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I Don’t Think You Can Put a Number on How Valuable It Is to the Community’

How Title X cares for patients in rural America.

Aerial image of rural Catskill, NY
Catskill, a town located in rural New York serves as the site for the Greene County Family Planning Clinic. (halbergman/ Getty Images)

When Emily, living in rural New York State, realized it was the right time to make a next step in her serious relationship, she knew she needed to get birth control — she didn’t want to get pregnant. 

Greene County Family Planning was the clinic she knew could help her, answer her questions, and make her feel comfortable. She had heard about the contraceptive options the clinic offered confidentially and free of charge. 

On Emily’s first visit, she was able to receive a birth control implant the same day. It was helpful to have access to what I needed to be safe,” she said.

For low-income residents, the clinic is an indispensable resource. There’s just one private obstetrician-gynecologist office in the county, and the wait times for an appointment there are months long — if a patient can afford a private provider in the first place. By and large, the clinic’s patients can’t. Many are struggling to find affordable housing as high-end real estate developers flock to the county and prices soar. The clinic is often their only option. 

Emily, who lives in nearby Greenville, is still coming for care 10 years after her first appointment. This past December, she was there to get a routine reproductive health check-up and have her birth control implant removed. She is one of the many patients who access contraception and other forms of care at Greene County Family Planning. The clinic has been open for nearly 50 years, and it serves over 1,000 patients annually. In 2022, its providers saw 1,108 people for a total of 2,953 visits. In rural Catskill, Cairo, and Lexington, as well as more remote towns, it’s one of the only providers where a low-income and underinsured population can get a same-day appointment, birth control device, or prescription. The services at Greene County Family Planning, part of the Greene County Public Health Department, also include STD testing and treatment, breast cancer and cervical cancer exams, and do not include abortion or fertility treatments.

They’ve been very supportive. They take extra care to make you feel comfortable.
Emily patient with Greene County Family Planning Clinic

Many patients like Emily have been visiting for over a decade. They’ve been very supportive,” said Emily. They take extra care to make you feel comfortable.” Others come because they lack insurance and can’t get free or affordable contraception elsewhere.

Greene County Family Planning has been open since 1973. Its rural county of 48,500 is home to several communities with a high concentration of people living in poverty. The primary employer is local government, and with ski resorts in Hunter and Windham, the county also has a strong leisure and hospitality sector. The median income for locals, however, has remained stagnant, according to the clinic’s internal data.

The days at the clinic follow a similar cadence, broken up on occasion by special meetings or training sessions. This morning, Community Action, a local organization that promotes community wellness and offers supportive housing, delivers an in-service training on domestic violence. People who suffer abuse and control by an intimate partner need contraception if they want to avoid having children with that partner, explained Wendy Johnson, clinic manager and nurse practitioner. A lot of them will want a method that they can hide from their partner.” The clinic will provide that service, and Community Action frequently refers its clients. 


drop in teen pregnancy rates over the past seven years in Greene County

Over the course of the day, a steady stream of patients trickles in. Shelby, 23, a low-paid EMT, has been coming to the clinic for over four years. In 2018, she first had an IUD inserted before going away to college, both for birth control and to regulate reproductive health issues. Today, she had an annual check-up to make sure the IUD was positioned properly, along with a battery of routine testing. She was grateful that the clinic’s staff didn’t make her feel guilty about falling behind on check-ups, as some private providers have in the past. 

They take the time to explain what they’re doing while they’re doing it,” Shelby said. It makes me feel so much more comfortable than a doctor who just goes in there, opens you up, and doesn’t tell you anything — that’s terrifying.” 

The clinic’s approach has contributed to measurable improvements in local life outcomes. A 2021 annual report showed a 44% drop in teen pregnancy rates over the past seven years in Greene County.

Emily knows the importance of specialized reproductive health care in her community. There are a lot of people who don’t know what they have access to, or just don’t understand sexual health at all,” she said. So having the clinic here is really important.”

For patients, these services make Greene County Family Planning an oasis. I don’t think you can put a number on how valuable it is to the community,” Shelby said. Something like this needs to stick around and should be supported more, and I don’t think people grasp how much they actually do.”