Iowa's family planning service use plummets 85 percent after switch to new program

Planned Parenthood supporters gather in the rotunda of the State Capitol in January 2017 following a senate subcommittee
Planned Parenthood supporters gather in the rotunda of the State Capitol in January 2017 following a senate subcommittee hearing on a bill that proposes removing the Iowa Family Planning waiver and would create a state-run organization denying funding for health providers that offer abortion services in Des Moines. (Rebecca F. Miller/The Gazette)

Family planning service providers last year spent only a small portion of the $3 million allocated to Iowa’s program — which may be due to the more than 85 percent decline in individual use since officials ousted Planned Parenthood and implemented a state-funded program instead.

A report from the Iowa Department of Human Services attributes to the sharp decline in part to the Affordable Care Act. But critics of the Family Planning Program say the data indicates individuals aren’t getting the services they need.

“Ultimately this report from the Department of Human Services reinforces what we have seen and heard anecdotally, which is (that) far fewer Iowans are accessing vital reproductive health care that they need,” said Erin Davison-Rippey, Iowa executive director of Planned Parenthood North Central States.

“What now appears to be a disastrous program was the result of a narrow political agenda of Iowa’s anti-abortion lawmakers. The health of Iowans is what’s at stake here.”

Human Services Director Kelly Garcia was unable to comment on the report before the Council on Human Services meeting set for Wednesday in Des Moines, when board members are expected to discuss the report and its findings.

In 2017, the Iowa Legislature created the $3 million Family Planning Program, funneling state dollars into women’s health care clinics that do not perform abortions.

Between 2016 and 2018, the number of people served under Iowa’s Family Planning Program dropped from 10,817 to 1,502, or about 86 percent, according to the report released this week.


Use had been on the decline under the Family Planning Network, the state’s previous program. But the period between 2016 and 2018 represented the largest drop in the past four years.

More than 16,500 individuals accessed services in the program in 2014. By 2015, that dropped to about 12,600.

The drop is a major concern to advocates such as Davison-Rippey, who said a lack of access could lead to more unintended pregnancies, higher abortion rates and other indicators.

She pointed to the increasing rate of sexually transmitted infections across the state. Testing and treatment of these infections would be covered under the state-run program.

In 2018, Iowa public health officials reported nearly 20,000 cases of chlamydia, gonorrhea and syphilis — an increase of more than 1,800 from 2017. In Des Moines County alone, the gonorrhea rate spiked 296 percent between 2016 and 2017 — the biggest jump among the state’s 99 counties.

While it’s not clear where members previously enrolled under the program now are receiving family planning services, Human Services did report most individuals are using family planning services through Iowa’s Medicaid program.

“One reason for declining enrollment in the (Family Planning Program/Iowa Family Planning Network) over the last four years is the implementation of the ACA as individuals are now able to seek increased health coverage,” the report stated.

The analysis shows between 2017 and 2018 — after implementation of the new state-run program — the number of Medicaid members using family planning services rose from 351,388 to 358,275.

Overall, about 1.7 million Iowans used family planning services through the state in 2018.


However, Planned Parenthood’s Davison-Rippey pushed back on the report’s characterization, saying the data doesn’t clearly indicate if individuals who relied on the Family Planning Program now are receiving services under Medicaid.

In addition, the report does not include data on the use of specific services — including birth control, testing for sexually transmitted infections and preventive visits, among others — between 2014 and 2018.

“There’s a lack of comprehensive picture of this program to even understand what this program is providing, and it certainly doesn’t tell us what is happening to folks who had previously been served under the Family Planning Program,” Davison-Rippey said.

In its report, Human Services stated it intends to collaborate with the Iowa Department of Public Health and provider associations “to create maps of access points across the state for family planning services.”

In 2018, Iowa reimbursed Family Planning Program providers — which includes physicians, surgeons and other medical providers — nearly $212,000, the department reported.

That’s roughly 7 percent of the $3 million allocated for the state program.

That’s also only about a fourth of the funding used compared to the previous year, when $808,000 was reimbursed to providers for family planning services in 2017.

Cost of family planning services provided to Medicaid members remained steady between 2017 and 2018, both reaching about $59 million.

But between 2014 and 2017, Medicaid reimbursement to providers increased nearly 70 percent.

About 5,500 providers offered family planning services to both Family Planning Program and Medicaid members in 2018, according to the report. The number of providers has remained stable since 2014, when about 5,700 providers offered services.


The department reports there are 746 attested providers in the Family Planning Program as of December 2018. To offer services under the program, they must be enrolled in Medicaid.

A Gazette investigation last year found the state’s database of Family Planning Program Providers was plagued with errors and redundancies, listing dermatologists, surgeons and other physicians who didn’t offer family planning services to patients. Of the 1,400 listings, 135 were listings for independent laboratories that don’t see patients.

In creating the program in 2017, Iowa officials passed on federal funding that allowed participation by providers that include abortion among their offered services — most notably, Planned Parenthood.

Under the previous family planning program, no tax dollars were used to perform abortions.

Planned Parenthood in Iowa lost nearly $2 million in funding as a result, causing the organization to close four of its clinics. Davison-Rippey said the organization lacks the data to understand the exact impact, but officials believe its being cut from the program caused a major lack in services.

“When you defund Planned Parenthood from family planning programs, improvements aren’t made to these programs,” Davison-Rippey said. “We will see increases in unintended pregnancy and maternal mortality rates and just overall, poorer health outcomes. This is incredibly concerning.”

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