Clinic closures disrupt preventive health care for low-income women, study finds

LAWRENCE — Conservative legislation has resulted in funding cuts and clinic closures for abortion providers in many states. But such anti-abortion policies have damaging consequences on women who rely on family planning clinics for other health services, according to new research from the University of Kansas.

“Clinics are a crucial part of the universe of safety net providers of preventive care for low-income, reproductive-age women,” said David Slusky, De-Min and Chin-Sha Wu Associate Professor in Economics at the University of Kansas.

His new study, titled “The Impact of Driving Time to Family Planning Facilities on Preventive Service Use in Ohio,” details how adding miles between patients and their care facilities can lead to decreases in breast examinations, mammograms and Pap testing. The article appears in the American Journal of Preventive Medicine.

Cost-related health care avoidance also increases the overall burden on taxpayers.

“Reductions in preventive care rates lead to diseases like cancer being caught at later stages when it is harder and more expensive to treat,” Slusky said. “Some of these increased costs are paid through public insurance and come from taxpayer funding. Additionally, the increased side effects from treatment and premature loss of life reduces individuals’ ability to work, which decreases the volume of taxpayer funds available for the rest of the safety net.”

Slusky said that spending should be of secondary concern compared to finding ways to improving value in health. The aforementioned tests are typically high-value, low-cost services for reproductive-age women.

“We should be recommending and encouraging uptake of these services however we can,” he said.

“The Impact of Driving Time” — co-written with Jacqueline Ellison, Kevin Griffith, Madalyn Thursby and Jacob Bor — gathers data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System. The final sample included 4,722 low-income female respondents (household incomes below $50,000) ages 18-45 years.

The study found that each additional 10 minutes of driving time was associated with an 8.9% increase in the likelihood of avoided care owing to cost, a 10.4% decrease in the likelihood of mammogram receipt during the past 12 months and a 12.5% decrease in the likelihood of ever receiving a clinical breast examination.

This was the first study by Slusky in Ohio. (He’s examined similar questions in Texas and Wisconsin and found comparable results.) The Midwestern state has made several attempts to limit the distribution of federal and state funds to affiliates of abortion providers and, in 2013, successfully deprioritized public funds for private family planning facilities.

“More generally, Ohio has a hostile abortion policy landscape relative to other states,” Slusky said, citing the Guttmacher Institute, which quantifies such hostility based on the number and type of abortion restrictions in each state.

Exacerbating the problem is COVID-19. The pandemic has already led to a steady decrease in preventive care utilization during the last year. And those assuming that women’s health concerns could improve under the seemingly more amenable Biden administration may be disappointed.

“Most of these restrictions are enacted at the state level and not at the federal level,” Slusky said.

“The federal government branch that has the most impact on these policies is not the executive branch but the judicial branch, which now has many judges and justices appointed by former President Trump. So I don’t think a change in administration makes our results any less salient.”

While constraining the activity of clinics may indeed result in fewer abortions, it also leads to significant problems that disproportionately target low-income females, who already suffer substantial barriers to health care.

“Any policymaker attempting to reduce abortion rates has to either mitigate these unintended consequences or be willing to publicly own them,” Slusky said.