Reproductive Health Care Access Increasingly Uncertain in Colorado

Colorado’s family planning and teen pregnancy funding has suffered recent setbacks and faces even tougher challenges in coming months, as emerging federal policy changes threaten years of gains in reproductive health access.

The federal government ended one category of teen pregnancy grants, dooming highly regarded Colorado Youth Matter and its family planning and sexual health education programs.

“We’re living in constant fear of what they’re going to do.”
Ashley Wheeland

The administration also transformed Title X grants—one of the largest sources of family planning money in Colorado and nationwide—from three-year to one-year grants, with little information about how or when recipients can try to renew their multimillion-dollar awards.

Family planning advocates cite a handful of other looming threats:

-In early October, the U.S. Department of Health & Human Services reversed Affordable Care Act (ACA) rules requiring employers to include free contraception services for women in their health insurance plans.

-Congressional budget negotiations and ACA repeal efforts continue to threaten Medicaid expansion funding that brought women’s health services to hundreds of thousands of Colorado women.

-Rocky Mountain Planned Parenthood closed clinics in Longmont and Parker, as well as four more in Wyoming and New Mexico, in late spring, citing too-low Medicaid reimbursement for its services.

-A University of Colorado study revealed more than half of pharmacies surveyed are flouting rules requiring that the “Plan B” morning-after contraceptive pill be sold over the counter and with no age restrictions, instead setting up barriers that make women’s access harder than intended by the U.S. Food and Drug Administration (FDA).

“The unfortunate reality is that reproductive health and rights are under an unprecedented threat right now,” said Kinsey Hasstedt, senior policy manager for the Guttmacher Institute in Washington, D.C., a left-leaning reproductive research and advocacy organization. “We’re talking about undermining access to health care for people who, without these providers, wouldn’t have anywhere to go. And that’s just not okay.”

The program closures, changes to grant cycles and constant threat of more drastic cuts leaves some women’s health advocates in limbo even as they continue to deliver vital services.

“We’re living in constant fear of what they’re going to do,” said Ashley Wheeland, legislative and political director at Rocky Mountain Planned Parenthood (RMPP), of the Trump administration and socially conservative opponents of women’s health funding.

“We serve 70,000 folks. We have concerns about whether they will even let us service Medicaid patients,” Wheeland added. One third of RMPP’s patients are enrolled in Medicaid.

A Colorado Health Institute analysis after the recent Trump Administration decision to loosen rules on employer-covered contraception estimated that 30,000 Colorado women could lose such coverage. The institute (a Colorado Trust grantee) made the estimate based on the percentage of women of child-bearing age whose employers did not offer coverage before the ACA.

One of the great public health success stories of the past decade in Colorado is the steep decline in unplanned teen pregnancies, largely attributed to a statewide program offering long-acting reversible contraception (LARC) for free or at very low cost. (The Colorado Trust was among more than a dozen funders to provide short-term bridge funding for the program in 2015.)

Denver Health notes that Colorado’s LARC program was key to lowering the birth rate by 65 percent for Hispanic teens and 60 percent for African American teens since 2004. Researchers have disproven assumptions that differences in teen pregnancy rates were a cultural issue, said Lucy Loomis, MD, MSPH, director of family medicine at Denver Health. Within similar income groups, Loomis said, there is not much difference in pregnancy rates by ethnicity or race.

“The reason you see higher rates of pregnancy at lower incomes is because of lack of access to birth control methods,” Loomis said. “It’s not that they are irresponsible or don’t care. They do. It’s a huge equity issue.”

A Colorado Department of Public Health and Environment (CDPHE) report said 77 percent of women who received Title X family planning services at Colorado clinics in 2014 had incomes at or below the federal poverty level. The department said 47 percent of clients that year were of Hispanic ethnicity—far higher than the overall state population.

“The intent of the Colorado family planning program is for families to space the births of their children, giving them a chance to thrive,” said Jody Camp, the family planning unit section manager at CDPHE. “It’s also about a woman’s choice if and when to start a family, accessing basic public health screenings such as breast and pelvic exams, and for women and men to gain the chance for economic self-sufficiency, and to complete their education by spacing and timing their families as they choose.”

Family planning cuts are already being felt in communities like Sterling, in northeastern Colorado, where the Family Resource Center received grant funding via Colorado Youth Matter, which will shutter its operations at the end of the year. The family center used the money to fund Wyman’s Teen Outreach Program, a combination of community service hours, meals and classes on pregnancy risk, healthy choices and lifestyles.

Family Resource Center clients “hear some of this information from their friends, but it’s important for them to hear it from people who are trained,” said Yvonne Draxler, the center’s executive director. “And a lot come from families where parents are working so much, they may not have the time or the energy to do things the way we did. We were providing a safe space for these kids.”

The senior citizens who received technology lessons from the teens as part of the community service have already been asking when the program will resume, Draxler said.

“I’ll have to start looking elsewhere for funding,” Draxler said. “It’s getting harder and harder to find support out here in the rural areas. I know there’s need everywhere.”

Colorado family planning providers say they will continue their work while advocacy groups keep a close eye on Washington budget negotiations and federal administration actions. They know that some of the most vocal sentiment has been for further cuts, even as the programs pile up more evidence of success.

“We’d be naive,” said Hasstedt, “to think we’re ever out of the woods.”

Read the full article at: http://www.coloradotrust.org/content/story/reproductive-health-care-access-increasingly-uncertain-colorado

Michael Booth is a Writer in Denver, Colorado.

Reproduced with permission of The Colorado Trust (www.coloradotrust.org).

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