ACOG said, “Planned Parenthood Provides Essential Services That Improve
Women’s Health
Hal C. Lawrence, MD, and Debra L. Ness, MS
For more than 100 years, Planned Parenthood has
served communities in need of affordable, safe, and
accessible care. Across 50 states, 491 counties, and
650 clinics, Planned Parenthood provides comprehen-
sive, quality health care to 2.5 million women and men
in the United States each year. Despite these deep and
trusted ties to communities across the nation, U.S. con-
gressional leadership recently announced its intention
to defund Planned Parenthood. As leaders of the Amer-
ican Congress of Obstetricians and Gynecologists, the
nation’s leading professional organization of health
care providers for women, and the National Partnership
for Women and Families, a leading women’s health
advocacy organization, we adamantly oppose this
decision.
The move to defund Planned Parenthood is part of
an effort to shut down access to abortion care alto-
gether. Already, Medicaid funding cannot be used for
abortion care in most instances because of the harmful
Hyde Amendment. Defunding Planned Parenthood
health centers would exclude them from serving pa-
tients in the Medicaid program, reducing access to pri-
mary and preventive care services. If Congress were to
block all Medicaid patients from seeking care at
Planned Parenthood health centers, the Congressional
Budget Office estimates that 390 000 women would
lose access to these essential services altogether, and
up to 650 000 women might face reduced access to
preventive health care within a year (1). Women sud-
denly would have dramatically fewer options for where
to receive care.
Proponents of Planned Parenthood defunding of-
ten assert that other providers will fill the gap. They are
wrong. Our health system is unprepared to meet that
need. Both obstetrician–gynecologists and primary
care physicians face workforce shortages. Planned Par-
enthood health centers help minimize the gap in pri-
mary care and reproductive health services in rural and
medically underserved communities, with 54% of their
health centers located in those areas (2). Services pro-
vided range from annual well-woman examinations to
vaccinations. In a single year, Planned Parenthood
health centers conduct more than 270 000 Pap tests
and more than 360 000 breast examinations—essential
services for detecting cancer (3). Three in 5 patients
who come to Planned Parenthood for preventive care
rely on federal programs for their care. In many areas,
Planned Parenthood health centers are the only family
planning option for those patients.
Forcing the closure of Planned Parenthood health
centers would put immense pressure on private
and unaffiliated health care providers, especially
obstetrician–gynecologists and primary care physi-
cians, to assume care for patients previously seen at
those clinics while their own practices already are at full
capacity. With much lower reimbursement rates from
Medicaid than private insurance, providers would need
to address how to provide care for more Medicaid pa-
tients while continuing to see enough privately insured
patients to financially sustain their practices. In reality,
Medicaid managed care plans already face extreme
provider shortages (4), and this is unlikely to change
suddenly.
Planned Parenthood addresses this access issue. It
is unparalleled in its ability to meet the preventive, con-
traceptive, and primary care needs of women who rely
on Medicaid and other safety net programs. In fact,
other safety net health centers that cannot offer the
same level of contraceptive care often refer women to
Planned Parenthood clinics (5). Although its centers ac-
counted for only 10% of publicly funded clinics in 2010
(the last year with available data), Planned Parenthood
provided contraceptive care to 36% of publicly funded
contraceptive clients that year (6). As a result, contra-
ceptive services provided by Planned Parenthood pre-
vent approximately 579 000 unintended pregnancies
annually (2).
Contraceptive services are essential to women’s
lives and futures. Women’s health, economic security,
equity, and dignity are closely tied to their ability to
plan whether and when to have children. The loss of
the services Planned Parenthood provides would dis-
proportionately affect women of color and women liv-
ing in rural areas and other medically underserved
communities. When a local Planned Parenthood health
center closes, women may face long trips to access a
publicly funded clinic, creating a barrier to scheduling
and keeping health care appointments. Delaying care
may lead to delayed diagnosis and management of dis-
ease. Nobody wins, especially not their families, when
the care women need becomes difficult or even impos-
sible to access.
The experience in several states whose legislatures
have denied public funds for Planned Parenthood is a
cautionary tale. When politicians in Texas excluded
Planned Parenthood from a state program serving low-
income patients, the number of women using the most
effective methods of birth control decreased by 35%
and the number of births covered by Medicaid in-
creased by 27% (7). In Indiana, when cuts to public
health funding forced many clinics, including Planned
Parenthood centers, to close, rural areas of the state
experienced one of the largest and most rapid HIV out-
breaks the country has ever seen (8). It is possible that
This article was published at Annals.org on 7 February 2017.
Annals of Internal Medicine
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access to Planned Parenthood’s free testing for sexually
transmitted diseases may have curtailed this outbreak.
Providers, patients, and communities benefit when
they have more care options. Defunding Planned Par-
enthood is political interference that would limit the
ability of physicians and patients to make shared health
care decisions based on patients’ health and needs
rather than insurance coverage or payment capabilities.
Moreover, defunding Planned Parenthood would have
a devastating effect on many women. Women’s access
to the full range of reproductive and preventive health
services is essential not only to their health and well-
being but also to their ability to pursue an education,
hold jobs, support their families, achieve economic se-
curity, and function as free and equal members of soci-
ety. Without access to the full range of reproductive
health services, all that is in jeopardy.
Congress should never deny coverage of the
health care services patients need from any qualified
provider, including Planned Parenthood.
From the American Congress of Obstetricians and Gynecolo-
gists and National Partnership for Women and Families,
Washington, DC.
Disclosures:
Authors have disclosed no conflicts of interest.
/ConflictOfInterestForms.do?msNum=M17-0217.
Requests for Single Reprints:
Hal C. Lawrence, MD, American
Congress of Obstetricians and Gynecologists, 409 12th Street
Southwest, Washington, DC 20024; e-mail, evp@acog.org.
Current author addresses and author contributions are avail-
able at Annals.org.
Ann Intern Med.
doi:10.7326/M17-0217
References
1.
Congressional Budget Office.
Cost estimate: H.R. 3134, Defund
/default/files/114th-congress-2015-2016/costestimate/hr3134.pdf
on 25 January 2017.
2.
Planned Parenthood Federation of America.
The urgent need for
enthood.org/files/4314/8183/5009/20161207_Defunding_fs_d01_1
.pdf on 25 January 2017.
3.
Planned Parenthood Federation of America.
This is who we are.
/20160711_FS_General_d1.pdf on 25 January 2017.
4.
U.S. Department of Health and Human Services, Office of Inspec-
tor General.
Access to care: provider availability in Medicaid man-
-00670.pdf on 25 January 2017.
5.
Wood S, Goldberg D, Beeson T, Bruen B, Johnson K, Mead H,
et al.
Health Centers and Family Planning: Results of a Nationwide
Study. Washington, DC: George Washington University; 2013.
6.
Frost JJ, Zolna MR and Frohwirth L.
Contraceptive needs and
ceptive-needs-and-services-2010 on 25 January 2017.
7.
Stevenson AJ, Flores-Vazquez IM, Allgeyer RL, Schenkkan P, Pot-
ter JE.
Effect of removal of Planned Parenthood from the Texas
Women’s Health Program. N Engl J Med. 2016;374:853-60. [PMID:
26836435] doi:10.1056/NEJMsa1511902
8.
Peters PJ, Pontones P, Hoover KW, Patel MR, Galang RR, Shields
J, et al; Indiana HIV Outbreak Investigation Team.
HIV infection
linked to injection use of oxymorphone in Indiana, 2014-2015.
N Engl J Med. 2016;375:229-39. [PMID: 27468059] doi:10
.1056/NEJMoa1515195
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Planned Parenthood Provides Essential Services That Improve Women’s Health
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Annals of Internal Medicine
Annals.org
Current Author Addresses:
Dr. Lawrence: American Congress
of Obstetricians and Gynecologists, 409 12th Street South-
west, Washington, DC 20024.
Ms. Ness: National Partnership for Women and Families, 1875
Connecticut Avenue Northwest, Suite 650, Washington, DC
20009.
Author Contributions:
Conception and design: H.C.
Lawrence.
Drafting of the article: H.C. Lawrence, D.L. Ness.
Critical revision for important intellectual content: D.L. Ness.
Final approval of the article: H.C. Lawrence, D.L. Ness.
Administrative, technical, or logistic support: H.C. Lawrence.
Annals.org
Annals of Internal Medicine
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