Editor’s Note: In the interest of full disclosure, this author worked for Planned Parenthood’s Kansas City location for a brief period in the late 90s.
Every day I work with low income women, assisting them in finding the support they need to rebuild their lives after experiencing domestic violence. When women begin services with me, we talk for some time about their specific goals and needs. I ask a lot of questions, pointing out goals they may not have thought about and highlighting their strengths. Every time I do this, I ask about their health. Nothing extensive, just a few questions about the last time they saw a doctor and their health goals. A vast majority of the many women I have worked with have not had regular contact with a physician in many months or sometimes years. They rarely have a medical home or trusted professional with whom they can have discussions about their health concerns. Many times they are in dire need of medical services, often in the field of reproductive care. I have seen more than one pregnant woman in her last trimester that had been forbidden to see a doctor by her partner, women who were struggling with an unwanted pregnancy at the hands of an abusive partner, or complications from miscarriages induced by violence or stress. Women who were carried on a violent spouse’s insurance and were met with suffering if they used the insurance for birth control, or forbidden from seeing a doctor at all for fear of them disclosing the abuse they lived with daily. Women who had an extensive family history of reproductive cancers who hadn’t been in for a pap smear in decades.
Domestic violence survivors have very specific needs relating to empowerment, healing, and safety, but they are not unique in their need for quality, low-cost health care. Without the services of Planned Parenthood, these women and many others would be left without viable alternatives.
Why not just use the Affordable Care Act? Wasn’t that its point? The specific safety concerns of domestic violence survivors, such as reproductive coercion, medical abuse, financial abuse, and sexual violence, all contribute to the need for low-cost, anonymous health services for men and women of all income levels. The need for anonymity is shared by teens empowered to take responsibility for their health when parents or guardians forbid it, those who work for religious corporations who are inexplicably not held to the same requirements as other businesses in providing health care to women, or religious institutions who are exempt from providing them, but may administer consequences to their employees if they find they are accessing those services, even at full cost.
Those examples aside, most low income people do not meet the minimum requirement to access the ACA market place. In theory, that population should be able to access Medicaid instead. Unfortunately, “accessing Medicaid” is a months-long process, filled with information gathering, signatures, interviews, phone calls and verifications; for the homeless, mentally ill, and those without reliable access to the internet, a phone, or transportation, asking them to complete the process is nearly impossible. Even if someone is capable of doing so, there is a gap in coverage between those eligible for Medicaid and those able to access the federal subsidies on the marketplace in 22 states. Most single able-bodied men and women without children are ineligible for healthcare coverage of any kind. In Missouri, for example, there is an exception for women’s health services. Women age 19-55 may be eligible, depending on income, to access family planning and reproductive health services— care they often receive at Planned Parenthood.
Planned Parenthood serves 2.7 million women and men annually across the country. The vast majority of those services include preventative reproductive health checks, cancer screenings, treatments for STIs, low-cost access to birth control, family planning and counseling services. 97 percent of what Planned Parenthood does has nothing to do with abortion, and the money they receive from the federal government through Title X cannot be used to fund abortion services. The money they receive from Medicaid can only be used in instances of pregnancy through rape or incest, or when the mother’s life is at risk. (Some states may go beyond this and use state-funded Medicaid money to fund medically necessary abortions.)
What is the most likely outcome of defunding Planned Parenthood at the federal level, as Sens Ernst, Lankford, and Rand would like to do with H.R. 3134? According to the bill summary, it aims to remove all federal funding from Planned Parenthood and their affiliates if they continue to perform abortions, unless the abortions are in the cases of rape, incest, or risk the mother’s health if not performed. Planned Parenthood gets about 1/3 of its budget from the government, which is split between Title X money and Medicaid budgets, both from the state and federal level. As it currently stands, none of that money can be used for abortions, besides those exceptions listed above. By taking away that money, they take away nothing from abortion services, which are already privately funded. As the freedom for women to choose safe, clean, and legal abortions has been a core belief of Planned Parenthood for decades, it seems unlikely they would stop performing abortion services. By removing this money, other services would likely have to be cut to make up for the shortfall.
One of Planned Parenthood’s core services since its inception has been providing free and low-cost birth control. This is an extremely important service. Women often choose Planned Parenthood for their birth control needs instead of a family doctor or utilizing insurance because of the anonymity they provide. Planned Parenthood also provides outreach education on effectively utilizing all forms of birth control, the limits of their effectiveness, and the importance of communication and trust between partners. They counsel women dealing with unwanted pregnancies on all of their options and help them find affordable prenatal care, adoption services, and assistance programs if they choose. In all likelihood, these are the services HR 3134 will be cutting. These important services, along with lifesaving cancer screenings and STI treatments will be even harder to find than they are currently. The only logical conclusion to the removal of family planning services is a rise in unwanted pregnancy. With nearly half of unwanted pregnancies ending in abortion, there is a serious chance that defunding Planned Parenthood could result in a rise in the number of abortions performed, the exact opposite of the supposed aim of HR 3134 and its anti-choice supporters.
There is an elephant in the room that is often ignored by even the pro-choice side of the debate: the importance of the availability of safe abortions. We don’t want to somehow confirm the accusations of the anti-choicers, that all of us are sitting on the street corner recruiting women to have unwanted abortions while laughing maniacally, counting stacks of baby-parts money. But abortion is legal, and safe, clean access to it is a basic tenant of the reproductive rights movement. Abortion is accessed for many reasons. I’ve listened to women lamenting the idea of bringing another child into a home where violence was the norm. Women, who despite every societal trope, just can’t love an unborn child they didn’t want and were forced to carry by a violent partner. Women who just got their own lives back and can’t imagine being able to care for another human being. Women with medical issues so grave that, while there is no clear and present danger, the trauma of birth could likely kill them, leaving all of her children without the only person in the world that cares for them. Many of these women chose not to abort, but having that choice was so important, so empowering, that it lifted them and assisted them on their journey of healing. We must not back away from the importance of access to abortion itself. It is core to the reproductive freedom of women.
Defunding Planned Parenthood is a horrible idea.
It will put millions of low income women and men at risk for huge health problems.
It undermines the core of women’s health rights.
It’s amoral and illogical.
It will cause more abortions.