Editor’s note: This story was revised to include information about services available at federally qualified health clinics in Kansas.
At a small domestic violence shelter in Hays, Kansas, director Tiffany Kershner sits with a client in a small meeting room. Leyila, 35, who asks that only her first name be used to protect her privacy, recently left an abusive marriage. Today she’s hoping she can get an appointment with an ob-gyn, but Kershner knows that’s no easy task in Hays.
“We’re looking for the money to try and help with the exams and help with the doctor’s visits,” Kershner says. “But there’s just not a lot of money for it, so we’re just looking for any particular grant we can write.”
Like many of the women at this shelter, Leyila is a working single mom with no health insurance. She says most weeks she struggles to feed and clothe her two children, making the extra expense of a doctor’s visit nearly unsustainable. As someone who’s struggled to maintain her health for years, Leyila knows that’s a problem.
“I’ve had female issues all my life and I’m supposed to have a Pap smear every six months,” she says. “I haven’t had one in five years because I can’t afford it.”
When she moved back to Hays earlier this year, Leyila discovered that the local Planned Parenthood clinic had closed. State funding cuts to Title X family-planning clinics had forced the organization to shutter its Hays clinic in 2014. Since then, there’s been no other provider in the area that offers preventive screenings at a cost Leyila says she can afford.
“For me not to have access to that is scary,” Leyila says. “The type of uterine cancer that I am at risk for is very aggressive and once it’s started there is no treatment, so catching it early is my only chance."
The nearest provider that offers the free and sliding-scale preventive screenings she needs is the Planned Parenthood clinic in Wichita – about 180 miles away. Getting there means a six-hour round trip, not including time for the appointment. That’s a full-day off from work that Leyila says she can’t afford. Not to mention she doesn’t even own a car.
She probably doesn’t realize it, but Leyila is at the center of a long-running national debate over women’s health care. In the last few years, politicians in states like Texas, Wisconsin, Indiana and Kansas have pushed for the closures of federally funded family planning clinics such as Planned Parenthood because they provide abortion services. But when such clinics shut down, it’s not just abortion services that suffer.
David Slusky, a health economist at the University of Kansas, wanted to know if there are broader consequences for women’s health when a clinic like Planned Parenthood closes. He says his research was motivated by Planned Parenthood’s assertion that for many women, it’s the only health care provider they see in the course of a year.
At first, he says, he was dubious.
“I, as a health economist, looked at that statement and said, ‘That’s a pretty bold statement given the size and variety of our healthcare system.’”
So Slusky and his co-researcher, Yao Lu, decided to look at what happened in Wisconsin and Texas, both of which have seen multiple family planning clinic closures in the last couple of years. In both states they mapped the locations of federally funded family planning clinics between 2007 and 2012. Then they looked at data from a national survey by the federal Centers for Disease Control and Prevention on preventive care screenings.
“Our survey asks questions like, ‘Have you ever had a mammogram?’” he says. “'If so, how long has it been? One year? Two years? Have you ever had a Pap smear? Have you ever had a professional breast exam?'”
Using state-provided data, Slusky and Lu were able to connect the rates in preventive screenings with the zip codes where the women surveyed lived. This, says Slusky, allowed them to calculate the driving distance from each zip code to the nearest Title X clinic.
“What we found,” he says, “was that increases in driving distance were linked to relative decreases in the rates of preventative care.”
More specifically, Slusky and Lu found that when the driving distance to the nearest Title X clinic increased by 100 miles or more, the rate in preventive screenings decreased by as much as 10 percent. Even though their research wasn’t carried out in Kansas, Slusky thinks it’s just as relevant there.
“What Kansas and Missouri have in common with Texas and Wisconsin is the more rural a state is and the more kind of open space and spread-out towns a state has, the more applicable these results are,” Slusky says.
In other words: When a Title X family planning clinic in western Kansas closes, women have to drive farther to access the next closest clinic. And because many of them are unable or unwilling to do so, the rate of screenings declines.
To be sure, Title X clinics aren’t the only providers offering women’s preventive services.
“Kansas has several federally qualified health centers (FQHCs) and other safety net clinics that offer these services,” says Denise Cyzman, executive director of the Kansas Association for the Medically Underserved.
She notes that younger women in particular may may not think of their local safety net clinic as an alternative place to receive the preventive services they need.
“We have FQHCs in Hays, Salina, and Newton — to name a few — that serve western Kansas,” she says. “All provide services regardless of ability to pay and use a sliding fee scale.”
Back in Hays, Tiffany Kershner says the center may have come up with a temporary solution to the lack of affordable women’s health care: Once a month, she and her colleagues plan to drive their clients three hours away to the Planned Parenthood clinic in Wichita.
For Leyila, that’s a possible option. But in the meantime, she says, she’ll wait until she can afford to see a doctor in Hays.
Until last week, Esther Honig was a freelance reporter for KCUR. You can reach her on Twitter, @estherhonig. She is now a reporter for the WOSU-FM, the public radio station in Columbus, Ohio.