Indiana is in the top 10 states with the highest rates of
infant and
maternal mortality. Access to contraception has been
proven to reduce maternal mortality rates. It stops births from persons who are considered too young or too old, and it allows people who already have children to create a healthier spacing between children. Additionally, access to contraception has also been proven to
lower infant mortality rates and
decrease abortion rates.
While there are many factors that contribute to Indiana’s poor health rankings,
PATH4YOU is hoping to make an impact through free and accessible contraception for Hoosiers. Their name stands for, “Pregnancy at a time that’s happy and healthy for you.”
PATH4YOU was created through a grant in early 2020. In their first year, they helped over 360 individual patients. From its beginning, the team involved has been very intentional about the type of care they provide and how it’s provided. Dr. Tracey Wilkinson, Pediatrician and Principal Investigator at PATH4YOU, says they base their work on
the reproductive justice framework started by Women of Color in the 1990s. It states that it is a human right to have bodily autonomy, make decisions to parent or not to parent, and do so in healthy and safe communities.
“That grounds a lot of our work in the respect that we want to make sure that no matter whether you want to talk about natural family planning or an IUD that will last 10 years, you get the same amount of care, the same amount of attention, and it's all free,” says Wilkinson. “We make sure also that these decisions are patient-centered and led.”
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Dr. Tracey Wilkinson, the principal investigator on the PATH4YOU project.PATH4YOU has three pillars every patient experiences. First is a universal pregnancy screening, which asks patients if they ever plan to get pregnant, and if so, how far out is their timeline. The second pillar is comprehensive contraception counseling. Patients are encouraged to use their
online Birth Control Explorer tool before their appointment, which asks questions about birth control wishes, experiences, and pregnancy plans and then provides a recommendation to best fit their needs based on their answers.
The third pillar is ensuring patients receive same-day, free care for whatever type of contraception they pick. Eliminating the stress of having to pay for contraception gives patients the freedom to pick what will be more effective for them, rather than picking a method based on price. Additionally, ensuring same-day care eliminates the need for multiple office visits, which can deter patients from choosing methods like IUDs that often require a minimum of two appointments.
PATH4YOU’s belief in bodily autonomy extends to a patient's desire to stop using birth control, too. They offer to remove intrauterine devices (IUDs) and Nexplanon at the request of patients, even if PATH4YOU did not insert the device. Patients can come back to PATH4YOU as many times as they wish to find a birth control method that works for them.
Wilkinson describes instances where some clinics or offices only remove such devices upon their expiration as coercion. She says they’ve also seen patients who can’t afford to have a contraception device removed, or they will be denied further services until bills are paid, which she also describes as reproductive coercion.
Reproductive coercion, which simply means any behaviors that inhibit a person's ability to make decisions about their own reproductive health, is common and has happened in Indiana’s own history. In 1907, Indiana became the first state to pass a law requiring the sterilization of anyone the state deems “unfit” to reproduce. Their methods of deciding who is unfit, and then involuntarily sterilized, were “informed by racism, colonialism, and eugenics, institutions disproportionately targeted Black and Native American women, poor people and disabled people,” as Hannah Good puts it
in a 2021 Washington Post article.
Clinical trials done in the 1950s to study the birth control pill were done on psychiatric patients in Massachusetts and in Puerto Rico, where participants were not informed they were participating in a clinical trial.
These and many other examples of coercion, racism, classism, and ableism from the history of contraceptives have shaped the reproductive framework, and continue to shape how doctors, like Wilkinson and her colleagues at PATH4YOU, work with patients. Wilkinson says part of this involves making sure patients know they’ll be trusted to make decisions and listened to when they have questions or concerns about their healthcare.
Patients can meet with medical professionals in Indianapolis, Fort Wayne, Bedford, Sullivan, Terre Haute, Vincennes, and Washington, or virtually from anywhere in Indiana by making an appointment on their website. Wilkinson calls the major transition to telehealth and virtual appointments during the pandemic a silver lining.
“We pivoted to telehealth during the pandemic,” says Wilkinson, “And the silver lining to that is that, actually, people got really comfortable with telehealth, and it enables me to reach a person in Indiana, anywhere, as long as we can get an internet, which is different than, than us trying to set up a clinic in every single county in Indiana.”
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PATH4YOU provides free and accessible birth control to Indiana residents.As many as
32 counties in Indiana do not have obstetrics care, and some counties have no hospital, which means accessing healthcare is not easy for some Hoosiers. Providing care virtually ensures that, no matter where a Hoosier is located, they’ll have access to medical professionals who can provide contraceptives. They're also working to add more locations. Wilkinson says in the coming months they'll have more clinics opening.
PATH4YOU can also provide transportation to patients who choose a form of contraception that requires an in-person visit, like an IUD. Patients aren’t required to provide information about insurance, income, or citizenship to schedule an appointment or receive care.
Removing these common barriers to accessing contraceptives allows patients to decide what method will work best for them freely, and when patients pick based on preference, rather than availability, their chosen method is likely going to work better for them. Wilkinson says they’re coming out of a period of time where, in the family planning work, efficacy, which is how well a birth control method works, was considered the most important part.
“The last few years, there's been a pushback to saying, ‘We care about efficacy because we're doctors, and 99 percent is better than 78 percent,” she says. “But it turns out, that that's actually not what matters to patients. So I always say the best birth control method is one that the patient will take. If that means natural family planning, but they're going to be in love with it, and they're going to be really diligent with it, and they're going to really use it, I'm 100 percent behind that.”