Affordable Reproductive Health Available In Wyoming, But Limited

May 26, 2017

Credit Photo by Sarah Mirk with use under Attribution 2.0 Generic (CC BY 2.0)

Following the presidential election, family planning centers in Wyoming experienced a sharp increase in women seeking long-term contraceptives. Recently, that’s begun to slow down. Now, concern from the centers is about around funding and healthcare access.


Planned Parenthood clinics across the country saw an unprecedented rise in donations following the election, mainly because of threats to its future funding.


However, it was recently announced that six different clinics in the region will soon be closing their doors, including Wyoming’s only branch in Casper.


Adrienne Mansanares is a leader with Planned Parenthood of the Rocky Mountains, the affiliate that oversees the clinic in Casper. She said the decision to close the medical center was not entirely a financial one.


“In part, it’s because patients in Wyoming have access to care from a variety of providers,” said Mansanares.


The clinic in Casper was seeing about 500 patients a year. When it closes on July 21, Mansanares said she’s expecting those patients to be able to get care from other providers in town and right now they are coordinating that transition.


“We will be reaching out to folks via letter, or email, oftentimes we make phone calls,” said Mansanares. “Just to ensure we’re connecting with our patients to make sure that there’s a smooth and trusted continuum of care to other providers.”


Those other providers include the local community health center as well as the Casper-Natrona County Health Department, which is the Title X Service site for the county – Title X is the only federal grant program dedicated to family planning and preventative services for individuals.


The Wyoming Health Council oversees 12 Title X agencies and their satellite clinics across the state. Wyoming Health Council Executive Director Susie Markus said about 8,000 Wyomingites receive care from these clinics a year.


“We serve anyone who comes through our doors to request reproductive health care,” said Markus. “But our priority population is people who are vulnerable living with low incomes.”


For Wyomingites living at or below the poverty line, they can receive care at no cost. At higher levels of income, there’s a sliding fee scale meaning you pay based on how much you earn.


This is all thanks to the Title X Family Planning Program, which was specifically designed to provide services to low-income or uninsured people. For many of those 8,000 Wyomingites that receive care from Title X clinics, it is oftentimes the only doctor they will see and the least expensive way to get services like mammograms, pap smears, as well as STD testing and counseling.


Markus said they try to reach as many patients as possible with the program, to fill any gaps in care.


“Our funding is very, very small and we stretch it as far as we can, but we’re not able to reach the entire state,” said Markus.


There are nine counties in Wyoming where there are no Title X clinics, and some of these counties are among the 18 that also have primary care shortages. Markus said some people will travel to other communities for care, but rural geography and weather make that challenging.


The Wyoming Department of Health had been providing contraception to public health clinics without Title X funding, but Markus said that service was recently cut by the Wyoming Legislature.  


“So now we have some non-Title X funded communities out there that do not have that service,” said Markus.


And it’s those places that concern Markus, more so than Casper or other towns with Title X clinics.


However, Title X clinics are certainly facing challenges too. Funding is one issue, but a specific issue those clinics have faced since the presidential election has been the surge in demand for long acting reversible contraceptives, or LARCs.


Many patients were concerned that access to contraception would become limited under the Trump administration, so they sought out IUDs and implants that could last through the new administration’s years.


“And we have always had a pretty high-demand of LARCs,” said Markus. “So, we offer services on that sliding fee and zero pay, but then we work very, very, very hard to provide the patient’s preferred method of contraception.”


If someone who is fully subsidized and on zero pay comes into a Title X clinic and requests a LARC, Markus said they want to provide that to the patient. But the problem is that LARCs are too expensive to keep in supply.


The Wyoming Health Council is now working with the Wyoming Department of Health on a project to increase access to LARCs across the state.


The other issue the council is trying to resolve is how to provide overall health care services in rural areas with limited funds.


One idea is to use telehealth as a way to connect patients in more remote areas over the phone or video chat to a nurse practitioner in order to get a contraceptive prescription.


“We would still have to find a way to address those issues that need to be addressed in person, the physical aspect, but still we could provide some of that contraceptive care I think through telehealth,” said Markus.


Despite some initial concern, Markus said she remains hopeful that Title X funding will not be reduced by Congress.