Network News

August Updates

Reproductive Health Care & Advocacy Fellowship:

Applications are open!

The Reproductive Health Care and Advocacy Fellowship is excited to announce that we are now accepting applications for fellows to start in the summer of 2021!

This is a one-year, clinical fellowship open to family physicians with the goal of developing leaders who will provide, teach and advocate for full-spectrum reproductive health care, including abortion, within primary care. There are now fellowship positions available in Massachusetts, Michigan, New Jersey, New York City, and Washington. For more information about individual fellowship sites and how to apply, please visit our fellowship webpage.

RHAP seeks to train a diverse community of leaders and encourages applicants from backgrounds which are underrepresented in medicine to apply. High priority will be given to applicants who plan to:

Provide abortion care in an abortion provider shortage area;
Provide abortion training to other trainees;
Actively engage in reproductive health advocacy and speak publicly about being an abortion provider.

The application deadline is December 1, 2020. Applications will be reviewed on a rolling basis.

Mobilizing to Defeat HB 918 in North Carolina

A report back by Organizer, Hailey Broughton-Jones

“I am proud that many of my primary care colleagues took a stance against the NC HB 918, favoring more equitable care and working to eliminate barriers for marginalized communities. This bill threatened to dismantle the foundational family unit, disproportionately affecting families afflicted by systemic racism and poverty. Taking a stance against HB 918 communicates our commitment to achieving a more unbiased and nondiscriminatory health care system for North Carolinians.” – Keyona Oni, MD | North Carolina Cluster AAFP Liaison

On June 18th, leaders in the North Carolina Cluster received word that House Bill 918, a bill criminalizing pregnant people for substance use, moved swiftly through the Committee on Rules and Operations and was poised for a full vote on the Senate floor.

The North Carolina bill makes positive prenatal drug screening tests grounds to separate newborns from their parents and expedites the termination of parental rights. The threat of family separation and prosecution deters pregnant people from seeking prenatal care and addiction treatment.(1) Local groups like The North Carolina Urban Survivors’ Union, a grassroots harm reduction organization dedicated to protecting the rights of drug users, have played a critical role in amplifying the harmfulness of HB 918 and centering the voices and autonomy of drug users and their families.

HB 918 would be disproportionately weaponized against poor communities of color. A 1990 study conducted in Pinellas County, Florida found that although Black women and white women had similar rates of positive drug tests, Black women were 10 times more likely to be reported to authorities than white women. (2) HB 918 stems from the long and racist legacy in this country of violently prescribing criminal intervention for Black and Brown communities instead of equitable public health initiatives.

North Carolina Cluster members quickly mobilized as HB 918 headed to the Senate floor. Members persistently sent emails to Senators, highlighting their position as medical experts who denounce HB 918 and the criminalizing of medical care. The Cluster listserv was constantly flooded with updates and encouragement from colleagues after receiving responses from Senators who were thankful to hear from clinicians and who planned to vote against HB 918. A contingent of family physicians within the North Carolina Cluster also called upon the North Carolina Academy of Family Physicians to issue an official statement opposing the bill. (3) Unfortunately on June 24 HB 918 passed in the Senate (25 -20) and moved on to pass in the House (59-53). Fortunately, however, after receiving waves of veto requests from North Carolinians, Governor Roy Cooper vetoed the bill on Thursday, July 2nd. (4)

As an Organizer at RHAP, witnessing the mobilization and peer-support of the North Carolina Cluster community was motivating. Seeing how clinicians’ can leverage their positions as medical experts and organize alongside grassroots initiatives reminds me of how inherently connected our reproductive health advocacy in primary care is to other social justice movements.

Showing up for patients in and outside of the clinic brings us closer to a reality where everyone can truly access equitable, person-centered health care.

Call for Stories | 20 Years of Mife

By Civil Liberties and Public Policy Program Vishu Chandrasekhar

The 20th anniversary of the U.S approval of mifepristone is coming up on September 28th, 2020! For years, mifepristone has helped clinicians provide patients with medication abortion and early pregnancy loss care. This September, RHAP wants to celebrate mifepristone’s impact on reproductive health access by highlighting your stories.

The mission of the Reproductive Health Access Project is to ensure that reproductive health care is accessible for all, and so we are particularly interested in clinicians’ stories about how mifepristone has provided access to abortion care for those facing the most barriers to care. We believe it is especially important to amplify the voices of Black, Indigenous, People of Color (BIPOC) clinicians and clinicians who identify as LGBTQ+. Protecting patients’ agency, confidentiality, and consent is critical. We want your stories. Please center your thoughts and feelings throughout your narrative.

You can submit your stories via this form, and they can be about any experience (whether it be sad, scary, funny, or inspiring) that you’ve had providing mifepristone. We also have a list of prompts you can refer to in the form.These prompts are just suggestions, so please feel free to share your story even if it doesn’t exactly fit the prompt.

We’ll be accepting submissions until August 25th. If you’d prefer to tell your story via audio or video, and/or if you’d like to be anonymous, please let us know in the form. Please reach out to National Organizer, Laura Riker if you have any questions, and we look forward to hearing from you!

Call for Stories | Expanding Access to the Self-Administered Contraceptive Injection

By Research and Evaluation Manager, Silpa Srinivasulu

Depot medroxyprogesterone acetate (DMPA), often referred to by the brand name, Depo Provera, or “the depo shot,” is birth control that is administered as an injection every three months to prevent pregnancy. The most common form is an intramuscular injection, which usually involves going to a health care provider — like a doctor, nurse, or pharmacist — to receive it. While coming to the clinic to receive birth control is typically acceptable for some patients, accessing birth control in an in-clinic setting during the COVID-19 pandemic can put patients and health care workers at risk of exposure to the virus unnecessarily. There is, however, a self-administered version of the depo shot called DMPA-SC (SC means subcutaneous, or under the skin), in which clinicians send a prescription to patients’ local pharmacies every three months where they can administer the shot at home. DMPA-SC helps address the barriers and risks of accessing contraception every three months through an in-clinic visit. Unfortunately, not all insurance companies cover DMPA-SC, some pharmacies do not carry it, and some pharmacists will not dispense it without an additional note for clinician-supervision. Despite ample evidence in the US and globally that self-administration is just as safe and efficacious as clinic-administered, the FDA label as clinic-only administration most likely contributes to these obstacles to access. These barriers are unacceptable, especially during a pandemic when improved access to DMPA-SC not only can provide people with the continuous contraception care they need and desire, but also limit the risks of COVID-19 spread.

Members of the Reproductive Health Access Network are taking a stand against these access barriers and are organizing in their states, like California and New York, to pressure policymakers to guarantee coverage of DMPA-SC during COVID-19, and beyond. For example, in March as COVID-19 cases in the US began to grow, Dr. Jennifer Karlin, a family physician and family planning fellow at the University of California San Francisco, contacted Medi-Cal (the public health insurance provider in California) to advocate for coverage of self-administered DMPA-SC. The Chief Policy Officer (CPO) for the Pharmacy Policy Division within Medi-Cal reached out to Dr. Karlin and requested an informal literature review on the safety and efficacy of self-administration. This advocacy and literature review provided evidence for Medi-Cal to pass a temporary policy on April 8, 2020 to pay for pharmacy-dispensed DMPA-SC without requiring prior approval. Dr. Karlin explained: “By aligning the State of California’s goals of social distancing and maintaining access to the drug benefit with the goals of expanding access to contraceptives based on patient preference, we were actually able to facilitate reproductive autonomy in the State of California during a health care emergency.”

But Dr. Karlin is not done. As Medi-Cal passed a temporary policy, she and the CPO hope to analyze Medi-Cal claims data about usage, continuation, and outcomes during this coverage expansion, as well as interview patients regarding their interest and experiences switching from the clinic-administered intramuscular injection to self-administered DMPA-SC. Such data may support continued state-based and national advocacy efforts for expanding coverage of DMPA-SC after the pandemic.

To support ongoing advocacy, RHAP has been working to understand the national scope of DMPA-SC insurance coverage and pharmacy availability. By exploring various insurance plan formularies online, we found differences in coverage across companies. But, if a company covers DMPA-SC in one state, they likely cover it in all states. Some plans require co-pays and/or prior authorization, but others cover it fully under the Affordable Care Act. Some did not cover DMPA-SC at all. Additionally, RHAP volunteers have been calling a random selection of franchise and community pharmacies in various states to investigate the availability of DMPA-SC and pharmacists’ awareness of this contraceptive method. Among 76 pharmacies called in states like New York, New Jersey, California, Illinois, Alabama, Connecticut, Indiana, Louisiana, and Iowa, we found that most pharmacists were unfamiliar with DMPA-SC. 60% of pharmacies called would dispense DMPA-SC, but it would take 24-48 hours to fill as they would have to order the medication. However, a few stated they would only fill the prescription if a doctor called to confirm that the patient can self-administer. Nearly all pharmacies called in Alabama and Iowa would not dispense DMPA-SC.

Take Action Today:

The fight to increase access to DMPA-SC during and after the pandemic continues. While advocating for temporary coverage in individual states may be a faster solution, to truly strengthen access during and after the pandemic, national-level advocacy is required. This includes a plan to change the DMPA-SC label to include self-administration. If you are a clinician and would like to share stories regarding patients who have wanted to switch to DMPA-SC from the intramuscular version, and whether they have been able to do so, please contact RHAP’s Research and Evaluation Manager at silpa@reproductiveaccess.org. To learn more about DMPA-SC as a method of contraception, check out RHAP’s resources and Innovating Education’s video “This is How I Teach: Self-Injection DMPA-SC” (narrated by Dr. Karlin).

Resource Highlights:

May Updates

Rethinking Creating Community in the Time of COVID-19

A reflection by National Organizer Laura Riker.

The Reproductive Health Access Network is a community of clinicians from all over the United States, and while we have always connected with our Network members virtually through newsletters and listservs, the heart of our work has been in bringing clinicians together in person. These in-person gatherings serve as touchstones for our Network members, whose daily lives are so busy that they can feel disconnected from other primary care clinicians providing reproductive health care in similar settings. These meetings also serve as opportunities for training, strategizing, and reconnecting with old friends and co-conspirators who fight alongside each other to expand and protect access to reproductive health care, despite mounting opposition. Like many of our Network members, the RHAP Network team also feels reinvigorated and revitalized when we are able to attend Cluster meetings, or go to conferences and meet people in person.

COVID-19 has presented the Network staff with a unique set of new challenges. The pandemic has driven us into our homes, canceling conferences and travel, while our clinicians are on the front lines – working in the hospital, providing telemedicine for 8 – 10 hours a day, continuing to go into the clinic to provide abortion care and other reproductive health services, and so much more. We’re trying to be mindful of the balance between asking too much of our Network members and giving them opportunities to continue the reproductive health care work that they feel so connected to. As a team, we’ve had to reevaluate and reimagine how we can continue our work to expand access to reproductive health care and support clinicians without the critical element of face-to-face gatherings.

We know that for many Network members, connecting with like-minded peers and offering spaces for support is what helps them stay motivated. With threats to abortion access such as Executive Orders banning abortion procedures, the challenges of telemedicine abortion, and the June Medical Services v. Gee decision looming, it is more critical than ever that clinicians come together as a community to remain inspired and motivated. In mid-March, we started hosting regular virtual “RHAPpy Hours” for our Network members. These open-ended spaces now happen at least once a week, and all Network members are welcome to call in. On a personal note, participating in these national calls has provided me with a new level of insight into the diverse range of experiences, workplace settings, and backgrounds that our Network members have.

Seeing for ourselves the strength of our Cluster leaders and the communities that they foster has been a new source of inspiration and learning that has helped inform how we think about the Network moving forward. It may be a long time until we can all come together in person, but in so many ways, this pandemic has forced us to reshape how we provide each other with the human connection and support that is now more necessary than ever.

Spotlight on a Cluster: New York – Getting Ready for a Virtual Congress of Delegates

A report back by Organizer Hailey Broughton-Jones.

“Advocacy in the AAFP is a way for me to lend a voice to those who cannot. It provides the 10,000 foot view which helps put my daily practice in context and provides a platform at a local, state and national level, where I can advocate on behalf of my patients and colleagues.” – Dr. Ivonne McLean, AAFP Liaison, NYC Cluster co-leader, NYSAFP Board Member, Chair of NYSAFP Leadership Commission, and Young Physician Delegate to the AMA

2020 has become a year of change and adaptation. Earlier this week, the New York Cluster gathered to prepare testimony for the annual New York State Academy of Family Physicians’ (NYSAFP) Congress of Delegates (COD). Instead of gathering in Albany in June, members will participate in the COD and provide testimony for resolutions virtually. During our meeting we focused on the following resolutions: Remove the X Waiver; Support Family Physicians Providing Gender-Affirming Care for Youth; Confidentiality Protection for Non-Policy Holders in Healthcare Billing; Resolution Against Criminalizing People Who Obtain An Abortion Across State Lines or Aid; and, Support Full Coverage of SubQ Depo.

Although meeting virtually was a big change from last year’s testimony prep workshop, the grounding aspects of sharing institutional knowledge, fostering mentorship, and providing feedback remained the same. Using Zoom break-out rooms, Cluster members practiced using a resolved clause to anchor their testimony in personal experiences, shared values, and vision. Throughout the workshop, I was constantly reminded of the vital role administrative advocacy plays in the long game of reimagining health care in general and reproductive health care specifically. Professional organizations are platforms to magnify our efforts and we are ready to take the microphone and shift the narrative, one resolution at a time.

March Updates

Thank you!

Dear Network members,

There is no question that the events of the last few weeks and days are taking a toll on mental and physical health for everyone. To the clinicians we have the honor, privilege, and joy of working with – thank you. Thank you for your selflessness and determination. Thank you for your dedication to your patients and community while navigating the personal and professional stresses of being a health care provider during this public health crisis.

Whether testing for COVID-19, ensuring folks in isolation have the medication they rely on, working in public health departments, or providing abortion care to those who need it, we know that you have stepped up during this pandemic.

We want to acknowledge the unbelievably hard work and personal sacrifice this asks of clinicians and thank you for your tireless work always, but especially for providing the full spectrum of essential care to those in need during the crisis. We at RHAP want to support you in any way we can; please do not hesitate to reach out if you need assistance, time, or just a support system.

If you are interested in hosting a virtual Network event (especially just a community building session to talk about how everyone is coping!) please email National Organizer Laura Riker at laura@reproductiveaccess.org.

In virtual support & solidarity,

Dalia Brahmi, MD, MPH
Regional Clinical Network Leader

Hailey Broughton-Jones, BA
Organizer

Laura Riker, MSSW
National Organizer

Lily Trotta, BS
Organizing Associate

Linda Prine, MD
Medical Director

Silpa Srinivasulu, MPH
Research and Evaluation Manager

January Updates

Our Network Team is Growing!

We are excited to announce fantastic new additions to our Network Team. Dalia Brahmi, MD, MPH is joining us as our Regional Clinical Network Leader. Dalia, current North Carolina American Academy of Family Physicians (AAFP) Liaison, will be the mentor for our Southern state AAFP advocacy efforts. She will be working with AAFP liaisons in the Florida, Georgia, and Virginia Clusters. She will also provide mentorship and peer support for AAFP liaisons in the Colorado Cluster and Louisiana as it evolves towards becoming a Cluster. As the Regional Clinical Network Leader, Dalia will be working closely with Medical Director Linda Prine, MD on AAFP administrative advocacy efforts. We are thrilled to have Dalia join our team and provide her expertise in strategic organizing and leadership development!

Lily Trotta B.S. (pictured on the right) has joined us as an Organizing Associate, providing needed support to our growing national network of clinician activists. Lily earned her B.S. in Media, Culture, and Communication at New York University, where she also minored in Creative Writing. Her introduction to advocacy was sparked by her time in the service industry, where rampant issues of discrimination and harassment based on gender, sexuality, race, and immigration status prompted a desire to inform and represent her peers in a more effective way. Coming from a background in event booking and customer service, Lily hit the ground running providing excellent support to the Reproductive Health Access Network.

Silpa Srinivasulu, MPH (pictured on the left) is a public health researcher and practitioner who focuses on sexual and reproductive health and rights. Silpa joins RHAP as its Research and Evaluation Manager. She previously worked as a Program Manager with the Institute for Family Health where she managed the Hands-on Reproductive Training (HaRT) Center, a project to increase the availability of comprehensive family planning services in New York City. While in graduate school, she participated in community-based participatory research to explore the experiences of patients and primary care providers in asking and responding to pregnancy intention screening questions. Her work has been published in a range of scientific journals including Contraception, Family Practice, Women’s Health Issues, and Progress in Community Health Partnerships.

She is committed to incorporating a reproductive justice framework into her work, to ensure all people have access to high-quality and dignified sexual and reproductive health education, services, and care. Silpa earned her MPH from Columbia University Mailman School of Public Health with a certificate in Public Health Research Methods.

RHAP worked closely with Silpa in her former role at the Institute for Family Health and we are thrilled to have her as an official RHAP staff member. As our Research and Evaluation Manager she will be leading efforts to evaluate and strengthen the impact of our organizational initiatives, including our Reproductive Health Access Network!

Research Survey | Columbia Law School Project on Religious Hospitals

We are sharing this survey on behalf of The Law, Rights, and Religion Project (LRRP) at Columbia Law School, where researchers want to hear from medical providers about how religion impacts patient care, especially at non-Catholic religious institutions. The LRRP has produced groundbreaking reports on religion and health care, including the disproportionate impact of Catholic health care restrictions on women of color. LRRP is now conducting research on religious restrictions, such as bans on the provision of certain reproductive health care services, at Protestant-affiliated hospitals.

They are also interested in hearing from providers who have observed instances of religion impacting the provision of health care—such as denials of care, anti-LGBTQ discrimination, or proselytizing—both by individual providers or institutions, including in secular and public funding facilities. You do not need to provide your name or the name of the institutions(s) where you’ve worked or trained in order to participate in this survey. If you indicate that you’re willing to participate in a follow-up phone interview, researchers may contact you with the information you provide. If you have any questions about the survey, please contact Amy Littlefield at littlefield.amy@gmail.com