Jamie Bardwell, Danielle Lampton, and Danielle Lampton spent years at the Mississippi Department of Health learning about the state’s family-planning programs. Converge, an organization that focuses on reproductive health, was founded by them after they left the Department. Their team provided training to Mississippi health care providers, and assisted clinics in expanding their access to affordable birth control. Converge won a $4.5 million federal grant called Title X to help provide family planning services throughout the state. Title X-funded services have been available in Mississippi for a long time, but access has not been universal. Sometimes patients had difficulty calling clinics, even though they could get family planning services at nearly every county health department. The wait times for appointments can be lengthy. People ended up using shorter-acting IUDs and implants, rather than the more effective options like the pill or male condoms. According to federal data, the majority of Title X patients in Mississippi are below the poverty level and many are not insured. Poor access to care has obvious consequences: Most pregnancies occurring in Mississippi are not planned. Mississippi has the highest rates in chlamydia, gonorrhea, and HIV of any state in the nation. It also has the sixth-highest HIV rate. Converge cofounders claim that they have spent the past decade learning Title X’s complex rules and regulations. They also developed relationships with providers and patients to help ensure Mississippians have access to quality care. Bardwell stated, “It took us so long to become experts in this topic.” “And it is a topic and subject area that not many people in Mississippi are clamoring for to be experts on,” Bardwell said. They will offer services at a lower number of clinics than they did in the past, prioritizing the areas with the greatest need instead of the largest population. Scott County is one example of a target area. It has no federally accredited health center that focuses on people without insurance. They want to offer telemedicine, which will allow people to get their birth control prescriptions online without needing to travel to a clinic. Lampton stated that Converge is one of the main drivers of change in the way people receive family planning care. “And, most importantly, we believe that Converge will increase the amount of family planning care that is person-centered. This means care that is about patients’ preferences, values, and needs. Open Arms Healthcare Center, Jackson’s president and CEO, is cheering. Her clinic, which focuses its efforts on marginalized populations, has been a Title X subgrantee since 2005 and expects to see improvements under Converge. Gipson spoke highly of Converge co-founders. She has known them for many years. They actually care about women.” Title X programs are also being run in other states by nonprofits. Every Body Texas has been overseeing the state’s $15.4 million grant since 2013. Since 2014, Title X has been administered by an FQHC in Georgia. This FQHC beat the state’s health department to be named as Title X administrator. After the change, Title X usage in Georgia dropped from 115,000 to 86,000. The program had served 170,000 patients by 2020. This is the highest number of patients since 2006. Georgia’s state leadership stated that it was deeply concerned by the federal government losing Title X funding. The Mississippi health department has a different tone. Mississippi Today was told by Dr. Thomas Dobbs, the state’s health officer that Mississippi has been moving away from county clinics for many decades. He also said that Converge will allow them to form new partnerships with other providers. He said, “We are working closely with Converge in order to ensure a smooth transition in service delivery.” Converge will be setting up its network, he said. He also stated that Converge has extended previously unutilized grant funds to the department so that state clinics can continue operating for at least one year. Access to reproductive health care in Mississippi is limited by many of the same barriers that prevent all people from having access to it. In rural areas, especially, there aren’t enough nurses and doctors. Without transportation, people without access to healthcare may be unable to go to the pharmacy to obtain a prescription for birth control. Providers don’t have the obligation to give birth control to certain patients if they don’t wish them to. Caroline Weinberg, founder of Plan A, a mobile clinic that focuses on Delta reproductive health care, said, “Title X alone will not solve all of the issues.” Title X funded many clinics across the country since 1970 to ensure that all Americans have access to family planning and birth control services. The services include basic infertility treatment, birth control, sexually transmitted infections (STI) testing, and breast and cervical cancer screening. Patients whose family income is below the federal poverty level pay no fees, while those with higher incomes pay on a sliding-scale basis. Since the late 1970s, the Mississippi health department has managed the program. It offers services in nearly all counties. In 2021, eight subgrantees were also awarded funds. These were mostly federally-qualified health centers. The program was only used by about 25,000 Mississippians in 2018, a tiny fraction of the state’s reproductive-age women. Converge was commissioned by the health department to evaluate its 2019 family planning services. This report outlined basic problems that could have serious consequences for patients. It was first reported by Erica Hensley, Rewire News Group, and then obtained by Mississippi Today via a records request. Lampton spoke out about the Mississippi landscape for family planning care. The patient could also be placed on hold until the line is cut off. Staff misled patients about the cost of services, saying that they would be charged if they didn’t have insurance. Instead of explaining that fees are determined by income and waived for those with lower incomes, staff said something like “You will receive a bill if your insurance is not current.” The time was when the health department required that patients come in for an examination before they could receive full supplies of birth control. It could take several months to schedule an appointment. The report stated that a patient could go without birth control for up to six months and experience an unplanned pregnancies. The Mississippi Reproductive Health Access Project at Texas at Austin published a December 2021 study that summarized 498 client calls to federally-qualified health centers, private practices and health departments. Sometimes, staff at clinics said that patients could not choose which type of birth control they would receive. One caller was informed that it was up to the doctor what they wanted. Converge found that some clinics ran out of condoms. Dobbs stated that there would be “anecdotal problems and opportunities to improve standardization and customer services” in any operation. No doubt, staffing shortages have only exacerbated the problem. We will be able to focus our resources on specific needs by having Converge as our partner. We are also restructuring the oversight structure in counties to improve quality.” Although family planning visits to sites of health departments dropped slightly due to the COVID-19 pandemic, it was state policy which brought a dysfunctional system closer to collapse. Hensley reported that Mississippi was among at least four states that used an emergency rule to obtain federal authorization to divert Title X workers to COVID-19 response. The health department data shows that the sharpest drop in visits occurred almost a year after the outbreak. Hensley reported that the department had moved staff to the vaccination rollout. The total number of visits to the health department sites decreased 33% between December 2020 and January 2021. They dropped another 45% the following month. The number of visits increased the remainder of the year but had dropped by 30% by 2021. Dobbs stated that the state’s “severely diminished” health workforce was given extraordinary tasks, especially early in the vaccine distribution process. He said that “these public health heroes worked countless overtime AND made sure TB, STIs were addressed.” “Though follow-up appointments were sometimes delayed, refills were kept in order to maintain continuity of treatment.” Wyconda opened Healthy Living Family Medicine Center in Gunnison in 2018, a small town in Bolivar County. Rosedale was eight miles from her home and she wanted to help the same community where she grew up. She describes herself as a “one-stop shop” and her clinic motto says, “Delivering quality healthcare where it’s most needed.” The closest hospital is about 30 minutes away. She said that Rosedale used to receive an ambulance service twice a week. “So you had the choice of which day you had heart attacks.” She doesn’t anymore see Rosedale’s ambulance. In 2021, Thomas was a Title X Subgrantee. According to health department data, her clinic had 426 family planning visits in her first year. This was more than any other sub-grantees or five county health departments. She was able to offer family planning services to patients she already saw regularly with the $40,000 grant. She also sees many teenagers and takes advantage of their well child exams to provide some basic information. She said, “We also include family planning, just education about their body, changes in their bodies and what their bodies can do, which is getting pregnant.” If they are interested, we discuss the various types of birth control. We discuss how to avoid pregnancy. Tyler Harden, Mississippi’s state director for Planned Parenthood Southeast said that people can’t learn a lot about things they don’t already know. Thomas is able to see that link daily with her patients. They rely on her for information about their options and the possible side effects of contraceptive methods. She also offers her opinions on which method might be best for them. She said, “If they don’t know something it falls on me.” Converge leaders state that they will actively promote services rather than wait for patients to find them. They also want to provide information for patients. Converge created Personally to assist patients in finding a clinic. Users can search for services and accept different payment methods on the site. Jitoria Hunter is the director of external affairs. “We wanted patients be able see things before even getting to their visits,” she said. “Like talking to your providers and looking into the different methods they have access too.” Title X is open to all non-profits, county health departments, and hospital-based clinics. The application process for online membership is ongoing. Prospective and current subgrantees will be waiting to see what Converge brings. Thomas stated that she would love to have more opportunities to attend conferences and trainings. She said, “Just like resources that I could go to and learn more to return to my patients.” Gipson hopes Converge will be more responsive to the suggestions and questions of subgrantees. She hopes that the program will be less bureaucratic and provide more support for innovation. Desiree Norwood was the mayor of Sunflower, Delta before joining Plan A to serve as program coordinator. She witnessed firsthand the reactions of people who live in areas with limited options for healthcare when a mobile clinic visited their community. Plan A plans to apply for funding through Converge. Norwood stated that Converge would fund “small, innovative programs,” such as Plan A. Converge will also be funding programs that are rooted within the community. This is just as Converge takes over Title X administration. Converge’s move comes as the Supreme Court is poised to significantly weaken Roe through a ruling in Dobbs v. Jackson Women’s Health Organization in Mississippi. However, Mississippi’s Roe did not fully protect abortion access. Only one clinic is still open, down from thirteen in 1982. Reproductive health advocates now see an attempt to blur the line between contraceptives and abortion: Some Republicans in Missouri have argued that IUDs “abortifacients.” The Title X program was a target in the past. A Trump administration regulation in 2019 prohibited grant recipients from referring patients to abortions. This caused about a quarter (25%) of the Title X network sites to exit. Converge will need to do more than just expand access to quality health care. Converge may have to defend Mississippians’ rights to birth control. Lampton stated, “It’s important that everyone understands that getting family planning care at a Title X location is legal.” Bardwell said that family planning care would be the next priority if Roe is repealed. It’s all about reproductive autonomy. We know that people need to be aware, as Danielle stated, that this is health care. This is fundamental health care.