Dalia Brahmi is a practicing physician who has been working in family medicine, reproductive health, and public health education for the last 20 years. In 2021, she joined VaxCare as a Senior Medical Director leading our Long-Acting Reversible Contraception (LARC) program—bringing the ease and efficiency of VaxCare to the world of contraceptive implants and IUDs—which is currently running as a pilot in the state of Ohio.
We recently sat down with Dr. Brahmi to ask her why better access to contraceptive choice is needed and just how she ended up leading the charge at VaxCare.
Interview by Teresa Kalowsky
What’s the process like today for patients who want to receive a long-acting reversible contraceptive (LARC)?
Because of the cost (more than $1000 per device), many practices do not stock LARC. When a patient does decide they want an implant or IUD, it often has to be ordered through a specialty pharmacy. Delivery can take anywhere from four to six weeks. Then the patient must schedule a new appointment. So many things—from childcare to work obligations to missing class—can get in the way of the patient making it to that next appointment.
In some places I have worked—even with really dedicated staff and clinicians—they were still unable to offer all patients their preferred methods of contraceptives that day.
I worked in an office where they had an entire closet full of unused implants and IUDs that had been ordered and paid for by an insurance company but never used. No one else can benefit from that contraception because the implant or IUD is tied to each individual patient’s insurance claim. It’s considered fraud to use it for another patient.
What sort of barriers do people in the United States face in accessing reproductive health care?
Having practiced medicine now in Indiana, California, New York, and North Carolina, I can tell you that access to reproductive health care really depends on geography and income. Thankfully, the Affordable Care Act required insurance plans and payers to cover, with some exceptions, all FDA-approved contraceptives. So in theory, contraception options are covered for patients who have commercial insurance or Medicaid. Many patients remain uninsured and many states have not expanded Medicaid, although we are seeing some states expand Medicaid for 12 month post-partum.
But there is still a lot of room for improvement in access to reproductive health care. In some places I have worked—even with really dedicated staff and clinicians—they were still unable to offer all patients their preferred methods of contraceptives that day. This does not meet the standard of care, which is to receive contraceptive care when and where you want it. When care is delayed, and is not centered on the needs of the people seeking care, it leads to poor health outcomes.
What brought you to VaxCare’s long-acting reversible contraceptive (LARC) project?
VaxCare’s Chief Medical Officer, Dr. Wanda Filer, came to the North Carolina Academy of Family Physicians to share their plans for the LARC program. I was excited that this would bring the same ease of access to LARC that VaxCare brings to vaccines. It allows a clinician to immediately check and verify that a patient’s insurance will cover the contraceptive they choose. And because implants and IUDs are always on-hand in the office, the doctor can offer all contraceptive options to the patient on the same day. I saw that could allow people to access care in a way that respects their autonomy and dignity, and frankly does not waste their time.
[With VaxCare’s platform] implants and IUDs are always on-hand in the office, so the doctor can offer all contraceptive options to the patient on the same day.
This pilot sounds like it could transform the way that contraception, especially LARC, is delivered in the United States. Who’s able to participate right now?
In January, VaxCare launched a pilot in Ohio offering hormonal IUDs, non-hormonal IUDs, contraceptive implants, and injectable contraception (Depo or the shot). We’ve seen interest from midwives, nurse practitioners, family physicians, pediatricians who care for adolescents, and OBGYNs all across the state—urban, suburban, rural—as well as different practice settings. I’m excited that we’ll be launching in my state of North Carolina very soon.
