Reproductive and Complementary Health Care

Background

In 2016, the Centers for Disease Control (CDC) reported over 2 million cases of chlamydia, gonorrhea, and syphilis in the US, which is the highest number of sexually transmitted diseases (STDs)(1). Surveillance data doesn’t encompass more than a fraction of the US’s prevalence of STDs because countless cases of the above-mentioned diseases, as well as HPV and herpes, oftentimes go unreported to the CDC(1). It is imperative that the fundamental substructure of prevention services be adequately maintained and strengthened to increase an effective response nationwide(1). When resources are limited within communities, it can be challenging to provide treatment for and identify STDs(1). Budget cuts to essential STD programs at the state and local levels impede diagnosis and treatment access for infected persons(1). This makes it difficult for people to afford services that may now require a co-pay or a much higher patient co-pay, find clinics with longer hours of operation, and have adequate staffing at other facilities to accommodate patients(1). Individuals with STDs will remain susceptible to varying degrees of consequences to their health when care is not received(1). America’s STD encumbrance is further exacerbated by this, thus, the probability of transmission to other people will continue to rise(1).

STDs are merely one health concern that can be negatively impacted by imposing upon access to sexual and reproductive health care services. The largest provider of sex education and the leading provider of sexual and reproductive health care is Planned Parenthood Federation of America(2). Planned Parenthood offers free and low-cost health care services to individuals within various communities. If it weren’t for the services offered by Planned Parenthood, many people in vulnerable communities who lack insurance coverage or don’t receive adequate coverage may not have access to certain sexual and reproductive health services. Not only are sexual and reproductive health services offered, but Planned Parenthood also provides primary health care services such as vaccines, and screening for various diseases like breast cancer, and inclusive care to persons who identify as LGBTQ(3). For several years, federal and state legislators have tried to eradicate Planned Parenthood clinics. These actions have come from attempts to implement laws that would reduce funding for Title X and reimbursement for Medicaid, which threatens the health of communities throughout the US(3). Medicaid pays for more than half of the women’s health programs in the US, and Planned Parenthood falls under that umbrella. Planned Parenthood has been targeted for many years by politicians because it also offers pregnancy terminations that many view as controversial or that is not within the confined moral beliefs. Abortion services only account for 3% of its overall services(4). The attempts that have been made to discredit and dissolve the organization are aimed at eliminating the access women have to abortion services at some of its facilities(3). Federal entities that seek to demobilize Planned Parenthood health centers are negligently putting people in jeopardy of losing access to health care services that alone cannot be sustained by regular health clinics because those clinics don’t have the capacity throughout vulnerable communities.

Position

The United States Congress should continue to allocate funds in the yearly budget to Planned Parenthood without prejudice of certain services the organization offers in different states. The valuable sexual and reproductive health care services, primary care, and education Planned Parenthood provides to women, men, LGBTQ members, and children are vital and must be supported. The most controversial aspect of Planned Parenthood’s offerings that lawmakers and the current administration are attacking include abortion services, which only account for approximately 3% of what the organization provides(4). Vulnerable communities (women, low-income, uninsured, underinsured, etc.) throughout the US will continue to face negative impacts if access to care through Planned Parenthood is reduced, and adequate substitutes are not made available.

Substantiation and Proof

Researchers and policy analysts study a number of effects that restricting funding to Planned Parenthood can have on communities previously and currently utilizing its health care services. A study conducted by researchers on the effects of removing Planned Parenthood centers as recipients of funding from a Texas health program funded by the state assessed the rates of providing contraception, the method used while participating in the family-planning program, and coverage of childbirth under Medicaid before and after Planned Parenthood was excluded from the program(5). Changes in contraception claims were analyzed before and after omission of Planned Parenthood. Rates of contraceptive continuation and of childbirth that Medicaid covered among women using injectable contraceptives were observed. The results showed adverse effects. Results illustrated a decrease from 56.9% to 37.7% among the percentage of women using injectable contraceptives who were returning for a subsequent injection appointment before and after the elimination of Planned Parenthood funding(5). When the organization was excluded, counties with affiliates of Planned Parenthood saw a 27.1% increase in the frequency of childbirth deliveries that were covered by Medicaid within 18 months from the claim date at baseline(5).

The current health care system is straining itself to deliver adequate health care services to all vulnerable populations. Before the Affordable Care Act (ACA) became a law, an alarming 33% of primary care physicians and 22% OB-GYNs reportedly were not accepting new Medicaid patients(3). These estimates varied by states and reports illustrated that recruiting OB-GYNs to accept Medicaid-managed plans from patients posed a significant difficulty(3). Once ACA was signed into law, the number of primary care physicians and physician assistant reports of accepting Medicaid and newly insured patients doubled and nearly tripled(3). This increase in the number of medical providers who are seeing patients, and patient access to a qualified provider, supports the prospect of improvement within America’s health care delivery system to meet the needs of the underserved.

Access to and the use of contraceptive care and health services has had positive lasting impacts on women in the US. In a study that surveyed over 2,000 women who received services from family planning clinics throughout the US, including Planned Parenthood, 63% of women said that the ability to use birth control has enabled them to better provide for themselves and their families; 56% reported being able to financially support themselves; 51% were able to complete their education; and 50% reported being able to keep or obtain employment(6). Women find it very important to have the ability to plan for when they want to have children of their own. The ability to receive access to sexual and reproductive health care services that provide tools they need for prevention and unintended pregnancies, as well as education, are resources that should not be stripped away from anyone.

Opposition

The opposing views of conservatives, anti-abortion groups, republican and democratic legislators of the current administration under President Trump have been trying to defund Planned Parenthood and restrict access to abortion services. Trump signed a law in 2017 aimed at terminating federal funding for Planned Parenthood which would allow states to exclude the organization from receiving Medicaid funding. This attempt has been futile because, in order to take away Medicaid funding access, the federal law that guarantees Medicaid patients have the right to use any qualified medical provider would have to be changed(7). The Congressional Budget Office has reported an estimate that direct spending would decrease by $235 million if legislation to defund Planned Parenthood is passed into law(8). This could then allow for funding to be reprioritized to health care alternatives, such as pro-life health care reform that anti-abortion groups are in support of(9). President Trump, however, has not demonstrated a priority in protecting and investing in women’s health through other alternatives, even with the proposal of the American Health Care Act to replace the ACA.

A report from the Congressional Budget Office, however, also estimates that if Planned Parenthood is permanently defunded, a $135 million increase of direct spending due to increased spending on Medicaid between 2016-2025 would take place, and the additional births covered would add to federal spending for Medicaid(7). Thus, this estimate of increased funding could significantly increase. Planned Parenthood has recently been accused of illegally selling fetal tissue from completed abortions. The launch of an investigation by the Justice Department in relation to the sell fetal tissue donated for research by women who have had abortions began after a video surfaced of a Planned Parenthood official discussing such sales. Unauthorized use and selling of fetal tissue is a questionable offense. However, a lack of records to validate this claim, and the alleged heavy editing of the video by anti-abortionists, weaken the opposing view of Planned Parenthood defunding. Fetal tissue, obtained by informed consent from women, can provide groundbreaking support in medical research to gain an improved knowledge of genetics, health disparities that different racial groups face, and much more.

Conclusion

Planned Parenthood is a fundamental organization in the US’s health care system that provides essential health care services for women, men, LGBTQ persons, and adolescents. Those services, which encompass not only abortion services, help bridge the gap between adequate health services and underserved populations. Eliminating funding to this organization will allow for the current gap of health disparities among groups of differing socioeconomic statuses and communities to further increase. One limitation that may not be overcome is the decades-long political battle of stripping funding from Planned Parenthood. Conservatives and other legislative members who oppose abortion will continue fighting for the defunding of the organization. Other limitations include scarcity in the literature that illustrates the positive impact Planned Parenthood has on communities with greater numbers and a more direct correlation of how a lack of its resources impacts vulnerable populations. Future research could provide more support for the argument to maintain funding for Planned Parenthood within the US government so that no one is receiving inadequate health care services.

References

1. CDC. Reported STDs in the United States, 2016. 2016. (https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/STD-Trends-508.pdf). (Accessed 2018).

2. Parenthood P. Our Impact. (https://www.plannedparenthood.org/about-us/our-impact). (Accessed April 2018).

3. Diana Silver FK. Planned Parenthood is Health Care, and Health Care Must Defend It: A Call to Action. American Journal of Public Health 2017;107(7).

4. Taylor J. How Women Would Be Hurt by ACA Repeal and Defunding of Planned Parenthood. 2017. (https://www.americanprogress.org/issues/women/news/2017/01/18/296705/how-women-would-be-hurt-by-aca-repeal-and-defunding-of-planned-parenthood/). (Accessed April 2018).

5. Stevenson AF-V, Imelda; Allgeyer, Richard; Schenkkan, Pete; Potter, Joseph. Effect of Removal of Planned Parenthood from the Texas Women’s Health Program. The New England Journal of Medicine 2016;374:853-60.

6. Frost JL, Laura. Reasons for using contraception: perspectives of US women seeking care at specialized family planning clinics. Contraception 2012;87(4):465-72.

7. Rovner J. That Vow to Defund Planned Parenthood: Easy to Say, Hard to Do. 2017. (https://www.npr.org/sections/health-shots/2017/01/15/509662288/that-vow-to-defund-planned-parenthood-easy-to-say-hard-to-do). (Accessed April 2018).

8. Gray M. Economic Impact of Defunding Planned ParenthoodL The Debate Around Women’s Healthcare. University of Pennsylvania: Public Policy Initiative; 2017. (https://publicpolicy.wharton.upenn.edu/live/news/2073-economic-impact-of-defunding-planned-parenthood). (Accessed April 2018).

9. Davis J. Trump Signs Law Taking Aim at Planned Parenthood Funding. The New York Times; 2017. (https://www.nytimes.com/2017/04/13/us/politics/planned-parenthood-trump.html). (Accessed April 2018).