dr. Tracey Wilkinson is an assistant professor of pediatrics at IU School of Medicine and one of the leaders of PATH4YOU.
Can you tell me about PATH4YOU's mission and how this project to bring contraception to Indiana's counties came about?
Yeah, so PATH4YOU was a project that was stemmed from a focus to impact infant and maternal mortality rates in our state, we unfortunately do not have good rates when we look at these data. There have been a lot of people working on trying to impact this, but one of the things that has not been touched is really this idea of pregnancy planning, and giving people the ability to decide when and if they become pregnant.
So PATH4YOU actually stands for 'pregnancy at a time that is happy and healthy for you.' And we are really committed to providing patient centered access to birth control for free for any Hoosier.
As you mentioned, we have some really bad mortality rates for both moms and infants. How exactly are you going about trying to help fix that?
When you hear about infant and maternal mortality, you tend to focus at that moment when it happened. But when you start examining these data, and there are reports that are put out by the Department of Health examining infant and maternal mortality, you realize that the factors that are playing into the circumstances happening are much more upstream than the actual event when it happens.
And so having the ability to decide, you know, when and if you become a parent is a fundamental piece of that. And unfortunately, our state does not have really good access to comprehensive options of birth control. If you look at our state by county, there are multiple counties, many counties that do not have enough clinical access for the amount of people living there that would potentially be eligible for birth control.
And so PATH4YOU is trying to change that.
We are delivering care, both in person but also via telehealth, to make sure we are able to reach people where they are and to remove some of the barriers that are often in place to people accessing birth control. Obviously, one of the big barriers is cost. So we make sure that nobody pays anything for their consultation or their birth control method. And I emphasize to everybody we do everything from natural family planning, to long acting reversible forms of contraception, such as IUDs and the contraception arm implant. Everything in between those two for free.
So a lot of information on your website uses the term "reproductive justice," can you just explain what reproductive justice means for yourself and for PATH4YOU?
Absolutely. So reproductive justice is a framework that was developed back in the 1990s, actually, by women of color that were in the reproductive health movement. And it really has defined our work at PATH4YOU. And it is a really important concept that we try to apply to all of our work. So the framework states that it is a human right, to have children or not have children, and to parent the children that you have in safe and healthy communities.
So that means that when you think about the reproductive justice lens being applied to your work, this is not only about birth control access, this is about making sure that our patients have access to everything they need to raise the families that they want to raise in safe and healthy communities. So we are advocates and we love collaborating with organizations that are focused on, you know, health care access, health insurance access, making sure that Hoosiers have enough food on their table to eat, equal pay, paid family leave. All of the above are important elements to making sure that Hoosiers are able to parent the way that they want to the way that they should with dignity.
And so when you talk about education as a means of reproductive justice, as I feel a lot of people do, how are you working in the community to help foster that education?
So we live in a state where sex education is not required. If it is provided, that means that it has to emphasize abstinence-only and it does not have to be medically accurate. So it's not surprising that we have a lot of people in the state of Indiana that are not as knowledgeable about reproductive health, contraception options, and ways to, you know, prevent pregnancy if that is their desire.
One of the first things on our website that any patient and every patient we hope gets to do is what we call a birth control explorer. This is a validated kind of patient-centered questionnaire that really focuses on what matters to people and their birth control method, and provides counseling and information based on what's important to them. And we find that you know, patient-centered care is really important when you're talking about birth control, no two patients are alike, no two patients have the same priorities. And so, you know, you can't have standardized counseling that applies to every patient, it really needs to be tailored.
And so you know, you can come to our website, complete the birth control explorer. And that's it. Or you can come to our website, complete the birth control explorer and make an appointment. You know, making an appointment is really easy. We just asked for minimal information. And we do not ask for insurance. So we've learned that that was really complicated when you get insurance involved. And it's a lot easier for us just to go ahead and make everything for free, make sure that patients do not incur any cost when they interact with our program and provide wraparound care for if and when they need it after they see us.
Not getting insurance involved, how are you making sure that all of that is free?
You know, we're a grant funded program. And we are very lucky to have the support of, you know, local foundations as well that are committed to this work as much as we are. The way we make sure that patients don't pay is, you know, if they pick up a prescription at a pharmacy, we provide them a voucher so that they don't pay but the pharmacy bills our program. We've also partnered with a mail order pharmacy that delivers birth control to people's homes within 24 to 48 hours of the order being placed. Which is really helpful when you think about our patients in rural areas or, you know, people that just can't get to the pharmacy because their life is complicated, they don't have transportation, or they don't have the time off of work to go get this during working hours when the pharmacy's open.
And so having your birth control delivered is a great option for them. So because of our partnership there, we are able to have them bill us as well for the prescription. And so it doesn't fall on the patient.
When patients want to have a long acting form of birth control, which you know, traditionally means an IUD or contraceptive arm implant, that does require an in-person visit. And so we partner with clinical centers that are able to provide that care. And again, through lots of conversations, have made sure that they bill us and not the patient for that visit.
You mentioned it a couple times, but it's also mentioned a lot on your website, you talk about the efforts to push long acting reversible contraception. Why is prioritizing that specific type of birth control harmful?
When you prioritize birth control based on efficacy, that's not prioritizing birth control based on what matters to a patient. So I always say to people, the most effective form of birth control is the one that you like, and that you're going to use. And it's not up to me to decide what that is.
There are some people that are really, really good at taking birth control pills every single day. And there are some people that aren't. And so for me to say that birth control pills are not as effective, well, it depends on the patient. And traditionally, when we emphasize long acting, reversible forms of contraception, which are also called LARCS for short, unfortunately, there have been instances of coercion, patients reporting that they did not really have a choice. And the data reflects that this tends to happen to minoritized communities and patients much more than it does those that don't identify as minorities. And that's a huge problem.
We don't want patients to feel coerced with any part of their healthcare, but especially something as important as reproductive health care and birth control.
What do you recommend to those who are maybe younger or newer to the fight and are feeling kind of hopeless about things right now?
Yeah, I would tell them that I too feel hopeless at moments. And it is not surprising, given all the news that we hear, to feel that way. And so I would just say that you're not alone, if that's how you feel. It is terrifying to think that we are having decisions about our bodies being taken away from us. And I always say to people, that I trust patients to make the best decisions for their bodies and for their families and for their lives.
And those decisions lie with my patients, they do not lie at a state house. And they should never be there. And so I would encourage anybody, anybody who is pregnancy capable, and of the age where they could potentially become pregnant, to seek out providers that can provide you the care that you want. And if it's not PATH4YOU, please find a provider that can do that. But we are here, providing patient-centered care for anybody that needs us.
But it's very important that people find providers that they trust, providers that are listening to them. We hear quite often from patients that they have been told that the side effects of the birth control that they were on, were just not listened to, or they were required to come in for a pap smear before they could get a refill. All of these things are not medical evidence based, you know, statements to patients, and they're not patient-centered. And so I encourage people to find a clinician that listens to them, and that believes them, and that trusts them to make these decisions.
So with a special session coming up later this month, what do you see as the next steps of that?
Yeah, you know, we don't have any language yet for the special session in terms of what legislation will be proposed. But I encourage everybody to reach out to your state representatives, your senators, your congress people, to make sure that you let them know how you feel. It is quite likely that there will be an abortion ban in Indiana. And I think the big question is whether we're going to have exceptions for the most vulnerable; rape victims, incest victims, women whose lives are in danger and also women whose health is in danger.
A lot of people don't think about this, but you know, you can have a chronic health condition that gets much worse or even a diagnosis of cancer. If you're not actively dying, the life exception will not cover you. And so, you know, when we're talking about this special session, I think it's important for our state representatives to be hearing from members of their community, hearing about what matters to them. And remembering that this is not going to be the end. The language being proposed can apply to fertility treatments. It can apply to miscarriage management, ectopic pregnancy.
And our big fear is that it will extend to things like forms of contraception. And that is something that, you know, I think, when you look at the data, and when you look at surveys, a lot of Hoosiers do not agree with those types of restrictions and so it's time for the Statehouse to hear from you. So I encourage you to reach out to your state representative. I also try to remind people that you know, the local fight is important and it's always important to engage. The anti abortion groups have made it very clear that a federal ban on abortion is their goal. And so when we think about having Illinois border Indiana, it is important to remember that they might not be a protected state for very much longer. So while local is very important, I encourage people to also think about national efforts.
