Friday, November 21, 2008

Please, Have a Conversation...

Most Iowans I talk with are surprised to learn that we are 48th in the country in terms of access to family planning and birth control. I was surprised, too. In Mt. Pleasant I lived three blocks from the Southeast Iowa Planned Parenthood clinic, so I thought everyone else in Iowa had access.

The Iowa Department of Public Health contracts with Iowa Rural Health Clinic Providers to deliver primary care, including reproductive services. Women on Medicaid can get reproductive health services at these rural health clinics in counties where there is no family planning clinic. I have come to realize that access is more complicated than that.

In cities like Des Moines or Davenport a woman might not have access if she has no car and the local bus doesn’t stop near a clinic. Recently the Visiting Nurses of Des Moines opened a family planning clinic at Park Fair Mall Shopping Center, right next to the Fareway grocery and the Walgreens pharmacy on the local bus line.

In fact, they advertise in the Des Moines buses. The ads are important because if women don’t know about the three new kinds of long-acting reversible contraceptives, then they aren’t really accessible.

If a woman lives in Lyon County or Taylor County and there are no family planning clinics within 30 miles, then access is a problem, because most women work, sometimes on shifts that make it inconvenient to access birth control and reproductive health services on a regular basis.

Because of Iowa Initiative grants, existing clinics are opening satellites. A few weeks ago Northeast Iowa Community Action opened clinics in Postville, Fayette and New Hampton. Next week we’ll be opening Planned Parenthood of Greater Iowa clinics in Creston and Ft. Dodge.
Access also includes access to information. We created the first comprehensive map of family planning/birth control clinics in the state, so that anyone visiting our website may click on the town where they live and get contact information. In some cases they can make an appointment online. The Initiative also created a comprehensive chart of all hormonal and non-hormonal birth control options now available in most clinics across Iowa. It's also been translated to Spanish, because language can be a barrier to access.

When I was newly married, I was making $7,000 a year as a teacher in small town upstate New York. I had health insurance, but it didn’t cover birth control. I couldn’t afford to be pregnant those first three years of marriage, because I was supporting us while my husband finished law school. The nearest family planning clinic was 30 miles away, but that’s where I had access to low-cost birth control pills and a yearly check up. If a woman has no health insurance or has health insurance that doesn’t cover birth control, access is a problem.

Today the Pill can cost between $30-50 a month. College students and many women working minimum-wage jobs, simply can’t afford this expense. Iowa Initiative grants make long-acting reversible contraceptives (LARC) available at no-cost or low cost at every family planning clinic on our map. So far the best advertising for new clinics and LARC in Iowa is word-of mouth: roommates sharing information; daughters telling their moms; health care professionals counseling clients.

Please have a conversation with someone else about what you learn here.