Colorado family planning activists seek funds post-Roe v. Wade
The ongoing pandemic and the overturning of Roe v. Wade last year have increased demands on Colorado’s family planning clinics, prompting some advocates to call for more state funding — but it’s not clear if the legislature will respond.
Hunter Nelson, a policy analyst at the Colorado Children’s Campaign, said the U.S. Supreme Court’s decision in Dobbs v. Jackson — which found the Constitution does not confer a right to abortion — has increased pressure on family planning clinics.
Colorado’s family planning program doesn’t pay for abortions, but some clinics like Planned Parenthood offer both abortions and state-funded services like birth control prescriptions and testing for sexually transmitted infections.
Planned Parenthood reported a 95% increase in out-of-state patients seeking abortions after some states outlawed the procedure following the Dobbs decision, leaving fewer appointments available for other services.
“Wait lists are going from a couple days to a couple weeks,” Nelson said. “We want Colorado to have the capacity to serve both Coloradans and out-of-state travelers.”
Colorado’s family planning program covers contraception; pelvic exams; screenings for breast, cervical and testicular cancers; basic infertility services; and pregnancy testing and counseling.
The Colorado Children’s Campaign asked the legislature’s Joint Budget Committee for a $2 million increase for the family planning program.
The state estimated the program costs an average of $404 per patient, meaning an additional $2 million would increase the number of patients served by just under 5,000. The state doesn’t provide the services directly, but contracts with 80 clinics.
Andy Bixler, spokesman for Colorado Senate Democrats, said the Joint Budget Committee is still debating a possible increase for the family planning program, and it’s too early to say what they might decide.
Maria Livingston, a spokeswoman for the Colorado Department of Public Health and Environment, which runs the family planning program, said she couldn’t comment on pending legislation. In the most recent year, the program received about $10.1 million in state and federal funds.
In 2019, the state health department estimated about 93,300 women and teenage girls had an unmet need for contraception, meaning they weren’t pregnant and didn’t want to get pregnant in the immediate future, but were uninsured or felt they couldn’t use their insurance because of concerns about confidentiality. About 44,000 of them received services in 2022. The program also serves men, but in much smaller numbers.
Shaunti Meyer, senior director of medical affairs at STRIDE Community Health Center, estimated the number of people seeking family planning services at their clinics is 10% to 15% higher than it was in 2020.
It’s difficult to disentangle the effects of the Dobbs decision overturning Roe v. Wade from the pandemic and other factors that made people feel it wasn’t a good time to have a baby, she said, though clinics that offer abortions have referred patients who are seeking contraception or testing to them.
“Us, and other health centers, can help offset for patients who are looking for family planning services,” she said.
Women who become pregnant unintentionally are more likely to report depression, experience intimate partner violence and start prenatal care late, contributing to higher rates of complications for their babies. The outcomes tend to be worse when the mothers are still teenagers, since they’re less likely to graduate high school and more likely to live in poverty than those who had children later.
A University of Colorado study estimated at least half of the decline in births to women under 25 between 2010 and 2014 was due to increased access to contraception. It estimated the state saved between $66.1 million and $69.6 million on Medicaid and other programs for low-income families. The abortion rate among younger women also fell.
About half of the program’s funding comes from Title X, a provision of a 1970 public health law that made federal dollars available to provide contraception, tests for sexually transmitted infections and family planning counseling for low-income people. The state health department applied for an additional $5 million in Title X funds in 2022, but didn’t receive them.
Clinics in Colorado’s family planning program attempt to bill insurance first, then charge patients on a sliding fee scale and finally seek reimbursement from the state. About 77% of patients live below the poverty line, though, and aren’t charged.
The state health department showed nearly half of Colorado’s counties don’t have a provider participating in the family planning program. It’s possible that women in those counties have access to at least some services through other clinics or private providers, though.
More state funding wouldn’t immediately close the gaps, since it takes time to recruit new providers, Nelson said. But putting money toward attracting new providers and possibly offering higher rates would improve access in the long term, she said.
“Just because something is legal doesn’t mean it’s always accessible,” she said.
Meyer said that the state could also increase access by offering training for providers who aren’t accustomed to handling intrauterine devices and contraceptive implants. While today’s medical students are learning how to place long-acting reversible contraceptives, older providers who don’t see large numbers of patients seeking contraception may not know how to use them, she said.
The state health department also could increase access by doing outreach to undocumented people, letting them know they won’t be reported if they seek services, and by offering information in more languages and in places where immigrants and refugees congregate, Meyer said. Many people who have recently immigrated are at an age when they could have children, but they often don’t know there are services available to help them control when that happens, she said.
“It needs to be really grassroots, community types of marketing,” she said.
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