Sarah Wasko / Media Matters

In the wake of one-third of the Planned Parenthood clinics closing in the state, Iowa newspapers have rejected right-wing media talking points in favor of fact-based analyses about the limited capacity of so-called alternatives to the shuttered facilities. Iowa’s print media outlets are not only emphasizing the dire consequences of losing Planned Parenthood in many communities, but they are also modeling how other local media should handle politically motivated attacks on essential reproductive health care. 

On May 12, then-Gov. Terry Branstad (R-IA) signed a budget rejecting at least $3 million in federal Medicaid family planning funds in order to exclude Planned Parenthood from the state’s reproductive health program. Days later, Planned Parenthood of the Heartland announced that as a result of the measure, the organization would close four of its 12 clinics -- upending the primary health care system in the state.

Anti-choice lawmakers, and the coalition of anti-abortion groups behind them, have celebrated these closures by repeating several anti-abortion myths. They’ve particularly highlighted the supposed existence of plentiful alternatives to Planned Parenthood and the defeat of the right-wing-media-fueled fever dream of “taxpayer-funded abortion.”

A Media Matters analysis of three of the state’s largest circulation papers (The Des Moines Register, The Gazette, and Quad-City Times) found that Iowa print media are refusing to buy the myths right-wing media have been selling and thus providing a model for other media outlets in states whose essential reproductive health care will come under attack in the coming months. Already, Planned Parenthood has been forced to announce anticipated clinic closures in California, New Mexico, and Wyoming.

Outside of Iowa, anti-choice lawmakers and right-wing media have argued that Planned Parenthood should be defunded in order to prevent taxpayer money from subsidizing abortion services. In reality, because of the Hyde Amendment, federal funds are expressly forbidden from supporting abortion care -- much to the detriment of low-income patients and those from marginalized communities. Although some anti-abortion advocates argue that the “fungibility” of money means any funds given to Planned Parenthood contribute to abortion, this logic is deeply flawed. As Slate’s Amanda Marcotte explained, “Since medical services are billed and funded individually, that's not actually how this works.”

Instead, Planned Parenthood has long received reimbursements via Medicaid for non-abortion services provided to low-income patients. Nevertheless, anti-choice lawmakers have demanded that funds be shifted to “community health centers” (CHC), which they argue can absorb patient demand.

Experts argue this is “a gross misrepresentation of what even the best community health centers in the country would be able to do.” In a May 17 report, Kinsey Hasstedt of the Guttmacher Institute explained that although CHCs and other “federally qualified health centers” (FQHC) play “an important part” in providing contraceptives and other essential care, “they cannot be expected to deliver contraceptive care to the large numbers of women who currently rely on Planned Parenthood” and “to suggest otherwise willfully oversimplifies the considerable challenges FQHCs would face in doing so.”

As Planned Parenthood comes under attack across the country, here’s what other media outlets can learn from The Des Moines Register, The Gazette, and the Quad-City Times.

1. Demand specifics about clinics that can supposedly replace Planned Parenthood’s facilities

Iowa papers have dismantled claims by anti-choice lawmakers about the availability of care without Planned Parenthood’s clinics and lambasted them for failing to provide a list of even potentially feasible alternatives in a transparent way.

On May 26, the Quad-City Times editorial board mocked the lack of a publicly available list of alternatives, writing that while “Iowa’s GOP-run Legislature achieved its ultimate goal,” it “didn’t even try to fake it by rolling out some half-baked list of alleged alternatives.” The Times continued:

The timing was especially astounding, as the lawmakers spent this year's session hacking and slashing to plug budgetary holes. Defunding Planned Parenthood will cost Iowa $3 million in federal funds this year. Another $3.3 million will be spent creating a state-run program to, feasibly, make up for the self-inflicted shortfall of women's health care providers.

It's that yet-to-be drafted list that's at the heart of the matter. Four clinics across the state are closing. Many states that have tried similar attacks on a woman's access to health care at least attempted to compile other options. Not in Iowa. Lawmakers just did it blind and directed the state Health Department to force reality into their partisan narrative somewhere down the line.

In January, the editorial board of Iowa’s Des Moines Register responded to the proposed defunding of Planned Parenthood with a warning that lawmakers should answer specific questions about alternative providers and the particular services they were equipped to deliver before eliminating support for the organization. 

This is sound advice, and in fact, exemplifies the kind of reporting local outlets should be doing in response to threats to defund essential health care in their communities. Unsurprisingly, given this earlier push for accountability, the Register followed up with an investigation of so-called replacement clinics. In a May 27 piece, the Register’s editorial board modeled how local news outlets can easily debunk the myth that other clinics can fill in for the loss of Planned Parenthood’s clinics:

Republicans said more than 200 clinics statewide could fill any void left if Planned Parenthood clinics closed. This number was apparently derived from information provided by the Iowa Department of Human Services.

The Register editorial board obtained the list of 219 clinics from the agency on Monday.

One “behavioral health center” in Leon filled 11 spots on the spreadsheet. We took the liberty of assuming that entity would not be offering cervical cancer screenings, testing for sexually transmitted diseases, contraception and other medical services provided by Planned Parenthood. So we eliminated that one.

Then we decided to call three of the remaining 208, selecting providers in areas where Planned Parenthood clinics are closing.

First up was Wayne Mercy Medical Clinic, which the list identified as being located in Sioux City. The woman who answered the phone said the clinic changed its name years ago, was not affiliated with Mercy and was not even located in Iowa; it's in Nebraska and about an hour’s drive from Sioux City.

Next we called Mediapolis Clinic in West Burlington. It does not provide long-acting, reversible contraception, including birth control implants and IUDs, which are the method of choice for nearly 12 percent of contraceptive users nationally. Sutherland Mercy Medical Clinic in Sioux City said it did not provide those either.

In fact, none of Mercy Health Network’s 108 family practice clinics across the state, including those on the list provided by DHS, will provide any type of long-acting birth control.

[...]

So now that four clinics that served nearly 15,000 patients over the last three years are closing, the Republicans who insisted there would be “more access” to family planning services should compile and distribute a reliable, accurate list of where women can go for those services.

Building on this momentum, other local media did similar reporting, such as the Des Moines CBS affiliate, KCCI 8, which ran a story in which reporter Todd Magel tried to contact many of the so-called “other clinics” pointed to by state lawmakers. Magel found that few of the clinics referenced in the list of FQHCs provided “reproductive medical care and screenings” like Planned Parenthood does and that the lawmaker’s alternatives included a school “nurse’s office,” “a dentist’s office,” and “a homeless shelter.”

2. Include statistics about the loss of coverage and highlight the disproportionate impact closures have on low-income communities

Beyond emphasizing the lack of transparency from lawmakers, Iowa papers also relied on ample statistics to highlight exactly who was hurt by the closure of Planned Parenthood’s clinics in the state.

For example, Chelsea Keenan of The Gazette began a May 19 article with the information that “more than 14,600 people” would be impacted once Planned Parenthood closed “one-third of its Iowa clinics.” She also wrote about the specific number and types of services people would lose without the essential health care provider:

The budget discontinues a federal Medicaid waiver that, since its creation in 2006, has helped more than 80,000 Iowa women receive Pap smears, birth control and cancer screenings through the Iowa Family Planning Network, including more than 12,000 last year. The waiver helps extend reproductive health services to men and women who due to income often fall in the gap between private insurance and Medicaid eligibility.

[...]

Planned Parenthood — which said loss of funding through the Family Planning Network amounted to about $2 million — administered services to more than 30,000 Iowans last year, with nearly 50 percent of its patients at or below the federal poverty level.

The Quad-City Times also lamented that “per usual, it is impoverished women who will pay more than their share of the bill.” The editorial board continued:

Medicaid, mind you, provides health care for the poorest Iowans. It's already foundering in Iowa since last year's privatization. President Donald Trump has targeted Medicaid for deep cuts in his draft budget.

[...]

Yet, it's these patients to whom Planned Parenthood brought otherwise out-of-reach gynecological care. They're a population with an abnormally high risk for sexually transmitted diseases. They're less likely to receive regular gynecological exams. They're at substantially greater risk for unwanted pregnancy.

Women across the socio-economic strata relied on Planned Parenthood. But, suddenly, those in the lower tiers are destined to have fewer options.

To these women, Iowa just said, “Tough.”

3. Use empirical case studies about the consequences of losing Planned Parenthood

Finally, several Iowa papers drew on empirical case studies from what happened in other states when anti-choice lawmakers sacrificed their constituents’ health in order to engage in political attacks on Planned Parenthood.

As the Register’s William Petroski noted, Texas’ exclusion of Planned Parenthood from its reproductive health safety net “resulted in a significant increase in births among low-income women who lost access to birth control, according to a 2016 study published in the New England Journal of Medicine." 

The Gazette’s Keenan also reported on the similarities between Texas’ ill-fated plan to replace Planned Parenthood and the beginning stages of the same situation in Iowa. She wrote:

Starting in 2011, Texas took steps to bar abortion providers such as Planned Parenthood from participating in a program aimed at giving low-income women family planning services. It’s a move that, in the years following, research has shown hurt the state’s family planning safety net.

The funding changes forced dozens of Planned Parenthood clinics there to close in 2012, according to researchers at the Texas Policy Evaluation Project, which studies the effects of family planning funding cuts and restrictions.

Those that have remained open have reduced their hours, patient loads and available services.

Research by the Guttmacher Institute shows that Texas’ family planning program in 2013 served less than one-quarter of the women it helped in 2011. And that care became more expensive when you take knowledgeable providers out of the network — the cost to the state to provide family planning care jumped from $206 per client to $240.

The Gazette’s Lynda Waddington explained the negative effects of a similar decision in Indiana when then-Gov. Mike Pence eliminated funding for the provider:

Former Indiana Gov. and current Vice President Mike Pence declared a 2015 public emergency in his state due to HIV outbreaks. The county at the epicenter of the problem had been without a testing center since 2013, when the local Planned Parenthood clinic closed.

Just like three out of the four Iowa clinics now caught in the GOP’s defunding snare, the Indiana facility did not offer abortion services — none of the five Indiana clinics forced to close offered abortions, but they all provided HIV testing. Instead of being able to rely on ongoing prevention efforts provided by those local clinics, Indiana taxpayers took on the added cost burden of erecting pop-up clinics. Worst of all, Indiana residents needlessly suffered.

As attacks on Planned Parenthood continue, media can look to Iowa’s local media as an example of how to interrogate lawmaker’s claims about so-called alternatives and make clear the consequences when communities lose access to essential health care.