Removing Barriers to Care in a Rural Florida Community

In Marison Joseph's women's healthcare practice, many of the patients who ask for family planning services are already mothers or pregnant women about to give birth.

"They just had a baby last year…they're stressed, it's a lot of work for them at home," she explained. "When you see a patient like this, you're like, 'Would you desire a long-term birth control? We put it in and you don't have to think about it.'"

For Joseph, a nurse practitioner at Healthcare Network of Southwest Florida, helping these women access the right contraceptive care is a passion - and a health justice issue.

"We can reduce unintended pregnancies. Patients can get the birth control that they would like, they have more understanding, they know their options," she said. "The goal is to promote health and wellness in women."

Healthcare Network, a federally qualified health center in Collier County, Florida, cares for primarily rural patients who often have low health literacy, may speak Spanish or Haitian Creole as a primary language, or need culturally sensitive care.

"A lot of our patients have cultural and religious beliefs," Joseph said. Many have heard misinformation from family, friends, or social media. Asking patients, "Why does that concern you? Why do you feel this way? What information do you need?" often helps her get to the heart of patients' concerns and help them develop a more accurate understanding of family planning options.

Joseph is of Haitian descent, a background that helps her connect to patients who are wary of medical information. "They kind of have a sense of safety: 'You're Haitian, you speak Creole,'" she said.

Healthcare Network works to reach patients of reproductive age (approximately 15 to 44 years old) with accurate information about contraception and family planning - helping them prevent unwanted pregnancies and achieve the best reproductive outcomes for their lives. According to the Centers for Disease Control and Prevention, 45% of pregnancies in the U.S. are unintended, with rates highest among people with lower levels of education and income, people of color, and people between the ages of 15 and 24.

To help the health center provide culturally appropriate, non-stigmatizing, and accurate contraceptive care to more women, Direct Relief designated them one of four awardees for the 2025 Community Health Awards: Locally-Driven Approaches to Prevent Unintended Pregnancy.

These awards, funded by women's health company Organon, provide four $200,000 awards over two years to nonprofit partners working to prevent unintended pregnancies in vulnerable patient populations. Each of the four awardees provides contraceptive services and education in an under-resourced area, through programs designed to meet the unique needs of their local communities.

"A bigger need"

Lowering barriers to contraceptive care is complicated, explained Deisy Martinez, Healthcare Network's obstetric care coordinator. A patient population with low health literacy requires clear information in simple terms, sometimes illustrated with pictures. Transportation makes it hard for many patients to maintain continuity of care. Women in traditional family structures may depend on their husbands to make family planning decisions.

Of the approximately 10,800 women of childbearing age served by Healthcare Network last year, only about 2,500 receive contraceptive care. In the next two years, their goal is to bring that number to 3,500.

In many cases, the best way to ensure patients have accurate information about contraception and know the best decision for them is to start a conversation, Martinez explained. For example, a woman may not want to have more children, but may want to continue experiencing her menstrual cycle, worry about weight gain, or be concerned about maintaining future fertility.

"We ask a lot of questions…to understand where our patients are coming from," said Gabrielle O'Boyle, Healthcare Network's senior director of marketing and communications.

Earning trust means offering reliable interpreters, layperson-friendly language, and helpful visual aids, O'Boyle said. Because Healthcare Network is active in the community, O'Boyle said, offering healthcare services at schools, community health fairs, and home visits, people know "we are a safe place to get care and that we welcome patients of all backgrounds."

For Joseph, a program specifically aimed at reducing unintended pregnancies meets "a bigger need": Her patients "need the care, they're not really informed like they should be. There's a lot of language barriers, there's a lot of culture barriers," she said.

"They're just not aware of what's out there"

Healthcare Network will use the Community Health Award to support the Contraceptive Access, Resources, and Education (CARE) program, a multi-faceted approach to preventing unwanted pregnancies. Staff members will be trained in new approaches to contraceptive counseling, with a focus on providing care that is culturally sensitive and non-stigmatizing. Contraceptive counseling will help women choose and implement their preferred method of preventing pregnancy. In addition to providing contraceptive services in on-site clinics, health workers will offer contraceptive education and counseling through telehealth and Healthcare Network's mobile unit, the Van Domelen Health Express, which travels to geographically isolated areas to offer a range of preventive, dental, and primary health services.

In addition, Healthcare Network will use the award funding to develop informative, engaging content about contraception, including videos for social media - three each year, featuring expert information and lived experiences and offered in English, Spanish, and Haitian Creole - and programming for a local radio station.

Martinez explained that an earlier series of videos - focused on maternal health issues like nutrition, gestational hypertension, and diabetes - made the new project a natural fit for them. The maternal health videos introduced women in the community to accurate information and explained how the health center could help them maintain their health during pregnancy.

Healthcare Network "treats about 90% of this community," Martinez said. The goal is to teach patients about the range of services on offer, and to help overcome hesitation, misinformation, and stigma. "We…understand that some people have never seen a contraceptive device. Some people have never seen a condom before."

Joseph said helping patients find the birth control method that's right for them is rewarding. A patient who kept forgetting to take birth control pills but is thrilled with a patch or vaginal ring, or one who was worried about side effects and is now delighted with her IUD, can make her day.

Often, "they're just not aware of what's out there," she said.