MIDDLEBURY ––Planned Parenthood has drawn more attention on the national stage over the past few years, largely due to concerns about the organization’s provision of abortion care.
Zeroing in on that single service, which is only two percent of what Planned Parenthood of Northern New England (PPNNE) does, grossly overlooks the other 98 percent of primary and preventive services, explained Weybridge’s Diana Barnard, a palliative care assistant at Fletcher Allen. Barnard used to practice in Middlebury and often referred patients to the Middlebury Health Center, a small branch of PPNNE.
“The most important thing about Planned Parenthood is really handing out birth control and condoms, creating access to safe sex and spreading the word about prevention,” she said. “Prevention and thinking ahead and having really good access to birth control is more important than the things that people are complaining about.”
Preventive care is an important aspect of Planned Parenthood for many patients. A large number of the patients at the Middlebury site and of PPNNE qualify for Medicaid and Title X funding. Without this federal assistance, they would struggle to afford important services such as cancer screenings and sexually transmitted infection (STI) testing.
Title X and Medicaid are often on the chopping block when it comes to setting the federal budget. This is unfortunate, said Jill Krowinski, PPNNE director of Vermont public affairs, because it politicizes people’s basic health needs.
“It’s really unfortunate when politicians use Planned Parenthood as political tool instead of thinking of us as a health care provider,” she said. “For a majority of patients we are their primary source of health care.”
Congress already made $2.9 million in cuts to Title X while setting the 2013 budget. Krowinski explained that cuts on this scale are damaging and more could come.
“This $2.9 million cut, basically every time it goes through another committee or another process it’s vulnerable to more cuts,” she said. “Trying to plan out our budget and staffing based on money coming from D.C. is really challenging. I suspect it will be cut further and we’re going to have to plan for that.”
Each year as Congress works on the federal budget, officials from PPNNE and other regional affiliates watch carefully for potential cuts to Title X and Medicaid. Last year Planned Parenthood faced the threat of being defunded by the federal government. This would have meant that Planned Parenthood would no longer receive any federal money. Had the measure succeeded, Planned Parenthood health centers across the nation would have suffered and smaller centers like Middlebury would have been shut down.
“The thought of completely being defunded and having no Medicaid or Title X dollars is huge,” Krowinski said “The impact on our patients would be devastating. We’re not talking about cutting hours and staff, we’re talking about closing health centers. That would be devastating in communities like Newport, Hyde Park and Middlebury where we serve that very targeted demographic and community.”
Beyond numerous patients losing their only source of primary care, the defund would have caused serious public health consequences, explained Krowinski.
“The defund would affect the access to health care for patients and the long-term consequences of that, I think in a public health world, we’re talking about an increased number of pregnancies because women don’t have access to birth control, increase in cervical cancer and breast cancer because they don’t have access to those screening services, an increase in STIs because they don’t have access to testing and treatment,” she said.
While the defund failed, it speaks to the constant uncertainty that PPNNE must deal with. The organization can never be sure that its patients will have the access they need to Title X and Medicaid funding. New cuts come each year and are not without consequences.
“It always comes back to Title X and Medicaid because that is support for so many of our patients and the deeper those cuts get the bigger effect that they will have on our health centers, whether it’s cutting down hours that we’re open or cutting staff,” Krowinski said.
Krowinski explained that PPNNE works to make up the difference if a patient loses Medicaid or Title X money. They may need to alter something else to accommodate those expenses, but they do not cut services or make the patient pay.
“We work really, really hard to ensure that we raise the funds to help cover those costs through donations because the last thing we want to do is put the burden on the patients,” she said. “That means making sure they still have access, but we’re open one day less a week, things like that.”
However, ongoing federal cuts make it challenging to maintain several centers in a state as small as Vermont.
“The past three years we closed (centers in) St. Johnsbury, Waterbury and Springfield because of the cuts that have been coming down,” Krowinski said. “Making those really tough decisions about closing those health centers, we thought about things like can patients drive to another health center that’s within the service area.”
The Middlebury Health Center is still open and doing fairly well.
“We’ve worked hard to keep Middlebury as consistent as possible,” she said. “They may have had a couple tweaks in their hours, but Middlebury is a site that we definitely try to keep consistent with hours. We aren’t open every day, we are open four days a week there.”
Krowinski said that dealing with rigid beliefs about reproductive and women’s health creates many of the obstacles the organization faces. Controversial issues can cause hang-ups in funding that patients need to obtain basic care.
“Every nonprofit has their unique set of challenges because of the services they provide,” she said. “For us, we have a lot of challenges because people don’t always agree with our mission of women having access to all women’s health services.”
The financial uncertainty for Planned Parenthood and its patients is unfortunate because the services provided are so valuable, said Barnard.
“I think it’s really a matter of targeting a population that always isn’t able to advocate for themselves,” she said. “Being in a warm, welcoming and affordable environment where they can get care when otherwise they couldn’t is so important. Young women who don’t know where to go, young women who might not know what options they have, women in abusive relationships who might not trust medical officials, they can all feel welcome at Planned Parenthood.”