The political push to defund the organization could have troubling consequences for women's health care

Picture yourself in a situation where you have a history of a certain medical issue, but you don't have a job and you don't have health insurance. Where would you go?

For Katherine Getson, this is more than a rhetorical question. Seven years ago, it was her reality. In 2010, Katherine had just moved to Columbus from Long Island, New York. She had a temp position and was searching for something more permanent, but before she could find anything else, she was abruptly laid off. Getson found herself with little income, a broken wrist and no health insurance.

She'd broken her wrist in an ice skating accident, and the injury to her dominant hand only made it harder to find a job. Meanwhile, she had another problem. “I had a history of irregular Pap smears, and I knew I needed to get in for my annual exam,” Getson said. “Planned Parenthood was one of the places I knew I could go.”

Despite some trepidation she might be harassed, Getson visited a Planned Parenthood clinic. After filling out some paperwork, she received free care based on her income, which had been reduced to a small unemployment benefit. “Thankfully that Pap came back OK,” she said. “But this past year I had my first exam for my pregnancy, and sure enough, my irregular Pap had turned into precancerous cells that I had to get removed once I had my baby.”

She said she still wonders about the “what ifs.” What if the problem had arisen earlier? What if she didn't have the option of using Planned Parenthood? But, as important as that Pap smear was, her appointment at Planned Parenthood covered much more than just her physical well-being.

Five years prior, Getson had been sexually assaulted. The attack happened while she was still in college, but the university didn't offer much help. “I went to a counselor who made me feel like it was my fault, and so I stopped going and never bothered to try anything else,” she said.

In the intervening years, she shared her history with her doctors during annual exams. Getson said none of the private OB-GYNs she visited discussed the assault with her in depth. “They seemed more concerned with my physical well-being than my mental well-being,” she said. “No one really followed up to see if I'd gotten the support I needed.”

Her experience at Planned Parenthood was different. When the practitioners there found out about the assault, they not only offered Getson free HIV and STI testing, they also offered to connect her with local resources for counseling and support. “Then, a few weeks later they called me to make sure I got the assistance I needed and that I felt I was in a good place,” she said. “I'd never had that kind of support from a medical provider before. They treated me as a whole person.”

Getson believes she wouldn't have revisited counseling if she hadn't gone to Planned Parenthood.

“After the experience I had in college with the counselor, I had this negative idea of psychologists and just brushed off the idea of going anywhere else for support,” she said.

Her story isn't uncommon. Thousands of Ohio women rely on Planned Parenthood for reproductive health care services. For Getson, Planned Parenthood offered a vital resource during a temporary period of unemployment. For many other women, accessing health care without the aid of insurance isn't a temporary problem, it's a chronic one. Yet in Ohio, Planned Parenthood's ability to serve low-income women is increasingly strained by the political battle over abortion.

The Campaign to Outlaw Abortion

Ohio captured national media attention in December when the legislature passed the so-called “heartbeat bill” outlawing abortion after a fetal heartbeat is detected. Governor John Kasich vetoed the bill, which would have banned abortion beginning about six weeks after conception, and signed a 20-week abortion ban instead.

The 20-week ban is the latest in a string of laws restricting abortion access in Ohio. After Kasich signed the legislation, The Columbus Dispatch reported it was the 18th restriction on abortion he's enacted since entering office in 2011. Nearly half of Ohio's abortion clinics have closed, bringing the total down to nine clinics. And early last year, the Ohio legislature passed a bill prohibiting the state from contracting for health services with any organization that provides or promotes abortions.

The bill did not name Planned Parenthood directly, but it sought to strip the organization of an estimated $1.2 million in funding, including grants to increase HIV testing, prevent violence against women and reduce the infant mortality rate. (Ohio law already prohibits women from using state funds for abortions, except in cases of rape, incest or threat to the life of the mother.) A federal district court judge later permanently blocked the measure from going into effect.

All these attempts to restrict abortion access, including the move to block Planned Parenthood from accessing state funds for non-abortion related health care services, are the result of a strategic campaign waged by anti-abortion groups.

“Eventually, we want the Supreme Court to overturn Roe v. Wade, and we believe the incremental strategy is the best way to do that,” said Katherine Franklin, director of communications for Ohio Right to Life. “We want to chip it back until it's overturned in the long term.”

To some, “the long term” suddenly seems much shorter under President Donald Trump, who has vowed to nominate justices to the Supreme Court who are sympathetic to the anti-abortion movement. But anti-abortion activists and politicians made Ohio a critical testing ground for abortion restrictions well before the election, with the hope of generating a case to take to the Supreme Court.

Ohio Right to Life activists believe that incrementally passing stricter legislation is less likely to backfire in a court ruling that protects abortion access. Others push a more extreme strategy exemplified by the fetal heartbeat bill. The end goal is the same either way, and anti-abortion activists have made Planned Parenthood one of their most visible targets. Franklin said the health care provided by Planned Parenthood “doesn't justify funding an organization that is the state's largest abortion provider.”

A Reproductive Health Care Crisis

The debate over Planned Parenthood's funding is often centered on the issue of abortion, but defunding the organization could have wide-ranging consequences for reproductive health care access in Ohio, including making it more difficult for women to access family planning services that help prevent unintended pregnancies in the first place.

Iris Harvey, CEO of Planned Parenthood of Greater Ohio and Planned Parenthood Advocates of Ohio, said using the word “defund” in this context can be misleading. “There is no federal line item that provides funding to Planned Parenthood,” she said. “So ‘defunding' is really denying low-income people who use Medicaid as their insurance from being able to use their Medicaid benefit at Planned Parenthood.”

The Ohio bill barred Planned Parenthood from accessing state funds, but Republicans in Congress have promised to stop Planned Parenthood from receiving Medicaid reimbursements, and potentially reimbursements from the federal family planning program Title X, as part of repealing the Affordable Care Act.

Here in Ohio, that would affect thousands of women. Together, Planned Parenthood of Greater Ohio (PPGOH) and Planned Parenthood Southwest Ohio serve about 80,000 Ohioans annually at 28 different locations. Only three locations perform abortions — most focus on providing birth control, Pap smears, STI testing, cancer screenings and more. According to PPGOH's 2015 annual report, 39 percent of its patients use Medicaid to pay for their visits.

Opponents argue women can simply go elsewhere for health care. “I think it's a straw man argument about women's health care being dependent on Planned Parenthood,” said Rep. Christina Hagan, a Republican representing eastern Stark County and a co-sponsor of the bill aimed at defunding the organization. “Redirecting those funds from abortion providers doesn't decrease access; it increases access because it redirects funds to more points of access for care.”

Hagan is referring to the state's 49 Federally Qualified Health Centers, also known as Community Health Centers, which offer comprehensive health care services to low-income patients and patients on Medicaid at more than 200 locations. However, even though there are more Community Health Center locations, that doesn't mean those centers can provide the same care Planned Parenthood offers its patients.

While Community Health Centers do provide women's health care services, Harvey said Planned Parenthood has more family planning options than other safety-net providers and even many private physicians' offices, particularly when it comes to long-acting reversible contraceptives like IUDs and implants. Planned Parenthood also offers extended hours and same-day appointments designed to meet the needs of low-income women.

Harvey added Planned Parenthood is also an extremely efficient provider, able to serve a high number of patients at relatively low cost to the state. An analysis by the nonprofit Guttmacher Institute, a reproductive health research and policy organization, shows that, despite the smaller number of clinics, Planned Parenthood served 52 percent of patients who received contraception services from a publicly funded clinic in Ohio in 2010.

Setting aside arguments about quality of care, is it possible that the state's Community Health Centers could absorb Planned Parenthood's patients? That question is difficult to answer, in part because Community Health Centers are facing an uncertain future themselves. Ohio's Medicaid expansion and the overall structure of the Medicaid program are both up in the air as Congress decides whether to repeal and replace the Affordable Care Act.

“With the uncertainty of Medicaid moving forward, coupled with the fact that the Health Center Program is facing a 70 percent reduction in direct federal funding at the close of this federal fiscal year, it is challenging to comment on expanded capacity at this point in time,” said Julie DiRossi-King, chief operating officer of the Ohio Association of Community Health Centers, in an email.

Ultimately, directing funds away from Planned Parenthood in the form of state grants or Medicaid reimbursements narrows women's options. That's a problem because many women are not getting the care they need under the current system.

According to a report by the Guttmacher Institute, an estimated 730,110 women in Ohio were in need of publicly supported contraceptive services and supplies in 2014. In the same year, publicly supported health centers (including Planned Parenthood) provided contraceptive care to 105,440 women—less than 15 percent of overall demand. While this doesn't mean that all the remaining women in need of publicly supported contraception could not access it, it does place Ohio below the national average of need met by publicly funded clinics.

A report released by NARAL Pro-Choice Ohio paints an equally troubling picture, especially for women of color. Hispanic women are doubly at risk of developing cervical cancer compared to non-Hispanic white women, and African-American women have 1.5 times the risk. In 2014, the HIV infection rate, defined as occurrence of infection per 100,000 females, was 0.9 for white women. For Hispanic women it was 4.6 and for black women it was 10.9. Although the HIV infection rate for black women has since decreased, it remains far higher than that of white women.

“Because we're not funding health care adequately, there's a health care crisis for women of color in this state,” said NARAL Ohio Executive Director Kellie Copeland. “And when people don't have the access they need, no one should be surprised to see this kind of suffering.”

Harvey said Planned Parenthood is already positioned to help address these issues. “Over a third of our patients are people of color, and we are frequently in African-American communities serving these people,” she said. “If last-resort providers are denied them, it does create a crisis. As you take away choice, you leave women open to facing an unintended pregnancy. Nobody wants that.”

What's Next? Activists and Lawmakers React

Looking ahead, one thing is clear: Ohio will remain a key battleground state on the issue of abortion and reproductive health care. The state is already appealing the court's decision to strike down the bill defunding abortion providers. Meanwhile, Ohio Right to Life recently unveiled its legislative agenda for the next two years, with a ban on dilation and evacuation (D&E) abortions as the centerpiece.

The fetal heartbeat bill is likely to return as well. “It will absolutely be reintroduced” said Rep. Hagan, who is also a lead sponsor of the bill. She added that while she believes in supporting women, “It's necessary to pose the question to the court of the legitimacy of Roe v. Wade as it pertains to human rights.”

While the Trump administration has given the anti-abortion movement a greater sense of optimism, it's also created a new sense of urgency for those who support abortion rights. On Jan. 15, an estimated 2,000 people joined a march in Downtown Columbus in solidarity with the Women's March on Washington. Although the march encompassed a range of issues, women's health care access was a key theme, with plenty of “I Stand with Planned Parenthood” signs in sight.

“They (anti-abortion activists) are closer to overturning Roe v. Wade than they've ever been,” Copeland said. “That's why pro-choice activists, organizations and politicians have their work cut out for them. We have to delay and deconstruct what the anti-choice movement has built.”

Others saw this backlash coming long before the election. “For every social rights win we've made over the past 50 years, there's been a plan to dismantle it,” said Jasmine Burnett, director of community organizing for the Cleveland branch of New Voices for Reproductive Justice, an organization that uses a human rights framework to promote the health and well-being of women and girls of color in all areas of their lives.

In a system that chronically under-serves women of color, Burnett said pro-abortion rights activists should look to the leadership of women of color and organizations like New Voices. “Trust black women,” she said. “The way we voted [in the presidential election] showed that when we make a decision, it's collective. I believe the choice movement and every other social justice movement can learn from that.”

It's impossible to predict what will happen next. But as this battle is waged on the state and national level, it's important to remember that behind the statistics are women like Katherine Getson, who credits her current health and happiness to the resources she uncovered through Planned Parenthood.

“You think that you have closure, but you really don't,” she said of her assault. Working through the unresolved trauma helped her come to terms with the experience of being sexually assaulted and break a pattern of unhealthy relationships.

“Because of the help I got, I placed more value in myself as a person,” she said. “Without placing that value on myself, I never would have been able to have a successful relationship that would lead to getting married, buying a house, having a baby and being incredibly happy.”