Greene County Family Planning, a health clinic in rural New York state, is busy on a Friday, and that’s the norm. Located in the blocky, brick-and-concrete county Department of Health building in downtown Catskill, the clinic specializes in reproductive health care for underserved patients in a county of 48,500.
“We are specialists,” said Laura Churchill, deputy director of public health and clinical services at the clinic, noting that patients rarely receive such close attention at a primary care provider. “We offer a no-judgment zone where patients can come in and access a high level of care from providers who are board-certified and experienced.”
Patients pass through a set of double doors to a gray-carpeted reception room plastered with friendly flyers and pamphlets on reproductive health topics such as what to expect in a cancer screening, managing endometriosis, and trying to conceive. There, a receptionist screens them to learn what services they need and assure them that their visit can be confidential.
The clinic expects to serve 15 patients today, some of whom must travel from several towns over for their appointments. They get annual reproductive health check-ups, IUD insertions, and birth control implants, not to mention a range of other reproductive care procedures. The services at Greene County Family Planning, part of the Greene County Public Health Department, include same-day access to birth control, STD testing and treatment, and breast cancer and cervical cancer exams, and do not include abortion or fertility treatments.
Health centers that receive Title X funding are critical in closing the gap in access to care and promoting health equity.Audrey Sandusky National Family Planning and Reproductive Health Association
Greene County Family Planning is one of over 3,000 clinics across the country that receive the majority of their funding through Title X, a federal program devoted to providing family planning services to low-income Americans, free of charge or at discounted rates. At a moment when access to contraception faces grave threats across the U.S., Title X‑funded clinics offer an increasingly urgent service.
“Health centers that receive Title X funding are critical in closing the gap in access to care and promoting health equity in a way that meets patients where they are,” said Audrey Sandusky, senior director of policy and communications at the National Family Planning and Reproductive Health Association (NFPRHA), a member organization that represents publicly funded family planning providers. “They’re a lifeline for people who are seeking a broad range of contraceptive methods.”
And yet, funding for Title X clinics across the country has flatlined for the past eight years.
Barriers to Service
Despite its significant contributions to the health of its community, Greene County Family Planning’s services are not guaranteed. The clinic sits in a rural county, and its continued existence depends on the local county health department.
Family planning is an optional program, and officials could always decide to close it. Over the years, other county health departments have gotten rid of their family planning programs altogether. The Greene County administrator has told Churchill that while Family Planning it is not a mandated program, it receives full county support, and there is no imminent danger of its closure. Still, it’s largely up to Churchill to make the case to local decision-makers for its value. She keeps the conversation in motion.
“I have had to address concerns with legislators,” she said. “I had one ask me once, when he looked at the voucher for a purchase of IUDs, if they cause abortions. I explained that they are so good at preventing pregnancies that they prevent the need for abortions. No one gets an IUD unless they have a negative pregnancy test.”
With education and awareness about the impact of the clinic’s work on the rural community, the state and county health departments have continued to prioritize it. Still, it can be difficult to provide all the services its leadership would like to.
“A big issue is staffing,” said Wendy Johnson, clinic manager and nurse practitioner. For months, the clinic has been unable to fill two open staff positions: a medical assistant and a medical receptionist. Medical staff can make more money in private practices, so the clinic has received few applications.
What’s more, it’s hard to reach the area’s far-flung population. Greene County spans some 658 square miles, and the clinic lacks resources to meet patients where they are. “We don’t have buses, we don’t really have any active public transportation,” said Marianne Powers, a nurse practitioner who has worked at the clinic for almost 15 years. For the last few years, a partnership with the state’s Office of Addiction Services and Supports has allowed the clinic to borrow a van — largely to help providers deliver medication-assisted treatment to opioid users, although they also use it to provide contraceptives and other services. But the clinic lacks its own vehicles “to go out to these mountaintops and bring services to people who don’t drive,” Powers said. “There are these barriers.”
Title X and a ‘Growing Demand for Contraceptive Care’
The Title X program, created over 50 years ago, funds a nationwide network of public health care providers like Greene County Family Planning, granting awards based on providers’ ability to meet the needs of people with low incomes. By law, the program offers free services to people living at 0% to 100% of the federal poverty level and discounted services to people living at 101% to 250% of that level. In 2020, Title X‑funded providers served more than 1.5 million patients, mostly young women under the age of 30.
Number patients who received care through Title X‑funded providers in 2020
“We’re seeing providers unable to meet a growing demand for contraceptive care among patients who are scrambling to figure out how to meet their reproductive health care needs,” Sandusky said.
In New York, the Department of Health applies for Title X funding from the federal government and distributes it to around 50 clinics statewide, including Greene County Family Planning. When federal funding has been decreased or cut off, the state has stepped in to make its clinics whole, so they can continue operating.
But publicly funded clinics in many other states are less fortunate. Last year, some Title X grantees, including those in high-need areas of Nevada and West Virginia, were approved but given no new funding — essentially a message from the federal government to close out their programs, Sandusky explained. Others, including one Denver clinic, face severe staffing shortages due to underfunding.
This moment demands so much more than just the status quo. It requires urgent action.Audrey Sandusky National Family Planning and Reproductive Health Association
Faced with these challenges, NFPRHA is pouring its energy into lobbying Congress to increase funding for the program during the next appropriations cycle, so that providers can continue to provide care in communities. “This moment demands so much more than just the status quo,” Sandusky said. “It requires urgent action.”
At Greene County Family Planning, clinicians continue to take care of their community’s health needs — one day at a time. By close of business, Johnson had called patients with lab results, treated a yeast infection, and administered STI prevention. Powers had conducted pap smears, removed a birth control implant, and checked up on an IUD. The clinic’s needs are local, too: more staff, and a van of their own to deliver services throughout the small, rural county.
For now, Greene County Family Planning remains steadfast in its mission to provide this high standard of care to its community. “We’re still here,” Churchill said. “The doors are open, the patients are coming, and the work is getting done.”