JACKSON, Miss. \u2014 Two years ago, after an emergency cesarean section at a Mississippi hospital, Sherika Trader was denied a tubal ligation. Trader, now 33, was told that to have her tubes tied, she had to have a second child or a husband\u2019s permission, even though she wasn\u2019t married.<\/p>\n

Jasymin Shepherd had heavy menstrual cycles because of a birth control pill prescribed after the birth of her son 13 years ago. The symptoms continued even after she stopped taking the medication. Last year, a doctor in Jackson responded by offering Shepherd, 33, a hysterectomy, which she didn\u2019t want.<\/p>\n

The experiences left the women feeling as though providers acted like \u201crobots,\u201d or, worse, they felt stereotyped. Black women already face major barriers to accessing health care, including provider shortages and racial bias rooted in the medical system.<\/p>\n

But with contraceptive care, which deals with deeply personal patient preferences, they must also contend with providers who dismiss their concerns. Decisions about whether \u2014 or when \u2014 to have a baby and how to prevent pregnancy are not as standardized as care for other conditions. Yet providers hand out prescriptions or recommendations while disregarding a patient\u2019s specific circumstances, Shepherd said.<\/p>\n

Late last year, the White House made new recommendations for a federal program that provides funding for free contraceptives, wellness exams, and certain cancer screenings. Health officials want to regain the trust of patients like Trader and Shepherd, who feel as though their doctors don\u2019t always listen to them. The goal of the Title X program, which distributes grants to states and other groups for family planning, is to let patients dictate the care they want, said Jessica Marcella<\/a>, who is the deputy assistant secretary for population affairs at the U.S. Department of Health and Human Services and oversees the Title X program.<\/p>\n

\u201cOur belief, and that of the family planning field, is that it is essential that you respect the interests, needs, and values of a client,\u201d she said. Providers shouldn\u2019t force patients to take a birth control method because it\u2019s more effective, she said, or deny them a particular method because they think a patient might want more kids.<\/p>\n

\u201cWhat we don\u2019t want is a provider to create trauma or do unintentional harm,\u201d Marcella said.<\/p>\n

In Mississippi, efforts to implement that approach have started with a change in who gets to administer the Title X funds, taking that responsibility from the state and giving it to a four-year-old Jackson-based nonprofit named Converge. The Biden administration\u2019s decision this year to give Converge the $4.5 million grant marks the first time in four decades that Mississippi\u2019s health department hasn\u2019t won the federal family-planning grant.<\/p>\n

Converge doesn\u2019t offer family planning services. Instead, the group provides funding to a network of clinics statewide, organizes provider training, helps clinics navigate technology challenges, and keeps them stocked with supplies. For example, when a provider was having trouble printing out a survey that patients took about their contraception preferences, Converge co-founder and co-director Jamie Bardwell shipped the clinic a wireless printer.<\/p>\n

Jamie Bardwell (left) and Danielle Lampton co-founded Converge, a nonprofit that administers federal family-planning funds in Mississippi through a grant it won earlier this year.(Nico Hopkins)<\/span><\/figcaption><\/figure>\n
But across the South, the attempt to change the culture of family planning care faces old and new obstacles. Some are deeply rooted in the medical system, such as the bias long faced by Black women and other women of color. In addition, contraception care is limited in the conservative South, and the Supreme Court\u2019s June decision to overturn *Roe v. Wade<\/em> has led to the curtailing of abortion access across much of the region.<\/p>\n*
Black women often feel disrespected and dismissed by their providers, said Kelsey Holt, an associate professor of family and community medicine at the University of California-San Francisco. She co-authored a *2022 study<\/a> in the journal Contraception in which dozens of Black women in Mississippi were interviewed about their experiences getting contraceptives.<\/p>\n*
Women told researchers that they struggled to get appointments, faced long wait times, and had to put up with condescending behavior. Many of the women said providers didn\u2019t inform them about alternatives to the contraceptive Depo-Provera, a progestin shot administered once every three months, despite the known side effects and the availability of other, more appropriate options.<\/p>\n
Trying to undo decades of such damage \u2014 and overhaul how providers deliver family planning care \u2014 became even more difficult after the Supreme Court decision and the closure of abortion clinics across the South. Suddenly, women in Mississippi, Alabama, and about a dozen other states could no longer get abortions.<\/p>\n
\u201cA major service has been cut off,\u201d said Usha Ranji, associate director for women\u2019s health policy at KFF. Title X funds cannot be used \u2014 and have never been used \u2014 to pay for abortions. But, she said, clinics can no longer present abortion as an option, hampering their ability to provide comprehensive counseling, a key requirement of the Title X program.<\/p>\n
Many Mississippians can\u2019t afford to travel across state lines to terminate an unwanted pregnancy. In 2020, 84% of Title X clients<\/a> in the U.S. had incomes at or below 200% of the federal poverty level, and 39% were uninsured. Even women in Mississippi with the means to travel will face hurdles in nearby states, like Georgia and Florida, where abortion is not fully banned but access has been scaled back.<\/p>\n
*Even before the Supreme Court decision, access to family planning care in Mississippi came with hurdles and judgment.<\/p>\n*
In 2017, when Mia, who didn\u2019t want her last name used for fear of legal and social repercussions, became pregnant for the second time, she called the local health department in Hattiesburg for advice on obtaining an abortion. She had a daughter and wasn\u2019t financially or mentally prepared to have another child. The health department contact sent Mia to a faith-based, anti-abortion center.<\/p>\n
\u201cI felt judged,\u201d Mia said about the call. Eventually, she terminated the pregnancy in Jackson, about 90 miles away, at the state\u2019s sole abortion clinic, which closed in July<\/a>. \u201cUltimately, I did what was best for me,\u201d said Mia, who went on to have a son several years after the abortion.<\/p>\n
The loss of abortion care in Mississippi puts more pressure on family planning providers to win the trust of their patients, said Danielle Lampton, who also co-founded Converge. Patient-centered care is the \u201cbedrock of what we do,\u201d Lampton said.<\/p>\n
*Both Trader and Shepherd serve on Converge\u2019s patient experience council and receive occasional stipends for providing their perspectives to the nonprofit.<\/p>\n*
Providers shouldn\u2019t force or pressure low-income patients to use long-term contraception, such as an intrauterine device, to safeguard against pregnancy, said Dr. Christine <\/a>Dehlendorf<\/a>, a family physician and researcher at UCSF, who is advising Converge.<\/p>\n
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Wyconda Thomas, a family nurse practitioner, opened a clinic four years ago in Gunnison, Mississippi, a town of only a few hundred people. Thomas lets patients\u2019 life circumstances, their history, and their needs determine what type of contraception she prescribes.(Haleigh Brooke Thomas McGee)<\/span><\/figcaption><\/figure>\n<\/div>\n
Pressuring Black women to use IUDs, implants, and other long-term contraception is reminiscent of a history in which Black women were sterilized against their consent, she said. Even today, studies show<\/a> that providers are more likely to pressure women of color to limit the size of their families and recommend IUDs to them. These women also have a harder time getting a provider to remove the devices and getting insurance to cover the removal cost, Dehlendorf said.<\/p>\n
Too often, Wyconda Thomas, a family nurse practitioner near the Arkansas border, meets patients who are skeptical of birth control because of a bad experience. Many of her patients continued Depo-Provera shots even after they gained an unsafe amount of weight \u2014 a known side effect \u2014 because they weren\u2019t offered other options.<\/p>\n
Even if patients come in for another reason, Thomas talks to them about family planning \u201cevery chance I get,\u201d she said. Four years ago, Thomas opened the Healthy Living Family Medical Center in Gunnison, a 300-person town that is 80% Black. The clinic receives Title X funds through Converge. Still, Thomas doesn\u2019t force contraception on patients \u2014 she respects their decision to forgo a pill, patch, or implant.<\/p>\n
But Title X funds help Thomas stock a variety of contraception methods so patients don\u2019t have to worry about driving to a separate pharmacy.<\/p>\n
\u201cMy job for them is to get them to understand that there are more methods and there\u2019s no method at all,\u201d Thomas said. \u201cAnd that\u2019s a whole visit by itself.\u201d<\/p>\n
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