In larger communities, people without access to health insurance often turn to Planned Parenthood for family planning and abortion services. But here in Summit County - where a good portion of the population works in the service industry without health insurance - where does a low-income or underinsured individual turn?
Summit County has had family planning services available for low-income individuals and families for the last 15-20 years, according to Molly Lee, director of programs at the Summit Community Care Clinic. The Summit County Public Health department originally provided them, and the care clinic fully absorbed the services when they moved into their new offices - next to the hospital in Frisco - in 2006. The clinic offers women's exams, men's reproductive services, contraception, screening and treatment for sexually transmitted diseases, and reproductive and STD education.
"The object is to help people have planned pregnancies and offer basic health services to those who don't have anywhere else to go," Lee said.
Anyone - even those from outside the county - can access the care clinic's reproductive services, which are billed on a sliding scale based on income. The clinic's primary care, dental, behavioral health and physical therapy programs are only available to patients who prove lower income and obtain a community care card.
The care clinic receives Title X funding - a federal grant program currently in trouble of being chopped in Congressional budget cuts - for its reproductive services, which mandates anyone over the age of 12 can access services confidentially, and that no one can be turned away based on ability to pay.
Lee said a large portion of patients visiting the clinic for reproductive services are in their lower 20s and teens. She said many younger people work in the service industry where health insurance isn't readily available, or are only in the county for a season.
STD treatment and prevention is especially busy in this population, Lee said.
When it comes to contraception, Lee said the clinic works with the patient to come up with a "reproductive life plan." A provider chooses contraception - or even sterilization, which is funded through state dollars - based on how old the patient is and when they prefer to get pregnant. They offer oral contraceptive pills, birth control shots, contraceptive rings, implantable devices, diaphragms, and emergency contraceptives. Condoms are also located all throughout the clinic - even in a glass bowl at the front desk.
When an unintended pregnancy does occur, physicians go over the patient's options. They can choose to continue with the pregnancy and keep the child, plan to give the baby up for adoption, or terminate. Lee said most people go to Denver to receive an abortion.
"There is no place here in the county to get a termination," she said.
The care clinic does recommend three abortion agencies in the Denver area that past patients have reported to be respectful and confidential. The clinic does not set up termination appointments for the women, but hands them the agency's information. Lee said the clinic does not track information regarding how many women in Summit County choose to terminate, but there is "a handful."
"We're doing everything we can to avoid that in the first place," Lee said.
Planned Parenthood Stapleton in Denver is one of the agencies the clinic recommends. Monica McCafferty, director of marketing and communications for Planned Parenthood of the Rocky Mountains, said about 80 percent of Colorado counties don't have abortion services. She said Planned Parenthood does see patients coming down from Summit County for terminations, as well as regular reproductive services. Abortion services are offered at 10 of Planned Parenthood's 23 Colorado locations, but McCafferty said it's a very small percentage of what they do.
Nationally, almost 50 percent of pregnancies are not planned. Lee said only about 30 percent are unplanned in Summit County. She attributes the lower figure to the area's available services.
"That is due to the long history, I think, of having these services here in the county," she said.
There were 331 births in Summit County in 2009, according to the Colorado Department of Public Heath and Environment. 192 of those births were to women aged 30 and up.
Lee also said Summit's teen fertility rate is significantly lower than the state's. Only nine births of Summit County's 331 in 2009 were to women or girls aged 10-19. Summit's teen rate is about 33 percent lower than Colorado as a whole.
Lee said the clinic spends a lot of time on education, especially for teens. She said the clinic does community outreach to churches, nonprofits, and county middle schools. She tells young patients to tell their friends about the clinic's services.
"Any time I see a teen I think that's a great opportunity to do some education," she said.
While treatment is confidential, Lee said the clinic encourages teenagers to get their parents involved since they're often making big decisions.
"It takes a lot of guts to come in here," she said.