At This Dallas Clinic, Birth Control Isn’t a 7-minute Conversation

The final day that nurse practitioner Micaela Sanchez worked in a traditional women’s clinic, she was scheduled to see 52 patients.

She had woken up before dawn, feeling pretty lousy. Grinding through her morning routine, she dropped her 4-year-old at pre-K and headed from Oak Cliff to the low-cost clinic in Pleasant Grove. By the end of her 20-minute commute, she couldn’t ignore the flu-like symptoms. 

When Sanchez told her supervisor she was sick, the woman handed her a mask and two Tylenol and assured the 37-year-old she’d be fine. The directive “we can’t manage without you” bounced inside Sanchez’s aching head as she struggled through the day’s wall-to-wall appointments, a workload that limited her to spending no more than seven minutes with each patient.

Sanchez understood the business model. But even on her best days she yearned for the freedom to devote more time to those who needed it, especially the many women seeking birth control options. A single mother herself, Sanchez had picked women’s health as her specialty to provide others, especially younger patients, the knowledge and options to make better choices than she had.

She also knew abortion restrictions made contraception conversations more critical than ever, especially for lower-income women whose futures were already fragile. Every day Sanchez sensed their urgency and worried she was falling short as a provider.

Her throat and heart were tight as she walked to her car after finishing her shift that November 2022 evening, symptoms not of her illness, but of suppressing her concerns for so long. Adding to her despair were worries about her two girls, who deserved better than the sunbaked dish rag of a mother she felt herself to be when she got home.

Sanchez left the office that day and never returned. A conventional clinic focused on reproductive health — open only from 9-to-5 on weekdays, designed to see as many women as possible — wasn’t what she wanted for herself or her patients. All the way home, and for months afterward, she considered the same question: “How can I create something better?”

Sanchez’s youth was entwined in the high-spirited chaos of her family’s restaurants, La Calle Doce and El Ranchito, Oak Cliff institutions since the early 1980s. All the Sanchezes grew up working between the two, which is how 16-year-old Juan Sanchez, waiting tables at El Ranchito, met 15-year-old Juanita. They married, after written consent from Juanita’s father, and Micaela was born two years later.

Juanita bounced in and out of her daughter’s life, so Micaela was raised by Juan and her paternal grandmother. That meant hours following her dad through El Ranchito’s maze of dark mission-style tables and multi-colored flags — and occasionally grabbing a warm tortilla off the fire. 

At 13, when Micaela wasn’t in school, she worked as a hostess at the restaurant. There she discovered boys, often years older than she was, and soon was slipping out of the house at night to run the neighborhood streets.

At 15, she moved to East Dallas to live with her 16-year-old boyfriend’s family. “A missing mom definitely messed with my self worth,” she says. “How do you figure out who you are when you don’t know the other half of you?” 

She couldn’t find a way to access reliable birth control; she graduated from Woodrow Wilson High School seven months pregnant. “My grandmother was a teen mom, my mother was a teen mom, I was a teen mom,” she says. “It just goes back, on and on and on.”

Despite being a new mother, Sanchez was intent on becoming a nurse. She left her boyfriend, temporarily moved back to her dad’s, and waited tables at La Calle Doce and Landry’s Seafood House until she could afford an apartment. For a decade, with babysitting help from her former boyfriend’s family, she pursued her degree, one class at a time, while waitressing for 10 to 12 hours nearly every day.

Because she didn’t date much during those years, she didn’t pay attention to the fact that her intrauterine device had expired. “Then I met someone and ended up pregnant,” she says. “There’s just no excuse.”

Sanchez went into labor during her exit exam for graduation. “She wanted to come out and steal my thunder,” she says, “but I made her wait until I was done with that test.”

Even with a newborn and young teen, Sanchez did the additional work at Texas Woman’s University to earn her nurse practitioner’s license. Two years later, she had her certification, with a specialty in women’s health, and a full-time job at the Pleasant Grove clinic.

“I learned so much there,” she says. “There were lots of interesting cases.” But as her skills grew, so did her patient load. It started at 16, then expanded to 20, then 30, then 40. She heard similar stories from her former TWU classmates at their offices: Move more patients more quickly.

After Sanchez left her clinic job in late 2022, she began to sketch out how she’d do things. She wanted an intimate practice specifically for women at opposite ends of the spectrum: Those not ready to begin or grow their family and those who had finished that chapter of their lives.

Rather than take on the cost of a brick-and-mortar office, Sanchez found an examination room in another practice and, when appropriate, sees patients via Zoom. She doesn’t keep strict 9-to-5 hours but offers appointments in the evenings and on weekends, the times her patients are available. Most of her clients’ families make too much to qualify for Medicaid but not enough to afford private health insurance.

Sanchez named her practice “Comadre,” a Spanish term of endearment often translated as godmother or co-mother. Her mission is for every patient to feel they are in a judgment-free partnership with someone they trust. Sanchez educates patients, encourages difficult conversations, and helps them take charge of their reproductive health and family planning.

While Sanchez has seen more than 1,500 patients since 2023, she still considers Comadre Health, located in East Dallas near White Rock Lake, to be a startup. “I’m hungry to succeed and hungry to do more,” she says. “But for every woman I see, if I can be that one seed sown for them towards their future, then I call that a win.”

The same urgency around contraception that Sanchez hears from patients shows up in the work of Anna Chatillon, a research scientist at Austin-based Resound Research for Reproductive Health. As state and federal policies made abortions significantly harder to access in Texas, providing convenient ways to secure birth control is an increasingly immediate need.

Traveling to a state that allows abortion or finding a provider outside Texas to prescribe pregnancy-ending medication remain options, but come at a great cost, Chatillon says. (A new report shows the number of abortions nationally has increased since the Supreme Court overturned Roe v. Wade in June 2022.)

Those who are unable to scale the barriers to abortion often struggle to find conveniently located providers and afford the contraception that allows them to guide their reproductive future. Resound’s 2023 study shows that while 85% of reproductive-age Texans reported using contraception, more than half said they were not using the method they wanted. As with other medical decisions, Chatillon says, people should be able to choose what’s right for them.

“When people can use their preferred contraceptive method, they’re more likely to use it consistently,” she says. “They’re more likely to be able to achieve their family formation goals and other life goals.”

Research indicates the most structurally disadvantaged communities — lower-income earners, people who don’t speak English, and those uninsured or publicly insured — are less likely to have their preferred contraception than other Texans.

“Texas has a particularly tumultuous history when it comes to funding and administration of publicly funded reproductive healthcare programs,” Chatillon says. “Many providers have found it difficult to continue on in the programs and have ended up dropping out, meaning that there are fewer and fewer providers in that safety net.”

Every week, Dallas-based Trust Her, the women’s reproductive health division of the Child Poverty Action Lab, sees the importance of accessible contraception in the text messages sent to its 24-hour hotline. (The Lab Report is a local journalism project published by the Child Poverty Action Lab. Our newsroom operates with editorial independence.)

“Many of the helpline messages we get are from women who need care and need it quickly,” says Trust Her director Kate McCollum. Since launching the helpline in October 2024, McCollum’s team has responded to more than 1,000 individuals.

Most texters seek information about making appointments, qualifying for financial help, or comparing contraception options. Others are in need of urgent help. These texters hope to get a same-day appointment for birth control. Or they need emergency contraception after unprotected sex.

“When they ask, ‘Can I get in somewhere today?’” McCollum says, “I think of Micaela Sanchez.”

Comadre is one of 40 clinics that partner with Trust Her to provide free birth control to Dallas County women who are uninsured and at or below 250% of the federal poverty level, which is about $39,000 for a single earner or $80,000 for a family of four.

Sanchez’s practice is unusual because she has done everything she can to remove barriers to entry, McCollum says. “For Micaela, it’s, ‘How can I do the most to make it easiest for patients?’”

An Oak Cliff mother left a voicemail on the Comadre phone line in early May that sounded straightforward: How soon could she bring her 17-year-old daughter into the office to discuss birth control?

Seconds into the return call, Sanchez knew this would be a long conversation. The mother had learned about her daughter’s sexual activity and couldn’t wrap her head around that reality. “What did I do wrong?” she asked repeatedly.

Sanchez shared her own story and the importance of confronting the situation with candor. She also didn’t rush the woman — she understands those feelings of shame and disappointment. She felt them when her older daughter, now 23, became sexually active.

“Even though I wish somebody would have given me birth control, I was still struggling with giving my daughter birth control, and I’m a provider,” Sanchez says. “Those internal mental barriers are so familiar.”

When the 17-year-old and her mother arrived for the appointment, awkwardness and tears filled the exam room. Once Sanchez started talking, the pressure dropped. She asked about the teen’s goals after graduation, told the teen of her own journey, and then, with a big laugh, said, “There’s always a boy in the story, isn’t there? Some ‘slick Rick’ who will tell you anything. That’s why we are here today, to make sure you have protection.”

That same week, another mother from Oak Cliff, this one an established client with Comadre, called Sanchez about her twin 15-year-olds. “I had these girls at 17,” the woman told her, “and I don’t want that for them.”

The family’s clinic visit began badly; the girls rolled their eyes and glared at their mother.  Sanchez started over, talking individually to each of the three and again sharing parts of her own story. The teens’ embarrassment turned into honest conversation about their boyfriends and curiosity about their options. In the end, both girls selected a contraception method.

Sanchez admires mothers who bring their daughters to see her. “If you don’t teach your girls about what’s going on with their body, you’re feeding them to the wolves in the neighborhood and to learn wrong information on the streets.”

About 60% of Sanchez’s appointments are related to contraception and about 20% are older women, most of whom need help managing perimenopause or menopause symptoms. The Comadre exam room and counseling area are inside an aesthetics practice, and Sanchez also offers weight loss counseling and Botox treatments as time permits. (She pays for her space and equipment with her commission from the aesthetics clinic.)

Many of the appointments aren’t complicated. A woman about to turn 50 needed a refill for her hormone replacement therapy pills. A 37-year-old woman, concerned about whether her IUD was still within its expiration date, went home with updated information. A 32-year-old had her IUD removed because she and her husband want to have a second child.

But often, especially with younger women, hand-holding, repeated instructions, and extra time are required. A young woman, already with a 1-year-old, called Sanchez in tears over fears about having a second child. “We’re not ready for another,” the 20-year-old told Sanchez.

For the next two weeks, she texted Sanchez repeatedly, only to ignore the responses or fail to show up for appointments. “She’s one of my ‘comeback girls,’” Sanchez says. “We’ve had lots of texts and restarts because her life is pretty chaotic.”

Because the woman smokes, Sanchez had explained in their first phone call that birth control without estrogen would be safest. She encouraged her to consider Nexplanon, a “set it and forget it” option placed just under the skin of her upper arm, but the young mother was squeamish about an implant. After an hour-long conversation, she settled on a progestin-only pill, known as “the mini-pill.” Sanchez insisted she needed to be punctual in taking the pill in order for it to be effective.

“You’re juggling a lot,” Sanchez told her. “And you want this to work.”

Sanchez acknowledged after the appointment that the same advice is true when it comes to the way she is trying to provide reproductive healthcare. Behind the scenes, she’s working with trusted advisers to build out her business model and expand the ways patients can find her. She’s open to all ideas — except a practice that requires her to cut short her time with each patient.

“Those conversations are what is going to help them in preventing pregnancy, if they aren’t ready for kids,” Sanchez says. “Those take a while, and they aren’t just seven minutes.”

Sharon Grigsby is the co-founder and senior writer of The Lab Report. sharon@labreportdallas.com.