Indiana’s infant mortality rate is still among the worst in the nation.
The number of babies who died before their first birthday rose slightly in 2020 after declining steadily for four years, according to a report from the Indiana Department of Health.
There were 6.6 infant deaths for every 1,000 live births in 2020, amounting to 522 Hoosier babies lost. This rate is far higher than the national rate of 5.6 infant deaths per 1,000 births.
State leaders, policymakers, and various organizations have worked to combat the issue through programs and initiatives, even setting a goal of lowering the infant mortality rate to 6.0 by 2020. And while promoting safe infant sleeping practices and emphasizing good prenatal care has helped, there’s one stone that faculty members in the Department of Obstetrics and Gynecology at Indiana University School of Medicine feel has been left unturned: providing free and easy access to birth control.
The Pregnancy at a Time that is Happy and Healthy for You, or PATH4YOU, program fills this gap.
PATH4YOU aims to provide all people in Indiana with high-quality, non-coercive, patient-centered, comprehensive access to contraception. This includes all birth control options—from natural family planning to pills to long-acting reversible contraception (like intrauterine devices or arm implants).
Patients begin their journey at PATH4YOU.org, where they complete a birth control explorer and answer questions about pregnancy intentions. The birth control explorer is a validated contraception decision aid that allows people to explore which contraception is best for them. From there, they are given the option to connect with a clinician who can discuss options further, either via telehealth or in-person. If necessary, a prescription for the desired birth control can be sent to a local pharmacy for pickup or a mail-order pharmacy that delivers the method directly to the patient in 24 to 48 hours.
All costs are directed back to PATH4YOU so the appointment and chosen birth control method are completely free to the patient.
Six months since its kickoff, the program is off to a great start, said Tracey Wilkinson, MD, an assistant professor of pediatrics at IU School of Medicine and one of the leaders of the PATH4YOU program. Those involved are now eager to connect and serve more people across the state.
At its core, PATH4YOU is focused on providing patient-centered care, where one form of contraception is never emphasized or encouraged over another, Wilkinson said.
“That means, if someone’s goal is to not become pregnant at this time, we provide people with all the possible ways to achieve that goal, and make sure they are easy to access and free,” she said.
This approach falls into the framework of reproductive justice—an idea cultivated by activists and women of color in the 1990s that stresses bodily autonomy and ensures everyone has equal access to reproductive health care.
Those leading the PATH4YOU program hope that, by making birth control free and easily accessible, cases of infant and maternal mortality will decrease in Indiana—because if people are given the opportunity to time their pregnancies, they are more likely to be healthy pregnancies from start to finish, Wilkinson said.
Planning for PATH4YOU began back in 2019, but the official rollout was delayed because of the COVID-19 pandemic. Like their colleagues across the field, PATH4YOU’s leaders were forced to rethink how they would provide this medical care.
What resulted was a hybrid telemedicine and in-person care approach that they’re hopeful will ultimately allow them to reach and help more people, Wilkinson said.
All short-acting forms of birth control, like the pill, ring or patch, can be provided via telehealth, so the patient can choose between a virtual or in-person appointment. Certain birth control forms, like intrauterine devices or contraceptive arm implants, require in-person appointments.
Adults who use the PATH4YOU program have the option to participate in a prospective research cohort. Over the course of a year, these participants are asked to complete four surveys asking about their birth control use and whether pregnancies occurred.
Data collected will allow PATH4YOU to track its impact across the state. Using provided ZIP codes, researchers can see whether they’re properly reaching and aiding patients in the parts of the state where infant mortality is the most prevalent.
Decreasing infant mortality has been a priority in Indiana since 2014, according to IN.gov.
As part of the Healthy People program, state leaders have set a new goal of lowering the state infant mortality rate from 6.6 to 5.0 per 1,000 births by 2030.
In order to achieve that goal, a multifaceted approach will be needed, Wilkinson said, including access to affordable birth control. The PATH4YOU program hopes to provide that access for people in the state of Indiana.
What is Reproductive Justice?
The term reproductive justice was coined by the Atlanta-based coalition SisterSong, which was founded in 1997 by the indigenous women and women of color who felt underrepresented in larger women’s rights movements. The organization, according to its website, defines reproductive justice “as the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” The reproductive justice framework recognizes that those in marginalized communities may not have the same access to reproductive health care that others do; and calls upon those in power to dismantle such barriers.