Women hit by recession — Clinics feel the blow, too
Women hit by recession Clinics feel the blow, too
A Guttmacher Institute analysis of new U.S. Census Bureau data reveals the number of U.S. women ages 15-44 covered by private insurance dropped between 2008 and 2009, as widespread job losses resulted in many Americans losing their employer-based insurance.1 What has been the impact on family planning clinics?
Maternal and Family Health Services in Wilkes-Barre, PA, coordinates services to more than 38,000 family planning clients annually through a network of 46 contract and direct service sites in 15 Pennsylvania counties. Patient numbers have increased in the past year, growing by 7-7.5% from 2007 to 2009. In the same time period, the agency has seen an 28% increase in its lower-end sliding fee scale categories, says Bette Cox Saxton, president and chief executive officer.
"We have observed in many of our sites women coming back to us because they cannot afford birth control and anecdotally talk about the need to delay pregnancy because they just cannot afford to become pregnant or have another child," Saxton states.
The Indiana Family Health Council in Indianapolis is a private, non-profit corporation that administers federal Title X funds through contracts with non-profit and public agencies to provide family planning services for low-income working poor and teens. The number of those under 100% of poverty has risen in the past three years. It climbed from 71% in 2007 to 76.1% in 2010, states Gayla Winston, president & chief executive officer.
Family planning clinics across the country reported service delivery challenges in a 2009 Guttmacher Institute report. Almost half (48%) said they had to freeze or cut staffing levels, reduce the number of contraceptive options made available to patients (32%), or lengthen wait time for patients (25%).2
Maternal and Family Health Services has had one or more service delivery challenges that are focused more on staffing shortages and operations, rather than funding reductions, says Saxton. "Our challenges are not unique and only underscores how vital publicly funded family planning centers are as safety-net providers," she states.
Take a look at numbers
According to the Guttmacher Institute analysis, the decrease in the number of women of reproductive age who had private insurance was paired with significant increases in the number of women who were uninsured or on Medicaid. The Census Bureau also reported an upsurge in the overall number of Americans living in poverty.
The new calculations indicate the number of women ages 15-44 covered by private insurance fell by 2.3 million, from about 39 million in 2008 to 36.7 million in 2009. This shift resulted in a decrease (from 63.3% to 59.5%) in the share of women who had private insurance coverage.
Consequently, the number of women who were uninsured grew by more than 1.3 million, and the number of women on Medicaid increased by more than one million. According to the analysis, 22.3% of all women of reproductive age in 2009 were uninsured and 14.8% were on Medicaid, compared with 20.1% and 13.2% in 2008. This gain in the number of reproductive age women who are uninsured was at a higher and faster rate than for the U.S. population overall, the analysis shows.1
Options narrow for women
A 2009 Guttmacher Institute national survey of some 1,000 low- and middle-class sexually active women shows that nearly half of all women surveyed, and more than half of those with an annual family income below $25,000, said that due to the economy, they wanted to get pregnant later, wanted fewer children, or now did not want any more children.
With less income, women opt for risky contraceptive strategies, survey results show. 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% versus 6%).3
Start polling your patients on what they pay at local pharmacies for their contraceptive prescriptions, advises Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. Look at affordable options for them; many "big box" retailers such as Wal-Mart, Target, and Kroger sell Sprintec, a 0.035 mg ethinyl estradiol/0.250 mg norgestimate pill from Teva Pharmaceuticals USA, North Wales, PA, for $9 a cycle, he notes.
If you prescribe a pill that is too expensive for a patient to fill, then don't be surprised to see that patient without contraceptive coverage when she returns for the next visit, says Hatcher. Results of a 2010 study show that one-quarter of all prescriptions go unfilled.4
One issue in unfilled prescriptions is cost, says Hatcher. Help women review options that they can use, and afford, for successful pregnancy prevention, he notes.
References
- Guttmacher Institute. Women of reproductive age hit hard by recession, new census data show. Accessed at http://www.guttmacher.org/media/inthenews/2010/09/17/index.html.
- Guttmacher Institute. A Real-Time Look at the Impact of the Recession on Publicly Funded Family Planning Centers. New York; 2009.
- Guttmacher Institute. A Real-Time Look at the Impact of the Recession on Women's Family Planning and Pregnancy Decisions. New York; 2009.
- Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med 2010;25:284-290.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.