Reproductive health: Nonprofit aims for Brainerd family planning clinic

There is no family planning clinic in Crow Wing County.

Brainerd's Planned Parenthood clinic closed following federal funding cuts in 2011, and the clinic that replaced it folded soon after under economic and logistic pressures. Since then, the closest option offering confidential reproductive health care, including sexually transmitted diseases testing and contraception, is a once-a-month family planning clinic across the Cass County line in Pine River.

Leaders of a new nonprofit organization are on a mission to once again open a clinic with these services in Brainerd, while also advocating for comprehensive reproductive health education for the area's young people.

WeARE Advocates for Reproductive Education, established a little more than a year ago, is raising funds, seeking grant support and lining up health care professionals and a building to offer services its leaders believe the community desperately needs. The group presented on its vision Jan. 12 to the League of Women Voters of the Brainerd Lakes Area.

"I have this vision, along with the rest of our group, of a place where a teen can say, 'I can walk in and I know they'll answer my question, and I know they'll help me right this minute,'" said Sue Hadland, one of the founders of the group. "That's the kind of place that I envision. A place where they know they'll get accurate information, where they don't have to make an appointment to come back another day. That they can walk in, and if they can't get every part of what they need that day, they can get some parts. That's really what I think, the gap we're going to fill."

Let's talk about sex

Hadland, a retired nurse practitioner, and the other women leading the charge-Becky Twamley, executive director of WeARE, Julie Ingleman of Lake Shore and Cindy Moore, executive director of Brainerd teen center The Shop-came together over a shared passion for reproductive health education in the wake of the Planned Parenthood clinic closure.

"We tried to do some things at the time (of the closure), and we couldn't," said Twamley. "One and a half years ago, we decided to take a different approach because we wanted a clinic, which as you can imagine, is a very difficult thing to do."

That approach, Twamley said, is to focus on education and community outreach while in pursuit of establishing a local clinic. In 2015, the group began hosting monthly talks for teens at The Shop, called SxTalks, that cover topics such as healthy relationships, STD education and prevention, sex trafficking and birth control.

The teens are provided dinner, and incentives are used to engage them in the conversation. If they ask thoughtful questions, the presenters-which can include outside groups and health care professionals-will offer candy and condoms. If they complete a questionnaire at the end to demonstrate what they've learned, they earn a $5 bill.

"We're not here to test them, we're here to encourage them to find out information," Hadland said. "There's nothing wrong with incentivizing learning, I think."

The leaders of WeARE expressed the opinion that teenagers in the area are not receiving enough education on this topic. In 2016, the group supported a Brainerd student who brought concerns to administration about reproductive health education in the schools. In response, the district convened a committee to listen to the student's concerns, which led to an evaluation of the curriculum.

Tim Murtha, director of teaching and learning for the district, said that evaluation continues to update the curriculum. He said the district follows state law and federal standards in designing its classes, with a medically accurate and nonjudgmental focus.

"What we emphasize, because it's mathematically the best thing to do, is to remain celibate until marriage," Murtha said. "We also make sure that we provide medically accurate information for many forms of birth control."

"Helping students to abstain from sexual activity until marriage" is one of the requirements of state law.

Murtha said one area the district is looking to update is more information on emergency contraception, such as Plan B.

Twamley noted WeARE was looking for ways to partner with Central Lakes College, where the group believes it has a greater chance of making inroads. One of those ways is the potential for a working relationship with the college's nursing program, inviting students into the clinic setting for education on sexual health. The students could collect samples, do STD testing and treatment and refer students who want services, Twamley said.

CLC President Hara Charlier confirmed Thursday the college was in early conversations with the group. She said any opportunities to partner with community organizations were worth looking into.

"I think they are a good group that understands that women's health is important to Central Lakes College," Charlier said. "I think the issue of the health of our community is something we are all very committed to."

Filling a need

Twamley emphasized during the Jan. 12 presentation she was disappointed in the Crow Wing County public health department's family planning offerings, which she said were basically nonexistent.

"It's very disappointing," Twamley said. "I think family planning and reproductive health is one of the legs of the stool of public health, and they really are just ignoring it. It's unfortunate, but we're moving forward."

"I think to the extent that Crow Wing County ever offered (family planning) was condoms, as far as having those possibly available to give to their families," said Michelle Moritz, program coordinator of public health in community services. "Outside of that we never did shots, we never did pills, or any other family planning methods."

Moritz said the county focuses on encouraging its clients to establish a relationship with a primary care doctor and does offer counseling on pregnancy spacing to its clients part of the family home visiting program.

"Some of them will have concerns as far as insurance, but with the variety of different options out there, we make it kind of a dual referral," Moritz said. "Here's how you can apply for medical insurance and here's options for clinics in our area. ... If they cannot go to a clinic like Essentia or Crosby, the options would be the Pine River clinic that is once a month, or some will go to St. Cloud to the Planned Parenthood clinic that's there."

Hadland said traditional clinic settings might not work for teens in need of services-due to concerns over insurance, cost, parental notification or other confidentiality or access concerns. The rate of uninsured in Crow Wing County is higher than that in the state as a whole at 7.3 percent compared to 5.2 percent, according to the U.S. Census Bureau.

Beyond traditional primary care clinics, the once-a-month clinic at the Pine River-Backus Family Center is the nearest geographical option. Funded through a grant acquired jointly Cass, Todd and Wadena counties from the Family Planning Special Projects Grant Program, the clinic is operated by Mahube-Otwa Community Action Partnership. Clients can receive STD screening, physical exams, the Gardasil vaccine, pregnancy testing and contraception, along with referrals and counseling.

"We're only there one day a month," said Renee Lukkason, Cass County team leader for children, youth and families. "That's kind of a barrier, but that's all we can manage right now."

Lukkason said the targeted population is mostly individuals eligible for Medical Assistance or the Minnesota Family Planning Program waiver, although some private insurances are accepted.

Sarah Ohrmundt, family health director for Mahube-Otwa, said the funds received by the counties are delegated to the Community Action organization. When Planned Parenthood left Brainerd, the organization briefly operated a clinic in its wake, funded through the Cass-Todd-Wadena partnership. The clinic's location put a strain on the distant staff and did not gain traction in the community, Ohrmundt said.

"We met a lot of resistance, because I think a lot of people thought we were associated with Planned Parenthood, but we don't do abortions," Ohrmundt said. "We weren't actually able to make the Brainerd clinic work for our group."

There is one organization in Brainerd that addresses some needs for pregnant women in the Lakes Area Pregnancy Support Center. The organization offers free pregnancy tests and partners with area doctors and clinics, offering free first-time appointments and free ultrasounds. The group offers classes on healthy relationships, parenting and basic life skills. Those who attend the classes, said Executive Director Ginny Rogers, receive coupons good for free baby equipment, clothing and maternity clothing offered by the organization.

Rogers said many clients are referred by Lutheran Social Service, the county's Women, Infants and Children program, churches or doctors. She said the most common age group is ages 19-24, although the organization does see pregnancies among younger women as well. The group does outreach in the schools, Rogers said, including education on healthy relationships.

Rogers said the facility does not dispense any contraceptives, but does offer information.

The family planning clinic under development by WeARE would replicate the services offered in Cass County, taking a comprehensive approach, its leaders say. This does not include performing abortions, but could include referrals to places that do, should a client ask for such information.

The biggest challenge is acquiring funding-enough to start the clinic and show community support, which will help with the acquisition of grants, Twamley said.

High rate of teen pregnancy in lakes area

Filling that gap is important, the advocates said, because statistics show teen pregnancy is a problem in the Brainerd lakes area.

In 2014, Crow Wing County ranked 11th among all Minnesota counties for its adolescent birth rate, nearly twice as high as the state average. According to the Minnesota Department of Health, the county recorded 28.1 births per 1,000 females ages 15-19 compared to the state birth rate of 15.5 per 1,000 among the same population.

Nearby Cass County ranked third among all counties in 2014, with a birth rate of 30 per 1,000 females ages 15-19.

The difference between the county and state among 18- to 19-year-olds only was more stark. Statewide, that population recorded a birth rate of 28.4 per 1,000, but in Crow Wing County, the rate was 66.1 per 1,000. That rate is higher in Cass County, at 70.3 per 1,000.

Research supports impacts on teens who have babies include an increased likelihood of reliance on public assistance, poverty as adults and having children with poorer educational, behavioral and health outcomes. These teens are also less likely to finish high school.

One public assistance program within which the impact of teen pregnancy is measurable is the Minnesota Family Investment Program, known as MFIP. The MFIP is a program to help families with children meet basic needs while assisting parents with financial stability through work. The Tier 3 program identifies MFIP recipients who have the most difficulties becoming employed. Barriers to gainful employment can include mental health issues, physical health issues, chemical dependency or lack of education. Mothers younger than 18 years of age qualifying for MFIP are automatically enrolled in the Tier 3 program.

According to the Minnesota Department of Human Services, $64,290 was distributed in 2015 to Crow Wing County families that started with an adolescent birth. This represents 48.1 percent of distributions to all MFIP clients.

The prevalence of STDs-particularly chlamydia, the most common communicable disease in Minnesota-is highest among 15- to 19-year-olds in the state. Despite that population group making up just 7 percent of the population, it is responsible for 24 percent of reported chlamydia cases and 16 percent of reported gonorrhea cases.

Chlamydia is treatable, but often goes untreated because those infected have no symptoms, the Centers for Disease Control and Prevention reports. It can cause permanent damage to a woman's reproductive system, preventing the ability to become pregnant later in life. The state as a whole and Crow Wing County in particular have seen a rise in reported chlamydia cases, MDH reports. In 2000, 48 cases were reported in the county. Fifteen years later, 137 cases were reported.

"Compared with older adults, sexually active adolescents aged 15-19 years and young adults aged 20-24 years are at higher risk of acquiring STDs for a combination of behavioral, biological and cultural reasons. ... The higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality STD prevention services, including ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality," the CDC stated in a report on STDs.

Interested in learning more?

Visit www.wearebrainerd.org for more information, to donate or to volunteer.