Squeeze on Family Planning Clinics May Devastate Poor

Rocio Chavez had not seen a doctor in years when friends told her about a county-run clinic that offered free family planning services.

During her first visit, however, the 25-year-old single mother learned that she and thousands of other Orange County women could lose this medical service--for some the only medical care they receive--if the state goes through with plans to cut $24.1 million from family planning clinics.

A clinic in Anaheim that served 10,000 women has already closed in anticipation of the cuts. And health care officials predict that others will follow or will be forced to severely cut services, which range from describing birth control to screening for cancer and sexually transmitted diseases.

No Insurance

“I hope they don’t really cut funds, because this is a very good place for people who have nowhere else to go,” Chavez said recently as she waited for an appointment at the county’s Santa Ana clinic. “I’m not working, and I have no health insurance, so I would have to find someplace else where care is free--or not get care at all.”

Family planning officials fear that the long-term impact will be an upsurge of unwanted pregnancies. The immediate impact, they say, will be a greater demand for inexpensive prenatal care, now already at crisis proportions.

“That is going to be a real issue because there will be a much greater need for prenatal services for poor women,” said Beverly Sansone, medical director of Planned Parenthood of Orange and San Bernardino counties. Planned Parenthood officials estimate that 25,000 women could lose services if funding cuts stand.

In slashing the family planning budget from $36.2 million to $12.1 million a year, Gov. George Deukmejian suggested that the rising rate of teen-age pregnancies in the state indicated that the programs are not working. But critics say recent studies dispute that notion.

The most recent study, by researchers at UC San Francisco, concluded that eliminating the entire state family planning budget would result in an additional 86,000 pregnancies and would cost the state $285 million a year in welfare and medical bills.

They estimate that every dollar spent on contraception saves the state $12.20.

In Orange County last year, six state-subsidized family planning operators received $1.8 million and served more than 38,000 women.

Counseling, Screening

They are the Huntington Beach Community Clinic; the Laguna Beach Community Clinic; Planned Parenthood, which operates three clinics in Orange County; the Orange County Center for Health; the Coalition Concerned With Adolescent Pregnancy, which offers educational services for teen-agers, and county-run family planning clinics.

The services include pregnancy counseling, Pap smears and other cancer screening, gynecological exams, testing for the AIDS virus, blood-pressure screening and birth control. No state or federal family planning funds may be used for abortions.

Many women are asked to pay a sliding-scale fee based on income and household size, but about 54% of the patients fall below the poverty level and receive free care.

It is these women, the poor and the working poor, who will be hurt most by the cuts. For many--too poor for private health insurance but not poor enough for Medi-Cal--family planning clinics provide their only access to medical care.

Cruel Thing

“Cutting the family planning budget seems a very cruel thing to do,” said Margie Fites Seigle, executive director of Planned Parenthood of Orange and San Bernardino counties. “We know that family planning is often an entry point for poor women into the health care system. Many women will lose their only opportunity for early detection of cancer, which can save lives.”

In fact, the clinics often serve as multipurpose social agencies and clinic workers as friends and counselors.

Sandy Snyder, manager of maternal health programs at the county’s four comprehensive health clinics, said more than 20% of the patients have medical or social problems other than family planning for which they receive counseling or referrals.

More than 5% of the patients are referred to child protective services because clinic staffers have identified problems within the family. And Snyder estimates that at least another 5% receive some sort of housing and food assistance from clinic workers’ own pocketbooks.

“We are often the only way these people are going to have access to even someone to talk to about their problems,” Snyder said.

About one-third of last year’s $1.4-million county family planning budget was state funded, Snyder said. The county-run clinics, which are in Santa Ana, Buena Park, Westminster and Costa Mesa, serve about 17,000 women a year.

Ninety-eight percent of the patients at the county family planning clinics have incomes below the federal poverty level, 89% are Latinas, and 75% are between the ages of 18 and 30.

Better Informed

Connie Alva, a nursing assistant who has worked for nearly 19 years at the Santa Ana clinic, said that while myths about sex and family planning still abound, many young women are better informed now.

“Many are illiterate, but they are not dumb, just not educated,” she said. “They may leave here and go out and get pregnant once, but they finally realize that the old wives’ tales that their friends tell them are not true and they listen more. We don’t just provide family planning; we give them a little of everything.”

Gloria Hernandez is typical of many of the woman who use the Santa Ana clinic. She is 25 years old, married with two children. Her husband’s nursery job provides no health insurance, so they have few other options, Hernandez said.

She said she has been using the Santa Ana clinic for three years and received pregnancy counseling for both of her children, including 4-week-old Elizabeth, whom she rocked gently while waiting to pick up a prescription of birth-control pills at the clinic.

“I get very good service here,” she said. “I come by bus, and it only takes me 15 minutes. I would not know where else to go.”

Across town, in the comfortable waiting room of a Planned Parenthood clinic, Rebecca Cox, a 26-year-old single mother with a job and health insurance, explained that she, too, must rely on low-cost family planning clinics. The limited health insurance provided with her receptionist job does not cover birth control or family planning, she said.

Will Hurt Everybody

“If services are cut, I’d probably end up not getting checked like I should or it would cost me a lot of money,” Cox said. “It’s going to hurt everybody. I see too many children now who are not wanted, not fed properly, abused or abandoned. That will only get worse.”

Just how the family planning cuts will be distributed still remains to be seen, and local officials are awaiting word on just how severe cutbacks in their own budgets will be. Many fear the worst.

“Two-thirds of our budget is from the state, so the impact will be more than significant,” said Marty Earlabaugh, director of the Huntington Beach Community Clinic, which also provides primary health care services to nearly 15,000 women yearly.

County officials said that if the worst happens, they will work with privately run clinics to coordinate services for as many women as possible.

Planned Parenthood is seeking approval from its national office to begin a prenatal program to ease strains on the already overburdened county system and to handle the expected overflow of such patients that funding cuts will bring about, officials said.

Despite long odds, critics are hoping to persuade the Legislature to pass an emergency measure restoring some or all of the cuts, and Planned Parenthood is sponsoring a lobbying day Aug. 17 to urge residents to contact their state representatives on the issue.

“I truly believe that when the fiscal impact is considered along with the understanding of the incredible need for these services, that we will prevail,” Seigle said.