The looming threat posed by the Zika virus will reveal the vast inequalities faced by women seeking reproductive healthcare in poor and politically conservative areas, experts say.
“This is not a battle-ready public health infrastructure,” said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association.
As the calls to fund the fight against Zika get lost amid election year and abortion politics, public health officials say it's reproductive health that needs a boost in order to be prepared for a Zika epidemic within the U.S. that could cause more babies to be born with physical and developmental disabilities.
“It's really unfortunate in this country that it takes crises to draw attention,” said Coleman on Thursday during a panel hosted by the Center for American Progress.
Congress left for a seven-week summer recess without approving the $1.9 billion President Barack Obama requested in February to combat the virus. Proposals that have flitted around since then include provisions that target abortion and contraception.
In June, the House passed a $1.1 billion bill that stalled in the Senate after Republicans wanted the bill to cut $50 million to organizations like Planned Parenthood to provide family planning and birth control services, which critics say is badly needed in light of the fact that virus can be sexually transmitted.
Last month, a House appropriations committee proposed a funding bill that would have slashed money to the Title X Family Planning Program. In place for nearly 50 years, the federal program funds a network of 4,200 family planning centers that serve more than 4 million low-income patients a year. The program prevents an estimated 1 million unintended pregnancies a year.
Most recently, Republicans angered Democrats by adding a provision to a $1.1 billion take-it-or-leave-it measure that would have slashed funding for Planned Parenthood clinics in Puerto Rico, where the number of infected pregnant women is skyrocketing.
House Speaker Paul Ryan, writing in USA Today on Thursday, did not mention that provision in blaming Democrats for blocking the legislation. Ryan (R-Wis.) instead said the move is "a blatant ploy in an election year."
Politics are playing a significant role in the states that might be most vulnerable to the Zika virus.
Florida, where more than 320 cases of infection have been found as of Aug. 3, and which last week reported the first case of locally transmitted infection within the continental U.S., banned state funding to providers that receive private funds to perform abortions. That was seen as a move to defund Planned Parenthood in the state. But the move also affected safety-net providers who offer contraception and prenatal health services to low-income women.
Like Florida, many of the states that are at higher risk for a Zika outbreak have policies in place that limit reproductive health and family planning services.
At least 20 southern states also have failed to adopt policies that the National Women's Law Center says help women make responsible decisions about pregnancy. They include: allowing Medicaid to cover family planning services and abortions, allowing private insurers to cover abortions, and requiring workplace accommodations for pregnant workers.
Florida's Republican Gov. Rick Scott also rejected Medicaid expansion under the Affordable Care Act. Many of the 19 states that have refused expansion are in warm, Southern climates perfect for breeding the Aedes aegypti mosquitoes that are the primary carriers of Zika. Studies estimated as many as 3 million low-income women could be eligible for Medicaid through expansion. Nearly half of all births in the U.S. are paid for by Medicaid, and is the primary form of health coverage for approximately 70% of low-income, non-elderly women.
Total public funding for reproductive health services rose by 31% between 1980 and 2010, with Medicaid responsible for the vast majority of the increase. Title X program funding actually fell sharply during the time period, down 71% according to their figures.
Researchers say the virus is quickly evolving and that they're learning new things about it every day, making it even more important to have a stable infrastructure available for the most vulnerable to stand on.
Florida health officials this week told pregnant women who live near or within the active transmission areas to get tested for Zika and consider getting additional ultrasounds.
But it's not just this election cycle that's witnessed cuts to family planning and reproductive health programs.
Coleman said a "battle-ready" public health system would be one that has adequate resources for family planning as well as contraceptive services. But funding for such preventive healthcare has been cut for years within states either on financial or ideological grounds.
In the current public health crisis, such a measure has been viewed by some as antithetical toward efforts to limit the number of pregnant mothers infected with the virus, which would increase the possibility that their unborn children develop microcephaly, a defect that causes a baby to be born with a smaller head than normal size.
But the problem with underfunding reproductive health care services is not exclusive to Medicaid. According to a July report by the National Women's Law Center, despite the ACA requiring health insurers to cover the 100% of the cost of birth control, some plans still call for women to pay out-of-pocket costs in violation of the law.
Such costs can serve as barriers to access to birth control for some women, said Janel George, director of Federal Reproductive Rights and Health at NWLC, which are only one of a number of efforts over the years that have played a part in restricting reproductive health services.
“I think years of imposing barriers has negatively impacted and limited a lot of women's access to care,” George said. “This crisis, I think, is highlighting some of those access issues and some of those barriers, but they are barriers that have been present for years.”