United States - Even as a national debate rages over contraception insurance, tens of
thousands of low-income women and teenagers across the United States
have lost access to subsidized birth control as states slash and
restructure family planning funds.
Montana and New Jersey have
eliminated altogether their state family planning programs. New
Hampshire cut its funding by 57 percent and five other states made more
modest program trims.
But the biggest impact, by far, has been in Texas.
State
lawmakers last fall cut family-planning funds by two-thirds, or nearly
$74 million over two years.
Within months, half the state-supported
family planning clinics in Texas had closed.
The
state network, which once provided 220,000 women a year free and
low-cost birth control, cervical cancer tests and diabetes screenings,
will now serve just 40,000 to 60,000, officials said.
Another
130,000 low-income Texas women who get free exams and contraceptives
through Medicaid could lose those benefits by month's end, due to a
dispute between the state and federal governments over whether Planned
Parenthood should be allowed to serve women on that program.
At
the People's Community Clinic in Austin, the cuts mean that many
low-income patients, except the very poorest, are now charged for
contraception that used to be free: $5 for a dozen condoms; $10 for a
month of birth control pills; $225 for an IUD.
"I
have no clue what I'm going to do," said Rhetta Pope, 22, of Austin. A
stay-at-home mother of two, she lives off disability payments of less
than $1,500 a month.
Pope said
after paying basic living expenses, she has so little left she scrimps
on electricity by keeping the lights off and takes her laundry to an
aunt's house. She can't imagine how she would pay for birth control.
"I guess I'm going to have to stop using it because I don't have the money," Pope said. "I'm pretty shook up. I really am."
SAVINGS IN DOUBT
Texas
legislators who backed the 66-percent family planning cuts say they had
no choice - the state budget was in crisis and many worthy programs
suffered.
But a budget board analysis concluded the cut would actually cost Texas taxpayers more than it saved.
The
board projected that women unable to get low-cost birth control would
deliver 20,500 additional babies - costing state and federal taxpayers
$231 million in prenatal, maternity and infant care. The state's share
would be close to $98 million - significantly more than the family
planning cut savings.
State
Representative Wayne Christian, a Republican, acknowledged that the cuts
might be counterproductive "if you look at it from a financial cost,
perhaps."
But he disputed the notion that additional babies were a cost burden. "We value a human life more than just the cost," he said.
In
general, he said, the state should not try to deter births by widely
distributing free contraception. If women who want birth control cannot
afford it, he said, they should first seek help from families or
communities.
"I'm sorry," Christian said, "but there's this thing called individual responsibility."
Some women have found ways to pay for the care they once received free, but many have not.
After
losing much of its state family-planning grant, the Parkland Health
& Hospital System in Dallas in January began charging most patients a
flat $25-per-visit fee.
In the
first two weeks of the policy, 362 women cancelled appointments because
they could not make the co-pay. Only 20 percent found the money to get
care within a week or two, hospital officials said.
Another
20 percent were referred to one of the two Parkland locations still
providing free services. Those sites are now so busy, the first
available appointment at the Irving Women's Health Center is August 21.
Most
of the remaining women never came back for care after learning about
the co-pay, said Paula Turicchi, a Parkland senior vice president.
BLOCKING TAXPAYER DOLLARS
In
several states, including Texas, questions about birth control access
are now entangled with the politically explosive abortion debate.
Planned
Parenthood is the nation's largest abortion provider, with about
330,000 procedures a year. It also runs a network of urban and suburban
clinics offering birth control, gynecological exams and care for
sexually transmitted diseases.
The
organization gets about a third of its revenue, $360 million in 2009,
from government grants to provide those services to poor women.
In
the past year, Wisconsin, North Carolina, Tennessee, Indiana and Texas
all have moved to block Planned Parenthood from receiving taxpayer
money. Several other states, including Ohio, Oklahoma and New Hampshire,
are considering similar moves.
While
public funds don't pay for abortions, critics of Planned Parenthood
argue that hiring the organization to provide family planning to poor
women helps the organization stay afloat and thus indirectly supports
abortion services.
The Texas
funding cut prompted Planned Parenthood to shut down 11 clinics. It also
has jeopardized a $40 million family-planning program run as a Medicaid
extension.
The program provides
free birth control and annual exams to 130,000 low-income women of
reproductive age who don't qualify for regular Medicaid. The federal
government pays 90 percent of the cost; Texas puts up just $4 million a
year.
About 40 percent of women in
the Texas program get subsidized care from Planned Parenthood clinics,
but a new state law blocks those clinics from participating. The Obama
administration has said that violates federal Medicaid rules. If neither
side compromises, the program will likely close by the end of March.
That
infuriates Jonee Longoria, a single mother in Houston who relied on the
program for free services for several years as she put herself through
college. "I had one child living in poverty and I didn't want another,"
Longoria said.
She now works for a
social service agency and refers many clients to the program for
contraception. Without it, she said, "where would they go?"
Advocates
of defunding Planned Parenthood say they regret any service disruptions
for poor women. But they call it a necessary price to pay to take a
moral stance on abortion.
"We're
just doing what we think is best," said Joe Pojman, executive director
of Texas Alliance for Life, which opposes abortion.
