KFF
Twice a month, a 40-foot-long bus converted into a mobile clinic travels through the Rio Grande Valley to offer women in rural Texas health services that include contraception.
The clinic, called UniMóvil, is part of the Healthy Mujeres program at the University of Texas Rio Grande Valley School of Medicine.
In the United States there are about 3,000 mobile health programs. But OB-GYN Saúl Rivas said he didn’t know of any who shared Healthy Mujeres’ specific mission when he helped launch the initiative in 2017.
It is now part of a small but growing number of mobile programs aimed at increasing rural communities’ access to women’s health care, including long-acting reversible contraception.
There are two types of highly effective methods: intrauterine devices, known as IUDs, and hormonal implants that are inserted into the upper arm. These contraceptive options can be especially difficult to obtain—or be able to pick up—in rural areas.
“Women who want to avoid an unwanted pregnancy should have what is best for them,” said Kelly Conroy, director of mobile and maternal health programs at the University of Arkansas for Medical Sciences.
The university is launching a mobile women’s health and contraception program this month in rural areas of the state.
There are far fewer doctors in rural areas than in urban areas, including obstetrician-gynecologists. Additionally, according to program officials, rural providers may not be able to afford long-acting contraceptive devices, or may not be trained to administer them.
Mobile clinics help close that health gap in rural areas, but they can be complicated to operate, said Elizabeth Jones, director of the National Family Planning and Reproductive Health Association.
Money is the biggest obstacle, Jones said. The Texas program costs about $400,000 a year. A 2020 study of 173 mobile clinics found they cost an average of more than $630,000 a year. Mobile dental programs were the most expensive, exceeding $1 million.
Although many programs are launched with the help of grants, they can be difficult to maintain, especially because for more than a decade there has been a decline or stagnation in Title X funding, a source of federal money that helps low-income people to receive family planning services.
For example, a mobile contraception program serving rural Pennsylvania lasted less than three years and ended in 2023. It stopped operating when it lost federal funding, said a spokesperson for the clinic that ran it.
Rural mobile programs are not as effective or cost-effective as brick-and-mortar clinics. That’s because staff have to travel hours to get to towns where they’re likely to see fewer patients than they would at a traditional site, Jones explained.
According to her, organizations that cannot afford mobile programs can consider creating “pop-up clinics” in community and health centers already operating in rural areas.
María Briones is a patient who has benefited from the Healthy Mujeres program in South Texas. This 41-year-old daycare worker was worried because she was not getting her period with the IUD.
He considered going to Mexico to have the device removed because few doctors accept his insurance on the U.S. side of the Rio Grande Valley.
But Briones learned that UniMóvil was in a Texas town about 20 minutes from his house. She told the staff that she didn’t want to have more children, but was worried about the IUD.
Briones decided to keep the device when she was informed that it is safe and that it is normal not to have a period while using an IUD. Although the university health system does not accept your insurance, you will not be charged for the appointment you had at the mobile clinic.
“They are very patient and answered all my questions,” Briones said.
IUDs and hormonal implants are very effective and can last up to 10 years. But they’re also expensive — the devices can cost more than $1,000 without insurance — and inserting an IUD can be painful.
Patient rights activists are also concerned that some providers pressure people to use these devices.
They claim that ethical birth control programs seek to empower patients to choose the contraceptive method—if any—that is best for them, rather than promoting long-acting methods in an attempt to reduce birth rates and poverty. . They point to the history of eugenics-inspired sterilization and even more recent incidents.
For example, a Time magazine investigation found that African American, Latina, young, and low-income women are more likely than other patients to be pressured by doctors to use long-acting birth control, and to refuse to withdraw the contraceptives. devices.
Rivas assured that the Healthy Mujeres staff is trained on this topic.
“Our goal is not necessarily to put in an IUD or implants,” he said. We seek to “provide education and help patients make the best decisions for themselves.”
David Wise, spokesman for the University of Arkansas for Medical Sciences, said staff at the university’s mobile program will ask patients if they want to become pregnant in the next year, and will support their decision. The Arkansas and Texas programs also remove IUDs and hormonal implants from the arm if patients are dissatisfied with them.
The Arkansas initiative will visit 14 rural counties with four vehicles the size of food trucks used in previous mobile health initiatives. The cost of staff and equipment will be covered by a $431,000 grant from an anonymous donor over two years, Wise said.
In addition to contraception, faculty and resident doctors working in the vehicles will offer women’s health screenings, vaccinations, prenatal care and testing, and treatment for sexually transmitted infections.
Rivas explained that the Texas program was inspired by a study that, six months after giving birth, 34% of Texas mothers surveyed said long-acting contraception was their preferred method of contraception, but only 13% % used it.
“That was when we started thinking about how to address that lack,” Rivas said.
Fewer unwanted pregnancies
Healthy Mujeres, which is funded through multiple grants, began by focusing on contraception. It later expanded to services such as ultrasounds during pregnancy, cervical cancer screening, and testing for sexually transmitted infections.
Although the Texas and Arkansas programs may bill insurance, they also have funding to help uninsured and underinsured patients afford their services. Both rely on community health workers — called “promotoras” in largely Spanish-speaking communities like the Rio Grande Valley — to connect patients with food, transportation, additional medical services and other needs.
They partner with organizations trusted by local people, such as food banks and community colleges, who allow mobile units to set up in their parking lots. And to further increase the availability of long-acting contraceptives in rural areas, universities train their students and local providers on how to insert, remove, and obtain reimbursement for the devices.
One of the differences between the programs is dictated by state laws. The Arkansas program can provide contraceptives to minors without the consent of their parents or guardians. But in Texas, most minors need consent before receiving health care, including contraceptives.
Advocates say these initiatives could help reduce unintended and teen pregnancy rates in both states, which are higher than the national average.
Rivas and Conroy said their programs have not received much opposition. But Rivas said some churches that had asked UniMóvil to visit their congregations changed their minds after learning that the services included contraception.
Catherine Phillips, director of the Respect Life Office for the Catholic Diocese of Arkansas, explained that the diocese supports efforts to achieve health care equity and that she is personally interested in mobile programs that visit rural areas such as where she lives herself.
But Phillips added that the Arkansas program’s focus on birth control, especially long-acting methods, runs counter to the teachings of the Catholic Church. Offering these services to minors without parental consent “makes it more outrageous,” he said.
Jones noted that while these programs have high costs and other challenges, they also have benefits that cannot be measured in numbers.
“Building trust in the community and having an impact on the communities most affected by inequalities in access to health is something of incalculable value,” he said.
This story was produced by KFF Health News, a national newsroom focused on in-depth coverage of health issues, which is one of the main programs of KFFthe independent source for health policy research, polling and journalism.
