In the first half of his career, Mark Edwards developed a skill that is often underestimated: listening. While in college, he started a communications firm and spent more than 25 years helping nonprofits tell their stories, sharpen their messages, and speak with the media. To help them communicate, he listened carefully to what they needed to say.
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“You have to listen hard to understand the nuances and then tell the stories in ways that are powerful,” he says.
In fact, it was listening to the stories of people struggling financially that led Edwards to make an unorthodox connection between economic mobility and access to contraception. In 2014, he and a partner started Upstream USA, an organization that trains health-clinic workers to deliver effective birth control in a single primary-care visit.
About a decade ago, Edwards started Opportunity Nation, a coalition of 300 groups working to improve economic mobility. As part of that work, he and his deputy director, Elizabeth Clay Roy, went on a listening tour. They met nonprofit leaders as well as young people and families struggling to make ends meet to learn about barriers to financial opportunity.
Edwards wanted to talk to nonprofit leaders and those experiencing these problems firsthand to understand what worked rather than tout his own solutions, an important display of his characteristic humility, Roy says. “He was really thoughtful and committed to that approach.”
The most valuable conversations were with individuals and families who were struggling. “If you listen closely, they understand what their challenges are,” Edwards says. “I try to come at those conversations humbly and with deep respect, and out of those dialogues, gems emerge.”
What he heard again and again was that unplanned pregnancies — half of all pregnancies in the United States — often derailed education or jobs. Women told him that family-planning services often required multiple visits to different doctors. Research showed that when birth control was prescribed, it was often in forms that were unreliable. The most effective birth control — long-term, reversible methods such as the IUD or implant — were rarely available in primary-care clinics that cater to low-income people.
Edwards and his co-founder, Peter Belden, started Upstream USA to train health-care workers in government-funded primary-care clinics to add family planning to their services. His staff trains workers to ask every woman if she is planning to get pregnant. If the answer is no, the staff walk through the full range of birth-control options, including IUDs and implants. Once the woman makes a choice, either the birth-control device or a prescription is provided during that visit. No additional doctor’s appointment is required.
The program was piloted in health clinics in five states. In 2014, Upstream launched its Contraceptive Access Now program at more than 180 clinics in Delaware. A recent study commissioned by the group found that over three years, patients’ use of implants and IUDs at the Delaware clinics jumped from 14 percent to 31.5 percent. Based on that change, and a small drop in those not using any birth control, researchers estimated a 24 percent decrease in unintended pregnancies.
Nationwide Expansion
That early success led to a transformative grant. When Edwards ran into an old acquaintance, Kelly Campbell, a managing director at Blue Meridian Partners, a $1.7 billion collaboration of 14 foundations focused on scaling up solutions to poverty, he sent her a concept paper on expanding Upstream’s work across the country.
She was so impressed that Blue Meridian gave Upstream a $60 million grant over seven and a half years.
“The link that he was seeing between unintended pregnancies and keeping young women and their children in poverty, it was a very intriguing and compelling idea,” Campbell says. She also appreciated that Upstream’s work does not require expensive new infrastructure. It is a training program to add procedures to existing health clinics.
Another factor was Edwards himself. Campbell had served on a board with Edwards and knew he was the kind of executive who could manage such a large expansion. “He’s a very dynamic leader. He’s a very good communicator. He is very persuasive,” she says. “He has the hallmarks of what you would look for in a really inspiring leader.”
Edwards’s unusual background in both communications and economic inequity gave him a broader view of the issue, not just as a public-health problem or an economic one alone. “I’m not sure it would have struck him in quite the same way if he hadn’t spent so many years working on opportunities to get on different paths out of poverty,” Campbell says.
In the past four years, Upstream has grown from an annual budget of $1.5 million to an expected $45 million in 2020.
“I think many social entrepreneurs are wired to look at the world in a slightly different way. There is a hope that they can do something small to make the world a little better,” says Edwards. “It requires a humble approach.”
Jim Rendon is a senior writer who covers nonprofit leadership and fundraising for the Chronicle. He recently reported about a conference session on diversity, equity, and inclusion and has written about how few nonprofits have taken concrete steps to improve diversity. Email Jim or follow him on Twitter.
