An interview with Lisa Maldonado, Executive Director of the Reproductive Health Access Project
In 2008, the Low-Income Access Program gave out six grants to state and local groups that are implementing programs that work to expand access to birth control for low-income women. One of our grantees, the Reproductive Health Access Project, used the funding to integrate reproductive health care into free clinics and is working to replicate the model of the New York City Women’s Reproductive Health Free Clinic in other areas. To find out more about the Women’s Health Free Clinic’s activities, we spoke with Lisa Maldonado, Executive Director of the Reproductive Health Access Project.
How did the Women’s Health Free Clinic get started?
The Women’s Health Free Clinic came out of organizing efforts that started in 2005. The Reproductive Health Access Project (RHAP) pulled together a working group of New York City reproductive health advocates, including family medicine residents and medical students active in Medical Students for Choice, to explore ways that medical students and residents could get training in early abortion care. Though women in NYC have great access to abortion care, there are not enough training opportunities to accommodate interested medical students and residents. RHAP felt strongly that the inability to train these motivated future clinicians was a missed opportunity to address the national abortion provider shortage. After much planning, RHAP and the NYU Free Clinic, run by NYU medical students, combined forces to raise the funds necessary to launch the Women’s Health Free Clinic.
What services does the Clinic provide for women?
The Women’s Health Free Clinic (WHFC) providespregnancy testing, options counseling, Pap tests, screening forHIV and sexually transmitted diseases, Hepatitis B and HPV immunizations, contraceptive counseling, treatment of genital warts, IUD insertions, endometrial biopsy, first trimester ultrasound and medication abortion services. The WHFC also provides free contraception, including Emergency Contraception, and IUDs. We coordinate referrals for free mammogram and colonoscopy services and referrals for pre-natal care. All patients are screened for insurance eligibility and enrolled as appropriate by the WHFC’s social worker/case manager.
Who does the Clinic primarily serve?
The Women’s Health Free Clinic serves uninsured women and teens from New York City. We see women from all over the city, not just Manhattan. Most of our patients are not eligible for Medicaid or other public insurance programs – either because they aren’t documented or because they don’t meet the income criteria.
Who staffs the Clinic?
The services areprovided by a women’s health team made up of a family physician, a fellow, one or two family medicine residents, six medicalstudents and a social work intern. After appropriate training, the medicalstudents are responsible for providing patients with pregnancy testing, options counseling, HIV pre-test counseling, contraceptive counseling and medication abortion counseling. They also “shadow” their patients during the rest of their visit and learn to perform pelvic exams. All IUDs are inserted by the resident, fellow or the supervising family physician.
Can you talk more about the Community Advisory Board that works with the clinic?
Our Community Advisory Board is comprised of young women who reflect the WHFC’s patient population. They have provided important guidance in developing the program model and recently worked on updating all the educational materials used in the clinic. They have also attended RHAP’s board meetings and are helping fundraise for the project. The medical students on our Community Advisory Board have taken an active role in promoting the replication of the clinic.
What are some the successes the clinic has had thus far?
Our primary success is that the clinic has been realized and that all our collaborating partners have fully embraced the project! The clinic opened last February and by the end of 2008 had served 130 uninsured NYC women and teens. We had also trained 25 medical students and 12 residents in RHAP’s patient-centered, evidence-based approach to reproductive health. The NYU medical students are completely committed to the project. For them especially this project has been a tremendous experience. In addition to gaining valuable clinical skills, they are learning about the complex issues involved in providing reproductive health care and are becoming confident, articulate advocates for women’s health.
What obstacles does the clinic face?
The clinic is currently open every other Saturday. We would really like to expand the services – at least weekly. We have enough patient demand and student interest is also high. We just don’t have enough funding to support the expansion at this time. Fundraising is an area all free clinics struggle with, and now in this current economic climate funds are scarcer than ever and the need is growing!
How are you working to replicate the model in other areas?
We developed an online tool kit that summarizesthe steps we took todevelop theNYC Women’s Health Free Clinic (www.reproductiveaccess.org/freeclinic.html). It contains clinical protocols, patient information sheets, budget and planning tools, a teaching curriculum, you name it. We developed a postcard campaign to promote the website. And, we hit the road to spread the word. We developed a poster presentation and an interactive workshop on starting a Women’s Health Free Clinic that we are presenting at several national and regional conferences. We’ve been to Savannah, Kansas City, Pittsburgh, New York City and we plan on traveling to Omaha, Portland and Denver.
How have replication efforts gone? What other areas are working to duplicate this model?
There is tremendous interest in replicating the WHFC model. Since we started promoting the model and the tool kit, we have been working with medical students from New York City, New Jersey and New Haven. The Echo Clinic in the Bronx, run by medical students at Albert Einstein Medical College, just hosted a women’s health day. The Haven Free Clinic, run by medical students from Yale University, has already incorporated many of the elements of the NYC WHFC model into their clinic. In addition, next month we’ll go to Omaha to host a workshop on starting a women’s health free clinic at a national meeting of student-run free clinics. We will surely make more contacts there.
What are the future plans for the project?
We have three main goals for this project. One is to help the clinics we are currently working with remain financially viable. We also want to evaluate the educational effectiveness of the WHFC clinical experience. We are developing a survey that will assess changes in medical student knowledge, attitudes towards providing reproductive health and intentions to provide reproductive health services. It will take us some time to collect enough surveys to be able to draw sound conclusions, but we hope to have some finding within 18 months. And, finally, we’d like to raise funds to allow us to expand the amount of technical assistance we are now able to provide and to allow us to provide start-up grants to existing student-run free clinics interested in integrating our model.
Thanks to Lisa Maldonado for taking the time to talk with us about the Women's Health Free Clinic. To read more about the Clinic, visit the website.
