WILLMAR -- As the recession has deepened, Planned Parenthood is seeing growing numbers of women at its clinics in Minnesota, North Dakota and South Dakota struggling to pay for birth control and other reproductive health care.
"We're seeing more women in our clinics saying, 'I've just lost my job' or 'I'm afraid I'm going to lose my job,'" said spokeswoman Kathi Di Nicola.
It's an issue because Planned Parenthood's 27 clinics in the three states are often the safety net for women -- and sometimes for men as well -- who can't afford to go some-where else for contraception, pregnancy testing, testing for sexually transmitted infections and other basic services.
At Planned Parenthood in Willmar, the typical client is between 20 and 30 years old and earns less than $11,000 a year, Di Nicola said.
"We have sliding scale fees and provide care no matter the ability to pay," she said.
Most clients, however, need some kind of help or subsidy to pay for their care, she said. Of the 1,800 people who came last year to the Planned Parenthood clinic in Willmar, only 3 percent could afford the full cost of their care.
The Willmar clinic serves a population that is particularly diverse. While 6 percent overall of Planned Parenthood clients in Minnesota and the Dakotas are Hispanic or Latino, 25 percent of the clients in Willmar are Hispanic or Latino.
On average, clients at the Willmar clinic are poorer as well. More than 90 percent of them are eligible for free or very low-cost services, and almost two-thirds have an income that's less than 100 percent of the federal poverty level.
"We are the safety-net provider for them that they can rely on," Di Nicola said.
It's important for these women to continue to have access to affordable birth control, she said.
It's also critical for both women and men to have access to confidential testing for sexually transmitted infections, which have been on the rise in Minnesota.
The incidence of reportable sexually transmitted infections increased by 3.5 percent last year and has been steadily climbing for the past decade, according to the Minnesota Department of Health.
The rate of chlamydia alone was up 7 percent last year. Overall rates of sexually transmitted infections have been increasing especially rapidly in rural Minnesota and in the Twin Cities suburbs.
The economy also appears to be changing women's behavior in how they seek and use reproductive health services, Di Nicola said.
More women in their 30s and even in their 40s have been turning to Planned Parenthood, most likely drawn by the more affordable cost.
The organization expects to see a rise in the number of unemployed women seeking its services, as well as recent college graduates who are unable to land a job.
There has been an increase in the number of women opting for longer-term contraception, such as intrauterine devices, that they see as more affordable, Di Nicola said.
"We've heard that from a lot of women anecdotally. They're doing the math," she said. "They've always been thoughtful about it ,but we're seeing yet another dynamic come into it."
Health care reform that emphasizes prevention and access to affordable and culturally appropriate care is part of the national agenda for Planned Parenthood, Di Nicola said.
"We see the need for meaningful health care reform," she said. "Unemployment, the economy and health care specifically affect women. Poverty also seems to affect women in a more profound way."
Poor and low-income women often need extra help -- transportation, for instance -- if they're to overcome some of the additional barriers they face, Di Nicola said. "It's a real focus of the health care we provide. It's a focus of our staff."