The Effect of Women’s Health Clinic Closures on Community STI Rates

• In Event: Regulating Risk: State Policy and Health Outcomes Across Substance Use and Reproductive Care

Abstract

Women's health clinics serve as a critical safety net for women's care, providing discounted services and a trusted setting for preventive care, including sexually transmitted infection (STI) testing. These clinics disproportionately serve low-income, uninsured, and underinsured women who lack access to alternative providers, making them an essential component of the reproductive and preventive health infrastructure for vulnerable populations. STIs such as chlamydia impose billions of dollars in annual costs on the United States through medical expenditures and lost productivity, and can result in permanent health conditions including pelvic inflammatory disease and infertility. Left undetected and untreated, STIs spread silently through communities, compounding the public health burden of reduced clinic access in ways that extend well beyond the individuals directly affected by closures. Women's clinics receive federal and state public funding and are subject to cuts linked to their association with abortion services. These funding disruptions have accelerated in recent years as state legislatures have increasingly targeted family planning providers, with consequences that fall most heavily on communities with limited alternative sources of care. This paper exploits clinic closure events to estimate the impact of reduced access on STI rates in surrounding areas, using individual-level patient data to trace how care-seeking behavior and STI diagnoses shift in the geographic areas affected by closures. We employ a difference-in-differences design that leverages variation in the timing of closures across counties and states to identify causal effects, comparing outcomes in affected areas to those in comparable areas where clinic access remained intact. Heterogeneity analyses examine whether effects are concentrated among the populations most dependent on safety-net providers, including Medicaid enrollees and residents of areas with fewer alternative clinical options. The findings offer direct policy-relevant evidence on the public health costs of defunding women's health clinics and the extent to which these costs fall disproportionately on those least able to absorb them.

Author

• Jennifer A Mangano, Indiana University
  Presenting Author