Contraception is a top priority for the state of Delaware, thanks to the organization Upstream.

The nonprofit program is training health centers in the state to make sure women receive any form of birth control they want, the New York Times reports. State officials are trying to reduce unintended pregnancies and help women escape poverty by ensuring all women of childbearing age who enter a doctor’s office are asked if they want to get pregnant in the next year, and offered birth control options. Nearly every medical provider in the state has adopted the program within the past three years. 

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“I think if we’re looking for the biggest levers we have in this country to expand opportunity, one of the most important ones is helping women to achieve their own goals,” Upstream co-founder Mark Edwards told the New York Times.

Upstream raises money from foundations and individuals to provide states with initial funding and staff to train health professionals. The program ends up costing $200 per woman, but Upstream thinks it’s worth it because the benefits can last years. 

Delaware recently had the nation’s highest rate of unplanned pregnancies, but things are looking up. The number of women using some form of birth control has increased. The proportion of low-income women who receive affordable birth control under Title X, but don’t use it, has dropped to half, according to the nonprofit research group Child Trends. 

Unplanned pregnancies are common across the country. Nearly half of the 6 million pregnancies in the US each year are unplanned, according to Upstream. In 2014, the majority of the 900,000 abortions that occurred were in response to unplanned pregnancy, according to the Guttmacher Institute. But the country’s abortion rate is now the lowest since the government started keeping track in 1969. 

Delaware’s abortion rate dropped a year after Upstream arrived, and the health department anticipates it will fall again, according to the New York Times. 

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Upstream’s program not only trains physicians on proper hormonal IUD implantation, but also works with front-office staff who might need to help women reschedule contraception-related appointments.

While the program endorses long-term contraception options because they’re most effective, they let patients know they can choose any birth control method that works for them. There has been some resistance around the promotion of long-acting contraceptives since they have been used in the past as a form of forced sterilization. 

It’s clear that long-acting, reversible contraception is 99% effective and helps reduce unplanned pregnancies. I remain committed to ensuring Delaware continues to lead the way in making birth control more affordable and more accessible https://t.co/u0Dkqb2MK0

— Senator Tom Carper (@SenatorCarper) November 14, 2018

Upstream simply wants to let women know they have options to help themselves, and their children lead better lives. Mothers who have unplanned pregnancies tend to give birth when they’re younger, not finish their education, and earn less later in life. And unplanned pregnancies don’t only affect mothers; children whose births are unplanned are more likely to have health complications, be born into poverty, stop their education, and earn less.  

The link between poverty and unplanned pregnancies has been made in countries around the world. 

But Caitlin Myers, an economics professor at Middlebury College who teaches a course on unplanned parenthood in the US, argues the connection isn’t as direct.

“To what extent does unintended pregnancy cause bad outcomes versus bad outcomes causing unintended pregnancies? It’s a symptom of poverty, of inequality, of hopelessness about the future,” she told the New York Times. 

While some people have opposed Delaware’s contraception push, Dr. Karyl Rattay, Delaware’s director of public health, said the program has been mostly well received. 

Other states are now following Delaware’s lead. In 2018, Washington and Massachusetts announced they will work with Upstream to introduce similar initiatives. 

“It’s very expensive and very hard to reduce poverty,” Isabel Sawhill, a senior fellow at the Brookings Institution told the New York Times. 

“Reducing unplanned births is easy by comparison.”