Iowa Republican Sen. Joni Ernst celebrated the annual March for Life in Washington the way many do: by decrying Planned Parenthood and declaring that the nearly 101-year-old provider of women’s reproductive health care should be stripped of any federal funding. Along with Tennessee Republican Rep. Diane Black, Ernst has become the new face of the defunding movement — a mantle typically held by those among Congress’s white male contingent, including Vice President Mike Pence. Despite that change, the message remains the same: Because some Planned Parenthood clinics provide abortion care, none should be allowed to use federal funds to provide unrelated health services to women, despite the fact that no federal funding (except in rare circumstances) pays for abortion. “We as a pro-life community honor the civil liberties, independence, and strength of a woman — all women,” Ernst told the crowd on the National Mall. “And that means both supporting mothers and rising up to protect the most vulnerable in our society — the innocent babies who are unable to defend themselves.” But advocates for women’s reproductive health warn that should the defunding proceed, the intertwined networks of providers that offer women’s health services could be seriously damaged — leaving thousands of women without access to birth control and other preventive care.

March for Life participants gather around the Washington Monument in Washington, D.C., on Jan. 27, 2017. Photo: Astrid Riecken for the Boston Globe/Getty Images

At the march in late January, Ernst promised to file a measure that would forbid any funds from going to Planned Parenthood; she has vowed that nothing about the bill — the Protect Funding for Women’s Health Care Act — would reduce overall federal funding available to support women’s health. In practice, the measure means not only blocking Planned Parenthood from reimbursements for services provided to Medicaid patients, but also denying Title X grants to the group’s clinics. While Medicaid reimbursements represent a larger share of the federal funds at issue — Planned Parenthood receives roughly $390 million per year to cover the costs of providing care to some of the nation’s poorest women — withholding Title X grants could deal a far more immediate and lasting blow, not only to clients, but to the program itself. Title X, passed with strong bipartisan support and signed into law in 1970 by President Richard Nixon, is the only pot of federal funding dedicated to providing family-planning care — which includes counseling, access to birth control, testing and treatment of sexually transmitted infections, and cancer screenings.

Photo: Ilana Panich-Linsman for The Intercept

While there are more than 20 million women in need of publicly funded contraceptive and family-planning care in the United States, the Title X allocation has never covered all of them. In 2015, the program was funded with roughly $287 million and served 4 million individuals. Title X funds are apportioned among nine regions of the country and are directly granted to state and local health departments or nonprofit family-planning groups that disburse the money across a network of ground-level providers who in turn operate any number of individual clinic sites. As a result, grantees in each state have the flexibility to create a specific network of providers that works as a cohesive system to serve as many patients as possible. Although Ernst and others have asserted that federally qualified community health centers would be able to pick up the slack if Planned Parenthood is eliminated from Title X, experience on the ground suggests otherwise. In states like Vermont, for example, Planned Parenthood is the only provider of Title X services — in 2014, the state’s 10 funded clinics saw nearly 8,000 women, all of whom would lose access should the defunding take place. Moreover, community health centers are tasked with providing a panoply of services and are often at capacity. “They have a huge workload — ranging from newborns to old people — and they don’t have the capacity to absorb a huge hit to another part of the health care safety net,” Sara Rosenbaum, founding chair of the Department of Health Policy at the George Washington University Milken Institute School of Public Health, told The Intercept. That would likely be the case in Ernst’s home state of Iowa. Jodi Tomlonovic is the executive director of the Family Planning Council of Iowa, one of two grantees that distribute Title X funds. Her network of seven provider groups includes Planned Parenthood as well as primary care providers and county health departments. Her annual allocation is $2.5 million, and in 2015, that money served 30,000 clients — only a percentage of those in need. Because of funding issues — federal money for Title X has been in decline — the FPCI recently lost two providers. “We’ve had whole agencies shut down and we’ve had satellite clinics close down. And trying to replace them in the network is very difficult, especially in rural states,” Tomlonovic said. “Saying, ‘Oh, well, we can make you give up these providers, and those clients can just be absorbed by other providers’ — that’s not always true. A lot of our federally qualified health centers are filled to capacity and overflowing” — a circumstance likely to be exacerbated if the Affordable Care Act is dismantled. It’s not only in rural states where need outpaces funding and Planned Parenthood plays an integral role in the quest to serve as many people as possible. The Arizona Family Health Partnership has been the Title X grantee since 1983 in Arizona and a portion of southern Utah that is part of the Navajo Nation. The AFHP’s $5 million allocation covers care for roughly 35,000 clients per year — out of more than 800,000 in need of services. Planned Parenthood clinics are major providers in Arizona’s urban areas, and severing them from the network would deal an immediate blow to the AFHP’s mission. “Finding somebody else to provide those services, while it could be done, it’s also labor intensive, and in that process we’re not sure who could pick up all of those clients,” said Brenda Thomas, CEO of the AFHP. “The community health centers have great care, but their focus is primary care and not reproductive health care.” They’re also at capacity “and don’t necessarily have the bandwidth to be able to take over all of the care that is provided at our Planned Parenthoods.” And that’s problematic, providers say, because reproductive care is often time-sensitive. “Delaying care around reproductive health oftentimes can lead to an unintended pregnancy” or a sexually transmitted infection, like chlamydia, which can cause infertility, “so that person wouldn’t be able to have a child when they are able and ready to do so,” said Thomas. Federal funding for family planning significantly reduces government costs — including those associated with Medicaid-paid births and negative health outcomes, such as undiagnosed cancers or sexually transmitted infections. In 2014, Title X prevented more than 900,000 unintended pregnancies that would have resulted in 439,000 unplanned births and 326,000 abortions. In 2010, the most recent year for which statistics are available, Title X providers prevented 87,000 preterm or low birth-weight births, 63,000 sexually transmitted infections, and 2,000 cases of cervical cancer. In all, every dollar invested in Title X returns more than $7 in savings — an estimated $7 billion in total savings in 2010 alone. Although Planned Parenthood clinics accounted for just 10 percent of those funded by Title X in 2010, they served 36 percent of program clients. “It is deeply troubling that at a time when more women are in need of publicly funded care in this country, we’re bracing for attacks on the very provider network that is charged with delivering the high-quality family-planning services that communities count on,” Audrey Sandusky, director of advocacy and communications for the National Family Planning and Reproductive Health Association, wrote in an email to The Intercept.

Traffic moves along Interstate 65 past an HIV awareness billboard in May 2015. Photo: Christopher Fryer/News and Tribune/AP