By Melinda Young

EXECUTIVE SUMMARY

In recent years, family planning clinics have faced many obstacles to providing contraceptive access to all patients who need it.

  • Access issues worsened under changes to Title X and the Supreme Court’s recent ruling that allows some employers to opt out of providing contraception coverage.
  • Reproductive health experts worry these recent changes — and COVID-19’s effect on access — could result in more unintended pregnancies.
  • Some states, like Missouri, have helped low-income and uninsured people maintain access to contraceptives through privately funded programs.

The past few years have made ensuring contraception access challenging for family planning centers and reproductive health clinicians. Most challenging are the financial cuts and restrictive new rules regarding Title X coupled with the recent Supreme Court ruling that allows broad exceptions to the Affordable Care Act (ACA)’s contraception mandate.

These governmental actions are magnified by the COVID-19 pandemic, which is stressing family planning clinics in ways they never imagined. Health departments, federally qualified health centers, and family planning clinics are being pulled in many different directions as they try to provide services safely, says Michelle Trupiano, MSW, executive director of the Missouri Family Health Council, Inc.

“At this time, contraception is extremely important across our state,” she says. “Evidence shows that a lot of times — during any crisis, but especially when individuals are staying home for extended periods of time — contraception is important. There’s uncertainty of what’s ahead. Many women at this point in time want to delay pregnancy.”

Americans are facing job losses, financial burdens, loss of insurance, and the additional stress of the pandemic. For many, the year 2020 is not the time to have a baby and add additional stress to their lives.

Women do not want to delay their desires, but they also might not want to get pregnant during the pandemic.

“Some people are very worried about getting pregnant right now,” says Julie Rabinovitz, MPH, president and chief executive officer of Essential Access Health in Berkeley, CA.

With the increased obstacles to obtaining affordable contraception, there is the danger of a spike next year in unplanned pregnancies.

“It’s a perfect storm of what could happen with an increase in unintended pregnancies because of people not having access due to the Supreme Court decision, and not having access due to the pandemic,” Rabinovitz says.

Providers Under Pressure

Contraceptive providers also are under stress. Millions of Americans have lost their insurance since March. The continual assault on Title X and the ACA’s contraceptive mandate also put providers under financial worry.

“A lot of our sites are worried about keeping their doors open right now and having the funds to be able to do so,” Trupiano says. “When you add additional burdens, where they are reimbursed by insurance for a client and now are providing free or reduced costs, it will put even more burden on health centers.”

No one knows what the full repercussions will be, but health centers are feeling that strain, she adds.

For example, family planning centers in Arizona have been underfunded for a long time, says Bré Thomas, MPA, chief executive officer of the Arizona Family Health Partnership, a Title X grantee.

“We’re not funded to meet current demand in Arizona, so it’s hard to anticipate if folks are no longer able to access birth control through their health plan how they will come into the Title X system,” she explains. “They probably wouldn’t meet the need requirements for Medicaid, and our system is set up for no-income or low-income folks. If you make 250% of the federal poverty level [FPL], you pay the cost of the service.”

Private Funding Helps

Anyone in need of reproductive health services can visit a Title X clinic, but if they make more than the 250% of FPL, they will have to pay for the services out of pocket, she adds.

Title X centers cannot refuse service due to the person’s inability to pay. “We can make allowances for that, but we don’t have enough resources to cover the need,” Thomas says.

In some cases, private funding is helping to alleviate some of the burden. In Missouri, the effect would be worse if not for the Right Time initiative, a privately funded program focused on reducing all cost barriers for uninsured and underinsured women, Trupiano says. The initiative works with 12 health centers across Missouri.

“It’s a multipronged initiative, and it funds their visit and contraceptive method of choice at no cost to them if they’re uninsured or underinsured,” Trupiano explains. “In the short term, we hope we will be able to support anyone who will be losing their coverage. We know long-term funding sources change, and these now have long-term consequences.”

The Missouri initiative was in the works before the Trump administration proposed changes to Title X, but the need for the funding has increased because of the administration’s actions, she notes.

“Missouri has always been in need of additional funding for family planning services,” Trupiano says. “But having the funding available at this particular moment when health centers are under additional stress and strain has allowed us to support health centers to the point where we haven’t seen dramatic closings of health centers.”