More mobile clinics are bringing long-acting contraception to rural areas

Twice a month, a 40-foot truck converted into a mobile clinic travels through the Rio Grande Valley to provide rural Texas health care, including contraception.

The clinic, called UniMóvil, is part of the Healthy Mujeres program at the University of Texas Rio Grande Valley School of Medicine.

The US has approximately 3,000 mobile health programs. But Saul Rivas, a gynecologist, said he was not aware of anyone who shared Healthy Mujeres’ specific mission when he helped launch the initiative in 2017. ‘Mujeres’ means ‘women’ in Spanish.

It is now part of a small but growing number of mobile programs aimed at increasing rural access to women’s health care services, including long-acting reversible contraception.

There are two types of these highly effective methods: intrauterine devices, also called intrauterine devices, and hormonal implants that are inserted into the upper arm. These birth control options can be especially difficult to obtain – or have been removed – in rural areas.

“Women who want to prevent unintended pregnancy should get what works best for them,” said Kelly Conroy, senior director of mobile and maternal health programs at the University of Arkansas for Medical Sciences.

The school is launching a mobile health and contraceptive program for women in rural parts of the state this month.

Rural areas have disproportionately fewer doctors, including midwives, than urban areas. And rural providers may not be able to afford to stock long-acting contraceptives or may not be trained in their use, program leaders say.

Mobile clinics help close that gap in care in rural areas, but they can be challenging to operate, says Elizabeth Jones, senior director at the National Family Planning & Reproductive Health Association.

Money is the biggest obstacle, Jones said. The Texas program costs up to $400,000 per year. A 2020 survey of 173 mobile clinics found that they cost an average of more than $630,000 per year. Mobile dental programs were the most expensive, averaging more than $1 million.

Although many programs are launched with the help of grants, they can be difficult to sustain, especially with more than a decade of reduced or stagnant funding for Title X, a federal funding stream that helps low-income people receive family planning services.

For example, a mobile birth control program in rural Pennsylvania lasted less than three years before closing in 2023. It was shut down after federal funding was lost, said a spokesperson for the clinic that operated it.

Rural mobile programs are not as efficient or profitable as brick-and-mortar clinics. That’s because staff members may have to make hours-long trips to reach cities where they are likely to see fewer patients than at a traditional location, Jones said.

She said organizations that cannot afford mobile programs can consider setting up “pop-up clinics” at existing health and community sites in rural areas.

Maria Briones is a patient who has benefited from the Healthy Mujeres program in south Texas. The 41-year-old childcare worker was concerned because she was not getting her period with her IUD.

She considered going to Mexico to have the device removed because few doctors take her insurance on the U.S. side of the Rio Grande Valley.

But Briones learned that the UniMóvil was visiting a small town in Texas about 20 minutes from her home. She told the staff there that she did not want any more children, but was concerned about the IUD.

Briones decided to keep the device after learning that it is safe and normal to not get a period while using an IUD. She is not billed for her mobile clinic appointment, even though the university health care system does not take her insurance.

“They were very patient and answered all the questions I had,” Briones said.

IUDs and hormonal implants are very effective and can last up to 10 years. But they’re also expensive — devices can cost more than $1,000 without insurance — and inserting an IUD can be painful.

Patient rights advocates are also concerned that some providers are pressuring people to use these devices.

They say ethical contraception programs aim to empower patients to choose the contraceptive method – if available – that is best for them, rather than promoting long-acting methods in an effort to reduce birth and poverty rates. They point to the history of eugenics-inspired sterilization and even more recent incidents.

For example, a Time magazine study found that doctors are more likely than other patients to use long-acting contraception — and to refuse to remove the devices.

Rivas said Healthy Mujeres employees have been trained on the subject.

“Our goal is not necessarily to place IUDs and implants,” he said. It is intended to “educate and help patients make the best decisions for themselves.”

David Wise, a spokesman for the University of Arkansas for Medical Sciences, said staff members with the university’s mobile program will ask patients over the next year if they want to become pregnant and support their choice. The programs in Arkansas and Texas also remove IUDs and hormonal arm implants if patients are unhappy with them.

The Arkansas initiative will visit 14 rural counties with four vehicles the size of food trucks used in previous mobile health efforts. Personnel and equipment will be covered by a two-year, $431,000 grant from an anonymous donor, Wise said.

In addition to contraception, faculty and medical assistants staffing the vehicles will provide health screenings, vaccinations, prenatal care and testing and treatment for sexually transmitted infections for women.

Rivas said the Texas program was inspired by a study that found that 34% of Texas mothers surveyed six months after giving birth said long-acting birth control was their preferred birth control option — but only 13% used that method.

“We started thinking about ways to close that gap,” Rivas said.

Healthy Mujeres, which is funded through multiple grants, started with a focus on contraception. It later expanded to services such as pregnancy ultrasounds, cervical cancer screenings and testing for sexually transmitted infections.

While the Texas and Arkansas programs can bill insurance, they also have funding to help uninsured and underinsured patients pay for their services. Both use community health workers — called promoas in largely Spanish-speaking communities like the Rio Grande Valley — to provide patients with food, transportation, additional medical services and other needs.

They work with organizations that locals trust, such as food banks and community colleges, who leave the mobile units in their parking lots. And to further increase the availability of long-acting contraception in rural areas, universities are training their students and local providers in how to insert, remove and get reimbursed for the devices.

One difference between the programs is determined by state law. The Arkansas program can provide contraception to minors without the consent of a parent or guardian. But in Texas, most minors require consent before receiving health care, including contraception.

Advocates say these initiatives could help reduce the rates of unintended and teen pregnancies in both states, which are higher than the national average.

Rivas and Conroy said their programs have not received much criticism. But Rivas said some churches that asked UniMóvil to visit their congregations changed their minds after learning that the services included contraception.

Catherine Phillips, director of the Respect Life Office in the Catholic Diocese of Arkansas, said the diocese supports efforts to achieve health care equity and that she is personally interested in mobile programs that visit rural areas like where she lives.

But Phillips said the Arkansas program’s focus on contraception, especially long-acting methods, conflicts with the teachings of the Catholic Church. Offering these services to minors without parental consent “makes it even more egregious,” she said.

Jones said that while these programs come with high costs and other challenges, they also have benefits that can’t be measured in numbers.

“Building community trust and making an impact in the communities most affected by health inequities – that is invaluable,” she said.