Lack of family planning care in Iowa has ripple effects


When access to accurate sex education, birth control, and health care is poor, every taxpayer in Iowa bears the tax consequences.

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  • Cedar Falls resident Cyd Q. Grafft is a retired nurse.

Like many states, the Supreme Court’s recent Dobbs decision has reduced northeast Iowa to a healthcare wasteland. Despite the current anti-choice rhetoric, the existence of medical confidentiality and health care freedoms literally saves millions of dollars for millions of Iowans.

How much do taxpayers bear when non-medical staff make health care decisions? Even before the Dobbs decision, Iowa was already paying the price.

Mercy Hospitals and Clinics, a major health care provider in Iowa, no longer provides birth control in any form for men or women, including family planning, vasectomy or tubal ligation . For example, long-acting reversible contraception (LARCs), such as IUDs, are very effective in preventing pregnancies and Medicaid reimburses the very low cost, but Mercy still declined. Mercy’s decision to be a birth control wasteland removes choices for Iowa families, including men, who know their mental, physical and financial limits in providing for a child.

Between 2000 and 2021, 44 obstetric units and birthing centers in Iowa hospitals closed, causing a maternal/child health desert. Forty-six counties in Iowa are currently without a birth unit. Iowa ranks 49th out of 50 states with 1.49 obstetricians per 10,000 women. Low-income Iowans don’t have reliable transportation to a prenatal care center, so they just don’t get it. As a result, women may give birth outside of hospital, putting both mother and baby at increased risk.

Unplanned and unwanted pregnancies fuel Iowa’s behavioral health desert. Iowa ranks 47th for mental health services. Up to 80% of children placed in foster care develop serious mental health problems. School systems with limited resources are expected to help children with significant behavioral problems. Iowa closed two mental health hospitals and a children’s unit in 2015 and 2016, adding to the prison system’s burden of care. Iowa does not have enough licensed therapists and prescribers to meet the mental health needs of Iowa children and caregivers.

Limited reproductive freedoms contribute to a desert of jobs for economically disadvantaged women in Iowa. This demographic is most likely to have an unplanned pregnancy. Typically, these women did not complete high school prior to pregnancy. Many women lack the family support or childcare to complete high school and enter the workforce.

Why are reproductive freedoms important to Iowa taxpayers? Silver.

Every human being has basic needs to survive: food, shelter, education, health care, transportation and a living wage. The eradication of access to birth control, sex education and abortion fuels unwanted and unplanned pregnancies. Parents struggling to survive will turn to government social safety nets: Supplemental Nutrition Assistance Program (SNAP); Women, Infants and Children (WIC); Free and reduced school lunches; social housing; Medicaid; Electronic Benefits Transfer (EBT); Temporary Assistance to Needy Families (TANF); and the Children’s Health Insurance Program (CHIP). This list assumes a parent cares enough and can apply. Many parents are hesitant or afraid to seek help, which puts their children at increased risk of physical neglect and emotional harm, especially in minority communities.

A rising birth rate does not guarantee a larger, better-educated workforce; it creates millions permanently dependent on overburdened and exhausting social safety nets.

What about adoption or total prevention of pregnancy? Only 2% of unplanned pregnancies result in adoptions. Children adopted from the foster care system often require counseling and medication for months or years. Removing sex education and access to birth control increases the chances of pregnancy. Not all sex classes are consensual or legal. A number of uncontrollable factors can influence ovulation, making this fertile period very difficult to predict. No form of contraception prevents pregnancy with 100% accuracy. Abstinence is unrealistic in a country where, according to the CDC, a majority of Americans are sexually active. Might as well forbid people to eat or walk.

To insist that reproductive rights are only for women is just as inaccurate and dismissive as to say that property taxes are only for homeowners. When access to accurate sex education, birth control, and health care is poor, every taxpayer in Iowa bears the tax consequences.

Cedar Falls resident Cyd Q. Grafft is a retired nurse. Her credentials include Bachelor of Science in Nursing, Registered Nurse, Former Special Education Nurse, Master of Science in Nursing, and Advanced Registered Nurse Practitioner in Pediatrics and Psychiatry.

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