Recession impacts women's choices — How is your facility responding?
About 1 in 4 have delayed care in past year to save money
Check the records of women who are scheduled to return to your facility for a contraceptive refill or annual well woman exam. Are you seeing empty spots in the schedule?
New national survey data indicate you will. Nearly one in four women have put off a gynecologic or birth control visit in the past year to save money, and the same proportion report having a harder time paying for birth control than they did in the past, according to 2009 information from the Guttmacher Institute.1 While nearly half of the women surveyed said they want to delay pregnancy or limit the number of children they have due to the impact of the recession, economic hardship is causing many of them to skimp on their contraceptive use in order to save money.
The recession has put many women, including middle-class women who are having trouble making ends meet, in an "untenable situation," says Sharon Camp, PhD, Guttmacher president and CEO. Women want to avoid unintended pregnancy more than ever, but at the same time are having difficulty affording the out-of-pocket costs of prescription contraception, she adds.
"Unfortunately, while delaying a prescription refill or skipping pills may save women money in the short term, it increases their risk of an unintended pregnancy and results in greater costs related to abortion and unplanned birth later on," she states.
Further information is scheduled to be released this month says Laura Lindberg, PhD, a senior research associate at Guttmacher. Surveys from about 50 Title X family planning clinics will be analyzed for shifts in client types and numbers, staffing, and funding during the recession, she states.
What do women say?
Conducted in July and August, the Guttmacher survey includes responses from a nationally representative sample of some 1,000 low- and middle-income sexually active women. Designed to determine how the current economy has affected women and their families, researchers gathered women's views of contraceptive use, ability to access contraceptives, and their decisions on whether or when to have a child. Women included in the survey were in the 18-39 age range and had annual household incomes of less than $75,000.
More than one in four women or their partners reported lost jobs or health insurance in the past year, and many say they have lost confidence in their ability to provide for their families, survey findings indicate. Fifty-two percent of surveyed women said they are earning less or financially doing worse than they were a year ago. According to the Guttmacher report, these financial setbacks are occurring evenly across various groups of American women; there are no significant differences in the reported share of women who are financially worse off by age, education, marital status, race or ethnicity, region of the country or household income.1
With less money in hand, women are making risky choices when it comes to contraception. Eight percent of women said they sometimes did not use birth control in order to save money; researchers found this cost-cutting behavior was more common among those who were financially worse off than among others (12% vs. 4%). For those women using oral contraceptives, 18% reported inconsistent use as a means of saving money. Pill users said they skipped pills (4%), delayed getting a prescription filled (12%), went off the Pill for at least a month (11%), and obtained fewer pill packs at one time (8%). Again, women in less fortunate straits were more apt to have inconsistent use (25% vs. 6%).1
Clinics feel the pinch
Eleven percent of women surveyed in the Guttmacher Institute report say they have switched to a less expensive provider for their reproductive health care services.
"We are seeing more women in their 30s and 40s that depended on us in their 20s return for care," says Sarah Stoesz, president and CEO of Planned Parenthood Minnesota, North Dakota, South Dakota. "For many of these women, our doctors are the only ones they see all year."
Stoesz reports that more patients are telling her nurse practitioners that they have lost their jobs and insurance benefits or have had their hours cut back at work. Of particular note is the increase in women requesting long-term contraception, specifically intrauterine devices — up more than 50% over last year, she notes. Such developments are not unusual; Los Angeles County, Planned Parenthood reports that in the first three months of 2009, requests for intrauterine devices were up 83% over the same period in 2008.2
Planned Parenthood of the Great Northwest (PPGNW) in Seattle reports a 35% jump in patient demand from 2008. PPGNW health centers in Washington were seeing more than 9,400 patients a month as of Spring 2009.3 To be more effective in serving patients, the organization has instituted electronic medical records with their affiliates and a centralized contact center for appointments and follow-ups.3
What are clinics doing to help women stay on course when it comes to contraception? About 15% of Planned Parenthood affiliates offer the "Pills Now. Pay Later" program, where women can come into a health center for a quick visit and leave with a year's worth of birth control pills, says Tait Sye, Planned Parenthood spokesman. The center will bill a patient's pills to her credit card, check card, or flex spending card on a monthly basis, with fees guaranteed not to increase over the course of the prescription.
What's the next step?
The demand for health care assistance isn't about to fade away. A September 2009 U.S. Department of Health and Human Services analysis of U.S. Census data reveals the number of uninsured Americans increased from 39.8 million in 2001 to 46.3 million in 2008. The numbers do not include those who have lost their insurance during the recent recession or who had coverage gaps shorter than one year.4
Nowhere is the need for health care reform more evident than in rural Minnesota, says Stoesz. More than 94% of Planned Parenthood's 64,000 patients are women, and nearly 60% live in rural Minnesota.5 Poverty, lack of insurance, and limited access to health care combines to result in poorer outcomes for Minnesota's rural women, especially when it comes to reproductive health, states Stoesz. Fewer rural women receive recommended preventive gynecological care, including mammograms and breast, cervical, and colorectal cancer screening than do their urban peers.
How are organizations working with women who might be facing increased financial pressures due to the recession?
"Planned Parenthood utilizes a variety of appropriate funding streams designed to broaden access to family planning services," says Stoesz. "From state and federal programs to philanthropic support, we make sure that women in need of health care are not turned away because of the inability to pay." (Need ideas for augmenting your facility's funding? See what other clinics are doing in an upcoming issue of Contraceptive Technology Update.)
References
- Guttmacher Institute. A Real-Time Look at the Impact of the Recession on Women's Family Planning and Pregnancy Decisions. New York City; 2009.
- Yoshino K. Women's clinics see rise in calls and visits. Los Angeles Times, May 20, 2009. Accessed at articles.latimes.com/2009/may/20/local/me-abortion20?pg=2.
- Economic pressures push more patients to rely on Planned Parenthood. Focus on Planned Parenthood 2009; 1, 4.
- National Family Planning and Reproductive Health Association. HHS reports 46.3 million Americans went without health insurance in 2008. Accessed at www.nfprha.org/main/media_detail.cfm?ID=140.
- Mueller SB, Di Nicola K, Hill K. Planned Parenthood Minnesota, North Dakota, South Dakota's 2009 Rural Women's Health Report. Minneapolis; 2009.
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