Sarah Dwyer provides one-on-one, personalized support to patients who face barriers to accessing essential health care as the first patient access navigator at Planned Parenthood of Metropolitan Washington, DC (PPMW). In 2023, she assisted 103 patients, including 89 who needed help accessing abortion care and 14 patients who needed referrals relating to their unmet social determinant of health needs, such as housing support.
To understand the role of the patient access navigator and what it offers for patients, we sat down for a conversation with Ms. Dwyer.
PPMW Patient Access Navigator Sarah Dwyer
Why was the role of patient access navigator created?
Around 2019, Planned Parenthood Federation of America (PPFA) saw what was coming with the increasingly likely fall of Roe v. Wade and realized that patients would face even more barriers to care. Patient navigation existed in different organizations across the country, but not within PPFA, so they encouraged affiliates to explore what this role could offer patients.
At PPMW, the position was originally funded by a Washington AIDS Partnership grant, covering the part of my role that involves referrals for social determinants of health, and by a PPFA Consortium of Abortion Providers (CAPS) grant, covering the part of my role which involves the delivery of practical support services for patients. Today, my position is funded entirely by the CAPS grant.
What does your day-to-day work as a patient access navigator look like?
The patient flow can be variable, and when it gets busy it’s very busy. Yesterday, I worked with three patients from outside of the DC area, all of whom needed full-spectrum practical support with things like transportation, food, and a place to stay while they are accessing care.
In slower moments, I look into the more operations-based aspects of patient navigation. For example, one component of the program is providing local referrals related to patients’ social determinants of health, and I’ve realized that housing assistance is probably the biggest request that we get. So I’ve been exploring options and meeting with different groups that provide permanent housing support, temporary shelter, and rental assistance. I need to fully understand all the options available so I know which patients to refer to which providers.
This work is essential, because if someone doesn’t have stable housing, stable childcare, or stable employment, it’s going to be really hard for them to address their sexual and reproductive health needs.
When a patient is traveling from outside the area, what kinds of support do they typically need?
Patients who come to PPMW from outside of DC, Maryland, or Virginia are generally traveling 400 miles or more to reach us. I often provide practical support like assistance with a flight, hotel, and ground transportation once they get off their plane, as well as food, potentially childcare, and gas if they’re driving. When I refer to “full-spectrum practical support,” this means that we provide two or more of those things. This week I’ve had patients coming from Florida, Georgia, and North Carolina, so all of them required at least two of the following: flight, hotel, ground transportation, and food.
Have you noticed an increase in patients traveling to PPMW to receive care, particularly from states with abortion bans?
In 2023, more than half of the patients I worked with came from either Florida or Georgia. And so far this year, the most common states are Florida, Georgia, and North Carolina. One thing I really want to highlight on North Carolina is that at this time last year, all of my North Carolina patients could have received their care in North Carolina, but because North Carolina passed a 12-week abortion ban at the end of June 2023, these patients now have to travel outside of their home state for care.
I’ve also supported patients who have had to travel to multiple states seeking care before arriving at PPMW. I have really good relationships with patient navigators in Florida, and they have referred patients to me who traveled from Georgia (which has a six-week ban) to Florida (which has a 15-week ban), thinking they’re under 15 weeks pregnant, only to find out they are further along, and they need to travel once again, even further from home, in order to access care.
How does the role of patient access navigator impact the PPMW patient experience?
I’ve received some really moving messages from patients after they get home, saying things like, “Thanks for making sure I wasn’t just a number. You helped me through a really devastating time.” During chaotic weeks, that makes it extra worthwhile.
I really work to destigmatize the experience of accessing abortion care and emphasize that the patient’s experience matters. I hear so many patients saying, “I’m sorry, I don’t want to be a burden,” and I tell them, “No, the burden is that you have to travel out of state. The society around you may be telling you that you’re the burden, but I promise you it’s not true. You should be able to access health care.”
I’ve also developed a “frequently asked questions” list to let patients know what to expect on the day of their procedure, how long it will take, what they should bring with them, where they can park, and if they can drive after their procedure. These are questions that, if they aren’t addressed, could end up interfering with a person’s care experience. I emphasize that there isn’t one “right” way to feel about abortion, and I provide information on organizations that patients can call to talk through what they’re experiencing.
We also have a recommended packing list. For so many people, it’s their first time flying or traveling far from home. This came to me because I went on a trip recently, and I’m a pretty savvy traveler, but I felt overwhelmed. So I wondered, “How do our patients feel dealing with this?”
What other factors are important for supporting the patients you see?
PPMW’s Abortion Access Fund is a game-changer when it comes to supporting our patients. It’s an absolute lifeline for those who come here. Because of this fund, I’ve been able to cover at least 75% of travel expenses for most patients. I can remind them, “I know it’s daunting to ask for help, but please think about what you actually need. If there’s something that would genuinely make your travel and your stay easier, bring that up, and be honest about it.”
I’ll also highlight that we have partnerships with two hotels within a half-mile of the Carol Whitehill Moses Health Center in DC. It’s so comforting to know that we’re sending patients to these places where we know they’re safe and they can recover in peace and privacy. We assure patients that the hotel won’t know why they’re there, just that we booked them a room, and that we know that it’s a safe place to go. We met with the staff of these hotels recently, and they reaffirmed their commitment to our patients’ safety. That is an absolute blessing.
What aspects of your work do you find the most rewarding?
Among other things, being in a position to normalize abortion for folks and to respond to their individual needs is really satisfying. I’ve been in related roles for at least eight years — my abortion fund case management experience goes back to 2016 — so I know this ecosystem well. I’m able to confidently respond to patients’ concerns and say, “I know how we can address this. I know who to contact for this.”
I also remind them that I’m very matter-of-fact about abortion care because I’ve done this work for a while, but that whatever they’re feeling is valid. That’s not to say that we can resolve every case perfectly or that there aren’t challenges, but when I am able to confidently speak about the support we can offer, it’s wonderful to hear patients’ relief and see them start to feel like, “I can get through this.”
What it really comes down to is recognizing abortion as a routine form of health care and guiding patients towards care. It’s meaningful and rewarding work.
Support PPMW’s work to provide equitable access to abortion care by donating to the Abortion Access Fund
Tags: Support, Abortion Access