A renewed focus on protecting access to birth control may not help women who already struggle to find affordable contraception in some states with the strictest abortion laws.
At a family planning clinic in Tuscaloosa, Alabama, that primarily helps low-income women, executive director Robin Marty must ensure that the clinic, WAWC Healthcare, has a variety of contraceptives on hand, including pills, patches, implants and IUDs. so patients can obtain free or low-cost contraceptive methods during their appointments.
It’s something that has become increasingly difficult to do in Alabama, along with other rural Southern states including Mississippi and Texas.
“The vast majority of our clients are people who are at or below the poverty line. The majority of them are women of color and many of them do not have a primary care provider. They come to us to access contraception,” Marty said.
Years before the Supreme Court’s Dobbs decision overturned Roe v. policy changes, fixed financing It is closing clinics put pressure on small family planning providers who have to finance the initial cost of stocking a range of contraceptives, from birth control pills to injections and intrauterine devices, for their patients. That can amount to about $30,000 for a clinic that provides birth control to about 50 to 75 patients a month, said Kate McCollum, senior director of the Trust Her initiative at the Child Poverty Action Lab in Dallas.
Federal regulations require states to cover contraception for Medicaid recipients, but states decide which types are covered. It can also be difficult to qualify. For example, in Mississippi, a single woman who is not pregnant cannot earn more than about $20,000 before taxes to qualify for Medicaid.
Having birth control on hand is important. If a clinic doesn’t have a person’s preferred contraceptive method in stock, they often don’t return, McCollum said.
“We see that, especially for low-income people, finding child care, transportation and missing work is simply not viable,” she said.
Few community clinics have the amount needed to cover birth control every month, McCollum said. Even if they do, “you’re taking a risk by storing them because you might not get a refund.”
Closing clinics puts pressure on those that remain
There was hope that when the Food and Drug Administration approved the first over-the-counter birth control pill in 2023, the $20 per month cost would help. Opill is stocked in stores across the country, including some Target, Walmart, Walgreens and CVS locations.
But over-the-counter birth control pills have not reached many women in rural areas. They “often are lucky if they have a grocery store in their town,” Marty said.
In these rural areas, residents “don’t have broadband, the mail delivery doesn’t always show up,” Marty said. “I cannot reiterate how important it is that everything is in one person’s hands during an in-person consultation.”
In Mississippi, it is common for women seeking a clinic to travel two hours for an appointment, said Jitoria Hunter, vice president of external affairs at Converge, a nonprofit that provides federal funding for family planning services in Mississippi and the United States. Tennessee.
The most recently report from the Center for Healthcare Quality and Payment Reform, a nonprofit organization that advocates for improvements in healthcare payment and delivery systems, found that more than 40% of hospitals in Alabama, Mississippi and Texas, as well as neighboring Louisiana, Arkansas and Oklahoma are at risk of closure due to financial hardship, worsening the shortage of family planning care.
In many cases, these closures are the result of policy changes that eliminated a very important source of funding: Title X family planning subsidies.
Title main role in funding family planning services for women living at or near the federal poverty level, including birth control and preventive health services such as Pap smears. Each state decides which clinics will receive this funding. In 2011, in an effort to divert funds from Planned Parenthood, Texas lawmakers voted to exclude any clinic associated with an abortion provider from Title X subsidies. This meant that even if a clinic did not perform abortions, if it was associated with another that did, such as a Planned Parenthood in another state could not receive the funding.
Because of the Texas policy change about a quarter of family planning clinics in the state closed by 2013.
In Texas, “Title X clinics have had fixed funding for years. It’s not enough to meet demand,” McCollum said.
In Mississippi, the state with the highest adolescent It is premature birth rates and second highest maternal mortality rate in the country, “the Title
Even with deep discounts provided by the federal 340B subsidized drug pricing program, clinics face paying tens of thousands of dollars to stock contraceptive products without a guarantee from Medicaid, insurance or cash reimbursement. Private insurers may also not cover IUDs, which can cost up to $1,300, according to Planned Parenthood.
“If we have a patient who is on Medicaid and wants to get a Nexplanon implant, we have two options,” Marty said.
The first is to buy the device, The small rod implanted under the skin which releases hormones slowly for up to three years, for a total price of about $1,200, which Medicaid does not always reimburse and may not reimburse in full. Alabama, Texas and Mississippi are among 10 states that voted not to expand Medicaid this year, meaning it remains difficult to qualify.
The second option is to get the implant through the 340B program, which Marty said costs about $500. Even with that discount, many of his low-income patients can’t afford it.
“Anyway, we’re out of money,” Marty said.
When government programs fail, some nonprofits step in to help clinics provide free or low-cost contraceptives. In Texas, the Trust Her initiative subsidized 20 clinics in Dallas County with grants to cover a month’s supply of contraception.
“If someone doesn’t have insurance, we can pay for the visit and birth control,” McCollum said. “If they have Medicaid or private insurance, they can pick up that inventory when the patient is there and then get reimbursed.”
The nonprofit group funded Telemedicine Bedpan in Dallas, covering the costs of patient visits and birth control. Micaela Sanchez, a women’s health nurse practitioner and founder of the Dallas clinic, became a mother at age 17, so the mission to stock up on every type of birth control anyone could want is personal to her.
Because it is not a Title X clinic, Sanchez can counsel minors about contraceptives without parental consent, but that also means she does not have access to that funding source.
“The reason I’m able to do this is because Trust Her covers the costs for patients who receive same-day options,” Sanchez said.
Plan A, a free community clinic in Louise, Mississippi, which also operates a mobile clinic in the Mississippi Delta and a future clinic in Georgia, cannot afford to have all the forms of birth control that offers patients the all the time.
Plan A nurse Meta Anderson recently placed an order for Nexplanon for a patient in her late 20s who works as a hairdresser and does not have health insurance. She came to Plan A after being unable to obtain the contraceptive implant through her primary care provider. The provider, a federally qualified health center, charges patients a variable fee.
“She would have to pay a fee to be seen and then she would have to pay for the implant,” said Anderson. “She doesn’t have the funds to pay for this out of pocket.”
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