Over the past few years, a number of conservative politicians have proposed plans to "defund" Planned Parenthood. So far, 13 states have put legislation in place to prevent the organization from receiving certain state funds, but the new Senate health care bill could take things national — in addition to attempting to "repeal" the Affordable Care Act through measures like rolling back Medicaid expansion, the new bill also seeks to defund Planned Parenthood. The act would do this by cutting off federal support to health care providers that perform abortions for one year
But while the concept of "defunding" may seem abstract, it has a vast number of possible real-world consequences — including making it difficult or nearly impossible for women all over America to access birth control or get an abortion.
President Trump said in a February 2016 Republican debate that he would defund Planned Parenthood "because of the abortion factor...because I’m pro-life." But a federal ban called the Hyde Amendment has actually prevented any federal money from being used to fund abortions (except in cases or rape or incest, or threats to the life of the mother) since 1976. This hasn't prevented many conservative politicians from acting like federal funding is routinely used for abortions, though — like Paul Ryan, who, in January 2017, remarked to a town hall, “We don’t want to commit taxpayer funding for abortion, and Planned Parenthood is the largest abortion provider.”
So what would defunding Planned Parenthood prevent? It would prevent millions of Americans from getting their birth control, or force them to travel hundreds of miles to get abortions, Pap smears or STI treatment — and it wouldn't only have repercussions for people who live in red states.
What Does "Defunding" Actually Mean?
When politicians or pundits discuss "defunding" Planned Parenthood, they often make it sound like the organization receives a big check from the government each year, or that "defunding" the organization would automatically shut down all Planned Parenthood centers.
"There's no two ways about it — [defunding] would be devastating...people are going to be left with no place to turn."
But neither of these things are true. Rather, government funding — which accounts for 41 percent of Planned Parenthood's revenue, according to a recent annual report from the organization — comes from sources like Title X family planning program grants and Medicaid reimbursements. Of the approximately $450 million in federal funds that Planned Parenthood receives each year, approximately $390 million of that is provided through Medicaid reimbursements, according to a 2015 report by the CBO. Defunding would prevent Planned Parenthood from accepting much of that government funding, including Medicaid reimbursements.
While defunding wouldn't instantly shutter Planned Parenthood centers, it would radically slash the budgets of all Planned Parenthood affiliates. States would still have the option of sending more money to Planned Parenthood, so in certain areas, a few centers would likely be able to remain open. But this doesn't mean all would be fine in blue states; as a June 2017 piece in Monterey County Weekly observed, federal defunding would cause Planned Parenthood California to lose 80 percent of its operating budget, and possibly lead the organization to close 82 California centers. And in areas where there is already massive opposition to Planned Parenthood, it is likely that many health centers would close or face other major setbacks.
What Would A Defunded Year Look Like?
More than half of Planned Parenthood facilities are located in places where health care is difficult to come by, like rural areas. In fact, a 2015 Guttmacher Institute report found that "In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center."
So if Planned Parenthood was defunded, many low-income people and others in those areas might have nowhere to go for birth control, STI treatment, Pap smears, prenatal check-ups, and other reproductive health care. As Erica Sackin, Director of Political Communications at Planned Parenthood Federation of America, tells Bustle, "There's no two ways about it — [defunding] would be devastating...people are going to be left with no place to turn."
'The number of births in the Medicaid program would increase by several thousand per year' if Planned Parenthood were defunded.
We don't have to guess at what the outcome of defunding might look like — as Sackin notes, we can look to states like Texas, which has spent the last few years enacting a large-scale, state-wide defunding effort, and Iowa, which recently passed its own defunding bill aimed at abortion providers, to see what problems defunding Planned Parenthood might create in the country at large.
Lack Of Access To Birth Control & Other Health Care
According to a 2015 CBO report on the potential impact of defunding Planned Parenthood, of the more than 2.4 million clients served by the organization, roughly 15 percent of those people would "lose access to care in the first year following enactment of the bill," potentially leaving roughly 390,000 without care.
Many women in Texas suddenly lacked access to care after a series of laws passed between 2011 and 2013 prevented family planning clinics from receiving money from a variety of public health funds. After the "defunding," a quarter of the state's family planning clinics — 82 in total— closed as a result, according to a report published in the American Journal of Public Health. One-third of the clinics that closed were Planned Parenthood affiliates. Family planning centers that were able to stick around served 54 percent fewer patients than they had in the past, due to reduced hours and other strain caused by their decreased budgets.
And while some defunding proponents have claimed that it will be easy for community health centers to pick up the slack by serving patients who used to go to Planned Parenthood, experience has not borne that out. Not only is Planned Parenthood, as previously noted, the only option for family planning care in one-fifth of the counties where it operates; as George Washington University health policy and law professor Sara Rosenbaum told NPR, "For health centers, which currently serve about 25 million total patients, to have to absorb an additional 2 million people is totally impossible."
Andrea Flynn, women’s economic security policy expert and Fellow at The Roosevelt Institute, tells Bustle "We have a provider shortage, a physician shortage in this country and so asking community health centers to pick up that extra responsibility is just not possible."
And there are other reasons that community health centers might not be able to replicate Planned Parenthood's care: according to Flynn, staff at Planned Parenthood receive specialized training that familiarizes them with a wide array of birth control options, including the IUD and other methods that general practitioners might not know that much about.
That training also teaches them how to offer counseling and health consultations tailored to specific groups, including young people, LGBTQ people, and people who don't speak English as their primary language. "These providers have a skill set that is not found at community health centers," Flynn says, "[because community health center] providers are supposed to be able to provide a much broader scope of care. "
Again, we can look to Texas, where access remains profoundly limited today; according to a 2016 NPR report, "Midland Community Healthcare Services Clinic in West Texas is open, and every day it's three lines deep as women file in for treatment. The clinic's 15 examination rooms go full throttle all day but can't come close to satisfying demand. The numbers are harsh. In Texas, just 22 percent of childbearing-age women who qualify for subsidized preventive health care treatment actually get it...two years after the cuts, Texas' women's health program managed to serve fewer than half the number of women it had before."
And lack of access to care can have far graver effects than just long lines. A 2015 survey found that 100,000 to 240,000 Texas women had attempted to self-induce abortion; according to a CBS News piece on the study, "women who report barriers to accessing reproductive health care were significantly more likely to have tried self-induced abortion themselves or know someone who had attempted to end a pregnancy on their own." And a recent report revealed that Texas has the highest maternal mortality rate in the developed world, with pregnancy-related deaths doubling in the state over a two-year period; the Texas Observer reported that the state's maternal mortality task force tied the rise in maternal mortality to "lack of access to health care."
Increase In Unintended Pregnancies
According to Planned Parenthood's website, "In 2010 alone, publicly funded family planning services helped women prevent more than 2 million unintended pregnancies." With 41 percent of Planned Parenthood's budget in jeopardy, that number would doubtlessly drop.
In Texas, this proved true: in the 18 months following defunding, births among women on Medicaid increased by 27 percent. Why? A 2016 report, published in the New England Journal of Medicine, found that after Texas stopped including Planned Parenthood in its family planning program and made other funding cuts, the number of women using long-acting contraception, like IUDs, declined. A 2016 report in the journal Contraception similarly found that, among women in areas impacted by the Texas defunding who were using the birth control shot, "More than one in five women missed a dose because of barriers, most commonly due to difficulty finding a provider."
Joseph E. Potter and Kari White, two investigators at the Texas Policy Evaluation Project, published an article in the Washington Post in February 2017 based on previous research they had conducted assessing the impact of Texas' defunding; many of the women they spoke with "reported difficulties finding a new provider, having to repeat exams or make multiple appointments before getting a method and being charged unauthorized co-payments...Some said they did not seek care at all because they were unable to pay the new fees."
As NEJM noted, though they did not collect data on whether the women who had become pregnant had done so on purpose, "it is likely that many of these pregnancies were unintended;" an article in the LA Times on the studies reported that "These trends were not seen in counties that hadn’t had a Planned Parenthood."
How would that look on a national level? "The number of births in the Medicaid program would increase by several thousand per year" if Planned Parenthood were defunded, according to a 2015 CBO report.
And it is worth remembering that contraception isn't only used for preventing pregnancy — many women rely on it for reasons such as treating endometriosis or cystic acne. But they would encounter all the same barriers to access as women who rely on it for birth control.
Increase In Untreated STIs & Other Health Issues
Of course, Planned Parenthood doesn't only offer contraceptive services to its patients. Though the major studies about Texas focused on pregnancy and birth, Planned Parenthood provides care for other health and reproductive issues, like STIs. In fact, STI testing and treatment was the most common reason for visits to Planned Parenthood — 45 percent of visits were STI-related, while only 30 percent of visits were contraception-related — according to their 2015 annual report.
The same people who are unable to get birth control without Planned Parenthood would also have difficulty getting STI care, with potentially severe consequences; lack of STI treatment in some cases can lead to pelvic inflammatory disease or infertility (chlamydia and gonorrhea), cervical cancer (HPV), or AIDS (HIV). Planned Parenthood health centers also provide prenatal care, Pap smears, non-mammogram breast exams, prostate and testicular cancer screenings, and sex education. All of this would be put out of reach of many of the people who depend on it.
After The Defunded Year
If federal funding were actually taken away from Planned Parenthood for a year, there's no guarantee that it would be returned the second the clock struck midnight on the new year. And even if it was, things won't instantly go back to the way they were. Either way, the impact of defunding would make a long-term mark on this country.
Even If Funding Was Reinstated, Many Clinics Would Remain Closed
"Once a clinic is closed," Flynn tells Bustle, "its not very easy to open it again...Once it really gets closed, they lose their space, they lose their staff, they lose their patients… their entire infrastructure is eroded. And it’s not so easy to make all of that reappear again." Over the course of the year, spaces would fall into disrepair or be rented to other tenants, and staff would find new jobs. "We can’t really think about this one year defunding as a one year only ban," Flynn says. "I think everyone knows that once you close a clinic, it’s closed and it is really hard to reopen it."
Women Who Became Pregnant Due To Defunding Will Have To Raise Children They May Not Be Prepared For
Defunding may be temporary, but becoming a parent is pretty permanent. And people who became parents because they were unable to access birth control or abortion during the defunding will still be parenting a child that they may not be able to provide for financially for the next 18+ years — bringing funding back after a year won't change this. This is why the 2015 CBO report on permanently defunding Planned Parenthood noted it would increase Medicaid funding by $130 million over a 10-year period — many of the children born during the defunding would have to rely on Medicaid themselves.
And, as Flynn notes, "The domino effect of what that means for a family is pretty devastating. It means that children are going to be born into poverty, and there are a number of negative social and economic outcomes related to living in poverty." The American Psychological Association reports that poverty puts kids at "greater risk for several negative outcomes such as poor academic achievement, school dropout, abuse and neglect, behavioral and socio-emotional problems, physical health problems, and developmental delays."
But this situation won't just potentially hurt children — it could have dire repercussions for the parents, as well. It costs $233,610 on average to raise a child from birth to age 18 in America right now — and when people who are financially unprepared for that become parents due to inability to access contraception, it can lead them to defer education, prevent career development, and otherwise become unable to achieve financial stability.
And for women, that financial instability can become especially pronounced. A 2015 study that tracked two groups of women who had sought abortions — one who were able to obtain them, and one who were not — discovered in its initial findings that "Women denied abortion were more likely to be receiving public assistance (76 percent vs. 44 percent) and have household income below the federal poverty level (67 percent vs. 56 percent) than women who received an abortion."
Flynn tells Bustle that concerns about health and economics are always intertwined in the issue of abortion— and that decreased access might have negative effects on women's workforce participation: "Given what we know about how access to reproductive health and family planning services has enabled women’s ability to fully participate in the workforce, stay in the workforce, and pursue their careers, it's natural to think that losing those services will only hinder women’s ability to participate in the workforce even more."
How People Are Fighting Back
At the time of publication, defunding is not a done deal. A June 28 Quinnipiac University national poll showed that 80 percent of Americans oppose cutting Planned Parenthood funding — so if you're dismayed, know that you're not alone and that there is still time to let your representatives know how you feel.
Nancy Northup, of the Center for Reproductive Rights, tells Bustle that calling senators who have supported the bill or are on the fence is a great first step — "activating those phone lines is essential." Sackin agrees, noting, "The most important thing you can do...is call your representatives."
If your senator is at home right now, Northup advises readers to "show up at their offices and make sure that they know" that you do not support the health care bill. She also suggests that people use social media to let friends and family know exactly how high the stakes are — and to encourage them to make calls and show up at their senators' offices, too.
It's hard to know exactly how a federal defunding of Planned Parenthood would play out, because there are so many questions, including whether defunding passes muster legally. But we know enough to know that it would harm many, many people — and that harm won't end after the year is up.