Republicans in Congress have long aimed to cut Planned Parenthood’s federal funding. Despite the failure on Friday of the American Health Care Act, many observers expect Congress to try, try again to ensure that Planned Parenthood cannot receive Medicaid and Title X payments for delivering women’s reproductive health-care services such as mammograms, contraception and Pap smears. (The 1976 Hyde Amendment bans using federal funding to underwrite abortions, so what is at stake is money for other health-care services for women.)
However, the Congressional Budget Office’s recent report on the American Health Care Act (AHCA) estimated that such a move would both reduce women’s access to health care and lead to more births. I investigated the potential public health ramifications if congressional representatives were to respond to pro-life sentiment.
A recent poll from the Kaiser Family Foundation shows that 75 percent of the nation favors continuing federal funding for Planned Parenthood. Perhaps because of its range of non-abortion services, public support for funding Planned Parenthood exceeds the public’s support for the legality of abortion, which the Pew Forum recently found is 57 percent nationally.
But national numbers obscure major regional differences. Examining opinion at the state level, support for abortion rights varies greatly. In, say, West Virginia, only 35 percent of the state approves of abortion. Meanwhile, in Massachusetts, that approval is as high as 74 percent. Many other states are more narrowly divided. And the prevalence of Planned Parenthood clinics is positively associated with support for the continued legality of abortion.
Planned Parenthood as a health-care “safety net”
Precisely what percentage of Planned Parenthood’s efforts go to which services has been debated. But this much is clear: PP clinics offer a wide range of health services, including contraceptive care, testing and treatment for sexually transmitted diseases (STDs), HIV testing, and cancer screenings.
Further, PP clinics are what public health people call “safety-net health centers”: a last-chance offering for those who couldn’t pay full price if they had to, but who are covered by Medicaid. Thus, Medicaid patients can use their coverage toward non-abortion services, with Planned Parenthood submitting for reimbursement for the rest of the fees (as it does with private insurance as well). Planned Parenthood receives $553.7 million, or 43 percent of its total revenue, from this source of funding, according to its 2014-15 annual report.
In two-thirds of the counties in which a Planned Parenthood clinic is located, that clinic serves at least half of the women who turn to a safety-net health center to get contraception. And in 103 of the 491 counties in which a Planned Parenthood clinic is located, that clinic is the only safety-net provider women on Medicaid can turn to if they want contraception.
Few family planning centers accept Medicaid patients. Therefore, public health is powerfully affected by whether a county has — or does not have — a Planned Parenthood clinic. And with such issues as unintended pregnancy, STDs and HIV all associated with significant economic impacts, failure to access services to reduce their prevalence could result in both declines in public health and costs to the federal government.
How I did my research
I identified the total number of Planned Parenthood clinics that were operating annually in each state between 2008 and 2013, and determined the number per capita in each state. With data from the Centers for Disease Control and Prevention about every state’s annual teenage birthrate and annual rate of STD diagnoses, we can see whether there’s any relationship between access to PP clinics and public health along those two measures.
Of course, higher teen births and more STDs might also be related to higher levels of poverty and lower rates of being insured. I controlled for these additional factors, as you can see in my paper.
My working hypothesis was that in the years that particular states had more Planned Parenthood clinics — and therefore more of its residents could get reproductive health care — those states would have lower rates of teen births and STDs. (The caveat is that STD diagnoses might actually increase with more access to care, as people get diagnosed and treated rather than remaining ill and untreated, thus making showing fewer reported STDs).
And indeed, that’s what I found.
Reduced clinic access is associated with higher rates of teen births; more clinics per capita are associated with fewer teens having children. I find an even stronger relationship between clinic prevalence and STD diagnoses. That is, the more Planned Parenthood clinics in a state in a given year, the fewer teen births and STD diagnoses. I find similar effects of Planned Parenthood clinic access on the health outcomes of HIV diagnoses and reliance on emergency room care.
Other factors are at work as well. For instance, Planned Parenthood clinics are not randomly distributed. States that have more could very well have other social programs that help reduce the rate of teen births and STDs. Although I account in the statistical model for whether states mandate the provision of sex education as opposed to abstinence-only, and there does not appear to be a strong association between Planned Parenthood clinic access and the number of hospital beds per capita, other health and social program delivery could affect these outcomes.
But the findings suggest that unless other health centers were willing to offer reproductive health care to many more Medicaid patients, fewer Planned Parenthood clinics (the probable result of refusing PP the use of federal funding) would almost certainly hurt many states’ public health.
That affects economic stability as well. Research has found that teenagers who give birth are considerably less likely to earn a high school diploma or college degree, thus resulting in lost earnings, higher rates of poverty and crime, and diminished prospects for upward economic mobility. Moreover, those born to teen parents are themselves likely to have poorer educational and health outcomes than are those born to older parents, with both such factors associated with economic security.
Although social program delivery is often a source of political contention between the parties, and the complication of Planned Parenthood’s association with abortion certainly amplifies that tension, the public health benefits that appear to be associated with its prevalence may reap both economic and health advantages for many women and their families.
Reforming health policy is not easy. While responding to public opinion over abortion can help particular members of Congress get reelected, defunding Planned Parenthood may carry a significant price tag for their districts.