Public health advocates are warning that record-high rates of sexually transmitted diseases could worsen as Planned Parenthood, a major provider of STD testing and treatment, faces a loss of federal funding under a new Trump rule.
Planned Parenthood’s loss of $60 million a year in government funding is seen by advocates as a huge setback in the fight against “epidemic”-level STD rates that could lead to more low-income people going untreated.
“Planned Parenthood reached a large number of women, men and young people, and this is a blow to the availability of STD screening and treatment,” said David Harvey, executive director of the National Coalition of STD Directors.
STD rates in the U.S. hit a record high in 2017, with more than 2.3 million cases of chlamydia, gonorrhea and syphilis, according to the Centers for Disease Control and Prevention. Numbers for 2018 aren’t yet available.
But resources from the federal government have not kept pace with the rise in STD rates. And experts say Planned Parenthood's departure from the Title X family planning program could exacerbate the problem.
“We already have an enormous deficit in the U.S. around STD screenings and treatment,” Harvey said. “Anything that impacts our ability to offer STD testing and treatment is not a good thing.”
The Trump administration’s new rule bans abortion providers from Title X and prohibits clinics from telling a woman where she can get an abortion. Reducing abortion rates has been a priority for Trump, and his administration argues family planning funds shouldn’t support abortion providers. Federal funding doesn't go toward abortions.
Planned Parenthood’s 400 Title X clinics, along with several states and some local health clinics, left the federal program in August, calling the recent change unethical and a “gag rule.”
But it's Planned Parenthood's departure that left the biggest gap in the Title X program — it had served 40 percent of the 4 million people receiving low-cost, subsidized services such as birth control, STD testing and other reproductive care.
In 2017, Planned Parenthood’s clinics, including those that are not part of the Title X program, performed nearly 4 million STD tests. About 400 of Planned Parenthood’s 600 clinics in the U.S. participated in Title X.
While Planned Parenthood said its doors are still open, the loss of Title X funds means its clinics may have to reduce services and hours or raise prices.
Places such as Vermont and Oregon are using state funds to make up for what Planned Parenthood is losing in Title X funding.
But the biggest impact will likely be in states where Planned Parenthood has a large presence but not the backing of Republican legislatures or governors, namely Alaska, Arizona, Indiana, Iowa, Minnesota, Ohio and Utah.
In Arizona, where Gov. Doug Ducey (R) supports defunding Planned Parenthood, the organization served about half of the state’s 35,000 Title X patients.
“Planned Parenthood is the largest provider of STD testing in our network,” said Bré Thomas, CEO of the Arizona Family Health Partnership, which disburses Title X funds in the state.
She said she’s looking for clinics to take Planned Parenthood’s place in Arizona’s Title X program, but that could take time.
It’s a “large hole to fill,” she said.
Like many states, Arizona has seen its STD rates increase, jumping 16 percent from 2016 to 2017.
“Losing them [Planned Parenthood] means fewer people, men and women, will be receiving the testing and treatment until we can get up and running,” Thomas said.
The Trump administration has said it may replace providers where possible but has not released any more information.
The changes, however, are already having an impact.
A Planned Parenthood mobile clinic in Ohio that provided STD testing, among other services, has already closed down. In Minnesota, where Planned Parenthood serves 90 percent of the low-income patients in the Title X family planning program, some patients have left the clinics without an STD test after being told they would have to pay more for the service.
In Alaska, where Planned Parenthood serves 74 percent of Title X patients, access to health care is already at a crisis point. About 14 percent of Alaskans don’t have insurance, and the governor recently passed $50 million in cuts to Medicaid, the health care program for the poor.
Alaska has also had the nation’s highest chlamydia rates from 2010 through 2018, and Planned Parenthood performed more than 17,000 STD tests in the state last year.
“With cutting funding for these services, there’s going to be less access and likely our rates are going to increase,” said Tanya Pasternack, Planned Parenthood’s Alaska medical director.
In some counties, there are no other providers offering low-cost tests and treatments. And if there are, they might have long wait times due to more patients coming in from Planned Parenthood.
Planned Parenthood’s affiliate in Iowa says it knows from firsthand experience that excluding it from family planning programs can lead to increased STD rates.
Four of its clinics closed in 2017 after it was excluded from a state-run family planning program, and STD rates in those counties increased by 20 percent.
“We expect to see this rapid increase in STDs continue with the change in Title X and our withdrawal,” said Sheena Dooley, communications manager for Iowa’s Planned Parenthood affiliate.
“We are already seeing an unusually high number of patients who were previously covered under Title X not showing up or canceling their appointments, whether it is for birth control, STD testing and treatment, or other services,” she added.