Family Clinic Funding Cutbacks Hit Poor Hardest, Officials Say
Eva Barcia spends her days explaining the mysteries of conception and contraception to poor and working-class women and has become all too familiar with the strange discrepancies between what women say they want and how they end up living.
Time and again, in those intimate conversations between strangers, women make their confessions to Barcia: They would have limited the number of children they had had, they tell the family planning counselor, if they had only known how to go about it.
“They’ve never been given any choice,” Barcia said sadly, ensconced in a small office in Los Angeles with a collection of condoms, diaphragms and pills arrayed like party favors on a desk between her and a client. “These clinics give you a choice.”
But earlier this month Gov. George Deukmejian cut the state’s $36.2-million family planning budget by two-thirds, the maximum allowable under state law. He has suggested that the rising rate of teen-age pregnancy in California indicates that the program has failed.
Dozens of family planning programs are expected to close. The rest will severely cut their services--from prescribing low-cost birth control to doing pelvic exams and cancer screening to treating innumerable cases of sexually transmitted diseases.
The result could be tens of thousands of additional unwanted pregnancies a year, UC San Francisco researchers claim. Cancers, hypertension and venereal diseases such as syphilis and the chlamydia microorganism will go undetected, family planning officials say.
“Yes, the state will save some money by cutting these programs,” said George de la Mora, who runs a clinic in Highland Park. “But come the next administration, they’re going to have to spend more money to fix the things that are going wrong as a result of this.”
The budget cuts have been welcomed, however, by opponents of abortion--longtime thorns in the side of the state Office of Family Planning. They say the family planning clinics promote “abortion as a form of birth control,” feeding the demand for abortions.
Few of the clinics perform abortions. But those that do not perform them refer women to those that do, activists said. Opponents of abortion want the clinics to mention the procedure only in cases of rape and incest or when abortion is medically necessary.
“These people are in a sublimely profitable position,” Brian Johnston, Western director of the National Right to Life Committee, said of the family planning clinics. “When they fail on birth control, they can make money on abortion.”
The California cuts come at a time when some states are expanding their family planning spending while others are cutting back, research groups say. Meanwhile, federal funding has remained unchanged for the last five years, although it is being eroded by inflation. (Family planning programs in California receive a total of $12.1 million in federal money, separate from their state allocations.)
California was a pioneer of state-supported family planning. It set up its program in 1973. Last year, it paid out $34.15 million in grants and covered the care of about 470,000 women a year at an average yearlong cost of $62 each.
In Los Angeles County, state-subsidized clinics at 82 sites serve 150,000 to 170,000 women. They can be found in storefronts, shopping malls and health centers from Azusa to Chinatown and Beverly Hills to Manhattan Beach.
Their services range from gynecological exams, Pap smears, breast exams and birth control to testing for the AIDS virus, blood pressure screening and pregnancy counseling. For those able to pay, fees range from one-third to one-tenth of what a private physician might charge.
Five of the 82 clinic sites in the county offer abortions, according to Thomas C. Kring, executive director of the Los Angeles Regional Family Planning Council. No state or federal family planning funds may be used, however, to pay for or subsidize abortions.
The women who use the clinics with the state’s help are the working poor--too poor for private health care, not poor enough for MediCal. The poorest among them receive the services free. Others pay on a sliding scale, and many make small donations.
They are single mothers and married women with families. About half are Latino and most are over age 20. One veteran clinic official said she could count the virgins on one hand: Most teen-agers have been sexually active for a year before their first clinic visit, she said.
“They tend to be the people who fall through the cracks of the existing system,” said Donna Brown of the Harbor Free Clinic in San Pedro.
Margoth Henriquez, for example, fled El Salvador eight years ago with her parents, who worked at a university and ran a shoe store. Her sister had been murdered in the country’s civil war, said Henriquez, who emphasized that she was a political, not an economic, refugee.
Now Henriquez, 28, is married and has a 3-month-old child. Her husband works in a Los Angeles flower shop. They share an apartment with her parents, splitting the $600 monthly rent. That leaves about $600 a month on which Henriquez, her husband and child live.
Miriam Furlan, 27, shares a tidy one-room apartment near MacArthur Park with her husband and their young sons, Eduardo and Steve. Furlan’s husband works as a busboy at a private club in Beverly Hills--a job that comes with health insurance for him but none for his family.
So Miriam Furlan depends upon state-financed clinics for birth control. Several times a year, she rides the buses downtown for appointments, taking along her 3-year-old son and 10-month-old baby--and any other children she is baby-sitting that day.
During a recent visit to the UCLA Family Planning Clinic, which is already sending out lay-off notices, Henriquez said she had no idea where she would go if the clinic closed or if she were no longer able to get low-cost care and birth control pills.
She said her husband is willing to use condoms, available over the counter. But she said the sexual partners of many of her friends refuse, leaving the women dependent upon methods such as the pill or diaphragm, which require a prescription and regular checkups.
“It’s very difficult for them to have partner cooperation,” said Barcia, the bilingual counselor at the UCLA clinic. “They’ve been brought up to think their only reason for living is to reproduce. . . . I’ve heard really desperate pleas from them saying, ‘Where will we go?’ ”
Catherine J. Wylie runs the family planning programs at the county’s four comprehensive health centers. All but $100,000 of the $900,000 annual budget comes from the state. Pondering the cut, Wylie recently rattled off her program’s disturbing statistics.
The largest center, the H. Claude Hudson Comprehensive Center south of downtown Los Angeles, served 10,216 women in the 1987-88 fiscal year. Most had one to three children, and nearly 3,000 of them had had at least one abortion before going to the center.
Nearly 1,700 had never practiced birth control.
Sexually transmitted diseases were rampant. More than 3,000 cases were treated in that year--an ominous fact in light of the birth defects that can be caused by those diseases, and the link between cervical cancer and an increasingly common condition, genital warts.
An unusually high 7.5% of the 7,000 Pap smears done at the clinic during that year showed evidence of abnormal cell growth on the cervix. The clinic’s rate of so-called Class 4 Pap smears, indicating cancer, is more than twice the national mean, Wylie said.
“Cervical cancer is usually found in women over 40. In mine, the average was 28,” she said. “We had an 18-year-old who had to have (cancerous tissue cut from her cervix). If that isn’t sickening, I don’t know what is.”
Across the street from the Hudson center, where Grand Avenue meets 28th Street, Zenaida Torres, 29, lives with her four sons. They share a single room and access to a communal kitchen for which Torres pays $325 out of her $376 in monthly public assistance.
Salvador, who is 11, sleeps on a balcony over the sidewalk. Seven-month-old Froylan dozes in a hammock strung across the room. Torres receives $97 a month in food stamps and spends another $45 a month on food ($50 now that her mother is visiting from Mexico).
“It’s impossible to get $65 for food. Do you think I have $65 to go to the doctor?” Torres wondered recently. Gazing across the street to the clinic she has relied on for 10 years, Torres said, “That’s the only place the Latin people can go.”
A few miles north, in the heart of Chinatown, Christina Hsu sat in the small family planning office in the Chinatown Service Center, working the phones in search of money to keep her clinic open in spite of the state cuts.
The clinic opened in 1980 to serve newly arrived immigrants from Hong Kong, Taiwan and China. Serving women from countries where birth control is practiced widely, the clinic aimed to help them become settled before having more children.
Now the clinic counts 2,000 visits a year on a budget of $80,000 in state funds. It offers services in Cantonese, Mandarin, Chiu-Chou, Shanghaiese and Vietnamese, and receives referrals from clinics and physicians as far away as Hong Kong.
“This country is so advanced in everything. But they treat family planning services as nothing,” Hsu said. “They will provide money for people to have babies, but they will not provide money for decent services. It’s not logical at all.”
Precisely how the governor’s cuts will be distributed remains to be seen. They became effective July 1 but will not be felt until August or September, and critics are hoping to persuade the Legislature to pass an emergency measure restoring some or all of the money.
The Office of Family Planning last week was weighing options: It could simply slice two-thirds out of every contract, or it could spare the weakest clinics and force those with other sources of funding, such as federal money, to bear the brunt of the cuts.
But the cuts will have a domino effect, clinic operators fear. Once state money goes, matching grants could follow. Fewer services will mean fewer patients and fewer donations. Fewer staff will mean fewer volunteers that the staff can train.
One of the first casualties has been so-called teen advocate programs, in which clinics train students as peer counselors, educated on issues such as sexuality, suicide, venereal diseases, birth control, peer pressure and self-esteem.
Beyond that, clinics have begun whittling away. T.H.E. Clinic for Women on Martin Luther King Boulevard expects to eliminate its occasional free clinics, including two days a year on which it offers free mammograms and Pap smears.
Wylie, who runs the county programs, finds herself forced to consider criteria for who will get an appointment and who will not--a strategy aimed at limiting time on waiting lists to three weeks since the longer the wait, the higher the no-show rate.
“If they’re not going to get birth control, they’re going to get pregnant,” Diane Chamberlain of the Valley Community Clinic in North Hollywood said simply. “There’s no way to turn around and say if people can’t get birth control, they won’t have sex.”
A study by researchers at UC San Francisco concluded that elimination of all state family planning funds would mean an additional 86,000 pregnancies in California each year. Precisely how many fewer would result from the two-thirds cut would depend upon how it is divided up.
The researchers, led by Claire Brindis of the Center for Population and Reproductive Health Policy, said the cuts would cost the state $285 million a year--in welfare and Medi-Cal payments and handling the developmental disabilities of children born prematurely to teen-agers.
They estimate that every dollar spent on contraception saves the state $12.20.
Critics of the cuts have also predicted an additional 10,000 abortions in Los Angeles County alone--a claim disputed by Johnston of the National Right to Life Committee, who contends that the family planning programs themselves have increased the abortion rate.
“They’re the ones that put themselves in this bind,” Johnston said. “If they believed that providing birth control would stop abortion, they would do that. They would get out of abortion and be involved only in family planning.”
Johnston said his organization does not oppose family planning. But some clinic administrators suspect that behind the funding cuts is a belief that family planning clinics have somehow exacerbated society’s problems.
“Making primary health care available doesn’t do anything to create the ethics of the community,” said Sylvia Drew Ivie of T.H.E. Clinic for Women. Ethics are shaped by the media, entertainment, religious practices and the climate in the schools, she contended.
Then Ivie added, “There are so many other places to look to find where people get their ideas about what they ought to be doing, and with whom, that to lay that at our feet just seems dishonest.”