DES MOINES — Sex educators who gathered here last week for an annual conference have reason to be concerned. Iowa’s family planning landscape has changed, making it more difficult for teens to get needed information and services.
The Legislature’s decision last spring to forgo federal family planning money in favor of a state-run program that excludes health care organizations that offer abortion services provided a small window for officials to write rules and implement the system. Even now, three months after the system was supposed to be in place, questions remain.
The new process is time-consuming, requiring those hoping to access services to first apply at the nearest Department of Human Services or Title X office and wait for approval. A significant portion of providers listed on the department’s website have neither the capacity nor, in some cases, the capability of offering comprehensive family planning services. A handful are satellite locations, open only minutes each week or month.
Amid the shuffle, family planning clinics are closing — four Planned Parenthood locations, five St. Luke’s family planning clinics, Central Iowa Family Planning and, most recently, Northeast Iowa Community Action Health Services, which served a six-county region in the state’s northeast corner.
The curriculum used in Iowa schools to teach the benefits of abstaining or delaying sexual activity and to help sexually active teens protect themselves from disease and pregnancy offers recommendations to call health professionals or visit walk-in clinics. But for many teens in rural areas, such recommendations bring more questions than answers.
“It wasn’t that long ago that our state was chosen to be part of the Iowa Initiative that offered free, long-term contraceptives,” said Kristen Fairholm, executive director of advocacy group Eyes Open Iowa, which hosts the annual conference and works with educators, parents and faith groups throughout the year to meet a state requirement for public schools to provide age-appropriate and research-based instruction in human growth and development. “One of the reasons Iowa was chosen was because we already had a strong family planning network in place.”
Fairholm thinks that landscape is becoming increasingly more challenging for teens, especially in rural areas. It’s a situation that could result in more students engaging in risky behavior, which ultimately will increase the burden on taxpayers.
We know, for instance, that children of teen moms are more likely to have additional health problems, be incarcerated at some time in adolescence, give birth as a teen and face unemployment as a young adult.
These effects persist even after adjustments are made for factors that increased a teen’s risk for pregnancy, such as growing up in poverty, having parents with low education levels, growing up in a single-parent family and having poor academic performance.
What are the chances of a child growing up in poverty if mom gave birth as a teen, if parents were unmarried when the child was born or if mom did not receive a high school diploma or GED? If just one of these factors is present, the child is 27 percent more likely to grow up in poverty. Two factors result in a 42 percent chance of poverty. And, if all three factors are present, there is a 64 percent chance.
And teens in rural areas are more likely to experience poverty and early motherhood — more so than their urban peers, despite the fact that both groups are sexually active in similar percentages.
The teen birthrate in urban areas nationally, according to the most recent data from the National Center for Health Statistics, is about 18.9. In counties with fewer than 50,000 people, which includes 89 of Iowa’s 99 counties, the rate is 30.9.
From 1990 to 2010, as access to comprehensive and research-based sexual education and reproductive health care services expanded, pregnancy and birthrates among urban teens dropped 49 percent nationally. In suburban areas, it dropped 40 percent. But in rural counties the rate declined 32 percent. Not only are rural teens more likely to give birth, they’re more likely to have subsequent births still as a teen.
When researchers spoke with rural teens, they learned there is hesitation to seek contraceptives or help with reproductive health at local family physician offices due to a lack of privacy and a fear of moral reprimand. As a result, they often rely on peers for information on sex, and too often downplay their risk for sexually transmitted infection and pregnancy.
Such factors were taken into account when federal lawmakers and health officials crafted procedures surrounding family planning funding. Unfortunately, state officials can’t say the same.
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