How has blocking abortion clinics affected Iowa family planning services?

Six years ago, Iowa lawmakers redrafted a safety net program that provides family planning services to low- and moderate-income Iowans, abandoning a federal program to create their own state-run version.

But it never really caught on, and use of the program — already low — has been dropping significantly, down 83% since 2017.

Moreover, the program is paying for far fewer birth control pills, pelvic exams, pregnancy tests and other related services for Iowans compared with its previous incarnation under the federal program, which often utilized Planned Parenthood to provide services. The Republican-controlled Legislature reshaped the program to prohibit family planning funding from going to Planned Parenthood and other clinics that provide abortions.

Iowa’s top officials overseeing the state program say the coronavirus pandemic likely depressed patient visits, a contention that some researchers dispute. But officials also have acknowledged a general lack of awareness of the program among most Iowans, in part, they say, because no funding is being used to advertise its services.

But new state data and research are shedding more light on the ramifications for patients when state and federal policies undercut abortion providers like Planned Parenthood as the fight over abortion rights continues to play out in Iowa.

Planned Parenthood facilities have been known and trusted for reproductive health care, and without clear knowledge of where else to go, patients are more likely to forgo those services, researchers have found. The problem is compounded by the growing challenges health care providers face from staffing shortages, growing costs and dwindling funding.

“Overall, in this environment of limited funding for public health infrastructure, there have been a number of challenges we’ve been facing, whether budget cuts or program restrictions based on the administration that’s in power or COVID-19,” said Allison Smith, executive director of the Family Planning Council of Iowa. “It just really shortchanges reproductive health services and puts providers and patients in a fragile position.”

Officials with the Iowa Department of Health and Human Services, which oversees the program, did not respond to the Register’s questions.

Family planning patient enrollment totals drop from 2017 to 2021

As the debate over abortion access was heating up in 2017, the Republican-led Iowa Legislature took aim at Planned Parenthood clinics and other providers that offer abortion by excluding them from the new state-funded family planning program.

The program was launched in July 2017 after lawmakers directed the state to leave the federal family planning network, leaving behind more than $3 million in Medicaid funding annually.

Between 2017 and 2018, the number of Iowans receiving services under the program fell from 2,431 to 809, according to recent figures from the state. Participation increased to 1,600 in 2019, then fell to 1,269 in 2020.

In 2021, the latest total available, just 423 individuals received services under the program.

More: Few are using Iowa’s family planning program started to thwart Planned Parenthood

During that time, patients who had relied on these publicly funded family planning clinics were less likely to receive that care after the switch, according to the Guttmacher Institute, which has been studying Iowa as part of a multi-year study on impacts to reproductive health.

Among its findings, one study found that patients not using any contraceptive increased from 9% to 15% two years after the switch.

Patient count drops largely caused by clinic closures, researchers say

Megan Kavanaugh, a researcher behind Guttmacher’s Reproductive Health Impact Study, said the pandemic doesn’t explain the drop in patients enrolled in the program, since those totals were already “significantly declining” before COVID-19.

Instead, Kavanaugh said the drop is largely due to the closure of four Planned Parenthood clinics in the state, which were key sites for the program.

The clinic closures were a direct result of the loss of funding after lawmakers blocked Planned Parenthood from the program, said Ruth Richardson, CEO of Planned Parenthood North Central States.

“What we feel abundantly clear about is that there are hundreds of working-class Iowans who are not getting access to essential reproductive health care, and it’s clear that the state’s program is serving less people than it was prior to defunding Planned Parenthood,” Richardson said.

State lawmakers in favor of the switch had said at the time that patients would instead receive this care at community health care facilities, therefore helping reach more Iowans by spreading out these dollars to other providers.

The state has a list of 740 providers that state leaders say participate in the family planning program. However, Smith said it’s unclear how many of those providers are actively enrolling patients into the program.

In fact, the state data shows only 25 providers offered services under the program to the 423 patients served in 2021. That had fallen from the 84 providers that offered services to 1,269 individuals under the program the previous year.

While it’s clear excluding Planned Parenthood did result in immediate impacts to patients, Smith said there are still opportunities for the program to grow and meet the goals set out by lawmakers.

“It’s really disappointing to exclude providers that have been the trusted and preferred providers for patients,” Smith said. “At the same time, I think the program has a lot of potential. The need for contraceptive services hasn’t magically disappeared, so it was really concerning to see those drops in volumes and funding.”

Challenge in increasing Iowans served by family planning expected to continue

State data does show some uptick in the number of individuals using family planning services through Medicaid in 2020 and 2021, when state governments were not allowed to disenroll anyone from Medicaid coverage, even if they no longer qualified, as part of the federal government’s emergency response to COVID-19.

That expanded eligibility ended earlier this year, and over the next several months, thousands of Iowans are expected to lose their coverage. Kavanaugh said that means Iowans will “have less access to publicly supported sexual and reproductive health care.”

“More broadly, a large body of evidence has established that health insurance is a key facilitator to accessing sexual and reproductive health care and to using desired contraception,” Kavanaugh said. “It’s not too much of a cognitive leap to surmise that the more people who are disenrolled from Medicaid, the less care folks will be able to access, resulting in poorer sexual and reproductive health outcomes.”

Though Iowa Department of Health and Human Services did not respond to questions about the future of the program, state officials did previously voice hopes to discuss budgetary opportunities with legislative leaders to promote the program.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at, at (319) 339-7354 or on Twitter at @Michaela_Ramm

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