Education. Access. Collaboration.

EDUCATION. ACCESS. COLLABORATION.
A community health assessment focused on
preventing unintended pregnancies among
18- to 29-year-olds in Charlotte-Mecklenburg

C O N T E N T S
Message from the Funders
i
Acknowledgments
ii
Introduction 1
Key Findings 2
Why Does it Matter for
Economic Mobility? 3
Success Stories from across the U.S. 4
Setting the Stage 6
Research & Results 11
Data Collection Methods 11
Findings from Focus Groups 12
Findings from Clinical Assessment 13
Opportunities for
System-Level Improvements 14
Findings from Key Leader Interviews 15
Pathway to Prevention 16
Big Picture Strategies 17
Recommendations 18
Endnotes 19
Published September 2018 based on research
conducted from January to October 2017

MESSAGE FROM THE FUNDERS
In January 2017, a collaborative group of foundations
consisting of Foundation For The Carolinas,
The Duke Endowment, The Leon Levine Foundation,
and the Winer Family Foundation commissioned
the consulting firm 1000 Feathers, LLC, to
lead a community health assessment of unintended
pregnancy focused on 18- to 29-year-olds in Charlotte-Mecklenburg.
Our goal in producing this report was to better understand and draw attention
to the issue of unintended pregnancy, not only because of the health risks
to mothers and their children and the socioeconomic impact on families, but
also due to the onus placed on entire communities. 1 The Leading on Opportunity
report, released by the Charlotte-Mecklenburg Opportunity Task Force in
March 2017, shows the implication unintended pregnancy can have on the life
trajectory of both parents and children, particularly when financial resources
and social capital are limited. Conversely, the power of an intentional birth, the
opportunity to make informed decisions, and access to reproductive healthcare
are factors in a pregnancy and birth primed for success.
We knew that undertaking an assessment using sound, local data would allow
us to decipher the current landscape of access to effective birth control and
family-planning services and the potential impact on economic opportunities
for women and their families. The community’s perspective on the issue was
instrumental in understanding what, if anything, should be done to address it.
We also realize the project has the potential to be seen as controversial
given North Carolina’s shameful history of forced sterilization of minorities.
As the Leading on Opportunity report stated, “We acknowledge it can be a
charged topic and people will have different perspectives on the matter.” 2
Our objectives were to extend the work of the Opportunity Task Force
related to Strategy K by:
1. Increasing awareness, building capacity, and identifying opportunities
for cost-effective interventions to reduce unintended pregnancy;
2. Assessing the landscape of available resources to identify and create
linkages between existing service providers, community organizations,
and healthcare providers; and
3. Identifying feasible and appropriate paths forward, including a set of next
steps and detailed recommendations we could present to the community.
Moving To Action: Next Steps
As funders, we are encouraged by the positive efforts taking place in other
cities and states to reduce unintended pregnancy. We firmly believe progress is
achievable for Charlotte-Mecklenburg as well.
i
Strategy K:
Ensure young women and men have access to the necessary information
about and resources for reproductive healthcare to ensure they can plan
for pregnancy when they are ready to and choose to have a child.
—Leading on Opportunity report

This assessment outlines a number of recommendations
our community should consider to raise awareness
about the value of and options for preventing unintended
pregnancies, thereby empowering men and women to
plan for when they are ready and choose to have a child. It
represents a phase of much more work to come. Our next
steps will include convening local stakeholders to share and
discuss the recommendations to determine how we, as a
community, can lay the building blocks of work that will
be required to move to
An unintended pregnancy
is a pregnancy that is
reported to have been
either unwanted (that is,
the pregnancy occurred
when no children, or no
more children, were
desired) or mistimed
(that is, the pregnancy
occurred earlier than
desired).
—Centers for Disease
Control and Prevention
action. Identifying a
champion to help drive
a coordinated approach
to implementation,
building trust and understanding
within the
community, connecting
with emerging efforts at
the state level, and seeking
potential funding
partners for implementation
are among these
foundational blocks
of change. We believe
generating a few early
“wins” to help advance the work will be important, and we
will seek opportunities to support such efforts.
In the meantime, we invite you to read this report in
its entirety, discuss it with your friends, colleagues and
neighbors, and consider joining us as we take the next steps
towards implementing the big picture strategies and suggested
recommendations on pages 17-18.
ACKNOWLEDGMENTS
This community health assessment was
led by Forrest Alton and his team at 1000
Feathers: Dr. Heather Brandt, Isaiah
Nelson and Cayci Banks, who deserve
special recognition for a job well done.
1000 Feathers partnered with Power to
Decide (formerly the National Campaign
to Prevent Teen and Unplanned Pregnancy);
the University of North Carolina-Charlotte
Urban Institute; NP Strategy;
Darling Media Group; Leading to Change;
Philliber Research & Evaluation; Mecklenburg
County Public Health Epidemiology
Department; and the Academy for Population
Health Innovation (APHI), a collaboration
of UNC-Charlotte and Mecklenburg
County Public Health.
This project would not have been
possible without the generous support
of the individuals who contributed to
discussions, data collection, analysis,
interpretation, and report writing. Special
thanks to Drs. Michael Dulin and Claire
Schuch of APHI, Diane Gavarkavich and
Katie Zager of the Urban Institute, Erin
Sanders of NP Strategy, Katy Suellentrop
and Becky Griesse of Power to Decide,
Sara Lovett of Mecklenburg County Public
Health, Dr. Yhenneko Taylor of Atrium
Health (formerly Carolinas Healthcare
System), and Dr. Charlotte Galloway of
the University of South Carolina.
Finally, thank you to more than 800
residents of Charlotte-Mecklenburg who
participated in the assessment and were
willing to share their thoughts, opinions,
and insights.
ii

INTRODUCTION
This report does not focus on
preventing teen pregnancy.
Teen pregnancy prevention
efforts have been a traditional
staple of public health systems
for decades. In fact, the
U.S. has witnessed well-documented progress on this
front since 1991, when the rate of teen pregnancies
peaked nationally. Since then, teen birth rates have
decreased by 67 percent—among all age
groups and races. 3 Because these efforts
have been hugely successful with continued
declines nationally, statewide,
and locally, this report focuses on young
women between the ages of 18 and
29 who are responsible for nearly half
of all births in Mecklenburg County.
Without similar levels of attention and
investment, 18- to 29-year-old females
may continue to experience rates of
unintended pregnancy that contribute
to a broad array of socioeconomic and
health risks to mothers, children and
their families.
Women who plan their pregnancies
are more likely to prolong the interval
between pregnancies, receive prenatal
care, and avoid adverse health behaviors
such as smoking and drinking—all
of which are associated with healthier
birth outcomes. Preconception and
prenatal care impact the health of both
mother and child, helping
Women who
plan their
pregnancies are
more likely to
prolong the
interval
between
pregnancies,
receive
prenatal care,
and avoid
behaviors such
as smoking and
drinking.
reduce premature and
Pregnancies by Intention Status (2011)
low-birthweight births, and
In the U.S.
In North Carolina
infant deaths. 4,5
Despite efforts to
improve prenatal care
access and utilization, there
has not been a concurrent
decline in adverse birth
outcomes locally or nationally.
For over a decade,
premature births continue
45% 55%
n Unintended
54%
n Intended
46%
to account for roughly 12
percent of all births. Lowbirth-weight
Source: Guttmacher Institute
infants account for about 9 percent of all
births in Mecklenburg County. Significant disparities
1
in adverse birth outcomes also exist, especially among
minority women. Unintended pregnancy is also
associated with mental health issues, increased levels
of physical abuse for mothers and their children, and
less stable romantic relationships. 6
While the social and economic costs of unintended
pregnancies can be significant to individuals and
families, the costs to taxpayers is also high. According
to a 2015 study by the Guttmacher Institute, public
health related expenditures resulting from
unintended pregnancies nationwide totaled
$21 billion in 2010.
Estimates of state and federal medical
costs are upwards of $12.6 billion annually.
These costs include prenatal care, labor
and delivery, and postpartum care for women,
as well as infant care among women
who participate in Medicaid or the Children’s
Health Insurance Program. North
Carolina’s cost was $858 million. The
study further states that in North Carolina,
the potential gross savings from preventing
unintended pregnancies could have been
$632.7 million in 2010. 7
For North Carolina women aged 15 to
44, the unintended pregnancy rate remains
higher than national averages. In fact, the
proportion of unintended pregnancy in
North Carolina is 54 percent compared
with 45 percent nationally. Perhaps more
importantly, the unintended pregnancy
rate in the state has been relatively flat,
with no measurable decrease
between 2002 and
2010. 8
The issue of unintended
pregnancy is
complicated. An equally
complex, multi-method
health assessment was undertaken
in response. The
purpose of the assessment
was to compile and analyze
data, as well as energize
members of the community
to “own” the issue. The
key to success will be the continued involvement of
the community.

As the project team conducted the assessment
phase of this report, the researchers kept coming
back to three fundamental truths. These three
truths, as well as a set of universal key findings,
guided the project team as they created the big
picture strategies, the pathway to prevention, and
the suggested recommendations.
THREE TRUTHS
• Unplanned pregnancy is an issue that
impacts ALL women, men and families
regardless of race or socioeconomic
status. The issue is particularly prevalent
for women aged 18 to 29; therefore, this
is a population that deserves increased
attention.
• Efforts targeting education and access
should emphasize the full range of
current, effective contraception methods
in combination with family-planning
services. While long-acting, reversible
contraception (LARC), such as intrauterine
devices (IUDs) and implants, are the
most effective form of birth control, they
are not the only methods. All women
should be empowered to choose the
method that works best for them.
• National and local data and conversations
within the community indicate
inequities by race and socioeconomic
status continue to exist within Charlotte-
Mecklenburg.
KEY FINDINGS
The 10-month assessment yielded a set of universal key
findings, grounded in data and community input and
supported by national best practices, as follows:
• The sheer number of residents and public/
private support systems in Charlotte-Mecklenburg
make universal change challenging. A successful effort
should elevate community champions, engage community
members, and work with trusted organizations.
Although the community has widespread support for
practical solutions to preventing unintended pregnancy,
efforts must scale up carefully and be realistic about
short- and long-term outcomes.
• Healthcare providers’ lack of coordination creates
care that is highly fragmented, disconnected, and
difficult to navigate. Young adults should be provided
with information about where to receive care, what
types of contraception are available, and how to communicate
effectively with medical providers.
• Women cannot readily access the full range of
contraceptive methods available in a timely fashion.
All women, and especially those of low socioeconomic
status, should have equal access to prenatal care and
effective birth-control methods. In addition, barriers
to transportation and childcare should be addressed by
policies that create equal and affordable access.
• Limited capacity and training create gaps in
services among healthcare providers. Capacity building,
site-specific training on contraceptive options and
access, and system-wide changes are needed.
• Among 18- to 29-year-olds, a general feeling of
ambivalence surrounding pregnancy exists, as well as
a knowledge gap related to contraceptive options, available
healthcare services, and the connection between
unintended pregnancy and opportunities for upward
economic mobility. Education and information campaigns
should be created and implemented to close the
knowledge gap.
• Conversations about unintended pregnancy
occur within a complex narrative about life choices,
disparities, and access to healthcare. An array of
strategic partners and community-based organizations
is required to address this reality and provide consistent,
factual education, as well as referrals to affordable
contraceptive care.
2

WHY DOES IT
MATTER FOR
ECONOMIC
MOBILITY?
Unintended pregnancy is an
issue that impacts everyone,
yet rates of unintended pregnancy
vary with age, race,
income, and marital status.
Thus, increasing education
and information on birth
control for all women and
men is critically important. The same can be said
for ensuring uniform access to the most effective
methods of contraception, especially in traditionally
under-served communities where access and cost are
recurrent barriers.
Ultimately, the question we should ask is: How do
we best increase information on and access to all methods of
contraception for all women and men so they may determine
when, if, and under what circumstances to have children?
National data show disproportionality among
populations of women who already face significant
barriers to upward mobility. Women in their teens
and early twenties, who are unmarried,
already have children, and have low income
and lower levels of education are more likely
to experience an unintended pregnancy.
In fact, as many as 75 percent of unintended
pregnancies to women under 30 are
not their first pregnancies. Because women
with lower socioeconomic status have higher
rates of unintended pregnancy, it is both a
symptom and a cause of poverty. 6,9
Educational success is a closely related
outcome and is also influenced by unintended
pregnancy. Among female communitycollege
students, nearly one in 10 dropouts
is related to an unplanned birth. The majority
of community-college students who have
children after enrolling in school do not finish their
education. And teen mothers are less likely to attain
a high-school degree than their peers who delay parenthood:
30 percent of young mothers who dropped
out of high school cite pregnancy or parenting as a
reason. 10
Because earning a living wage without a highschool
or college diploma is harder, it is not surprising
that women who experience unintended
pregnancy have a greater chance of living below the
poverty line. Forty-one percent of mothers who gave
3
birth before age 20 were living in poverty within
the first year of their child’s birth. This percentage
increased to 50 percent when their child reached the
age of 3. Conversely, women earn more for each year
of delayed childbearing, even after accounting for
differences in other background characteristics that
affect their earnings. 6,9
Progress Is Possible
One of the reasons the issue of unintended pregnancy
garners so much attention is because communities
across the country have proven that progress
is possible. Successful initiatives across the U.S. have
focused on young adults in recent years; the emphasis
has been on increasing availability and access to
the full range of contraceptive methods, including
long-acting reversible contraception (LARC), such as
intrauterine devices (IUD) and implants. IUDs and
implants are the most effective methods; each has a
failure rate of less than 1 percent.
Nonusage of Contraception by Poverty Level in U.S.
Percent of single women, aged 15
to 44, who had unprotected sex in
year prior to survey (2011-2013)
16%
14%
12%
10%
8%
6%
4%
2%
0%
Less than 100 to 200 to 300 to 400%
100% 200% 300% 400% or more
Income level as percent of the federal poverty line
Source: Brookings
With assistance from the staff of Power to Decide
(formerly the National Campaign to Prevent Teen and
Unplanned Pregnancy), the project team for this assessment
compiled a list of recent efforts from around
the country that show success in reducing teen and
unplanned pregnancy. The majority of the success stories
highlighted on the facing page include an intense
focus on providing education, information, access,
and improving affordability of contraception. This
is important because 95 percent of all unintended
pregnancies in the U.S. are the result of inconsistent

Colorado Initiative to Reduce
Unintended Pregnancy
• Teen birth and abortion rates
statewide decreased 40% and 35%
respectively
• From 2008-2014, IUD and implant
use grew from 4.5% to 29.6%
• Abortion rate among women aged
20 to 24 decreased 18%
• 9 of 10 teen moms who received
an IUD or implant before leaving
the hospital after delivery did not get
pregnant again within 2 years
• Number of teens with repeat births
decreased 58%
http://bit.ly/2DaqXsy
Iowa Initiative to Reduce
Unintended Pregnancy
• Number of providers offering
LARC and number of clients
choosing LARC both increased
• Increase in access to family planning
services
• Decline in the proportion of
pregnancies reported to be unintended
• Decrease in abortions
http://bit.ly/2HkwSxF
Contraceptive CHOICE
St. Louis, Mo.
• 73% of women selected an IUD
or implant for their birth control
method
• Among women who selected
an IUD or implant, 86% were
still using that method 1 year later
compared to 55% who chose a
different method
• Women using a method other
than IUD or implant were 20
times more likely to have an unplanned
pregnancy
http://bit.ly/2I8UeaJ
Communities
across the nation
are reducing
unintended
pregnancy
Take Control Initiative
Tulsa, Okla.
• Teen birth rates declined 41%
• Abortion rates decreased 36%
• IUD and implant use increased
http://bit.ly/2c0ALdG
Gaston Youth Connected
Gaston County, N.C.
• Number of evidence-based teen
pregnancy prevention programs
increased
• Teen pregnancy rate decreased
40% over 3 years
• Systems were developed to
support evidence-based pregnancy
prevention strategies, including
program services integrated with
clinical services
http://bit.ly/2FkSvkM
South Carolina Campaign
to Prevent Teen Pregnancy
Spartanburg County, S.C.
• County’s teen birth rate fell below
the state rate for the first time in
history
• From 2010-2015, the disparity
between teen births among African
American and white females was
eliminated
• 1,800 youth were reached through
evidence-based programs; 500 youth
and families were reached by a community
health worker
• 15- to 19-year-olds seeking reproductive
health services inceased 22%
• Local implementation agency was
the Mary Black Foundation
http://bit.ly/2FzkHQm
4

Unintended Pregnancy Rates in U.S. per 1,000 Women (2011)
140
120
100
80
60
40
20
0
18 to 19
20 to 24
25 to 29
White
African
American
Hispanic/
Latino
< 100%
100 to 199%
> 200%
Married
Cohabitating
Neither
n Age n Race/Ethnicity n Income n Relationship
Source: Power to Decide
or nonusage of contraception. Data from the Guttmacher
Institute suggest that sexually active couples who
do not use contraception have an 85 percent chance of
experiencing a pregnancy over a 12-month period. Even
when couples do use contraception, they are not often
choosing one of the most effective methods. The reasons
range from lack of access to the inability to pay for
LARC.
Closing The ‘Contraceptive Gap’
Research by Brookings scholars Richard Reeves
and Joanna Venator has further emphasized the role
of closing the “contraceptive gap,” especially among
low-income women. Using data from the National
Survey of Family Growth, the researchers considered the
roles of sexual activity, contraceptive use, and abortion
on unintended childbearing across income levels. They
found no measurable differences in the sexual activity of
the groups. However, significant differences appeared in
contraceptive use—of any type—by income level. Reeves
and Venator surmised that equalizing contraceptive use
alone would reduce the differences in unintended births
across all income levels by half. 11
Given the importance of birth control, any initiative
to reduce unintended pregnancy should emphasize
education on contraceptive use and increased access to
all of its forms. Unfortunately, IUDs and implants are
5
the costliest and most
difficult forms to obtain.
Nationally, only
12 percent of sexually
active women are currently
using a LARC.
While contraceptive
use overall varies by
demographics, the
use of LARC methods
is fairly even
across indicators such
as income level and
insurance status. National
data on LARC
use indicate that
increasing its utilization
is a challenge for
Percent of Unintended
Pregnancies in U.S.
by Age (2011)
32%
15%
25%
28%
n 15 to 19 n 20 to 24
n 25 to 29 n 30 and older
Source: Power to Decide
every demographic group. 12 The majority of the successful
campaigns have focused on improving education and
access to LARC and IUDs.
Of course, reducing unintended pregnancy alone
will not solve the challenge of diminished upward
mobility, but research strongly suggests it is an essential
component of more comprehensive strategies for
communities seeking greater economic opportunity for
their residents. 6,9,11,13

SETTING
THE STAGE
Mecklenburg is North Carolina’s
most populous county,
and Charlotte is its largest
city. More than 1 million
people live in the county;
80 percent are within the
city limits. Charlotte-Mecklenburg’s citizenry is
heterogeneous: fewer than half (49 percent) are white,
making it a majority-minority county. In addition:
• 31 percent are African American,
• 13 percent are Hispanic or Latino, and
• 7 percent are other races/ethnicities.
Nearly 60 percent of residents were not born
here, and nearly one-quarter are aged 15 to 29. 13
An estimated 90,000 Mecklenburg County females
(9 percent) are aged 18 to 29.
Although data for the age group 18
to 29 are not as abundant as for 18- to
34-year-olds, looking broadly at statistics
for young adults is instructive. The
population of women in Charlotte-Mecklenburg
between the ages of 18 and 34 is
more racially and ethnically diverse than
the county as a whole, as well as North
Carolina as a whole. 15
In addition, women 18 to 34 graduate
from high school at a rate equal to
county averages, but a lower percentage
has earned a bachelor’s degree. Charlotte-Mecklenburg
residents with a professional/graduate
degree earn a median
income 2.5 times higher than those with
only a high-school diploma, and they are
four times less likely to live in poverty. 16
Women have higher rates of poverty
than men in Mecklenburg County, across
all levels of educational attainment. More
than a quarter of women aged 18 to 34 live
in poverty, a rate that is 10 percent higher than the
county as a whole. And Charlotte-Mecklenburg women
aged 16 to 34 are more likely to be unemployed.
Healthcare coverage also deserves mention in the
context of this report. In both the U.S. and North
Carolina, 18- to 34-year-olds are more likely to be uninsured
than those in other age groups. 17 Nationally,
8.8 percent of the total population has no public or
private health insurance, compared with 10.4 percent
in North Carolina.
Nearly 12 percent of North Carolina women aged
25 to 34 and 6.4 percent aged 18 to 24 are uninsured.
18 In Mecklenburg County alone, an estimated
174,000 individuals are currently uninsured. 15 And
North Carolina is one of 19 states that chose not to
expand Medicaid coverage under the Affordable Care
Act.
Local Birth Trends
To understand the distribution of births by age,
race/ethnicity, and where possible, by intentionality,
the project team analyzed local birth trends and related
data. According to Mecklenburg County Public
Health, there were a total of 14,851 births in 2015.
Of the total births, 47 percent (7,030) were to women
aged 18 to 29. 19
Birth Rate by Race/Ethnicity
Among Women Aged 18 to 29 (2015)
160
140
120
100
80
60
40
20
0
Total White African Hispanic/ Other
American Latino
n North Carolina
n Mecklenburg County
Source: Mecklenburg County Public Health
“Birth rate” is defined as the total number of live
births per 1,000 of a population in a year. Birth rates
are often compared to death rates to examine net
population growth and are used to compare juridictions—countries,
counties, etc. However, birth rates
do not take into account who is specifically having
children, i.e. women.
“Fertility rate” refers to the number of births to
women in a given age group per 1,000 women in that
age group (i.e. total births to women aged 15 to 44).
6

Fertility rates can be used to look
at reproductive patterns for different
female populations by age group, and
race/ethnicity.
Because the numbers for one county
are much smaller than those for the
entire U.S., local rates may fluctuate
more from year to year, so five-year rates
are often looked at for a clearer picture.
For the purposes of this report, the term
birth rate is used and specified by female
age group.
In 2015, the birth rate in Mecklenburg
County for all women aged 15 to 44
(the standard reproductive age) was 62.4
per 1,000 women. For women aged 18
to 29, the birth rate was 75.8 per 1,000
women.
The project team’s analyses of birth
data identified the following:
• Compared to African Americans and
Hispanic/Latinos, white females tend to
have children at a later age. Childbearing
peaks in the early 20s for non-Hispanic/
Latino black women and in the late
20s for Hispanic/Latino women. For
non-Hispanic/Latino white women, the
peak occurs in their early 30s.
• Birth rates have generally declined
in Charlotte-Mecklenburg across all
females under 30, with the most dramatic
decreases occurring among teens. Not
surprisingly, birth rates for women in
their 20s are considerably higher than
those for teens.
• Birth rates in North Carolina and Mecklenburg
County differ significantly by race.
While birth rates demonstrate who is having children
at what age, determining the intendedness of a birth
is more complex. The best measure of pregnancy intendedness
is conducted through a Centers for Disease Control
and Prevention (CDC) survey called the Pregnancy
Risk Assessment Monitoring System (PRAMS). This
survey asks mothers who recently gave birth whether
or not they intended to become pregnant prior to the
pregnancy. 20
7
Interpregnancy Interval of Six Months or Less
for Women Aged 18 to 29 by Zip Code (2011-2015)
Percentage of births
with IPI of six months
or less by zip code
n 0%
n 1% to 2.7%
n 2.8% to 5.4%
n 5.5% to 9.7%
Source: Mecklenburg
County Public Health
However, this survey is conducted only at the state
level and does not provide a specific picture of pregnancy
intendedness by smaller geographic areas, such as a
county. In addition, the survey sample size fluctuates: A
sample for a specific county might not be adequate to
appropriately represent the demographics of that county.
In the absence of true PRAMS data for Mecklenburg
County, the Interpregnancy Interval (IPI) is used
as a proxy to estimate pregnancy intendedness and the
need for family planning. While IPI has limitations, it is
the most accurate alternative to PRAMS data because it
is derived from birth-certificate data.

Interpregnancy Interval
For this assessment, IPI was analyzed among a subset
of women who have had two children or more. The
timing of this interval between a live birth and the next
pregnancy may affect the risk of adverse birth outcomes.
Factors such as maternal age and socioeconomic status
may affect IPI patterns negatively. The distribution of IPI
patterns among different reproductive age groups and
racial/ethnic groups shows the importance of providing
education and information about access to effective
family planning services during postpartum periods to
reduce adverse birth outcomes associated with short IPI.
Research shows intervals of less than 18 months and
intervals greater than 60 months have been associated
with higher risks of adverse health and birth outcomes,
Selected Birth Data in North Carolina by Age (2015)
Age Total births Percentage of births Percentage of all births
by age group among women under 30 in Mecklenburg County
17 and 204 3% 1%
younger
18 to 24 2,994 41% 20%
25 to 29 4,036 56% 27%
Total 7,234 100% 48%
such as prematurity and low birth weight. The shorter
the interval the higher the risk of adverse birth outcomes.
Changes in the distribution of the interval among
different age groups highlight the need to provide education
about the benefits of family planning and contraception
during the postpartum period to reduce short
interval term births. Thus, an especially short IPI (six
months or less) is used as a strong indicator of the need
for access to contraception and family-planning services.
From 2011 to 2015 in Mecklenburg County, the median
IPI for all women was 25 months, and it increased
with maternal age, which is consistent with national
data. For women aged 18 to 29, the overall median IPI
was 22 months. Women between the ages of 18 and 29
accounted for 51 percent of all women who had an especially
short IPI. Birth-rate patterns tell us which populations
are having more children in their 20s, and IPI data
show the frequency for which births to women in their
20s are closer together.
Where Are The Greatest Needs?
The Leading on Opportunity report introduced
many community members to the term “targeted
universalism,” a strategy that allows the conditions
of targeted efforts for marginalized groups to coexist
with mutual benefit for all. Given limited resources in
communities—both financial and in human capital—it
is critically important to understand where to focus
efforts. Throughout this assessment, the project team
was reminded of the necessity to develop strategies with
universal benefit, as well as the responsibility to direct
resources to communities where access to healthcare is
most limited. Therefore, the
obvious question was, Where
are the needs the greatest?
The project team was
frequently reminded of the
fact that “many voices in this
community go unheard...
make sure you are listening to
them.” A second, oftenrepeated
message was “assure
me you are not targeting a
specific community or a single
demographic.” This input impressed
upon the project team the necessity of utilizing
the concept of targeted universalism.
Source: N.C. Center for Health Statistics
Greatest Need By Age
Since 1991, the teen birth rate in North Carolina
has declined by 66 percent to the lowest level in recorded
history. 21 This and other data clearly support shifting
the focus to young adults under the age of 30. In Mecklenburg
County, 48 percent of all births occur within
this age group. According to the 2016 Mecklenburg State
of the County Health Report, 44.3 percent of all births
in the county the previous year were to mothers aged 20
to 29, and 4.5 percent were to mothers younger than 20.
Of the births to mothers under 20, more than two-thirds
were among those aged 18 to 19.
The recommendation to focus on women aged 18
to 29 aligns with the specific recommendation by the
Leading on Opportunity report that states, “We also
8

must not lose sight of our disconnected youth and
young adults—those aged 16 to 24 who are not in school
or the workforce. They are at exceptionally high risk of
economic and social hardship.” 2 Nationally, one in seven
young adults in this age range are “disconnected,” that
is, not in school and not working. 22
Finally, many conversations during the assessment
supported an incorrect assumption that “teen pregnancy
prevention” and “unintended pregnancy prevention” are
synonymous. They are not. Teens aged 17 and younger
deserve continued attention, yet preventing unintended
Total Births to Women Aged 18 to 29 by Zip Code (2015)
9
n 2 to 59
n 60 to 191
n 192 to 348
n 349 to 531
Source: Mecklenburg
County Public Health
pregnancy among this age group is an insufficient approach
to reducing the overall rate of unintended pregnancies:
The population of youth under 17 represents
2 percent or less of all births in Mecklenburg County.
By Neighborhood Profile Area
As the Charlotte-Mecklenburg Opportunity Task
Force reported, “Segregation by poverty, wealth, and
race/ethnicity are most apparent in Charlotte-Mecklenburg
when we look at maps of the county that reveal an
undeniable ‘crescent’ of lower-opportunity neighbor-
hoods wrapping around more prosperous
areas of our community.” 2
After extensive discussions with experts
at the Urban Institute and Power
to Decide, the project team decided to
test the crescent of lower-opportunity
neighborhoods identified by the Leading
on Opportunity report with indicators
related to unintended pregnancy.
Ultimately, 12 indicators were chosen—some
are predictors of pregnancy,
others are outcomes. 23
The indicators are:
• Births to adolescent mothers,
• Low birthweight,
• Adequate prenatal care,
• Proximity to low-cost healthcare,
• Public health insurance,
• Employment,
• Food and nutrition services,
• Median household income,
• High school diploma,
• Bachelor’s degree,
• Home ownership, and
• Proximity to public transportation.
For each indicator, the county
average was calculated and each neighborhood
profile area (NPA) was scored
against the average. Percentages on the
unfavorable side of the county average
received a 1. These 12 variables were
then summed to give each NPA a
cumulative score, and the NPAs were
mapped. The distribution of scores on
a map of Mecklenburg County clearly
confirmed the Opportunity Task
Force’s conclusion that “maps of our

county consistently reflect a ‘crescent’ of lower-opportunity
neighborhoods dominated by people of color in
contrast with a ‘wedge’ of white, wealthier residents in
south and north Mecklenburg.” 2
The project team concluded that to successfully
implement effective prevention strategies and programs,
one must recognize that people of all races,
ethnicities, economic classes, and zip codes are at some
level of risk of experiencing an unintended pregnancy.
One must also concede that areas of the community
that lack access to services require additional collaboration
and support.
lenburg County led the way. Given this dark reality, it is
not surprising that conversations about family planning,
pregnancy prevention, and LARC caused some consternation
in the early phase of this project.
Recognizing the importance of this context, the project
team took great care to conduct the research in a way
that was respectful of the past but also optimistic about
the future. Consequently, the issues of trust, race, and
history were frequently discussed; they are woven into
the recommendations and must be taken into careful
consideration.
Historical Context
Just as determining the greatest
need required the project team to be
conscious of Charlotte-Mecklenburg’s
history of segregation, it was equally
important to remember the historical
context of sterilization in our state.
As the Leading on Opportunity report
stated, “We acknowledge it can be
a charged topic and people will have
different perspectives on the matter.
We also discussed and acknowledge
North Carolina’s shameful legacy of
forced sterilization of poor and disabled
people, many of color, between
1929 and 1974...” 2
From the mid-1930s until 1974,
more than 7,000 people were sterilized
in North Carolina, many of whom
were minorities sterilized against their
will. Three times more people were
sterilized in Mecklenburg County than
anywhere else in the state. 24
The state Eugenics Board’s justifications
ranged from mental health
and threats to the public good, to
high numbers of pregnant women on
welfare assistance overwhelming the
system.
North Carolina is an outlier in the
nation’s ugly eugenics past. The longevity
of the program and the selection
processes used over the course of four
decades were not experienced anywhere
else in the country. 25 And Meck-
Priority Index of Neighborhood Profile Areas
n Low priority
n Medium low
n Medium high
n High priority
Source: 1000 Feathers
10

RESEARCH
& RESULTS
Why do unintended pregnancies
happen? The data
indicates a vast disconnect
between a woman’s desire
to become pregnant and
the use of contraception
to reduce unintended pregnancy. So then, why is
contraceptive use so inconsistent? In 2009, Power to
Decide studied this disconnect by commissioning The
Fog Zone, a national survey
of 18- to 29-year-olds. 26
The study found the
gap between intention and
behavior can be explained
by a number of factors,
many of which are directly
connected to a lack of
education and information
on the issue.
These factors include:
• Little to no public education on contraception,
• Myths and misinformation about pregnancy
and contraception,
• Fears of birth control side effects,
• Beliefs that contraception is not effective, and
• Beliefs about infertility.
Yet many young people still believe they have all
the information they need to avoid an unplanned
pregnancy. In addition, they often have fatalistic
views: It doesn’t matter whether you use birth control or
not, when it is your time to get pregnant, it will happen.
Many young adults are suspicious of birth control
and the systems that encourage its use. Perhaps most
importantly, a tremendous amount of ambivalence
persists among young adults about the timing and
circumstances of pregnancy.
Subsequent surveys and polling continue to
suggest many people are unaware of the full range of
contraceptive methods. While they may have heard
of the birth-control pill or condoms, 77 percent of
people aged 18 to 45 indicated they knew little or
nothing about implants, and 68 percent knew little
or nothing about IUDs. Ironically, in this same poll
many indicated they had all the information they
needed to avoid an unplanned pregnancy. 27
An ethnographic research project currently being
completed by Power to Decide is providing further insights
into how young adult women think about, plan
11
91% of Charlotte-Mecklenburg residents
who participated in a phone survey support
policies that make it easier for people
18 and older to get the full range of birth
control methods. But most are unaware of
their neighbors’ support, and fewer agree
that their neighbors would be supportive.
for, and experience contraception. While this research
is not yet published, three findings are relevant:
• Women are hungry for information and guidance
relevant to them. Today, peers and friends
are the most influential sources of information.
• Despite curiosity about sex and relationships, they
have little interest in birth control.
• Negative personal experiences, horror stories
from friends, other life events getting in the way,
and a belief that they already
know the options are among
the many barriers to using
contraception. 28
Research conducted
by 1000 Feathers with
diverse populations of 18-
to 29-year-olds in Charlotte-Mecklenburg
revealed
a picture that is remarkably
similar to the national story. The results are summarized
on the following pages.
DATA COLLECTION METHODS
More than 800 residents were engaged in data collection,
with the goal of combining existing data
and best practices with voices from the greater
Charlotte community. The primary methods of
data collection included:
Advisory Group- The project team convened
a community advisory board consisting of 44 representatives.
Members of the Mecklenburg Area
Partnership for Primary Care Research (MAPPR)
established a core group within the advisory
board.
Focus Groups- Staff from APHI, Philliber
Research and Evaluation, and 1000 Feathers conducted
16 focus-group sessions to hear from 128
residents across the entire county.
Key Leader Interviews- 1000 Feathers
interviewed 63 leaders and influencers to gather
feedback, inform leaders and build community
buy-in.
Clinical Assessment- Driven by the Center
for Disease Control’s Quality Family Planning
guidelines, this assessment explored barriers to

FINDINGS FROM FOCUS GROUPS
Young adults in their late teens to early 30s participated
in 16 focus groups. Some of the findings included:
• Many of the participants regard early pregnancies
as the norm. Pregnancy may even be viewed as popular.
• Sex-education classes in Charlotte-Mecklenburg
emphasize abstinence. Students are not taught about
other options; instead they learn about birth control
from friends, siblings, and social media.
• Participants were most comfortable and familiar
with condoms and withdrawal as methods of birth
control. Very few reported familiarity or experience
with hormonal methods.
• Misinformation occurs about the more effective
methods of contraception. Participants expressed a
reluctance to use these methods for a variety of reasons,
many related to real and perceived side effects.
• Access to contraceptive services is limited in Mecklenburg
County. Issues include long waits for appoint-
ments at clinics, transportation challenges, inconveniently
located clinics, and the unavailability of some forms of
contraception.
• Cost is a barrier. Participants were unaware of clinics
where birth conrtol is free or offered at a reduced cost.
Focus Group Demographics
By Age By Race/Ethnicity By Gender
6% 7%
9%
19%
14%
26%
32%
55%
74%
58%
n Under 18 n White n Male
n 18 to 24 n African American n Female
n 25 to 29 n Hispanic/Latino
n 30 and older n Asian
best practices. The project team selected seven
providers representing 37 sites based on their role
as a safety-net provider within the larger landscape.
Supplemental research methods included the
following:
Review of Existing Quantitative Data- A
review of national, regional, state, and local data
relevant to unintended pregnancy was conducted.
APHI, Atrium Health (formerly Carolinas
Healthcare System), and Mecklenburg County
Public Health did much of the collection and
analysis.
Random-Digit Dial Survey- The 2017
Charlotte-Mecklenburg Survey conducted by the
Urban Institute included questions about reducing
unplanned pregnancies. The final data from
400 respondents were weighted by age, race/ethnicity,
and gender.
Policy Analysis- The project team examined
policies affecting pregnancies in Charlotte-Mecklenburg
to develop an understanding of the
complexity of existing regulations and how they
might support or inhibit education and access.
Environmental Assessment- 1000 Feathers
conducted a modified environmental analysis
focusing on a select group of clinics and healthcare
providers and the Charlotte Area Transit
System to understand the physical infrastructure
of health centers.
Community Forums- Staff from APHI and
the Urban Institute facilitated three community
forums attended by a total of 56 people to engage
the broader community, obtain feedback, and
increase awareness of the results of the health
assessment.
Supplemental Surveys- The Urban Institute,
with assistance from the city’s Housing and
Neighborhood Services division, conducted a
neighborhood association survey of 39 people
from 16 zip codes. In addition, 47 “secret shopper”
phone calls were placed to healthcare centers
to assess their level of awareness, responsiveness,
and availability of services.
12

13
FINDINGS FROM CLINICAL ASSESSMENT
Two important objectives of this project were to gain
a better understanding of local providers’ capacity to
deliver the full range of contraceptives, and to determine
the services that are currently available.
This process involved a detailed clinical assessment
of five sites, a “secret shopper” phone survey of
healthcare centers, analysis of existing research, and
conversations with leaders of the two major hospital
systems and several community-based organizations.
The assessment of clinical sites was conducted at
the system level (the two hospital systems, the health
department, and seven federally qualified
health centers) as well as the individual
site level (Planned Parenthood
and Care Ring).
In North Carolina, 41 percent of
public funding for family planning
comes from Medicaid and 10 percent
from Title X. An estimated 20 percent
of people in need of contraceptive
services in the state received care at a
safety-net site in 2014. (A safety-net site
means services are provided with public
funding.)
While this may seem low, in the
absence of the publicly supported
family-planning services provided at
safety-net health centers, the rates of
unintended pregnancy, unplanned
birth, and abortion for all women
would be 34 percent higher in North
Carolina. 29
An important aspect of the community
health assessment was to identify
the commonalities across clinical sites
and develop “universal” suggestions for
improvements. The suggestions include:
• Sites should consider same-day
appointments to bridge the gap
between wait times for appointments
and high “no-show” rates. All participating
health centers have long wait
times and experience high (30 percent
to 50 percent) no-show rates. No-show
rates present a unique challenge because of the lack of
a uniform buy-back program for contraception. When
someone who has requested a LARC does not show up
for her follow-up appointment, the device is considered
“orphaned” by the health center and cannot be used.
• An unrestricted pool of funds should be established
to help clinics with stocking the full range of
contraceptives and other cost barriers associated with
providing appropriate contraceptive care on the same
day as initial appointments. Sites offer a wide range of
contraceptive options, and many offer LARC, but due to
Healthcare Sites with Full Range of Contraception
l Full-range clinic
--- Highway
NPA Priority Index
n Low priority
n Medium low
n Medium high
n High priority
Source: UNC-Charlotte
Urban Institute

financial and administrative barriers few offer sameday
insertion. Because of high no-show rates and long
wait times for an appointment, services should be
delivered on the same day. Thus, requiring someone
to return for a second appointment is a barrier. New
funding may be able to support immediate postpartum
LARC insertion in the short term, while advocates
continue to seek policy changes at the state level.
• Young adults should be provided information
and resources allowing them to better understand
and navigate the financial barriers to receiving care.
Available clinic funding and client costs for contraception
vary greatly, so clients need assistance with
navigating the financing of their birth control. For
example, Mecklenburg County Public Health offers
low- to no-cost services on a sliding scale, while
Planned Parenthood offers low-cost services but
no sliding scale. Definitions of these terms vary by
location and may be misunderstood by prospective
clients; clarity and consistency are needed.
• One Key Question TM (see page 17) should be
integrated into the standard intake process for all
medical providers to emphasize the importance of
conversations about family planning. For clinics
utilizing electronic medical records, templates and
prompts would help providers regularly assess pregnancy
intention and contraceptive use. This approach
is being utilized at some locations, but lack of consistency
is a problem.
• Community leadership should build on the
work of existing collaborative groups such as the
Leading on Opportunity Council, MedLink and
One Charlotte Health Alliance to develop a comprehensive
system of reproductive healthcare. Despite
recent efforts to the contrary, systems in Charlotte-Mecklenburg
are often perceived (and sometimes
behave) as competitors. The two hospital systems are
disconnected from each other, health centers do not
interact regularly, the health department is viewed
a stand-alone entity, and private providers such as
Planned Parenthood do not have a seat at the table
with MedLink. (MedLink is an advocacy group for
improving access to care through education, communication
and collaboration among service providers.)
OPPORTUNITIES
FOR SYSTEM-LEVEL
IMPROVEMENTS
Although progress has been made recently
by the state, the two local hospital sytems,
and Charlotte-Mecklenburg Schools
(CMS), policy shortcomings remain.
Best practices established by Power
to Decide were matched against state and
local policies to suggest the following
opportunities for system improvements:
• Local OB/GYN practices are not wellinformed
on the full range of contraception,
reimbursement policies, and payer
sources—despite the fact that in 2017 the
state Family Planning Program identified
Mecklenburg as a priority county. Local
organizations such as Community Care
Partners of Greater Mecklenburg have
the ability to assist with creating public
awareness campaigns, thus increasing
enrollment in the program.
• Currently, Medicaid does not reimburse
providers for immediate postpartum
insertion of contraception. A
separate billing code should be created so
providers would be able to be reimbursed
by the state.
• CMS’s sex-education classes do not
cover the full range of contraception,
and some teachers do not feel comfortable
teaching the curriculum. To ensure consistent
implementation, CMS should work
with the district’s new health curriculum
director to provide input and recommendations.
• Local colleges and universities provide
minimal sex education, contraceptive
counseling, and reproductive healthcare
services. One way to change the status
quo would be to partner with the state,
which recently released a Perinatal Health
Strategic Plan that includes an expanded
Preconception Peer Education program for
college campuses.
14

FINDINGS FROM KEY LEADER INTERVIEWS
Sixty-three leaders with divergent perspectives participated
in one-on-one or small-group interviews.
In addition to these formal, sit-down interviews, the
research for this report included dozens of informal
conversations, phone calls and meetings between the
project team and members of the community.
Those who participated in the formal interviews
ranged from healthcare professionals to educators,
experts in housing and transportation, and key leaders
of community-based organizations.
What emerged were the following themes:
• Interviewees expressed a genuine concern for
the issue of unintended pregnancy and its larger connection
to opportunity and upward mobility. Overall,
they are optimistic about this work.
• Issues related to trust and race need to be recognized
and addressed. Leadership on these issues must
come from within communities as much as by those
in power. Interviewees pointed to a well-recognized
and discussed “tradition” in Charlotte of affluent
white people making decisions that attempt to impact
or “fix” “poor minority communities.”
• All contraceptive options should be available
to all women. Future work on this issue should not
target a single demographic nor “push” a single contraceptive
choice. The real need is informed choice
about the contraceptive services offered and improved
delivery of care.
• Risk factors are interwoven into a highly complex
narrative about life, navigating services, and
growing up in Charlotte-Mecklenburg. Issues and risk
factors, such as childhood trauma, mental health,
crime, homelessness, housing, and transportation
were mentioned countless times throughout the
interviews. These comments serve as an important
reminder that the prevention of unintended pregnancy
is only one part of the solution.
• Mecklenburg County has many well-developed,
community-focused programs and organizations.
Yet, a lack of coordination among them seems to prevail.
Even though numerous committees and alliances
are doing good work, the community-at-large lacks a
general sense of how they work together.
• Operational challenges and barriers within the
healthcare system include staff shortages, inadequate
training, and little understanding of available services.
Leaders recognize a lack of coordination among providers.
Notably, access to care and coordination issues
negatively impact all residents.
• Despite an emphasis on unintended pregnancy
prevention—and reiteration that the priority age group
is 18 to 29—many interviewees defaulted to talking
about teen pregnancy, specifically school-based sex
education and CMS policies.
15

Pathway
to Prevention
Making the decision.
My partner and I decided we
don’t want to get pregnant right
now. What are our options?
How am I going to pay for this?
Do I have insurance?
How much will a doctor’s visit cost?
What if I can’t afford contraception?
How do I get to the clinic?
Do I have access to a car? Can I walk there?
How do I use public transportation?
What do I do now?
Is there a directory of clinics?
Text a friend for advice?
Google it?
Do I have a doctor?
Wait, you can’t see me until when?
In Mecklenburg County, wait times for
new patients range from two weeks to two
months. What if I have to work that day?
What if I have class?
Finally here! Now what?
Will I receive quality care?
What methods are available?
Do they have the one that’s
best for me? Can I get it today?
As the project team looked for solutions to prevent
unintended pregnancy, they discovered a potholed
pathway that young adults must traverse. The graphic
above depicts some of the steps and potential stumbling
blocks along the way. Each of the decision points
provides meaningful context to the “big picture strategies”
and recommendations on the following pages.
The Pathway to Prevention graphic focuses almost
entirely on improving the capacity of the service delivery
system. Taking into account the ambivalence and
knowledge gap of young adults, one cannot assume
that conversations about family planning and intentionality
are happening. However, for the purpose of
illustration, the graphic begins the journey with the
premise that education and information have been
received.
Even for those who are consciously considering
birth control, the pathway to contraception is not
easy to navigate. The project’s research suggests two
strategies would go a long way towards smoothing the
path to prevention: robust referral networks within
respected community-based programs, and routine
pregnancy-intention screening (One Key Question TM )
in healthcare settings.
Pathway to Prevention graphic by Cayci Banks
16

BIG PICTURE
STRATEGIES
The community health
assessment yielded three
big picture strategies—
1) education and outreach,
2) service delivery system
capacity, and 3) community
consideration—to inform the work moving forward.
They emerged from the key findings listed on page 2,
as well as a review of successful initiatives from across
the U.S. The following strategies provide a frame of
reference that links the key findings to the recommendations
on the facing page:
1. Education & Outreach
The consistent feedback researchers
received during the assessment was
to make the project about “informed
choice” rather than the promotion of
any single method of contraception.
Thus, gaps in knowledge can be closed
through sharing information, providing
education, and meeting young adults
“where they are.” Creating formal linkages
between service providers, community-based
programs and healthcare clinics
would make this easier. Young people’s
lives are constantly changing; therefore,
education should be an ongoing effort.
Educational outreach must expand to
provide young adults with a constant
stream of information from parents,
peers, trusted adults, community-based
programs, healthcare providers, and the
media. This may include expanding sexual-health
education into colleges, creating
social media campaigns, building robust
referral and education networks, using strategies such
as One Key Question, and placing community health
workers in high-need zip codes.
Young people’s
lives are
constantly
changing;
therefore,
education
should be an
ongoing effort.
Educational
outreach must
expand to
provide young
adults with a
constant stream
of information.
2. Service Delivery System Capacity
Linking young adults to high-quality, comprehensive
reproductive healthcare is a necessary component
to an effective education and outreach campaign.
Often, efforts to create demand and ensure supply
happen simultaneously, but it is critically important
to ensure an adequate supply is available to meet
any created demand. Fortunately, in Mecklenburg
County, 33 public and private health centers offer
the full range of contraception and accept publicly
funded forms of payment. However, while the number
of clinics may be adequate, they need
to provide consumers with innovative,
collaborative services to become fully
functional. Reducing unplanned pregnancies
will require improving access to these
sites, ensuring high-quality care, training
providers, and building a referral system
within and across providers. Critical
components of improving service delivery
system capacity include increased access
to clinics and transportation options
and the removal of barriers to receiving a
timely appointment.
3. Community Consideration
A one-size-fits-all approach to
this work will not succeed. In Charlotte-Mecklenburg,
countless communities
deserve consideration, as defined by
neighborhood, race/ethnicity, culture
and income. Universal solutions such as
education, policy revision, and provider
training should be supplemented by a
focus on specific communities that require
additional support to ensure access
and affordability. None of the work can happen in a
vacuum: It will require an in-depth understanding of
the community’s particular circumstances.
The notion behind One Key Question TM is simple: It asks all health providers and champions who
support women to routinely ask, “Would you like to become pregnant in the next year?” From there,
the provider or champion takes the conversation in the direction the woman herself indicates is the
right one, whether that is family planning, preconception health, prenatal care, or other needs.
—Power to Decide
17

RECOMMENDATIONS
The data and observations included throughout this
report speak to the need for a comprehensive, longterm
investment to ensure that all women and men
in Mecklenburg County:
• Are educated on the issue and their options,
• Have access to all methods of contraception, and
• Continue to have the ability to determine if,
when, and under what circumstances they would like
to become pregnant.
Any investment in preventing unplanned pregnancy
should take into account the key findings
and big picture strategies. Together they provide a
framework for the recommendations. (Each includes
an icon to indicate which strategy or strategies the
recommendation supports.)
Ensure clear, consistent, ongoing processes
are put in place for incorporating community
voices into every aspect of the initiative, including the
engagement of community leaders as visible, vocal
champions.
Maintain a well-articulated and unwavering
commitment to health equity and
cultural identity that acknowledges the historical
context and current political environment.
Incorporate multiple touch points to provide
reproductive health education to populations
of teens and young adults, including in high schools
and perhaps even middle schools, on college campuses,
and through nontraditional partners (such as
community-health workers and home visitors).
Design and implement a targeted education
and outreach campaign, inclusive
of traditional media and creative digital content,
to directly reach the priority population of 18- to
29-year-olds.
Expand training opportunities for
providers to improve clinical practice
and for front-office staff with regards to scheduling,
patient flow, and billing.
Utilize the One Key Question approach
throughout Mecklenburg County so it
becomes the norm for medical providers and other
nontraditional partners who work with women aged
18 to 29.
Invest in an ongoing mechanism to better
define and understand the universe
of existing contraceptive service providers, and create
more opportunities for community members
to contact providers who can expeditiously meet
their needs.
Create and maintain a privately funded solution
to address the numerous quick-start and
access issues that currently exist. This would ensure
all providers in the county are offering same-day
access to at least one form of every FDA-approved
category of contraceptive.
Address in creative and strategic ways
the access challenges facing many of
Charlotte-Mecklenburg’s communities. Clinical access
must be integrated with other priorities (such
as housing and transportation), and healthcare
systems must be willing to collaborate and communicate
more effectively.
Improve the connections between
unintended pregnancy prevention and
education and upward mobility. Given the network
of well-developed community organizations already
in existence, expand their focus to include working
with trusted service providers and nonprofits, the
faith community, providers, social services, transportation,
and housing.
Identify a series of key performance
measures for the initiative
that can be agreed upon by all partners and provide
an opportunity to measure progress. Ensure that
the initiative focuses on increasing information
about and improving access to all contraceptive
methods for all women.
18

ENDNOTES
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3. The National Campaign to Prevent Teen and Unplanned Pregnancy. [Online] www.thenationalcampaign.org.
4. Why It Matters: Teen Childbearing, Education, and Economic Well-Being. Washington, DC : The
National Campaign to Prevent Teen and Unplanned Pregnancy, 2012.
5. Kaye, K., Gootman, J., Ng, A.A., Finley, C. The Benefits of Birth Control in America : Getting the
Facts Straight. Washington, DC : The National Campaign to Prevent Teen and Unplanned Pregnancy,
2014.
6. Thomas, A., Monea, E. The High Cost of Unintended Pregnancy. s.l. : Center on Children and Families
at Brookings, 2011. Brief #45.
7. [Online] https://www.guttmacher.org/sites/default/files/report_pdf/public-costs-of-up-2010.pdf.
8. Kost, K. Unintended Pregnancy Rates at the State Level : Estimates for 2010 and Trends Since 2002.
New York : Guttmacher Institute, 2015.
9. Boyd, M., Murphy, D., Bielak, D. “Billion Dollar Bets” to Reduce Unintended Pregnancies. Creating
Opportunity for Every American. s.l. : The Bridespan Group, 2016.
10. Briefly... Unplanned Pregnancy Among College Students and Strategies to Address It. The National
Campaign to Prevent Teen and Unplanned Pregnancy. [Online] July 2015. http://thenationalcampaign.
org/resource/briefly-unplanned-pregnancy-among-college-students.
11. Reeves, R.V., Venator, J. Sex, contraception, or abortion? Explaining class gaps in unintended childbearing.
Washington, DC : Center on Children and Families at Brookings, 2015.
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