Spike In Demand For Long-Acting Birth Control Strains Clinic Budgets

In the two weeks since the election, Planned Parenthood Federation of America has seen a huge increase in volunteers and donations – over 200,000 donations in a single week. But this surge in support hasn't reached many other reproductive health organizations. And many of these centers are already struggling to meet a spike in demand for long-acting contraception after the election of Donald Trump.

Susie Markus, executive director of the Wyoming Health Council, says that she's heard people in Wyoming say they're going to donate to Planned Parenthood. "But there's only one Planned Parenthood in Wyoming." Her organization is the umbrella group for 15 publicly funded family planning centers in Wyoming. She's been hoping for donations, but none have come in.

The nonprofit Wyoming Health Council is funded in part by Title X, a 46-year-old federal law that helps provide family planning services to the poor by distributing funds to regional grantees. They in turn support 3,951 facilities, including local health departments, federally qualified health centers, independent clinics and hospital outpatient units. About 13 percent of the facilities are run by Planned Parenthood. Title X doesn't just cover birth control; it also covers breast and cervical cancer screenings, pregnancy counseling, and testing and treatment for sexually-transmitted diseases and other services, but not abortion. Centers funded by Title X are required to see all patients, regardless of insurance coverage, and charge them on a sliding scale based on income. Clinics cover the difference between the cost of the visit and what patients can pay.

In states like Indiana, funding is already so tight that the post-election rush on IUDs and other long-lasting contraceptives like implants has left clinics scraping for money. IUDs come with a high up-front cost – up to $1,000 for the device and insertion. "At the end of the day, we've decided that if a woman wants an IUD, we will get it for her," says Kristen Adams, president and CEO of the Indiana Family Health Council, a nonprofit that distributes funds to 26 clinics in the state. "That means a lot of budget shifting."

Because the clinics provide same-day services, Adams says they typically have a few IUDs in stock. "But can we afford to keep 20 on our shelves? No."

Family planning organizations in other states say they can handle a brief spike in patients, but if the rush of women seeking IUDs and other reproductive services continues, things might get difficult.

"Our demand for IUDs has about doubled, but we don't know if that's a short term spike or not. I think it would take a more consistent increase for it to begin to be an issue," says Kate Brogan, Maine Family Planning's vice president for public affairs. She says that Maine Family Planning has also seen a slight increase in donations.

This sentiment is echoed in California, which is served by Essential Access Health, the largest Title X-funded network in the country, with more than 340 clinics. According to Amy Moy, their vice president of public affairs, California's network serves about 1 million people, or one quarter of the people eligible for Title X services nationwide. She says that the state has additional programs that fund family planning for people with low incomes.

One of those centers, the Women's Community Clinic in San Francisco, has received some election-related donations, but "not like the increase Planned Parenthood has seen," says Carlina Hansen, their executive director. If the demand for long-acting contraceptives continues, she says her clinic will need to open up more appointments and possibly increase staffing. "We already operate at a loss, and donations help us carry that loss. If we need to increase our staff, balancing our budget gets difficult."

Even in states like California, Title X grantees are worried about the future. The Affordable Care Act and Medicaid expansion have increased the number of patients whose family planning visits are covered by insurance. If those expansions are rolled back, state programs and clinics will be pressed to take on the additional cost. And advocates are worried Title X will find itself on the chopping block.

It's not an unfounded concern.

In the last several years, numerous bills have been introduced in Congress to block Title X funds from organizations that also provide abortions, like Planned Parenthood. In 2011, the House voted to defund Title X in its entirety, but the measure didn't pass the Senate. Still, for the last several years Title X funding has decreased, from $317.5 million in 2010 to $286.5 million in 2016. Under a Trump administration and with a Republican Congress, those numbers could shrink even more.

"If we lost Title X funding — oh, gosh, given the history of Title X battles in Congress, I think that's a real question," says Brogan in Maine. "Right now we have over 50 clinics. There's no way we'd be able to maintain that without Title X."