In the wake of the Dobbs decision, confusion, fear, and uncertainty about abortion and contraceptive options have interfered with people’s ability to access critical reproductive health services, especially in Missouri, a state which has implemented many laws and legislative measures unfriendly to reproductive health care access. Recently, the Missouri Family Health Council (MFHC) launched a program that provides free emergency contraception, called the Free EC Program. Michelle Trupiano, executive director at the MFHC, spoke about the program.
The organization has been around for over 40 years. Its network includes 20 different health centers that operate around 70-75 health centers across the state and collectively serve over 40,000 patients per year. “Our mission is to champion access to every individual to culturally sensitive quality sexual and reproductive health services,” Trupiano said.
The MFHC operates in two ways. The first way is in the programmatic service delivery side, where they work as an administrator of grants to find opportunities to help the safety network provide quality family planning services to anybody who needs them, especially under-resourced people who may not be able to access them otherwise. They have also run the Title X federal Family Planning Program for over 40 years. Though they do not provide direct services through that, they put together a network that they flow funding to. They work with health departments, federally qualified action agencies, community action agencies, planned parenthood, and other standalone clinic sites.
It also runs an initiative funded by the Missouri Foundation for Health called The Right Time, a contraceptive equity initiative that aims to remove all financial barriers and any other barriers on the clinic side that may impede people from accessing the care that they need and deserve. They run training and a host of support activities to clinics to ensure that they have all the tools they need to provide quality services.
The other side of the MFHC’s work is an advocacy program that they run. “We know that there’s a lot of systemic and racist barriers that prevent people from accessing care,” Trupiano said. “We know that it doesn’t really matter how great of a job we do on the service delivery if people can’t get the care that they need due to a whole lot of obstacles in front of them, so we try to do a lot of work in Jefferson City and with lawmakers to try to break down some of those barriers and to look holistically at what that looks like.”
The Free EC (emergency contraception) Project launched on June 1, but it had been in the works for several months. The MFHC borrowed the idea from a model in Texas and launched it because of the Dobbs decision, wherein abortion became illegal immediately in the state of Missouri and many other states across the country.
“One of the other consequences was a lot of confusion and misinformation around contraception, especially emergency contraception and what it is, what it isn’t, and whether it was legal,” Trupiano said. “So we really launched the initiative for two reasons, and one was to try to combat misinformation around the legality of emergency contraception, that EC is different from medication abortion. A lot of people don’t know that and they confuse the two, and so they think that it’s illegal or something that they can’t access. The second reason was just to get it into the hands of anybody who may need it, so that they have it in their medicine cabinet in case an emergency were to happen. We are really excited about the initiative.”
Free EC has a women’s health nurse practitioner who acts as their clinical director overseeing the program to make sure that the information they are giving is medically accurate and factual. “In my non-clinician lay-speak, emergency contraception is just that,” Trupiano explained. “It’s contraception that works after unprotected or under-protected intercourse.” Emergency contraception works to prevent pregnancy like any other contraception works pre-sexual activity, so it does not terminate a pregnancy. It can work up to 120 hours after unprotected or under-protected intercourse.
In the kit MFHC provides are two doses of emergency contraception along with condoms, other safer sex materials, and two different education pieces: One specifically for emergency contraception, and one a broader sexual and reproductive health pamphlet with resources that talks about STIs, other birth control options, and places to receive services. There are QR codes in the kit that lead to additional resources for ongoing services, one of MFHC’s Title X or Right Time clinics, or even just more information. The emergency contraception boxes also have the traditional FDA approved education materials, what normally comes with purchasing over-the-counter medications. “There is definitely, as we like to say, easy-to-read information in there along with the typical medical insert that comes with any medical piece,” Trupiano said.
The Free EC program is able to provide these for free. “We are really excited that we are able to offer this to try to remove those financial barriers,” Trupiano said. If someone were to buy it at a retail store, emergency contraception costs approximately $50 for one dose, so the Free EC kits would retail for over $120.
“Kudos to my team, because what capacity did we have to do this, when you’re already operating where there’s not enough hours in the day? They were 100% behind making this work and really came together,” Trupiano said. “We have relied on a lot of volunteers making the kits, so that has been a lot of fun. We’ve had EC kit making nights.” Some of the MFHC’s partner organizations have hosted some kit making nights, which have been successful community builders, encouraging people to come together and do something tangible. “I think for my team, but that has also been really fulfilling, especially an organization that is this middle administrator organization. We felt like we were doing something really tangible. When you know that you’re making a kit and it’s going to somebody who needs it, that’s very fulfilling.”
Trupiano said the Free EC program has received positive responses so far. “We have not heard anything from lawmakers at this time. Now, do we know that there is an intention at some point in time to put forth policy that may try to classify emergency contraception, and other forms of contraception, as abortion. They did it two years ago. We’ve seen the groundwork laid. They didn’t come back to it this last year, but it would not surprise us if they were to try that again.” So far, the program has enjoyed positive feedback across the board, but the MFCH remains prepared. “We know our opponents are not stopping.”
Normalizing sexual health through programs like Free EC is important to reassure people that it is normal and important, rather than something to be ashamed of, so seeing the success of the program has been heartening for Trupiano and her team. “The first time we could see those numbers, the day after we launched, and we could see those requests coming in, we were like, ‘Oh, this is real.’ We were labeling and stocking kits up to get them to the post office, there was just something really powerful about that, just to see that real impact right away.” MFHC has also been hearing from their community partners as they have used them in tabling and outreach events. There, the kits have enjoyed even more success as people have encountered the kits and spread the word to others, recommending them to their friends. “Normalizing the conversation has been really rewarding,” Trupiano said.
Free EC is a program unique in that it serves an important need relevant to everyone, rather than just one demographic. Situations where free EC is useful may range from a broken condom to missing a birth control pill to wanting an extra form of protection to forgetting to use protection during intercourse to serious sexual assaults and sort of other forms of coercive behavior. With such a broad spectrum of applicable situations, free EC is important to public health and relevant to everyone.
The Dobbs decision has had devastating consequences across the country, specifically in Missouri. It was often said that Missouri was already operating post-Rowe even pre-Dobbs because of the action the state legislature has taken over the last decade. There were virtually no abortions happening in the state. Instead, that campaign from their opponents who opposed not just abortion, but access to medically accurate information and services spread confusion and misinformation. Dobbs sped up those misinformation campaigns due to the way laws work in Missouri.
“People are really scared,” said Trupiano. “They’re scared, they’re confused, and they’re not certain who they can trust. At the end of the day, they don’t want to do something that is illegal. They don’t want to do something that would put themselves in jeopardy.” The goal of the Free EC program is ensuring that people have accurate information. They are working with the legislature to combat any attempts to conflate contraception as abortion, or to re-classify certain methods of contraception as abortion. That attempt was made two years ago and MFHC was able to defeat it. This same effort didn’t recur last year, as those opponents’ efforts were focused on attacking the LGBTQ and trans community. But the Free EC program does expect to see those misinformation efforts renewed in the next year or two, so they are preparing for whatever campaigns may be coming.
After the Dobbs decision, misinformation started to spread immediately. Within a few days of the Dobbs decision last year, one hospital system in Kansas City, St. Luke’s, issued a statement that they were stopping providing emergency contraception to rape survivors because they were concerned about the legality. It took an uproar from people along with a statement from the governor and the Attorney General to say that all contraception is legal. But those official corrections still have not stopped the fear and confusion and misinformation.
These legislative barriers are causing people to lose bodily autonomy. Another generation is growing up without access to factual information about how their bodies work or being able to determine what is best for them. “This isn’t just about abortion, and we know that,” Trupiano said. “We know that our opponents are not going to stop.” When it comes to pregnancy, the consequences are not just about bodily autonomy. They are more far-reaching than just abortion care. The fear caused by misinformation has affected patients and also providers.
Trupiano predicted that within the next year they would see the devastating impact of medical care providers leaving the state in order to practice in states without fear of repercussions, affecting where people choose to go to medical school and where they choose to practice. There has already been a severe healthcare shortage within the state of Missouri, especially in rural areas, and Trupiano believes it is only going to get drastically worse. The fight in the state legislature is not just about whether somebody can access contraception, it is about whether or not a person will have a provider in their community. “The impact isn’t just about reproductive health, it’s much greater than that,” Trupiano said.
The MFHC ran this program as a pilot and had 5600 kits. Now, they are out of the pilot. Not all of the kits are distributed; some are in the hands of distribution partners who are in the process of distributing them, so they are on their second round of kits. They are purchasing the product to do a second round of 5600. In just the three weeks that they have launched, they mailed out over 2,000 individual kits to people who have requested them. They have another 3,000 in the hands of their distribution partners, and they have over 40 distribution partners across the state. Their partners are giving them out at outreach events, where the kits are available for people to come in and grab one, or their partners are giving the kits directly to their clients if appropriate.
Anyone can sign up for their action network on mfhc.org. You can go to their action network to stay up-to-date and participate in calls to action. Following other trusted sources of information on social media in addition and sharing those widely is equally important to combat the deep misinformation campaign. More people sharing accurate information helps combat that. “People’s voices are so powerful, even within their own individual friend and family circles,” Trupiano said. “They can really influence folks. Our goal is just that people have accurate information to make decisions that are best for them. We do not have a specific goal in terms of contraception people do access or don’t access, it’s just about people having accurate information and ability to access it if they want it.”
Visiting their website, mfhc.org, offers many places to click on to get free EC. It can be requested via mail. Filling out that form on their website will allow the kit to be mailed to you. The Free EC program mails the kits within seven business days, so if you are in an emergency, it will need to be sourced elsewhere because the sooner it is taken, the more effective it is. The MFHC suggests that people visit one of their distribution partners if that is accessible. If not, it can be purchased at a lot of ‘big box’ retail stores like Walgreens, Target, etc. The Free EC program’s goal, especially through mail, is that people have it on hand, whether they need it or a friend needs it, so that they have it on hand and can easily access it. Mailing the kits is completely confidential. They come in a discrete package with nothing but a name and address on it. It does not say who it is from so that it is discrete, and the Free EC program does not keep information on anyone so that confidentiality is protected. Anybody in Missouri can order a kit. Emergency contraception does not have any age restrictions, so the MFHC does not ask for age when ordering kits either.
“We want anybody to be able to order it so that you can have it on hand, whether you may need it or you may be in a position that you’re the person your friends go to when they’re in crisis, to have it available to give to somebody else,” Trupiano said. Anybody in Missouri with a Missouri address is able to order it. To answer any questions, the program and their health centers are available to call and help find answers.
To learn more about the Free EC project or order kits, visit https://mfhc.org/.