Los Angeles County health care officials took steps Monday to close 13 family planning clinics and reduce services at more than a dozen others this week as a result of state funding cuts. Program directors predict the action could result in 5,000 or more unwanted pregnancies and an alarming increase in the spread of sexually transmitted diseases.
When the clinics close on Wednesday, thousands of women, most of them poor and Latino, will be redirected to other county-run programs, where they already face a wait of up to eight weeks to get an appointment, according to family planning officials.
"It's a horrific situation," said Catherine J. Wiley, head of family planning programs at the county's four comprehensive health centers. "The women at the highest risk will be the ones most affected and, by the time they're screened, they'll already be pregnant."
The county's 42 clinics provide gynecological exams, Pap smears, pregnancy counseling, birth control and testing for venereal disease to nearly 60,000 women each year. Dr. Irwin Silberman, the county's director of maternal health and family planning programs, estimated that at least one-third of those women--20,000--will be adversely affected by the clinic closures. "If we were to assume that as few as one-quarter of those (20,000) resulted in unwanted pregnancies, then we would have another 5,000 pregnancies."
The clinics are being shut down because of Gov. George Deukmejian's decision in July to slash two-thirds of the state's $36.2-million family planning budget--the maximum allowed by law. Deukmejian has suggested that the rising rate of teen-age pregnancy in California indicates that the program has failed.
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 would result from the two-thirds cut would depend upon how the cuts are divided up.
The funding cuts will not have as dramatic an effect on other counties, such as San Diego, which use less state funding to operate its family planning programs. However, San Diego County health officials say they plan to eliminate some services, including breast and cervical cancer screening for low-income patients.
Family planning officials said that the closure of the clinics will lead to an increase in unwanted pregnancies and, rather than reducing the number of abortions, will drive an increasing number of women to seek abortions at other facilities. The clinic closures also will mean that cancers and venereal diseases such as syphilis and chlamydia microorganism will go undetected.
However, abortion opponents downplayed the effect of the cutbacks, saying that the family planning clinics have wrongfully been "promoting abortion" with public funds.
"These clinics have long been used as a cover and funnel of money for the abortion industry," said Brian Johnston, Western director of the National Right to Life Committee. "I think it's an ironic situation that the very people who are promoting abortion are now complaining that there are going to be more abortions."
Health department officials say that only five of the 42 clinic sites offer abortions and that no state or federal family planning funds are used to pay for the abortions.
Thomas Kring, executive director of the Los Angeles Regional Family Planning Council, said that 29 county-operated family planning clinics from Pomona to Lawndale will continue to provide services. He said that those women redirected to other clinics "will be playing Russian roulette," trying to get an appointment.
"We're not even serving patients that we need to at the clinics we have open now," he said. "We don't have the staff to serve them and it's only going to get worse."
The family planning clinic at the downtown Central Health Center was at capacity Monday, but most patients seemed unaware it was about to close. Mia Henriquez, a 27-year-old immigrant from El Salvador with a 3-month-old child, said she didn't know where she would end up seeking services.
"It's tough enough to get here now," she said. "It takes forever to get an appointment. I can't believe it's going to get worse."
News of the cutbacks was as unpopular with county health workers as with patients in the San Fernando Valley, where four centers will no longer offer family planning services.
"We're back to square one," said West Valley district health officer Lucia Carpenter, who predicted that patients with nowhere to turn for services will end up having more babies.
Family planning patients at the Canoga Park health center will be referred to another, already overcrowded center in Van Nuys.
Other workers predicted that the cuts will have a particularly harsh effect on teen-agers.
"What we have nationally is a teen-age pregnancy epidemic," said public health nurse Jean Heller, relief supervisor at the Pacoima health center. "The more barriers you put up to these gals . . . the more likely they are of getting pregnant."
Silberman said that the clinics that are closing were spaced geographically, so that patients won't have to travel far to find similar services. He said the clinics that will remain open were designated as the "most efficient, well-run" programs in the county.
Last year alone, the largest family planning program in the county, at H. Claude Hudson Comprehensive Center, served 10,216 women. Most of them had one to three children and nearly 3,000 of them had had at least one abortion before going to the center.
And nearly 1,700 had never practiced birth control, according to health officials.
In addition, an unusually high 7.5% of the 7,000 Pap smears done at the clinic 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 average Wiley said.
County health officials huddled with family planning service directors Monday to decide where to redirect patients and how to notify them. Signs will be posted in English and Spanish at all clinics notifying patients where to go for services and they will receive similar information when they call. Most of the closed clinics are located within larger health-care facilities, which will continue to provide non-family-planning services, officials said.
"Basically what we have is that the nightmare we're all trying to avoid is going to happen," said Anna Diaz, head of the family planning program at Los Angeles County/USC Medical Center Women's Hospital. "A lot of women who desperately need health care are just not going to get it. And it's going to be very scary."
Family planning officials said that the funding cuts will be felt in other areas of the county's overburdened health care system when the patients show up in emergency rooms and maternity wards at hospitals throughout Los Angeles.
"It's a vicious cycle," Wiley said. "It's not just an issue of contraception, it's an issue of cancer, of preventive health care. There's just no way to get away from the fact that we're going to have more babies, more cervical cancer and more spreading of venereal disease."
Times staff writers Greg Johnson and Lynn Steinberg contributed to this story.
Starting Wednesday, when 13 family planning clinics will close, about 20,000 women in Los Angeles County will be redirected to other programs, which officials say are already overcrowded. Health officials say the closings will trigger thousands of unwanted pregnancies.
The following Los Angeles County health centers will discontinue family planning services: Canoga Park 7107 Remmet Ave. Canoga Park Central 241 N. Figueroa St. Los Angeles Culver City 4150 Overland Ave. Culver City Dollarhide 1108 N. Oleander Ave. Compton Harbor/San Pedro 122 West 8th St. San Pedro Hawaiian Gardens 22310 Wardham St. Hawaiian Gardens North Hollywood 5300 Tujunga Ave. North Hollywood Norwalk 12360 E. Firestone Blvd. Norwalk Pacoima 13300 Van Nuys Blvd. Pacoima Pico Rivera 6336 S. Passons Blvd. Pico Rivera South 1522 East 102nd St. Los Angeles Tujunga 7747 Foothill Blvd. Tujunga Venice 905 Venice Blvd. Venice