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Maria, Planned Parenthood, and how nursing chose me

Diamond, Ilana, BSN, RN

doi: 10.1097/01.NURSE.0000549725.92068.df
Feature: Issues in Nursing
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Abstract: This article examines how one patient and the recent political climate surrounding Planned Parenthood influenced a college graduate with career aspirations in criminology to pursue nursing instead.

Join the discussion about preserving women's access to basic healthcare services.

Ilana Diamond is an RN at Children's Hospital of Michigan in Detroit, Mich.

The author has disclosed no financial relationships related to this article.

With Issues in Nursing, our purpose is to lay the groundwork for further discussion about current controversies in the nursing profession. To succeed, we need to hear from you. E-mail us at Andrew.Parent@wolterskluwer.com; place “Issues” in the subject line. Be sure to include your full name, credentials, city, state, and daytime phone number.

*This patient's name has been changed to protect anonymity.

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I FELL INTO NURSING by accident after graduating from college in 2013. I had planned a career in criminology. Everything changed shortly after I met Maria,* the patient who inspired me to fight for people who have limited access to healthcare and protect their autonomy in making their own healthcare decisions.

Soon after graduation, I got a job at a Planned Parenthood clinic—the same clinic where my mother had worked as a nurse when I was an infant. I was a healthcare specialist trained in medical assistant tasks such as taking vital signs and obtaining lab specimens, educating patients, and assisting the NPs and physicians. Maria was one of the first patients I helped care for.

Maria had moved from Central America to the US with her husband. She did not speak English. She had no health insurance and very little money. When Maria came to the clinic for her annual exam and Pap test, she was visibly nervous. Being the only Spanish-speaking employee in the clinic that day, I was assigned to work with her. I stayed with her while the NP, a non-Spanish speaker, performed a physical exam.

At the end of the visit, Maria began to cry. I asked her what was wrong, fearing that the clinician or I had done something to upset her. Her response was the kindest and most meaningful one I have ever received from a patient. Maria told me that this was her first time in an American health clinic, and that my patience and kindness made her feel comfortable for the first time since moving to the US. She then took off a bracelet that she had made and slipped it on my wrist. She told me it honored St. Michael, the patron saint of protection. From that moment, Maria inspired my journey to become a nurse.

I got to know Maria well as I became comfortable serving as a translator for Spanish-speaking women and men who required various health screenings from our clinic. I loved working with people who would not have access to care if not for our staff. I learned about their struggle to obtain appropriate and compassionate healthcare given their limited access to quality care.

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Clinics in jeopardy

The recent political climate in the US has put the status of clinics like Planned Parenthood into question. Besides family planning and abortion services, these clinics offer many basic healthcare services that would be otherwise unavailable to patients who are underrepresented, underinsured, or, as in Maria's case, who do not speak English. These clinics offer people of all ages and backgrounds basic healthcare screenings, diagnostic lab work and exams, and referrals, all for little to no cost to the patient. Most insurance plans are also accepted through the clinic, although it is considered an out-of-network provider for many insurers.1

It has been argued that providers not affiliated with these clinics will be able to manage the increase of new patients looking for services if these clinics are closed, but that is not the case. Planned Parenthood is unique in its ability to provide affordable and life-changing services to those who need access.1 Planned Parenthood serves as a “safety net center” for general healthcare for many people, especially those who heavily rely on Medicaid.1 Many contraceptive and women's healthcare services that Planned Parenthood provides are not available at other safety net centers, such as local health departments, and these centers often refer women back to Planned Parenthood.1

Efforts in some states to reduce taxpayer funding to Planned Parenthood in recent years threaten women's autonomy in their healthcare decisions. Almost half of pregnancies in the US are unplanned.2 By having the option to plan pregnancies with access to safe and affordable contraception, women can keep their jobs and better plan for their financial and familial futures. These clinics allow women to maintain control over their own bodies.

As of January 2018, Planned Parenthood had 56 affiliates in its network, with clinics in all 50 states and the District of Columbia.3 In its 2016-2017 annual report, Planned Parenthood stated that abortions accounted for 3% of total services provided by its clinics each year.4 Further, about 80% of services are meant to prevent unintended pregnancies. Each year, these clinics serve 1.5 million people and perform more than 295,000 Pap tests, 320,000 breast exams, and 4.2 million tests and treatments for sexually transmitted infections, including more than 600,000 HIV tests.5

The reality is that when clinics like Planned Parenthood are no longer available, more harm is done than good. One example of this can be found in Indiana. In 2016 and 2017, many Planned Parenthood centers and other small clinics in rural areas were shuttered due to budget cuts and issues with Medicaid reimbursement.2 These clinic closures contributed to one of the worst documented HIV outbreaks in the US because of the lack of availability of testing and treatment for the disease.1 Another example of the effect of these clinic closures is in Texas, which began slashing state funding for Planned Parenthood and similar clinics in 2011. The number of women who were using all forms of birth control, including oral contraceptives and IUDs, decreased by 35% while the number of births covered by Medicaid increased by almost 30%.1

At Planned Parenthood, Maria felt comfortable enough to express her emotions openly. Clinics like Planned Parenthood offer women and men of all ages, backgrounds, and socioeconomic classes compassionate and quality care. Without these clinics, millions of individuals would lose the care they want and need.

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Following my path to nursing

When asked why I wanted to become a nurse, my answer is simple. I want to help people like Maria. Meeting Maria ignited the spark that led to my true mission in nursing, and she will always continue to serve as an inspiration and reminder as to why I chose the nursing profession.

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REFERENCES

1. Lawrence HC, Ness DL. Planned parenthood provides essential services that improve women's health. Ann Intern Med. 2017;166(6):443–444.
2. Ciccariello C. Defunding Planned Parenthood—the stakes for America's women. JAMA Intern Med. 2017;177(3):307–308.
5. Planned Parenthood Federation of America. Planned Parenthood at a glance. 2017. http://www.plannedparenthood.org/about-us/who-we-are/planned-parenthood-at-a-glance.
Keywords:

Affordable Care Act; health disparities; Planned Parenthood; women's healthcare

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