Upstream USA is a left-of-center group that promotes contraception in health clinics, which it argues is the key to ending poverty. It was formerly 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 nonprofit1
In 2022 and 2023, Upstream received a total of $55 million from philanthropist and Amazon founder Jeff Bezos’s ex-wife MacKenzie Scott’s Yield Giving. 2
In June 2023, the Biden administration through the U.S. Department of Health and Human Services announced a five-year public private partnership with Upstream to provide expanded access to contraception, which drew fire from “reproductive justice” advocates who compared it to eugenics. 3
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. 4 It identifies expanding provision of artificial birth control as a means of reducing poverty. 5
Blue Meridian Partners gave $60 million to Upstream. 6 Upstream USA has spent hundreds of thousands on lobbying campaigns for technologies that reduce childbearing. 7
In 2025, Upstream claimed it was on track to serve five million patients by 2030. 8
Philanthropist MacKenzie Scott’s Yield Giving gave Upstream $30,000,000 in 2022 and $25,000,000 in 2023. 2
In December 2025, Upstream was one of multiple organizations that received a grant from Yield Giving, the philanthropic initiative started by MacKenzie Scott, the ex-wife of Amazon founder and CEO Jeff Bezos. In 2025 alone, Scott, through Yield Giving, donated over $7.16 billion to philanthropies and other charity organizations around the world. 9
Advocacy
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. 10 LARCs are reversible, but it can take between two and 12 months from removal for the effects of a LARC to completely wear off. 7
The group says its model has been delivered to 1,300 clinicians with more than 200 healthcare organization partners across the United States. 11 12
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. 4
From 2014 to 2017, Delaware showed a 24 percent decline in unwanted pregnancies, according to Upstream-commissioned research by Child Trends,10 compared to a 3 percent decrease nationally during the same time period. 6
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. 10
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. 6
Legislation
In 2025, Upstream USA supported the Right to Contraception Act, which would codify the U.S. Supreme Court’s Griswold v Connecticut decision that held birth control was legal under the right to privacy. 13
In October 2024, Upstream USA supported a Biden administration rule that would require private health insurance companies to pay for over-the-counter contraception for patients. 14
Controversies
In June 2023, the Biden administration’s Department of Health and Human Services created a public-private partnership with Upstream USA to expand access to contraception. Upstream USA would identify areas of “high need” for contraception and where people may lack a health care facility that does not provide a full range of artificial birth control. 3
Advocates following the “reproductive justice” framework criticized Upstream, alleging that it coerced women into receiving long-acting artificial birth control and compared its program to eugenics. The “reproductive justice” advocates took exception to Upstream’s claims that increased contraception access would reduce or eliminate poverty and the group’s insistence on long-acting reversible contraception (LARC) methods. People who worked with Upstream on an outside capacity also claimed that it never saw Upstream’s complete training curriculum and raised questions about the group’s lack of transparency. 3
In 2019, the Black Mamas Matter Alliance wrote an op-ed asking Upstream to “conduct research on Black Mamas to hold structural systems and social policies accountable for poverty, instead of developing and advancing mechanisms for controlling and limiting pregnancy and childbirth for low-income people.” The group also encouraged states to not work with the group. 3
Researchers Jamie Manzer and Ann Bell, who interviewed providers trained by Upstream, also claimed that some of them expressed disturbing viewpoints, including one white doctor who urged that contraception should be put in the drinking water of zip codes with a high number of unintended pregnancies. 3
Leadership
Mark Edwards is the CEO and co-founder of Upstream USA, 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 sat on more than a dozen nonprofit boards and advisory committees, and is a graduate of Harvard. 6
Jessica Foster is the president and chief operating officer of Upstream. She previously worked as the chief strategy officer at Youth Villages. Before that, she was a strategy consultant at the Boston Consulting Group and the Monitor Group and worked as a legislative aide to the late former U.S. Senator Arlen Specter (D-PA). 15
Mark Perry is the chairman of the 14-member Upstream USA board of directors that includes Edwards and former Delaware Gov. Jack Markell (D), who brought the project to the state while serving from 2007 to 2019. Perry is a retired general partner at New Enterprise Associates. 15
Other board members are Howard H. Stevenson professor emeritus of Harvard Business School; former board chairwoman and philanthropist Anita Bekenstein; Paul Gannon, former chief operating officer at the Baupost Group; former Massachusetts first lady Lauren Schadt Baker; and Dr. Thea James, the vice president of mission and associate chief medical officer at Boston Medical Center. 15
Financials
According to Upstream USA’s 2023 tax return, the group had $121,746,531 in revenue, $45,445,245 in expenses, and $246,427,303 in net assets. The group paid $2,517,487 to healthcare providers to support training in Upstream’s methods. 16
The group paid CEO Mark Edwards $550,986 in salary and benefits. 16
References
- Return of Organization Exempt from Income Tax (Form 990). New Venture Fund. Schedule O.
- “Gifts.” Yield Giving. Accessed July 6, 2025. https://yieldgiving.com/gifts/?q=upstream%2Busa.
- Henderson, Garnet. “Upstream USA Promises to Transform Contraceptive Care. Experts Are Raising Red Flags.” Rewire News Group, June 22, 2023. https://rewirenewsgroup.com/2023/06/20/upstream-usa-promises-to-transform-contraceptive-care-experts-are-raising-red-flags/.
- About. Upstream USA. Accessed October 30, 2019. https://upstream.org/about/
- New Venture Fund. Ballotpedia. Accessed October 30, 2019. https://ballotpedia.org/New_Venture_Fund
- Staff. Upstream USA. Accessed October 30, 2019. https://upstream.org/team/staff/
- Stone, Lyman. December 21, 2018. Accessed October 30, 2019. https://thefederalist.com/2018/12/21/handing-birth-control-will-not-help-women-manage-fertility-way-want/
- “About.” Upstream. Accessed July 6, 2025. https://upstream.org/about/.
- Scott, MacKenzie. “We Are the Ones We’ve Been Waiting For.” Yield Giving, December 5, 2025. https://yieldgiving.com/essays/we-are-the-ones-we-ve-been-waiting-for
- Sanger-Katz, Margot. “Set It and Forget It: How Better Contraception Could be a Key to Reducing Poverty.” The New York Times. December 18, 2018. Access October 30, 2019. https://www.nytimes.com/2018/12/18/upshot/set-it-and-forget-it-how-better-contraception-could-be-a-secret-to-reducing-poverty.html
- How We Work. Upstream USA. Accessed October 30, 2019. https://upstream.org/how-we-work/
- “Our Program.” Upstream. Accessed July 6, 2025. https://upstream.org/our-program/.
- “Right To Contraception Act.” Upstream. Accessed July 6, 2025. https://upstream.org/news/right-to-contraception-act/.
- “Reproductive Healthcare Is On Everyone’s Minds.” Upstream. Accessed July 6, 2025. https://upstream.org/news/reproductive-healthcare-is-on-everyones-minds/.
- “Our Team.” Upstream. Accessed July 6, 2025. https://upstream.org/our-team/.
- “Upstream USA Inc, Full Filing – Nonprofit Explorer.” ProPublica. Accessed July 6, 2025. https://projects.propublica.org/nonprofits/organizations/352581424/202441729349301314/full.