By Arielle Zionts, KFF Health News
Twice a month, a 40-foot truck converted right into a mobile clinic travels through the Rio Grande Valley to offer women's health care, including contraception, to rural Texans.
The clinic, called UniMóvil, is an element of the Healthy Mujeres program on the University of Texas Rio Grande Valley School of Medicine.
The USA has about 3,000 mobile health programs. But Saul Rivas, a gynecologist, said he didn't know of anyone who shared Healthy Mujeres' specific mission when he helped launch the initiative in 2017. “Mujeres” means “women” in Spanish.
It is now a part of a small but growing variety of mobile programs aimed toward improving rural access to women's health services, including long-term reversible contraception.
There are two varieties of these highly effective methods: intrauterine devices called coils and hormonal implants inserted into the upper arm. In rural areas, obtaining or removing these contraceptive options may be particularly difficult.
“Women who want to prevent an unwanted pregnancy should get what is best for them,” said Kelly Conroy, senior director of mobile and maternal health programs on the University of Arkansas for Medical Sciences.
The school is launching a mobile health and contraception program this month for ladies in rural parts of the state.
Rural areas have disproportionately fewer physicians, including gynecologists, than urban areas. And providers in rural areas may not give you the chance to afford to stock long-acting contraceptive devices or might not be trained to make use of them, program leaders say.
Mobile clinics Help close this gap in rural care, but implementing it may well be difficult, said Elizabeth Jones, executive director of the National Family Planning & Reproductive Health Association.
Money is the largest obstacle, Jones said. The Texas program costs as much as $400,000 per yr. A Study 2020 Out of 173 mobile clinics revealed that they cost a median of greater than $630,000 per yr. Mobile dental programs were the costliest, averaging greater than $1 million.
Although many programs are began with the assistance of grants, they may be difficult to keep up, especially after greater than a decade reduced or stagnant funding to Title X, a stream of federal money that helps low-income people receive family planning services.
For example, a mobile contraceptive program for rural Pennsylvania lasted lower than three years before shutting down in 2023. It was discontinued after federal funding was lost, said a spokesman for the clinic that operated it.
Mobile programs in rural areas are usually not as efficient or profitable as brick-and-mortar clinics. That's because employees can have to travel hours to succeed in cities where they're prone to see fewer patients than at a standard site, Jones said.
She said organizations that may't afford mobile programs could consider establishing “pop-up clinics” at existing health and community sites in rural areas.
Maria Briones is a patient who benefited from the Healthy Mujeres program in South Texas. The 41-year-old day care employee was anxious because she wasn't getting her period together with her IUD.
She considered going to Mexico to have the device removed because few doctors on the U.S. side of the Rio Grande Valley take her insurance.
But Briones learned that the UniMóvil was visiting a small Texas town about 20 minutes from her home. She told the staff there that she didn't want any more children but was anxious in regards to the IUD.
Briones decided to maintain the device after learning that it’s protected and normal to not have a period while using an IUD. She is not going to be billed for her mobile clinic appointment, although the university health system doesn’t accept her insurance.
“They were very patient and answered all the questions I had,” Briones said.
IUDs and hormonal implants are highly effective and might last as long as 10 years. But they're also expensive — devices can cost greater than $1,000 without insurance — and IUD insertion can occur be painful.
Patient rights advocates also worry that some providers are pressuring people to make use of these devices.
you say Ethical contraception programs aim to empower patients to decide on one of the best contraceptive method, if any, for them, reasonably than promoting long-acting methods to cut back birth and poverty rates. They confer with the history of Sterilization inspired by eugenics and even more moderen incidents.
For example one Time investigation The magazine found that doctors are more likely than other patients to induce black, Latino, young and low-income women to make use of long-acting contraceptives — and to refuse to remove the devices.
Rivas said Healthy Mujeres staff is trained on the problem.
“Our goal is not necessarily to place IUDs and implants,” he said. It’s about “providing education and helping patients make the best decisions for themselves.”
David Wise, a spokesman for the University of Arkansas for Medical Sciences, said staff within the university's mobile program will ask patients in the event that they need to grow to be pregnant in the following yr and support their decision. Programs in Arkansas and Texas also remove IUDs and hormonal arm implants if patients are unhappy with them.
The Arkansas initiative will visit 14 rural counties with 4 food truck-sized vehicles utilized in previous mobile health efforts. Personnel and equipment shall be funded by a two-year, $431,000 grant from an anonymous donor, Wise said.
In addition to contraception, teachers and medical assistants within the vehicles provide checkups, vaccinations, prenatal care, and testing and treatment for sexually transmitted infections for ladies.
Rivas said the Texas program was inspired by that a study It found that six months after giving birth, 34% of Texas moms surveyed said long-term contraception was their preferred approach to contraception – but only 13% used that method.
“We started thinking about how we could close that gap,” Rivas said.
Healthy Mujeres, funded through several grants, initially focused on contraception. It later expanded to incorporate services equivalent to pregnancy ultrasounds, cervical cancer screenings and sexually transmitted infection testing.
While programs in Texas and Arkansas can bill insurance firms, additionally they have resources to assist uninsured and underinsured patients afford their services. Both use community medical experts — called promotoras in predominantly Spanish-speaking communities just like the Rio Grande Valley — to offer patients with food, transportation, additional medical services and other needs.
They work with organizations that locals trust, equivalent to food banks and community colleges, who’ve the mobile units arrange of their parking lots. And to further increase the supply of long-term contraceptives in rural areas, universities are training their students and native providers on how you can insert and take away the devices and how you can get reimbursed for them.
There is a difference between the programs dictated by state laws. The Arkansas program may provide contraception to minors without the consent of a parent or guardian. But in Texas, most minors require consent before receiving medical care. including contraception.
Advocates say these initiatives could help drive down rates unintentionally And Teenage pregnancies in each states, that are above the national average.
Rivas and Conroy said their programs haven’t faced much opposition. But Rivas said some churches that had asked UniMóvil to go to their congregations modified their minds after learning that the services included contraception.
Catherine Phillips, director of the Respect Life Office for the Catholic Diocese of Arkansas, said the diocese supports efforts to realize health care equity and he or she is personally eager about mobile programs that visit rural areas like where she lives.
But Phillips said the Arkansas program's focus is on contraception, especially long-acting methodsviolates the teachings the Catholic Church. Offering these services to minors without parental consent “makes it even more egregious,” she said.
Jones said that while these programs include high costs and other challenges, additionally they provide advantages that can’t be measured in numbers.
“Building community trust and making a difference in communities most affected by health disparities – that is invaluable,” she said.
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