Plan seeks to stop unintended pregnancies in Vermont

Universal access to free contraception would be another huge step.
— Maggie Gardner, Porter Women’s Health

Emergency contraception causes infertility. You can’t get pregnant while breastfeeding. Non-hormonal intrauterine devices cause blood clots. These are only a part of the misinformation women’s health care providers have been fighting for decades — misinformation that has contributed to unintended pregnancies.
In 2012, almost half of all pregnancies in Vermont were unintended, according to the Vermont Department of Health. Seeking to change that, DoH officials set a goal for 65 percent pregnancy intention by 2020.
The plan, laid out by the Women’s Health Initiative, is multipronged.
It focuses on increased conversations and education about pregnancy, contraception and reproductive health, between health care providers and patients and amongst families and partners.
This includes enhanced screenings during regular women’s health visits for mental health issues, substance use disorder, partner violence or difficulty accessing food or housing. Women who are identified as at-risk are connected with a social worker for counseling and further assistance.
The Women, Infants and Children (WIC) office in Middlebury has one of these initiative-funded social workers on staff, “to make sure that women are well cared for beyond physical health issues,” said Moira Cook, Health Services District Director for the Department of Health.
The plan also includes comprehensive family planning counseling at participating practices. Health care providers are encouraged to ask patients “are you planning on becoming pregnant in the next year?” and then provide appropriate recommendations based on patient responses, Cook explained.
Women who intend to become pregnant are provided with pre-conception counseling and services. Those who do not plan to have a baby in the coming year are given information about contraception options.
Now providers can even offer same-day access to long-acting, reversible contraception, known as LARC. A patient can come in to discuss their options, and if they decide on a LARC, have an intrauterine device (IUD) and subdermal contraceptive implant placed “that day before they leave the office,” said Maggie Gardner, a nurse midwife at Porter Women’s Health.
Another component is community referrals. Participating women’s health practices develop agreements with three or more community organizations to see their patients within one week of a referral, to “ensure that women most at-risk of unintended pregnancy have fast access to effective contraception,” according to the Women’s Health Initiative webpage. Practices also make agreements with primary care practices to accept their patients.
The plan appears to be working.
“We have seen an increased rate of intended pregnancies,” Cook said. “The overall birth rate is declining in Vermont, but intended births have increased from 50.3 percent in 2012 to 56.7 percent in 2017.”
Efforts to reduce unintended pregnancies have been going on in Vermont since long before the Department of Health first published its Healthy Vermonters 2020 plan seven years ago.
Planned Parenthood offers sexual and reproductive health care at 12 health centers around Vermont, including in Middlebury.
“In schools and communities, we continue to provide high-quality sex education, and we partner with many local leaders to protect and improve sexual and reproductive health and rights,” said Maura Graff, director of Population Health for Planned Parenthood of Northern New England.

At the Addison County Parent/Child Center, Donna Bailey has been running high school education programs for 21 years. Bailey teaches students about birth control and healthy relationships. She brings teen parents in to high schools to talk their teenage peers about their experiences having children.
Bailey also runs Learning Together, a series of programs for teen parents that include high school classes, job readiness and parenting training, as well as a job placement component. Childcare is available.
Although unintended pregnancies are often associated with women under 20, Vermont’s teen pregnancy rate is low in comparison with the national rate. The state ranked 48 out of 51 (50 states and the District of Columbia) in 2016.
“We’ve had some of the best data in Addison County, and it’s not by accident,” Bailey said.
State Department of Health  records show that teen pregnancy in Addison County went from 23 per 1,000 teens to 8.6 per 1,000 in 2016. Bailey believes efforts to educate youth are to thank.
Women of all ages are affected by unintended pregnancies, but Vermont’s Pregnancy Risk Assessment Monitoring System (PRAMS) “shows that young people (age 24 or younger), people who are low-income, and people with less education are more likely to have births resulting from unintended pregnancy,” Graff said.
“We decided to focus on unintended pregnancy at the Department of Health because it’s really important for women to understand the significance of their health during pregnancy,” Cook said.
Women who have unintended pregnancies and their children are at risk of bad health consequences.
“Decades of research show that unintended pregnancy is associated with adverse health, social, and economic outcomes,” Graff said. Unintended pregnancy can increase the risk of delayed prenatal care, smoking and drinking during pregnancy, violence during pregnancy, premature birth, low birth weight, poorer childhood physical and mental health, maternal depression and more.
Achieving 65 percent pregnancy intention by next year may seem ambitious, but Gardner believes “in order to make any change, you have to aim high… Big goals encourage time, energy and effort being put into them.”
There’s still a lot of work to be done to increase pregnancy intention — that is, to decrease the rate of unintended pregnancy.
Early and comprehensive sex education in schools will continue to be an effective solution to unintended pregnancy reduction.
Education should also happen at home, experts say. Conversations about STDs and STIs (sexually transmitted diseases and infections) and about pregnancy “need to happen outside the bedroom,” Bailey said, adding, “Parents of teenagers should also make sure their daughters have a primary care doctor and go annually.”
“We need better information for general practitioners, not just women’s health providers, about methods that are available and who’s a good candidate for what,” Gardner said.
Graff is focused on reaching underserved communities.
“We need to focus on reducing health disparities, and prioritizing people who have the greatest unmet need for sexual and reproductive health care and education,” she said.
“Universal access to free contraception would be another huge step,” Gardner said.
Organizations like WIC, Planned Parenthood, and the Parent/Child Center and health care providers will continue to work to improve education around sex, pregnancy and reproductive health, and access to contraception and health care.

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