Voice in the Wilderness Tapestry Health Strives to Provide Women with Choices

Leslie Tarr Laurie believes in choice. Not just in the context of abortion, although she’s a staunch believer in a woman’s right to choose that option. No, Laurie wants Americans to have all kinds of choices.Take Plan B, the emergency contraception recently approved by the U.S. Food and Drug Administration.

“We have known for many years that Plan B is quite effective in preventing pregnancy after unprotected sexual intercourse,” said Laurie, president of Florence-based Tapestry Health. “It took a long time to allow American women to enjoy the benefits of technology that those in other parts of the world have been able to use for many years. And as a parent myself, it seems to me that the most important choice people make is if and when to be a parent.”

OK, so Laurie won’t be speaking at the Republican National Convention anytime soon. But through Tapestry, a 33-year-old network of health care and reproductive services for women and men, she has found a different audience — the 50,000 Western Mass. residents who access the programs yearly.

With more than 10 centers spread across Hampden, Hampshire, Franklin, and Berkshire counties, the non-profit Tapestry has grown into a crucial health care delivery system for the region’s uninsured, providing gynecological care, birth control and pregnancy counseling, HIV testing, and a plethora of other services — all with a patient-focused touch not always seen in a busy doctor’s office.

“People are often rushed through important and life-changing decisions, but it’s important to have time to think things through until they make sense,” Laurie said.

This month, The Healthcare News makes sense of some of the work being performed at Tapestry — and why Laurie and her staff are so passionate about it.

Service and Advocacy

Tapestry Health, first known as the Family Planning Council of Western Mass., was established in 1973. Laurie was on the council’s board even from those first days, and although the range of services has changed over the years, the basic mission of the agency has not.

“The idea was to create a four-county regional organization that provided health and reproductive services, particularly to people who were uninsured,” she said, explaining that Tapestry was the first such program in the region to use a sliding fee scale that corresponded to patients’ income and family size.

“So many women don’t have access to these kinds of services,” said Monica Rose, director of communications for Tapestry. “If you have health insurance, you can go to a regular doctor, but how many people can afford to pay $125 out of pocket to see a doctor? I can’t imagine not being able to get these services, and it’s unbelievable that some people think they have to go without them.”

However, Tapestry’s innovations don’t stop at the sliding scale. “We were also the first organization in Western Mass. to use a team approach to medicine,” Laurie said. “In health care, this is now routine, but years ago, it was quite unusual to have a doctor teamed up with a nurse and a counselor.”

Also from the beginning, Tapestry has always maintained a dual focus on service and advocacy — promoting causes on the state and national level while serving patients locally.

Tapestry’s needle-exchange program, which recently marked 10 years of operation on Center Street in Northampton, is a good example. Last year alone, the program removed 70,000 dirty syringes from circulation, reducing the spread of communicable diseases. But the service also has relationships with area detoxification and rehabilitation centers and helps drug addicts to connect with these services.

“We view ourselves as part of the substance abuse treatment system,” said Tim Purington, the needle-exchange program director. “Probably about 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the work we do is helping people figure out what they can do about their problem.”

However, needle-exchange programs are controversial among many lawmakers, and Tapestry has seen a drying up of federal and state money to fund the initiative, so the agency continues to lobby legislators for support while educating the public on the program’s successes.

“We see our work as public health, and I’m proud of the work we do saving lives,” Laurie said. “But unfortunately, many others see the work we do as deeply political, and use some of our services to further their political aims.

“Untold numbers of studies have let us know that one of the primary ways HIV is passed is through dirty needles,” she noted. “Research shows that needle-exchange programs don’t encourage drug use. But instead of seeing this program expanded, we find ourselves strapped for dollars.”

Breastfeeding is another issue where advocacy comes into play. Specifically, Tapestry has argued against hospitals presenting new mothers with gift bags that include infant formula.

“We encourage women to breastfeed their children, which is beneficial to the mother bonding with the baby and also passes on antibodies, which help protect the baby in the future,” Laurie said. “But if women don’t start breastfeeding quickly after the baby is born, that option is obliterated. If formula is readily available, it makes it more challenging for women to start breastfeeding.”

A Unique Niche

Laurie stressed that Tapestry has been especially committed to the area’s gay, lesbian, bisexual, and transgender communities.

“Our breast health program has a special focus on lesbian health,” she said. “As it happened, lesbians have had a higher incidence of breast cancer, and some of that stemmed from the manner in which clinics dealt with lesbians; instead of feeling comfortable going to the doctor, some of them were hesitating” — and often missing out on important screenings.

In the same way, Tapestry has created a men’s health program that has a specific focus on the health concerns of gay men — again, an effort to serve a population that has at times felt disenfranchised from traditional health services.

Laurie noted several times during her talk with The Healthcare News that Tapestry serves several groups of people who often feel disconnected from conventional health care, from the HIV-positive to the uninsured. But Tapestry’s open arms are nothing new, she noted.

“From the beginning, we never discriminated against anyone who came to us for services,” she said. “If a woman was unmarried and pregnant in 1973, that was a bigger deal than it is now, but we never discriminated. If someone was 17 years old and came to use our services, we saw that as something responsible and positive.”

Indeed, Tapestry has always taken a pragmatic approach to teenage sexuality, a viewpoint Laurie believes most people in Western Mass. share. As a result, she has harsh words for lawmakers who push abstinence first in health education programs.

“While we recognize that it’s better if young individuals refrain from sexual intercourse, the reality is that, by age 17, 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of young women have been involved in sexual intercourse,” she said.

“We want to make sure that people don’t make decisions that will alter their lives negatively forever,” Laurie continued, referring to Tapestry’s emphasis on educating women on birth control and making sure pregnant women are counseled on all their options, including abortion.

With the advent of HIV and AIDS, she said, being educated on proper contraception is even more crucial.

AIDS has now been around for 25 years, and for the past two decades it has been the focus of several Tapestry services, including not only education on HIV risk reduction and safe sex, but confidential testing and, for those who test positive, referrals to other medical and support services.

Getting people to undergo HIV testing has been an uphill battle for years, Laurie said, but although some stigma remains, constant education has led to increasing mainstream acceptance of those carrying the virus — and that, in turn, increases the likelihood of individuals getting tested.

“People are becoming educated enough to know that you can be in the same room with someone who is HIV-positive, or that you can drink from the same water fountain, and not get it,” she said. “But we still need to remind people that this is the most significant health emergency there is, and we need to remain vigilant in providing information.

“It’s still no easy thing to be HIV-positive,” Laurie continued. “The number of drugs you need to take to maintain a healthy status is a challenge for many.” What has changed, she said, is that with the proper regimen of drugs and other treatments, HIV sufferers are living longer, fuller lives than before.

“It’s possible for someone who is HIV-positive to live a quality life,” she said. “Of course, it’s better for someone not to be HIV-positive, but today, they don’t have to feel like it’s a death sentence.”

The Work Never Ends

There’s still plenty of work to do, of course, especially considering that one out of every three people in Massachusetts infected with HIV don’t know they’re carrying it, she said.

But that just makes Laurie and her staff want to work harder, often employing edgy, innovative ideas, such as passing out key chains containing condoms.
“We recognize that sexuality is a natural part of life, and we want people to make decisions that protect themselves from disease,” she said.

Laurie has helped thousands of women make such decisions over the past 33 years, and even though she’s frustrated at times by government bureaucracy, she takes comfort in the fact that her agency remains independent and free of external red tape.

“One of the things I feel so positive about is our organization’s ability to respond, because we are local,” she said. “We don’t have a national organization telling us what to do. That affords us the ability to respond effectively to the specific needs in Western Mass.”

Those needs, she said, are no different than in other parts of the state, so neither should the available health resources be different.

“We don’t see Western Mass. as a backwater; we see it as a beacon,” she said. “The people who live and work here have access to the same quality of health care as those who live in Boston. And we’ve tried to be that kind of provider.”

It’s yet another choice for Pioneer Valley residents — and, for many without health insurance, Tapestry is a choice they can’t live without.