Rural Georgia gets more contraceptive options through expanded delivery of birth control implants

The Georgia Department of Public Health is kicking off its Power of Family Planning program, an initiative that aims to reduce unintended or complicated pregnancies. And women in rural Georgia stand to benefit the most. 

Now registered nurses are allowed to administer contraceptive implants, such as Nexplanon, into the arm. Previously, the implantable could only be inserted by a physician, a nurse practitioner or a physician assistant.

Georgia is the first state to give registered nurses the leeway to perform this procedure. 

The Georgia Maternal Mortality Review Committee, the American College of Obstetrics and Gynecology, the Centers for Disease Control and Prevention and others have pushed for long-acting reversible contraceptives to reduce unintended pregnancies, said Victoria Gordon, director of advanced practice registered nurses for the Georgia Nurses Association. 

That can lower the risk of premature births, low birthweight in newborns and other pregnancy-related complications, she said.

“Georgia could be the blueprint for a lot of other states in terms of coming up with creative ways to increase access to women’s health care, GYN care and OB care when there isn’t a provider available, ” Gordon said. “So it is a creative way to use what you have to accomplish what needs to be accomplished.”

The first group of nurses was trained last fall, and based on DPH data, a total of 63 nurses have been trained in non-metro districts across the state, including a total of three trained nurses in Lowndes County near the Georgia-Florida line.

Diane Durrence, the director of women’s health for the department, said that the family planning program had a significant increase in federal funding in last year’s budget. And the department has implemented new initiatives in reproductive health since the program’s official start in March.

 Cobb County bus stop advertisement for the Power of Family Planning program by the Georgia Department of Public Health. Aaleah McConnell/Georgia Recorder

Caption

Cobb County bus stop advertisement for the Power of Family Planning program by the Georgia Department of Public Health.

Credit: Aaleah McConnell/Georgia Recorder

The contraceptive implant has been provided in public health department facilities for several years for free or at low-cost, according to Nancy Nydam, the department’s director of communications. 

The problem is patients in many rural communities lack access to the local public health departments, which in many cases is the only provider of the service, she said.

“Adding RNs as providers of implant services will increase the workforce available to provide the service,” Nydam said. “There will be more staff available in more locations, especially rural areas that have fewer numbers of higher-level providers.”

One of the goals of the Power of Family Planning Program is to prevent the chance of high-risk pregnancies caused by cardiovascular conditions and hemorrhages, which are two of the leading causes of pregnancy-related deaths in the state, said the department’s director of government relations, Katie Kopp, who manages the maternal mortality review committee. 

That committee recently found that the rate of pregnancy-related deaths in Georgia increased about 20% during a three-year period that includes the first year of the pandemic. And according to the U.S. Maternal Vulnerability Index, Georgia has a high maternal vulnerability score of 62 in reproductive health care. Which means there is less access to high quality family planning and reproductive services, such as abortions. 

Mitchell County and bordering Worth County have the highest maternal vulnerability rates in the state. Mitchell County ranks 72nd and Worth County ranks 84th. According to the Georgia Data Analytics Center’s physician workforce distribution data, there are little to no maternal care physicians in these rural counties. 

The closest county with only one actively practicing physician in maternal and perinatal care is Lowndes County.

As the chairwoman of the House Appropriations Subcommittee on Health, Thomasville Republican Rep. Darlene Taylor, helps craft the state’s health care budget. 

And like any other program, Taylor said, she’ll be watching to see if this program works and is reaching the right places.  

“I represent rural Georgia so to me it is important that we have access just like they do in the larger communities,” Taylor said. “This is something that I think will help.” 

Rep. Carolyn Hugley, a Columbus Democrat who also sits on the subcommittee, said it is important that women in Georgia have family planning options and the support of medical professionals, especially today. When the U.S. Supreme Court overturned the decades-old precedent protecting abortion access last June, Georgia’s six-week abortion ban took effect about a month later.

“We find ourselves in a situation where there’s so many areas in our state where maternal health services are not available,” Hugley said. “People are great distances away from doctors. There’s a shortage of medical professionals in certain counties. So, I think it’s a great opportunity for us to learn and to see how we can ameliorate some of those problems.” 

Although registered professional nurses have been authorized to provide this service under Georgia law since 1989, nurses have vied with higher-level medical physicians to expand their services for years, Hugley said. This turf war even spilled over into this year’s legislative session. 

But lawmakers ultimately passed Senate Bill 197, prohibiting non-physicians, including advanced practice nurses and physician assistants, from using the title “doctor” in their advertisements, even if they have a doctorate. Many nurses argued that this bill further divided health care professionals. 

The start of this program is one way registered public health nurses in particular can expand their services for those in the most need of it, Gordon said.

“A lot of times public health nurses will be trained and taught on a variety of different procedures that may or may not fall under the usual scope, or territory for RN,” Gordon said. “Allowing an RN to be able to administer this medication just increases its availability in those counties.” 

Funding from the federal Temporary Assistance for Needy Families Block Grant, which DPH receives from the Georgia Department of Human Services, backs the training for public health nurses, according to Nydam.

The company that provides training for the implant procedure is Organon, a pharmaceutical company based in New Jersey that previously only trained medical doctors and mid-level providers. 

Nurses must complete observed checkoffs, in addition to completing the training and meeting the required standards set forth by Organon, Nydam wrote. 

“Nurses have always been a critical part of our health care network,” Hugley said. “They’re the first person to actually meet with patients and talk to them and relate to them. So I think it’s a great opportunity for us to expand on what they’re doing, and learn from it.”

This story comes to GPB through a reporting partnership with Georgia Recorder.