By Michael Howell
Having fallen completely out of the unanimously approved House Budget Bill, Title X funding – federal money that funds family planning and preventive health – has become a topic of concern as HB2 goes to the Senate. Passage of the House budget bill by a unanimous vote, rather than haggling over amendments, was a first for the legislature. Critics of the bill argue that it amounts to “back door dealing” that left out some critical programs in need of funding, like those typically funded through Title X. Governor Steve Bullock has urged the Senate to reinstate the funding. Last year Title X funding totaled $4.5 million. According to figures cited by the Guttmacher Institute, this funding supports about 30% of the budgets at 20 community clinics and five Planned Parenthood clinics in Montana.
According to the U.S. Department of Health and Human Services, Title X family planning clinics have played a critical role, for more than 40 years, in ensuring access to a broad range of family planning and related preventive health services for millions of low-income or uninsured individuals. In addition to contraceptive services and related counseling, Title X-supported clinics provide a number of related preventive health services such as: patient education and counseling; breast and pelvic examinations; breast and cervical cancer screening according to nationally recognized standards of care; sexually transmitted disease (STD) and Human Immunodeficiency Virus (HIV) prevention education, counseling, testing and referral; and pregnancy diagnosis and counseling.
According to the Guttmacher Institute, in 2006, contraceptive services provided at Title X–supported centers in Montana helped women younger than age 20 avoid 1,669 unintended pregnancies. In the absence of these services, the number of teen pregnancies in Montana would be 88% higher.
In 2008, contraceptive services provided at Title X–supported centers in Montana helped women avoid 5,300 unintended pregnancies, which would have resulted in 2,400 births and 2,200 abortions. In the absence of these services, the number of unintended pregnancies in Montana would be 62% higher, and the number of abortions would be 114% higher.
The institute also estimates that one-quarter of all poor women who obtain contraceptive services each year do so at a site that receives Title X funding, as do 17% of poor women obtaining a Pap test or pelvic exam and 20% obtaining services for a sexually transmitted infection. They claim that by helping women avoid unintended pregnancies and the births that would follow, the services provided at Title X–supported centers in Montana saved $14,361,000 in public funds in 2008.
By law, Title X funds may not be used in programs where abortion is a method of family planning.
Despite this legal restriction, many opponents to Title X funding object on the basis that they believe it indirectly supports abortion. One adamant critic of Title X funding, Senator Jason Priest of Red Lodge, told AP reporter Katherine Haake (published in 10TV.com) that Title X funding, “through complicated loopholes” makes it easier for organizations to raise money for abortion services.
Last summer, Matt Kanenwisher, Ravalli County Commissioner at the time, took a stand he said was based on his religious beliefs and voted not to accept Title X funding for the county. He was concerned about the “abortion pill” and the fact that under age children could receive counseling from the Title X-funded clinic about birth control without parental approval.
Current Commissioner Suzy Foss also has concerns about Title X funding and abortion. She voted in favor of accepting the funding last summer, but describes herself as being “torn over the issue.”
With funding for the program coming up for review and approval again this summer, Foss decided to get the facts from the County Health Department to help prepare herself and the other commissioners for the upcoming discussion.
“The two big concerns most commissioners have had concern the ‘Morning After’ shot or pill or whatever it is that is administered by the Public Health Department along with birth control/STD treatment offered to underage minors without parental notification,” wrote Foss to Public Health Nurse Judy Griffin. She asked for “hard data” regarding the number of minors (17 and under) treated by the clinic and a breakdown of what services have been provided to that age group for the current fiscal year, also the number of adult clients treated for the same along with total number of clients and services provided.
Foss adds, “Also we have had a lot of comments regarding your bringing in out of county Pro Choice people to bombard our emails and to protest during our meetings. While this gets lots of press it does not help your perceived agenda with us, at least not with me. It actually ticks me off and I have to fight my urge to say no on principle versus listen to a staff report. I pass this along simply because I hope for a smooth running meeting based on facts provided, not emotional turmoil in the meeting room.”
“Title X evokes a great deal of emotionality, not just in Ravalli County but throughout Montana and the nation. We recognize your concern and appreciate your communication,” responded Public Health Nurse Judy Griffin, stating that the requested information would be made available by the next Monday.
Foss responded that she had been told “that the morning after shot/pill(?) is no longer available not just for minors but for adults due to issues with side effects, is this true? I have taken tremendous heat for supporting abortions and for those of us who believe that life begins at conception (and now backed by science) tax payer $’s is really hard to swallow and as I said, a huge issue for many, many taxpayers in our county. Thanks for all you do and for your professionalism.”
What Foss received from Griffin was the data she requested, including an age breakdown by purpose of visit report and a medical services by age breakdown report.
Out of 434 total visits between July 12, 2012 and March 11, 2013, only one was under 15 years old and 71 were between the ages of 15 to 17. The remaining 362 were over the age of 18. The single visitor under 15 years of age was given a urinalysis test, a chlamydia test, and prescribed birth control. The majority of the 15 to 17 year olds got birth control, hormonal injections or chlamydia tests.
“Emergency Contraception (ECP) is available in single tablet form in our office,” wrote Griffin. “It is also available at local pharmacies throughout the county for women 18 years of age and over at variable cost without prescription. ECP has few side effects. The Abortion Pill is NOT available in Ravalli County.”
Griffin was adamant about this point. The Ravalli County Department of Health does not participate in abortion nor does it provide Abortion Pills.
Griffin enclosed a fact sheet comparing Emergency Contraception and the Abortion Pill. She also included the Adolescent Counseling Guidelines, and copies of the Montana Code Annotated regarding the validity of consent of minor for health services and release of information by a health professional. Also included was the reportable communicable disease sheet, which includes the mandatory reporting of the listed diseases which also includes Sexually Transmitted Diseases.
Foss said that after reviewing the material, her concerns have been alleviated to a large degree.
“I voted to continue accepting Title X funds in the past,” said Foss, “but I was torn. I’m a Christian, but I am also a woman.” She said that she understands that women, especially poor women, need Title X-funded services, for cancer testing, for communicable diseases, and for many other health issues. She said that she was satisfied that the Ravalli County Health Department was not dealing in abortions. She said that now that science has proven that life begins at conception she could not condone abortion.
“What they are doing is preventing conception,” said Foss. She said that she could live with that.
“I’m not as concerned as I was before receiving this information,” said Foss. “Information helps.”