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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. "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 Planned Parenthood's reputation isn't as pristine as it once was. Women I spoke with reported encounters with 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 phones are staffed only during business hours, when most women aren't able to deal with their reproductive-health issues.
Erin, twenty-five, left her local clinic without the morning-after pill when she was 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. "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
There are already so many barriers for women trying to get contraceptives. |
women without health insurance to get their ob-gyn options taken care of."
No one — including Nerve — wants to take potshots at an organization that strives to do important work. And I'm not suggesting that PPFA has a lock on miscommunication or poor bedside manner. (A gynecologist who regularly appears in glossy magazines recently misdiagnosed my friend with herpes; she actually had an ingrown hair.) But women already face so many barriers to obtaining contraceptives. In some states, there are proposals to require parental notification before clinics can dispense birth control to teens; in South Dakota, one bill would impose a $200 fine and jail time upon public-school teachers who refer students to family-planning services. Additionally, young adults aged nineteen to twenty-nine are one of the largest and fastest-growing segments of the U.S. population without health insurance. That makes high-quality, low-cost reproductive health care at PPFA all the more necessary. And it makes what one woman calls the "aggressively unhelpful" staff at an Austin clinic and a sign that read "A lack of planning on your part does not
constitute an emergency on mine" all the more alarming.
So what's going on? When Hannah was quoted a high price for birth-control pills, "maybe she got someone new," suggests Dr. Vanessa Cullins, PPFA's vice president for medical affairs. Feldt agrees: "Entry-level jobs are hard. They're often held by young people just starting out. That doesn't mean they're not smart, but they may not have as much experience in delivering complex messages about sliding scales and government funding restrictions."
In fact, according to a 2003 report by the Alan Guttmacher Institute, many Title X clinics spend significant amounts training rookie staffers to perform critical functions, from scheduling to client intake, only to see them lured away by private physicians with the promise of larger salaries. Then the money-losing cycle begins again, and women end up dealing with new people at every visit. (Clinics are having trouble hanging on to other medical providers for the same reason.) Hannah did have recourse, says Cullins: "Every affiliate has a vice president of patient services, director of patient services, or clinic manager, and they need to be aware of that," she says. Of course, most people aren't. "Most agencies that provide free or low-cost services don't have tremendous resources," Cullins adds. "They may have an inadequate phone-response system. You need to be patient. If you're trying to get through to a health department, you may get transferred a couple of places."
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