Assault on Poor Women

The War on Planned Parenthood Is Also an Assault on Poor Women of Color

The Right’s war on federal funding to health clinics is putting public health at risk. 

By Michelle Chen

Our elected representatives have taken to the airwaves to proclaim they are extremely concerned with the fate of discarded fetal tissue; the fate of the health of poor women? Not so much.
 
Conservatives have again vowed to defund Planned Parenthood, now with even more gusto, following a strategically edited sting video suggesting the organization somehow exploits inanimate post-abortion fetal tissue to do scandalous things, like facilitating biomedical research.

While that “controversy” over fetal tissue tampering drones on, lawmakers tamper every day with the lives of real women, particularly the 20 million who need publicly supported reproductive health services. Their access to care is more needed than ever but facing unprecedented political threats, thanks to the perennial budget slashes proposed by right-wing lawmakers looking to prove their anti-abortion bona fides. Planned Parenthood has long been an embattled pillar of that healthcare landscape, but it is just one of many recipients of a federal funding stream that is coming under increasing political threat.

A key source of federal family planning funding, known as Title X, has seen a 10 percent cut in its budget since fiscal year 2010. Title X-funded clinics have already shed services for some 667,000 clients—capping a generation of funding declines since the 1980s, according to the National Family Planning & Reproductive Health Association. For more than 4,100 clinics nationwide, these cuts have not only coincided with diminished services but outright closures. Under continual budget strains, about one in three family planning clinics in South Dakota, and one in five Maryland clinics, have vanished.

For that uninsured minimum-wage worker, her local Title X clinic is a fraying lifeline: she relies on it for birth control, health counseling, and cervical cancer and HIV screening (Title X funds, along with federal Medicaid, are restricted to non-abortion services). In 2013, according to Guttmacher Institute, “the contraceptive services provided by clinics alone helped women to prevent some 1.4 million unintended pregnancies, thereby helping women avoid 705,000 unplanned births and 485,000 abortions.” Even Republicans should be glad to know that publicly funded family planning prevented 164,000 unplanned preterm or low birthweight births.

There are additional benefits for sexual health, including some 99,000 averted chlamydia cases, mostly thanks to Title X-funded facilities. Not a bad track record considering how severely Title X funding has lagged behind inflation over the past generation despite low-income women’s increasingly complex needs: In real dollars, the current funding of less than $300 million represents a two-thirds decline from the program’s funding level in 1980.

The number of women in need of publicly funded reproductive healthcare has risen steadily in recent years, growing from 2010 to 2013 by about five percent. This category, defined as women earning below 250 percent of the federal poverty level or younger than 20, includes several million uninsured women (additionally, many other demographics, including men, are served by these programs). Yet since 2001, “the overall proportion of need met by all publicly funded providers fell by seven percentage points, from 49 percent to 42 percent.”

“The need has been going up at the same time that not as many women are being served by the public system,” says Adam Sonfield, Senior Public Policy Associate with Guttmacher.

The country’s Title X and Planned Parenthood family planning clinics are only a piece of the reproductive healthcare infrastructure: Most public support for family planning services is provided through Medicaid and state funding.

The war on reproductive healthcare is also an assault on poor women of color. Reflecting demographic changes across the country, the proportion of blacks and Latinas among the population needing care has risen more than whites in recent years. Immigrant women are especially dependent on subsidized community clinics, as they are often excluded from formal healthcare services like Medicaid.

Beyond Title X, basic reproductive health under the Affordable Care Act is imperiled as private insurance systems find ways around federal mandates. As the Hobby Lobby case showed, employer-provided insurance coverage for contraceptive care can be cut if your evangelical boss finds it too sinful. The threat has deepened with various legislative proposals to expand the use of “conscience clauses” by private institutions to cut off contraception access.

While Medicaid coverage for family planning is generally protected by federal guidelines, the program faces a general attack by conservatives on public healthcare. Reimbursement rates are so low many providers refuse to accept Medicaid, and public health centers struggle overall with underfunding, which acutely affects healthcare access for poor women, many of whom lack any source of medical care.

Financially strapped local clinics are especially in need of Title X support to close gaps in operating costs, says Sonfield. These funds might be used, for example, to “let a clinic upgrade its information technology… or to train its staff on how to work with health plans or just dealing with salary crunches… trying to keep your clinic doors open after normal business hours or on the weekends, since there are a lot of women who really just can’t take off during the day.”

So the clinics under threat serve the most vulnerable women, who face the most pressure to forgo the care they need because it’s too expensive or too far from home.

Paradoxically, conservative officials’ effort to defund and shutter family planning centers may actually be having the opposite effect than the purported goals of “family values” Republicans: one study found that greater access to a local family planning center—for instance, having a clinic in your neighborhood providing condoms and reproductive healthcare—“may lead to less risky sexual behaviors among older youth.”

According to Guttmacher, “gross potential savings from averting all unintended pregnancies in 2010 would have been $15.5 billion.” At $7 saved per dollar spent, family planning funds yield remarkable taxpayer value. But of course, the debate in Washington isn’t really about the numbers—as the shrill morality play over fetal tissue demonstrates, it’s about visceral anxieties over women’s right to control their bodies. For a poor woman who can’t get a day off work to drive across state lines for an abortion, or must choose between rent and birth control pills this month, just one number matters: The difference between one remaining clinic open in her town, or, after the next round of budget cuts, none.