Upstream USA is a left-of-center group that promotes contraception in health clinics in order to reduce the national population, which it argues is the key to ending poverty. It was a project of the New Venture Fund, a center-left “dark money” nonprofit managed by the for-profit consulting firm Arabella Advisors, but has since become a standalone nonprofit. ¹

Background

Upstream began as a project of the New Venture Fund. The organization was founded in 2014 with headquarters in Oakland, California and Boston, Massachusetts. ² It identifies expanding provision of artificial birth control as a means of reducing poverty. ³

Blue Meridian Partners gave $60 million to Upstream. The organization’s budget went from $1.7 million in 2014 to $25 million in 2019. ⁴ Upstream USA has spent hundreds of thousands on lobbying campaigns for technologies that reduce childbearing. ⁵

Upstream has set a goal of serving 1 million women each year by 2024. ⁶

Long-Acting Reversible Contraception

Upstream has promoted doctors and clinicians recommending devices known as LARCs, and acronym for long-acting reversible contraception. These devices change a woman’s fertility, meaning she is unlikely to get pregnant until she takes steps to reverse the treatment. ⁷ LARCs are reversible, but it can take between two and 12 months from removal for the effects of a LARC to completely wear off. ⁸

The group says its model has been delivered to more than 3,000 clinicians at 180 sites across the United States, delivering training and technical support to health centers serving 150,000 women of childbearing age. ⁹

The Upstream formula for clinics includes direction for doctors to provide encouragement for contraception when a woman of childbearing age visits. In Delaware, doctors are instructed to ask, “Do you want to get pregnant in the next year?” If the woman answers no, clinics are trained to ensure the woman gets some form of birth control. ¹⁰

Delaware Project

Upstream organized what it calls its “first statewide intervention” in Delaware. It has expanded programs into Washington, Massachusetts and North Carolina. ¹¹

From 2014 to 2017, Delaware showed a 24 percent decline in unwanted pregnancies, according to Upstream-commissioned research by Child Trends,¹² compared to a 3 percent decrease nationally during the same time period. ¹³

Delaware state government officials said Upstream provided the state with initial funding at a cost of about $200 per woman. Upstream CEO Mark Edwards said this is a one-time investment and “ends up being really cheap if you think of two, three, four, five years of benefit” by reducing the number of unwanted pregnancies. ¹⁴

Further, health centers that work with Upstream in Ohio, Massachusetts, New York and Texas reported “greater patient choice, and sustainability” after the partnership, according to the group. ¹⁵

Leadership

Mark Edwards is the CEO and co-founder of the organization, working out of the Boston headquarters. Before co-founding Upstream, Edwards was the co-founder and executive director of Opportunity Nation, a national campaign made up of 300 national nonprofits focused on expanding economic mobility through federal public policy reform. He has served on more than a dozen nonprofit boards and advisory committees, and is a graduate of Harvard. ¹⁶

Anita Bekenstein is the chairwoman of the eight-member Upstream USA Board of Directors that includes Edwards and former Delaware Gov. Jack Markell, a Democrat, who brought the project to the state while serving from 2007 to 2019. ¹⁷

Other board members are Howard H. Stevenson of Harvard Business School; Mark Perry, a retired general partner at New Enterprise Associates; Paul Gannon, former chief operating officer at the Baupost Group; Sarah Brown, the former CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy; and Dr. Thea James, the vice president of mission and associate chief medical officer at Boston Medical Center. ¹⁸

Liz O’Neill is the Delaware executive director, leading what was the first statewide effort that now has measurable data. She previously was the project director of Christiana Care Health System’s Community Center of Excellence in Women’s Health and held the post of director of program services for the Delaware chapter of the March of Dimes. ¹⁹

Chelsey Wailiser is the Washington executive director. She ran President Barack Obama’s re-election campaign in Washington state for 2012. ²⁰

Jenna LeMieux is the Massachusetts executive director. A former social worker, LeMieux also formerly worked at nonprofits Partners In Health and for Compass Working Capital. ²¹

Nicole McKinney is the North Carolina executive director. She came to the job with more than two decades of experience at nonprofits in North Carolina and South Carolina. ²²

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