It’s not abstract anymore.

We knew eliminating state funding for Planned Parenthood’s family planning services would cause thousands to lose access to basic health care.

We knew deep cuts to state funding for victims assistance would affect thousands of sexual assault and domestic abuse survivors.

Now we are starting to see which Iowans will be the first to suffer from Republican choices on how to spend the public’s money.

FOUR PLANNED PARENTHOOD CLINICS CLOSING

By creating a state-run family planning program that excludes abortion providers, Iowa will be forced to spend some $3 million in state dollars per year, rather than using $300,000 in state funds to leverage $3 million in federal Medicaid funds. But this post isn’t about the idiocy of spending ten times more on family planning when the human services budget is already under tremendous strain.

Today we’re talking about the human cost of removing Planned Parenthood as a qualified provider of contraceptive exams, advice, and supplies; testing or treatment for sexually transmitted diseases; and pregnancy or Pap tests.

Planned Parenthood of the Heartland announced on May 17 that due to an expected loss of about $2 million from the discontinued Family Planning Network, it will close four of its twelve Iowa clinics: Sioux City, Bettendorf, Burlington, and Keokuk. In the last three years those clinics have served more than 14,600 patients, mostly from Iowa but also from neighboring states. Nearly half of those using family planning services from Planned Parenthood’s Iowa clinics are “at or below the federal poverty level.” A post on the organization’s Facebook page outlined the expected consequences.

These changes are devastating. More than 14,000 patients who trust Planned Parenthood with their health care in these communities and in neighboring areas no longer have access to their provider of choice.

Anti-choice politicians – who are driven by their personal beliefs, not facts – are hurting women by preventing us from being able to provide critical family planning services and life-saving cancer screenings.

As we have said before, defunding Planned Parenthood will set a health care crisis in motion in Iowa. We will be watching and holding these politicians accountable for the hurt they have caused, the futures they have irreparably damaged – the lives they have shortened.

Talk of shortened lives is not hyperbole. After Texas revoked all state funding from Planned Parenthood, maternal mortality doubled in just a few years. Unplanned pregnancies increased, especially among low-income women and teens. Sexually-transmitted infections became more widespread too.

Republican lawmakers and their allies in the anti-abortion movement keep promising that other health care providers, including many in rural Iowa, will be able to meet the demand for services Planned Parenthood offers.

They couldn’t back up those claims on the floor of the Iowa Senate, and they can’t back up those claims now.

When Texas clinics closed, women had less access to services; other providers did not fill the gap. Some Iowa health care providers may be able to offer Pap smears or a few kinds of birth control–probably with much longer wait times than if Planned Parenthood clinics were available. But are their staff trained to offer injectable birth control and highly effective long-acting reversible contraceptives such as implants and intrauterine devices? Can they handle STD testing and treatment?

Advocates of defunding Planned Parenthood in Iowa have never produced a list of clinics that actually offer the full range of family planning services. Instead they have talked about federally qualified providers, which might be a dentist’s office or a high school nurse or a homeless shelter.

William Petroski reported for the Des Moines Register,

Jodi Tomlonovic, executive director of the Family Planning Council of Iowa, who had testified against the legislation, said the loss of services at the four health centers can’t be duplicated by other Iowa medical providers. She said they lack the expertise and ability to accommodate a large number of additional family planning patients.

“We are concerned this will have a severely negative impact on family planning services,” Tomlonovic said. “You will see increases in unintended pregnancies, teen births, and abortions” as well as increases in sexual transmitted diseases and cervical cancer.” […]

Planned Parenthood’s clinics in Burlington, Keokuk and Sioux City will shut down June 30, the same date that family planning services will cease at the Bettendorf center. However, the Bettendorf facility will continue to provide some limited telemedicine abortion services after June 30 until the building is sold, said Susan Allen, Planned Parenthood of the Heartland’s marketing and communications director.

Chelsea Keenan reported for the Cedar Rapids Gazette,

According to the Guttmacher Institute, a Washington, D.C.-based reproductive health research organization, Planned Parenthood provided 80 to 96 percent of family planning services for patients accessing care at a publicly funded provider in 2015 in Burlington, Keokuk and Sioux City.

“It’s just not a good thing for the state,” Tomlonovic said. “And it’s not a good thing for Iowans who want and need family planning services. It’s going to have a real ramification in a number of ways — not just increased abortions, but increased STD rates. You only have to look to Texas to see what we’ll have here.”

Barbara Rodriguez and Linley Sanders reported for the Associated Press,

The current system that used federal Medicaid money will expire June 30, according to the Iowa Department of Human Services. Participants will automatically be transferred to the new state-run program, which covers the same services as long as they are not sought at a clinic offering abortions. […]

Ben Hammes, a spokesman for the governor, cited data he claims will ensure there are family planning services “in every corner of the state.”

I’ve asked Hammes and Iowa Right to Life for a list of clinics that can offer all the non-abortion services Planned Parenthood provided. I’ll update this post in the unlikely event I hear back.

THREE PROGRAMS FOR SEXUAL ASSAULT VICTIMS DEFUNDED

Republicans voted along party lines last month to reduce state funding for victim services from a $6.73 million appropriation for the current fiscal year to $5.02 million in fiscal year 2018. That $1.7 million represents a 26 percent cut to victim assistance in a justice systems budget that kept most other line items near status-quo levels. In addition, federal funding under the Victims of Crime Act will decline in the next year by an estimated $4 million (17 percent).

Janelle Melohn, director of the Crime Victim Assistance Division in the Iowa Attorney General’s Office, explained the recent history of state and federal funding in this area. I posted her message here for those who want to read the somewhat complicated details.

State grants from the Crime Victim Assistance Division support a wide range of programs, mostly for survivors of sexual violence and domestic abuse. A report to the state legislature on the division’s work from fiscal year 2013 through 2016 features “snapshots” about the budget and services. This page from that document shows how many more domestic abuse, sexual assault, or other violent crime victims were helped during that period, thanks to larger state appropriations and an increase in federal Victims of Crime Act funding, starting in 2015. (click to enlarge)

The “unexpected, but awesome for states” federal funding boost allowed the Attorney General’s Office to improve or expand some programs and raise compensation for advocates who work with domestic abuse or sexual assault survivors. (My acquaintances who work in this field vouch for those advocates as vital support for people who have experienced trauma.) Some of the extra money paid for new programs geared toward “victims who have historically gone unserved/underserved.” According to Melohn, those projects “were all funded solely through the new federal funds.”

This year, since the state was facing huge budget cuts, legislators believed the increased federal funds could cushion the blow of the loss of any state funds. I worked hard to explain this wasn’t the case for a variety of reasons, the most obvious being these funds had already been fully allocated. My legislative handouts outlining this can be found in the historical documents provided to the Justice Systems Approps Committee.

Here’s one of those handouts.

Here are a couple of pages from another handout.

Unfortunately, Republican lawmakers either didn’t understand the information Melohn gave them or were as deaf to her education efforts as they were to those who warned voter ID and signature verification would disenfranchise some eligible voters.

Soon after the GOP justice systems budget came out, proposing a $1.7 million cut to victims assistance, the Attorney General’s Office learned Congress changed the formula for Victims of Crime Act allocations to states, which is why the expected federal funding will drop by about $4 million next year. So Melohn’s office needs to cut $5.7 million from annual awards in fiscal year 2018. Unallocated federal money offset some of the cuts,

but our best estimates show we have to cut $2.8-$3 million from grant awards, beginning July 1, 2017. My staff spent almost a week, combing through project budgets and thoughtfully processing different ways to administer these cuts fairly, but also with the least harm for victims. In the past, we’ve tried to do across the board cuts, however, the cuts weren’t this large. Because every dollar of the state appropriation is passed through to programs serving only DA/SA [domestic abuse/sexual assault] victims, those programs would be disproportionately affected by a reduction. When we ran the numbers, the programs hit hardest would be Iowa’s 9 remaining DV [domestic violence] shelters. Furthermore, our most conservative estimates showed we would lose at least 25.5 FTE’s [full-time equivalents] in just our comprehensive SA/DA/Shelter/Hotline programs etc. This would decimate their ability to serve in our current model and to fully reach their populations.

Instead we decided to literally look at every line item in program budgets. In reviewing those line items, for SFY18, we have removed any/all costs that wouldn’t affect staff or their ability to provide services to victims. Through the elimination of these kinds of costs, we were able to come up with about $1.2 million in cuts. At that point, we knew staff would have to be cut from somewhere. Staff then reviewed performance statistics, victims served, duplication in services, overlap in service area, budget reversions, performance concerns/corrective action, etc. to determine where these cuts should be made. The final proposed cuts were put in front of the CVAD Board on Friday May 12, 2017 and approved.

$1 million was cut by not awarding a planned grant to upgrade the IowaVINE statewide victim notification system. Three cuts totaling $133,000 will affect the Van Buren County Attorney’s Office, Iowa Victim Assistance Academy, and Iowa Department of Public Health.

Three programs will be eliminated:

1. Monsoon United Asian Women of Iowa had provided statewide chatline services for victims of any violent crime. The non-profit will lose the entire $217,996 grant for that purpose. Melohn told me, “Monsoon will continue to receive grant awards for services to sexual assault and domestic abuse victims.”

2. Transformative Healing, an organization designed to be a “safe space for LGBTQIA survivors of sexual violence,” will lose $268,239 that supported their operations.

3. The Iowa Sexual Abuse Hotline managed by the Rape Victim Advocacy Program at the University of Iowa will be defunded. Melohn said the board “voted to merge the two statewide hotlines for crime victims. The SA hotline will be provide[d] with funds for the first quarter of SFY18 to transition out of these services ($97K). The state DA [domestic abuse] hotline will be provided an additional $125-$150K in SFY18 to provide SA hotline services. This will save roughly $140K the first year and about $240K in year three of the grant cycle, while still preserving these necessary SA hotline services.”

Lindsay Pingel, director of community engagement for the Iowa Coalition Against Domestic Violence, told me on May 18 that her organization and the Iowa Coalition Against Sexual Assault “don’t even have a guess as to what our budgets look like” for the fiscal year that begins on July 1.

Melohn acknowledged, “I cannot yet break down the loss of funds for individual programs (the $1.2 million I’ve outlined above) due to not having our final federal awards yet. We do believe we’ll be able to notify programs about the exact amount of their smaller cuts within the next 3-4 weeks.”

Not only will crime victims receive fewer services, Iowa will lose ten full-time advocates (three positions currently unfilled) and nineteen part-time advocates. Melohn told me, “The reality is, funding cuts have consequences and tough decisions had to be made. No one wants to be in this position and we hope the state legislature will understand the need for adequate funding for these services in future years. If state and federal funding stays level for SFY19, we will have to make an additional $1 million in cuts as we won’t have any other reserves to offset the loss of funds.”

Monsoon United Asian Women of Iowa described the impact in a May 17 press release:

IOWA’S MOST INNOVATIVE VICTIM SERVICES PROGRAM DEFUNDED

Last April, the Iowa Legislature approved a 26% cut from the state’s victim services program. Monsoon United Asian Women of Iowa was notified that IowaARCh, a program under Monsoon, will be defunded. IowaARCh is a program providing online victim services to victims of domestic violence, sexual assault, dating violence, stalking, and sex trafficking.

Eliminating funding to the statewide chatline at this time would cut an innovative new program just as it begins to hit its stride. IowaARCh is the first such service in the nation, and has received inquiries from organizations around the country hoping to learn from our model. Overall chats have increased dramatically in 2017 (by about 40%), as have the proportions of our users who are male, nonbinary, LGBTQ+, under age 26, and chatting about sexual assault (sexual assault chats have increased by 70% in 2017). These populations are known to be marginalized and less likely to reach out for support. In a field dominated by straight white female social workers, IowaARCh staff has always been incredibly diverse in age, gender, race/ethnicity, religion, national origin, career background, and sexual orientation. This exemplifies IowaARch’s focus on its mission of bringing marginalized experiences to the center, and makes our service a safer space for users who may be reluctant to reach out to traditional services. The feedback we have received from anonymous chatters speaks for itself: One writes, “It’s amazing how much help I got,” while another tells us, “This conversation has…opened my eyes more than anything else has.” IowaARCh is an example of Iowa creating innovative and forward-looking victim services, but due to the newness of the program, it was the first on the chopping block.

The defunding of IowaARCh will result in Iowa going backward instead of moving into the future.

A staffer for Transformative Healing posted this personal comment on Facebook. (Scroll down for the official statement later released by the non-profit.)

They [Crime Victim Assistance Division] had a couple of choices on how to enact this cut, and decided that they would eliminate funding to smaller organizations in order to soften the blow to larger, mainstream ones. Unfortunately, the smaller, younger organizations tend to have most of their funding tied up with CVAD because they need time to diversify their funding streams. They chose three organizations to eliminate funding to: The Iowa Sexual Abuse Hotline, Iowa ARCh, and Transformative Healing. Without community support, this will effectively kill these organizations on June 30th when the fiscal year ends. As you know, I work for Transformative Healing. We are not going to just lay down and die. We refuse to give up.

Let me tell you about the LGBTQIA survivors we serve: they survive the worst things that humanity has to offer, but they are beyond resilient. They have been through sex trafficking, rape, domestic violence, mutilation, prison violence, childhood sexual abuse, hate crimes, and some of them have seen people killed. A lot of them are impoverished because of what they went through. They sometimes go hungry, even with the help of food stamps and food pantries. Some of them have severe mental illness and a lack of access to treatment. Nurses don’t even understand how to properly collect a rape kit from the trans and intersex survivors. They get turned away from homeless shelters and DV shelters because of their identity. At every turn, they try to get a leg up and are shoved back down. But they keep fighting. They are continuously stripped of their support systems. But with a little help, I have seen people heal in ways I never foresaw possible. My job is to help them restore control, to listen, and to do what I can to empower them to survive. They didn’t deserve this. They deserve better than to lose one more support system. And let me tell you- informing my clients that their services might not be here in 6 weeks is one of the most heart breaking things I have ever done.

Within the next week, we’re attempting to fund raise. Our goal is to sustain ourselves for the next few months- this will buy us time to apply for grants that will sustain our services. We will be creating a crowdfunding page shortly with the other organizations being eliminated.

I will update this post as we learn more about how budget cuts affect the vulnerable and marginalized Iowans who have relied on Planned Parenthood or victim assistance programs.

Enjoy your handiwork, Iowa Republicans.

UPDATE: The Rape Victim Advocacy Program released this statement on May 19.

***URGENT ALERT: IOWA SEXUAL ABUSE HOTLINE DEFUNDED***
Earlier this year, the Iowa Legislature decided to cut state funding for victim services by 26% in fiscal year 2018. This week the Rape Victim Advocacy Program (RVAP) learned that the Iowa Sexual Abuse Hotline (ISAH), the statewide hotline hosted by RVAP since 1999, will be defunded as of October 1st, 2017. ISAH provides 24-hour phone counseling, support, information and referrals to anyone affected by sexual violence directly or indirectly. All of our support is confidential, trauma-informed, and culturally-competent.

Eliminating funding to this statewide resource will set victim services in Iowa back in profound ways.

The timing of this decision to defund ISAH is incredibly troubling. In the past two years, ISAH has experienced a 647% increase in call volume, and is projected to receive nearly 4,000 calls this fiscal year alone! While there are other hotlines available to survivors of sexual abuse, historically, when victim services are combined into one program, survivors of sexual violence are the ones who become underserved. It was for this reason that ISAH was originally established as a critical resource for persons who experience barriers and/or conflict of interest when accessing services. Persons who call the ISAH are offered immediate support as well as information to connect with services in their local areas and communities. ISAH also provides roll-over services to sister centers in the state, answering their hotlines during non-business hours, weekends and holidays. This service allows these agencies to focus their finite resources on other services, while still ensuring that those in need of support are able to access to confidential, trauma-informed support 24/7. To eliminate this critical service for survivors of sexual violence will push Iowa back decades.

Please consider clicking here to DONATE to RVAP and help us sustain our life-saving services for all Iowans who need them.
For more information, contact Adam Robinson at adam-robinson@uiowa.edu or Katryn Duarte at Katryn-duarte@uiowa.edu

Transformative Healing released this statement on May 19.

IOWA’S ONLY LGBTQIA+ SEXUAL VIOLENCE AGENCY DEFUNDED

In April, the Iowa Legislature approved a 26% cut from the state’s victim services— Last week, Transformative Healing was informed that the Crime Victim Assistance Division (CVAD) is completely defunding our organization. Transformative Healing is the only sexual violence agency in Iowa that provides comprehensive advocacy services specifically for LGBTQIA+ survivors, survivors in the BDSM/Kink community, and survivors engaged in consensual non-monogamy.

These funds made our work possible, and as a young organization almost entirely dependent on state and federal victim services funds, this devastating cut could lead to the complete halt of services. We have been serving LGBTQIA+ survivors for almost 3 years, and in that time we’ve seen tremendous growth. We provide free and confidential services to survivors and their support systems. These individual services to survivors include transportation, accompaniment to medical appointments or court dates, peer counseling, emergency financial assistance, and more. Our services also include statewide technical assistance to educate others about LGBTQIA+ identities and issues. Our trainings have reached SANE nurses, shelter providers, other advocates, classrooms, resource centers, the justice system, and beyond. We strive for change within many levels of our society and know that true social change occurs not in isolation, but in collaboration and partnership.

We are one of seven culturally specific advocacy organizations in the state of Iowa, and the need for these specialized services is dire. We know that LGBTQIA+ individuals are routinely underserved, and may even be re-victimized when accessing mainstream services systems.

Transgender and gender non-conforming individuals are especially targeted, and even denied services out right. This is in addition to other barriers stemming from anti-LGBTQIA+ bias, as well as discrimination and bias regarding other identities our clients hold whether it be race/ethnicity, class, religion, age, ability, citizenship status, and more. Transformative Healing recognizes the systems and influences that work against our clients, while also recognizing the incredible resiliency within the LGBTQIA+ community. We center our work around our clients, and provide any support needed to draw on these strengths. Our clients deserve to receive care that validates their identities and acknowledges their worth and power.

Defunding Transformative Healing means defunding LGBTQIA+ specific care for survivors of trauma. It means that people who already face a multiplicity of marginalizations will not be able to access services. It means Iowa is taking leaps backwards.
For more information, and further action items, contact our executive director: kimberly@thiowa.org, Des Moines advocate: stormy@thiowa.org, or Iowa City prevention/outreach specialist: mgordinier@thiowa.org.