Planned Parenthood's Pricey Pills

By Kara Jesella, Nerve.com. Posted February 27, 2006.

Conservatives paint Planned Parenthood as an abortion mill and birth-control factory, an institution that doles out emergency contraception to teenage girls like Halloween candy.

But a few years ago, I realized birth control wasn't quite as easy to get as I (or the religious right) thought. The first clue: a few teenagers I regularly interviewed for stories told me that they had stopped taking the Pill. Even if they had a doctor they trusted, they didn't want to use their parents' insurance -- too easy for mom and dad to find out -- and they didn't have the cash to pay out-of-pocket.

What about Planned Parenthood, I asked? "It's not an option," one of them -- we'll call her Hannah -- told me last year, when she was 17 and a senior in high school. "They charge $100 a session and $40 per pack of birth control. Teenagers can't afford it unless they're under 15."

Hannah tried to find less expensive services elsewhere, but without much luck. She's resorted to using condoms, less effective than the gynecologist-recommended two forms of birth control (particularly important for those abstinence-only students who aren't allowed to get the roll-a-rubber-on-a-banana demo in school) and, of course, requiring the cooperation of not-always-willing teenage boys.

Planned Parenthood Federation of America serves one in four American women during their lifetime. It's widely considered the most convenient and reliable provider of low-cost birth control. It's been that way since 1970, when Title X, the family-planning program of the Public Service Health Act, was passed. (George Bush Sr. was one of its primary sponsors.)

Whereas PPFA had once been small and funded entirely through private donations, Title X "was seed money to start family planning services all over the country," says Gloria Feldt, who stepped down as the organization's president last year. The result, she adds, "cannot be underestimated."

For the first time, women could decide when they wanted to have children and orchestrate the rest of their lives accordingly. So when did it become "not an option" for vulnerable young women?

According to Planned Parenthood representatives, Hannah should have gotten her pills for free. But that's something she didn't understand (and I can vouch that she's pretty sophisticated). It's unlikely the clinic meant to refuse her services because she couldn't afford them: Title X requires that a health center not turn away anyone under the federal poverty line. And it's Planned Parenthood's mission, according to Jodie Curtis, assistant director for government relations for PPFA, not to turn away anyone at all. When it comes to those not covered by Title X, she says, "it is up to Planned Parenthood to figure out how to help those people subsidize the cost if they can't pay. Some states have programs to help with this, and many Planned Parenthoods fundraise to help patients cover the cost of services." Plus, PPFA is allowed to assess teens on their own income level, not their parents'.

Yet Hannah's story is symptomatic of a growing trend. Jennifer, 24, also tried to get the Pill through PPFA in New York. "They were very unhelpful," she recalls. "I didn't have insurance, and they just couldn't comprehend why I didn't. They kept making hints about how they assumed I could afford it and thus it was my negligence. But I really couldn't afford it."

For some girls, the cost of the Pill has become so prohibitive that they're tempted to switch to more affordable methods. At PPNYC, a pill pack is free for insured patients; for those without insurance, it can cost up to $20 on a sliding scale. On the other hand, Depo-Provera is included in Planned Parenthood's visit fee; there's no additional cost. "That's alarming to me, as I think it offers an inappropriate incentive," says Judy Norsigian, the executive director of Our Bodies Ourselves, the women's-health advocacy organization. "Just because a method is free doesn't mean it's necessarily the right one."

In fact, she says, because Depo-Provera is associated with a loss of bone density in young women, it's important to consider alternative methods first.

There are other reasons the organization's reputation isn't as pristine as it once was. Women I spoke with reported clueless receptionists and lines worthy of the DMV. (One woman says she waited three hours to see a doctor for the morning-after pill; eventually, she got the prescription but never did get to see a doctor.) Voicemail systems are hard to navigate; many have actual people answering the phone only during business hours, when most women aren't able to deal with their reproductive-health issues.

Twenty-five-year-old Erin left her local clinic without the morning-after pill when told it would cost $50. When she said she'd try to get it cheaper somewhere else, the receptionist made her feel guilty for taking the last appointment of the day, causing another girl to be turned away. "They were honestly a bit curt, and there was a sense that it was a service for low-income people and therefore a bit of a cattle call," adds Erin. "I say this with great hesitation, because I really believe in Planned Parenthood, and I'm deeply grateful that it exists. It's one of very, very few options for women without health insurance to get their ob-gyn options taken care of."

Kara Jesella is a freelance writer in New York City. She is currently co-writing a book on Sassy magazine for Farrar, Straus & Giroux.

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