A typical woman spends 30 years of her life trying to control her fertility, and isn’t always successful.
Nearly half of all pregnancies in the United States are unintended, and among women at or below the federal poverty level, the rate is more than five times that of women at the highest income level.
As the Register has reported on increased child poverty in Iowa, readers have asked: How can families better avoid unintended pregnancies?
Families can take greater control of their fertility inexpensively, or even for free, through the Iowa Family Planning Network, Medicaid, federal Title X funding and other avenues. But Iowans who work in the field say there are more barriers between low-income women and family planning than cost, from lack of knowledge to distance to services.
The Iowa Family Planning Network offers a waiver that works like health insurance. Clinics and physicians can bill for contraceptive services, and the network will cover a portion of the cost. At Planned Parenthood, the remainder of the cost is covered by donation.
Patients using the waiver could potentially receive clinic visits and some birth control prescriptions without paying a penny, as long as they earn less than three times the federal poverty level (which calculates to $33,510 for an individual). As of Oct. 1, more than 30,000 people were using the waiver.
At Planned Parenthood of the Heartland, where half of all patients are below the poverty level, the network waiver helps low-income women receive birth control, annual exams, cancer screenings, breast exams and referrals for mammograms — services that can cost up to $600 per year, said Laura Dickey, a clinic assistant at the Susan Knapp Health Center in Des Moines.
According to the Guttmacher Institute, a reproductive health research institute, the average yearly cost of family planning per person in Iowa is $330, almost 30 percent more than the national average.
“To somebody at 100 percent of poverty level, that’s a big deal,” Dickey said.
But many women don’t know financial assistance is available. Such information doesn’t usually disseminate outside of clinics, and health curricula vary widely among school districts. Some school programs teach abstinence only, while others go in depth about family planning.
“Anything schools do has to be medically accurate and factual,” said Jodi Tomlonovic, executive director of the Iowa Family Planning Council, “but the state doesn’t say you have to provide information about the methods.”
Federal money that helps clinics provide services on a sliding scale has shrunk in recent years, Tomlonovic said, which hurts cash-strapped women who can’t take time off from work to travel long distances to a clinic.
Some sites in low-population counties have closed, Tomlonovic said. One alternative is to keep sites open for just one or two days per week. “It isn’t the best way to do it, but we try to get some access there.”
The Iowa Initiative, a privately funded five-year research project, found that access to long-acting reversible contraceptives, such as intrauterine devices and implants, reduces the rate of unintended pregnancy more than other forms of birth control, which a woman may forget to take or otherwise not use properly.
“The results are amazing,” said Deb Madison-Levi, the initiative’s communications director. “It helps a woman be able to reach her goals, go to school, contribute to society.”
The Iowa Family Planning Network and Medicaid cover costs for an IUD (up to $1,000) and hormonal implants (up to $800), but not everyone knows that, Tomlonovic said.
Planned Parenthood’s misunderstood reputation also can be an obstacle, Dickey said. “We have this reputation for being an abortion clinic, when 97 percent of the services we provide are really family planning and prevention,” she said.
Also struggling with brand consciousness are proponents of natural family planning, a variety of calendar-based fertility methods popular among Catholics. Rick Condon, a deacon at St. Pius X in Urbandale, said modern methods that consider body temperature and discharge are often overshadowed by memories of the less effective “rhythm method” from the 1960s.
In Des Moines, courses are offered in three methods by educators with religious affiliations. For low-income families, scholarships can cover the average $150 course fee.
The religious connection is not for everyone, Condon acknowledged.
“It becomes a way of life, and if people aren’t interested in living that way of life, there’s some issues,” he said. “Some 15-year-old on the street, this isn’t readily acceptable to them.”