LEWISTON, Me. — She is 17 years old, has an alarming itch “down there” and has come to the family planning clinic because she doesn’t know where else to go.
Sara Hayes, a nurse practitioner, breezes into the examining room and soothes the teenager. Hayes takes a swab and quickly diagnoses a mild yeast infection — perhaps from scented tampons — while setting aside samples to test later for gonorrhea and chlamydia. Then Hayes explains birth control options, and the girl brightens at the idea of an invisible implant in her arm, fully covered by insurance. It will last at least three years and be more than 99 percent effective at preventing pregnancy.
Finally, Hayes arranges to give the teenager condoms and fixes her in the eye and tells her to protect herself from infections. Always!
“If you’re having sex with someone, use a condom,” says Hayes, half sweet and half stern, the bluntest grandmother you ever met. “If he doesn’t want to use a condom” — she pauses dramatically — “then he’s not worth it!”
This is health care at its best, preventing diseases and averting teenage pregnancies, all while saving public money. Yet clinics like these across America are in peril because of myopic Washington politics.
Vice President Mike Pence and congressional Republicans have long tried to cut off federal funds for clinics that have ties to abortion, even tangential ones, and this year, with President Trump’s help, they may succeed.
Let’s be clear: This isn’t about the government paying for abortions. That’s already mostly banned. This is about paying for birth control and cancer screenings when the provider has some connection, even a remote one, to abortions.
This clinic in Lewiston is threatened because it is operated by Maine Family Planning, a nonprofit that provides some abortions. Health experts expect a G.O.P. push to defund such women’s health clinics, by barring Medicaid reimbursements or other federal funds from going to them, and by cutting or redirecting the Title X family planning program.
“We’re afraid we’re going to lose a critical part of the public health infrastructure,” says George Hill, the president of Maine Family Planning.
Patients are anxious. Clinic staff members say that some women have asked to get their IUDs replaced early, so that they don’t expire a couple of years from now when there might be less coverage.
Although the arguments in Washington about these women’s health clinics mostly involve abortion, what I saw in the three Maine Family Planning clinics I visited was that a vast majority of the care provided is pretty uncontroversial. It’s about ensuring women’s health, treating sexually transmitted diseases, testing for pregnancy or providing cancer screenings.
Meredith Batley says she has been coming to the clinic in Rockland for a dozen years, and for most of that time didn’t have health insurance or a primary care provider. In one routine screening, a cervical irregularity was found that could have led to cancer, but it was removed and she has had no problems since. She has also received birth control pills.
“If I hadn’t had that access, I’m not saying I would have had an abortion, but my life would have been different,” she muses. When Batley was ready for a baby, she came in for a consultation and received prenatal vitamins to avoid birth defects. Five months ago, she gave birth to a healthy baby girl.
That’s the kind of health care relationship that doesn’t happen often enough in America for young women. One woman dies in America of cervical cancer every two hours, and almost all these deaths are preventable. More will likely die if these clinics close.
Pence and his Republican colleagues in Congress are, I think, well-intentioned politicians driven by a revulsion for abortion. But the truth is that these clinics do more to reduce abortion rates than any army of anti-abortion demonstrators.
Later in the afternoon back in Lewiston, Hayes coaxes a 19-year-old named Destiny Burnell, who had already had one baby after an unplanned pregnancy, to consider long-acting contraception. After discussing several options, Destiny makes an appointment for an implant in her arm.
To those who think we can’t afford family planning services, remember: An IUD or implant like Destiny’s costs about $1,000, while a single Medicaid birth costs the public about $13,000. Each dollar invested in family planning yields $7 in savings for the public later on.
There are 2.8 million unintended pregnancies a year in the U.S.; among people living in poverty, 60 percent of pregnancies are unplanned. One study found that when Texas cut funding for Planned Parenthood and similar clinics, Medicaid births rose by 27 percent in one group of affected women.
The Guttmacher Institute, a research organization that supports abortion rights, estimates that without Title X funding for family planning clinics, there would be, in a year, an additional 900,000 unplanned pregnancies — and 325,000 more abortions.
About two-thirds of the women and girls who come to these clinics don’t have any other health care provider. They’re people like Amanda Bowden, 33, who comes annually to the Maine Family Planning clinic in Augusta to get birth control pills and a checkup.
I asked her about the effort to cut funding for clinics like these, and she said: “You’re not taking away abortion services. You’re taking away my health care.”
<NICHOLAS D. KRISTOF