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HPPR Health, Education & Welfare

For women in rural Kansas, a longer drive can mean less health care

Esther Honig
Heartland Health Monitor/KHI

From the Kansas Health Institute:

Editor’s note: This story was revised at 1:30 p.m. March 1, 2016, to include information about services available at federally qualified health clinics in Kansas.

At a domestic violence shelter in Hays, director Tiffany Kershner sits with a client in a small meeting room.

Leyila, 35, who asks that only her first name be used to protect her privacy, recently left an abusive marriage. Today she’s hoping she can get an appointment with an OB-GYN, but Kershner knows that’s no easy task in Hays.

“We’re looking for the money to try and help with the exams and help with the doctor’s visits,” Kershner says. “But there’s just not a lot of money for it, so we’re just looking for any particular grant we can write.”

Like many of the women at this shelter, Leyila is a working single mom with no health insurance. She says most weeks she struggles to feed and clothe her two children, making the extra expense of a doctor’s visit nearly unsustainable. As someone who has struggled to maintain her health for years, Leyila knows that’s a problem.

“I’ve had female issues all my life and I’m supposed to have a Pap smear every six months,” she says. “I haven’t had one in five years because I can’t afford it.”

When she moved back to Hays earlier this year, Leyila discovered that the local Planned Parenthood clinic had closed. State funding cuts to Title X family-planning clinics had forced the organization to shutter its Hays clinic in 2014. 

The closure of the clinic alarmed Leyila, who is at risk for uterine cancer and needs regular preventive screenings.

“The type of uterine cancer that I am at risk for is very aggressive, and once it’s started there is no treatment. So catching it early is my only chance,” she says.

The nearest Planned Parenthood clinic now is in Wichita — about 180 miles away. Getting there means a six-hour round trip, not including time for the appointment. That’s a full day off from work that Leyila says she can’t afford. Not to mention she doesn’t even own a car.

She probably doesn’t realize it, but Leyila is at the center of a long-running national debate over women’s health care. In the last few years, politicians in states like Texas, Wisconsin, Indiana and Kansas have pushed for the closures of federally funded family planning clinics such as Planned Parenthood because they provide abortion services. But when such clinics shut down, it can affect more than abortion services.

David Slusky, a health economist at the University of Kansas, wanted to know if there are broader consequences for women’s health when a clinic like Planned Parenthood closes. He says his research was motivated by Planned Parenthood’s assertion that for many women, it’s the only health care provider they see in the course of a year.

At first, he says, he was dubious.

“I, as a health economist, looked at that statement and said, ‘That’s a pretty bold statement given the size and variety of our health care system.’”

So Slusky and his co-researcher, Yao Lu, decided to look at what happened in Wisconsin and Texas, both of which have seen multiple family planning clinic closures in the last couple of years.

In both states they mapped the locations of federally funded family planning clinics between 2007 and 2012. Then they looked at data from a national survey by the federal Centers for Disease Control and Prevention on preventive care screenings.

“Our survey asks questions like, ‘Have you ever had a mammogram?’” he says. “‘If so, how long has it been? One year? Two years? Have you ever had a Pap smear? Have you ever had a professional breast exam?’”

Using state-provided data, Slusky and Lu were able to connect the rates in preventive screenings with the ZIP codes where the women surveyed lived. Slusky says this allowed them to calculate the driving distance from each ZIP code to the nearest Title X clinic.

Slusky and Lu found that when the driving distance to the nearest Title X clinic increased by 100 miles or more, the rate of preventive screenings decreased by as much as 10 percent.

But Title X clinics aren’t the only providers offering women’s preventive services, says Denise Cyzman, executive director of the Kansas Association for the Medically Underserved.

“Kansas has several federally qualified health centers (FQHCs) and other safety net clinics that offer these services,” Cyzman says, noting that younger women in particular may may not think of their local safety net clinic as an alternative place to receive the preventive services they need.

“We have FQHCs in Hays, Salina, and Newton — to name a few — that serve western Kansas,” she says. “All provide services regardless of ability to pay and use a sliding fee scale.”

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.