Every two weeks, a mobile clinic on wheels travels through the Rio Grande Valley, offering essential women’s health care services to rural Texans. The 40-foot-long truck is equipped to provide contraception and other reproductive health services.
The UniMóvil clinic is a vital component of the University of Texas Rio Grande Valley School of Medicine’s Healthy Mujeres program.
Dr. Saul Rivas, an OB-GYN, admitted that he was unaware of any mobile health programs with a mission similar to that of Healthy Mujeres when he co-founded the initiative in 2017. It is worth noting that “Mujeres” translates to “women” in Spanish.
There are two highly effective methods for birth control: intrauterine devices (IUDs) and hormonal implants inserted into the upper arm. These options can be particularly challenging to access or remove in rural areas.
Kelly Conroy, senior director of mobile and maternal health programs at the University of Arkansas for Medical Sciences, emphasized the importance of providing women with the choice to use the most effective method of preventing unintended pregnancies.
This month, the school will be launching a mobile program dedicated to women’s health and contraception in rural areas of the state.
Rural areas are facing a significant shortage of doctors, including OB-GYNs, in comparison to urban areas. This shortage is particularly evident in the availability of long-acting birth control devices, as rural providers may not have the financial means to stock them or the necessary training to administer them.
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According to Elizabeth Jones, a senior director at the National Family Planning & Reproductive Health Association, mobile clinics are a valuable resource in bridging the gap in rural healthcare. However, operating these clinics can present a set of challenges.
According to Jones, the biggest challenge is money. The Texas program has an annual cost of up to $400,000. In a 2020 study of 173 mobile clinics, it was found that the average cost per year exceeded $630,000. Among these programs, mobile dental clinics were the most expensive, with an average cost of over $1 million.
Maria Briones, a 41-year-old day care worker, had concerns about her IUD when she noticed that she wasn’t getting her menstrual period. Fortunately, she found relief through the Healthy Mujeres program in southern Texas.
She thought about traveling to Mexico to remove the device since there are only a few doctors in the U.S. side of the Rio Grande Valley who accept her insurance.
Briones discovered that the UniMóvil had made a stop in a nearby small Texas city, just a 20-minute drive from her home. Concerned about her IUD, she shared with the staff her desire to avoid having more children.
After discovering that it is safe and normal not to have periods while using an IUD, Briones made the decision to continue using the device. Despite the fact that the university health system does not accept her insurance, she will not be charged for her appointment with the mobile clinic.
Briones expressed her appreciation for the patience and thoroughness of the individuals who addressed her inquiries. She stated, “They took the time to address all of my questions.”
IUDs and hormonal implants offer long-lasting and reliable contraception for up to 10 years. However, these methods can be quite costly, with device prices exceeding $1,000 without insurance coverage. Additionally, the process of inserting an IUD can cause discomfort.
Patient-rights advocates are also raising concerns about healthcare providers pressuring individuals to utilize these devices.
Rivas mentioned that the staff at Healthy Mujeres receives comprehensive training on this matter.
“Our aim is not simply to insert IUDs and implants,” he explained. Instead, our primary objective is to offer education and support to patients, enabling them to make informed decisions that are best suited to their individual needs and circumstances.”
According to Rivas, the Texas program drew inspiration from a study which revealed that, six months after giving birth, 34% of surveyed Texas mothers expressed a preference for long-acting contraception as their birth control method of choice. Surprisingly, only 13% of these mothers were actually using this method.
Rivas reflected on the need to bridge that gap and brainstormed potential solutions.
Healthy Mujeres, a program funded by multiple grants, initially prioritized contraception as its main focus. Over time, it has broadened its services to include pregnancy ultrasounds, cervical cancer screenings, and testing for sexually transmitted infections.
Both the Texas and Arkansas programs have the ability to bill insurance for their services, but they also have funding in place to assist patients who are uninsured or underinsured. These programs utilize community health workers, known as promotoras in predominantly Spanish-speaking communities like the Rio Grande Valley, to help patients access resources such as food, transportation, additional medical services, and other necessary support.
They collaborate with trusted local organizations, including food pantries and community colleges, allowing the mobile units to set up in their parking lots. In order to enhance the accessibility of long-acting contraception in rural areas, the universities are providing training to their students and local providers on the insertion, removal, and reimbursement processes for these devices.
In Arkansas, there is a notable distinction in the programs due to state laws. The program allows minors to access birth control without requiring the consent of a parent or guardian. However, in Texas, the majority of minors are required to obtain consent before receiving any form of healthcare, including contraception.
Rivas and Conroy mentioned that their programs have not faced much opposition. However, Rivas mentioned that a few churches initially expressed interest in having the UniMóvil visit their congregations but changed their minds after discovering that the services offered also included birth control options.
