Officials at the Billings-based Planned Parenthood of Montana (PPMT) say the Missoula clinic will continue to offer medication abortions, but that the cost of providing surgical abortions was threatening access to reproductive services in other parts of the state.
"Access to abortions is already in Missoula," says Stacy James, CEO of PPMT. "We want to make sure that access is available in other communities."
According to Kalpana Krishnamurthy, field director at the Western States Center, a Portland, Ore.-based progressive think-tank, rising health care costs constitute just part of the financial pressure facing abortion providers. She says anti-abortion activism and harassment have forced clinics to take on additional financial burdens associated with improving security and fortifying entrances to clinics.
"In Montana, we know there is a history of violence that clinics have had to face and survive," says Krishnamurthy.
Missoula's Blue Mountain Clinic is the state's oldest provider of abortion services, and will take on extra patients in the wake of Planned Parenthood's departure from the field.
Raquel Castellanos, executive director of Blue Mountain, says the clinic is making preparations to accommodate what she believes will be a 50 percent increase in demand for services.
"We typically provide about 25 percent of the abortions in the state of Montana," explains Castellanos. "Last year we provided about 500 abortions. We're preparing to meet the needs of at least 750 patients now that Planned Parenthood is [eliminating surgical abortions]."
According to James, surgical abortion was causing the costs of other services at the Missoula clinic to go up as the costs of unrecompensed abortions were passed on to the clinic's other clients. She said that it makes financial sense for the organization to focus its resources in other parts of the state.
"Because we are a statewide health-care provider, we always have to look at the big picture, and that means what is best for the women of Montana as a whole," says James. "We are working hard to provide access to this service while maintaining other cost-effective services; as is the case for most health-care providers, our costs have increased."
Castellanos is quick to point out that she understands why Planned Parenthood made the decision to eliminate surgical abortion services in Missoula.
"My heart goes out to Planned Parenthood. I know it was a hard decision for them to make," she says. "I understand, financially, why they did it. It is challenging to provide these services nationally."
Reproductive services aren't immune to the economic forces acting on the national heath-care landscape. Rising costs and dwindling Medicaid reimbursements have put a serious financial strain on heath-care providers, including abortion clinics.
According to Rebecca Howell of PPMT, the Missoula Planned Parenthood clinic performed 312 abortions last year at a rate of about 25 to 26 patients per month.
Since PPMT merged with the Missoula clinic in 1998, the price of surgical abortions has risen from to today.
According to Howell, Planned Parenthood does not turn away women who cannot afford the cost of abortions, and that was costing the clinic a lot of money.
"We certainly don't turn these patients away, but we must look at the most effective way of serving them," says Howell. "Part of our decision to stop offering surgical abortions in Missoula is because there are other providers in the community providing abortions. Without PPMT, there would be no abortion provider in Billings, Helena or Kalispell. And our number-one priority is access."
According to Krishnamurthy, the declining number of abortion providers in the West and across the country is an alarming trend. She says there are currently fewer than 125 abortion providers or clinics in the Western region she monitors, which encompasses a quarter of the nation's landmass and about 15 million people, mostly in rural areas.
The period between 1996 and 2000 saw an 11-percent decrease nationwide in the number of abortion providers, she says. According to the Alan Guttmacher Institute, a New York-based nonprofit organization focused on sexual and reproductive health research, there were 23 abortion providers in Montana in 1978. By 2000 that number had dwindled to nine providers statewide. With the impending departure of surgical abortions at Planned Parenthood's Missoula site, Montana is down to four providers: Planned Parenthood's Kalispell, Billings and Helena locations, and Blue Mountain Clinic in Missoula.
"In Montana, although there may be another provider in [Missoula], our concern
is the overall access to those services," says Krishnamurthy.
Castellanos says Blue Mountain will do its best to step in and fill the void left by Planned Parenthood's decision to eliminate surgical abortions in Missoula, but the increased pressure is bound to put a strain on the nonprofit clinic.
"I can tell you in the last three years, Medicaid write-offs have doubled," says Castellanos. In Montana, unlike many other states, Medicaid covers many reproductive services, including abortions.
"We're seeing more and more patients who need access to these services but don't have the ability to pay," she continues. "We're still seeing them. We're not turning them away, but as a result, we're losing money."
Meanwhile, in Washington, D.C., the Senate is grilling U.S. Supreme Court nominee Samuel Alito about his stance on abortion, among other issues. Krishnamurthy says the local news is a logical extension of the national debate.
"I think people need to recognize the relationship between the political universe and the decline in abortion services," she says. "The far-right strategy of chipping away at access by targeting abortion providers and types of abortions has been very successful at limiting access to reproductive services. With these confirmation hearings taking place, I think we need to think about how national policy plays into what kinds of services Montana will and will not be able to provide."