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Examining the impact of STI on pregnancy outcome is difficult. For ethical reasons it is not usually possible to prospectively study the effects of an untreated STI once the diagnosis has been made. Many studies have therefore been retrospective in design, where data have been collected on STIs and birth outcomes at or after delivery, and where it may have been difficult to control for other confounding factors earlier in the pregnancy that affect pregnancy outcome.

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This issue brief begins by discussing the disparities in access to sexual and reproductive health care, including the glaring disparities in how STIs affect people of color. It then investigates how $16 billion dollars is spent annually on STI treatment and complications, as well as the personal stigma experienced by individuals diagnosed with an STI. The third section explores the types of health care facilities that provide the best care for STIs and the importance of multiple funding streams for STI testing and treatment. Lastly, the brief offers several policy recommendations—including the need to expand Medicaid, increase Title X funding, and sustain a variety of health care funding options and facilities—that would ensure that everyone who needs STI testing and treatment is able to access those services.

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This trend could be due to several factors. While the higher STI screening rates at a publicly funded clinics suggest that private providers lag behind on implementing current protocols or fail to inform patients of STI screening options, they also reflect the standards and regulations of care that come with Title X funding—while not all publicly funded clinics receive Title X funds, more than 4,100 do. Title X clinics, for example, must provide patients with screenings for symptomatic and asymptomatic STIs. These screenings are often performed concurrently with other reproductive and sexual health care at publicly funded clinics, meaning that they offer patients comprehensive care. All types of publicly funded clinics were more likely to provide STI care in their mix of services than private providers. Publicly funded clinic visits also involve a discussion of condoms—the only way to protect against STIs other than abstinence—more often than visits to a private provider.