“If this feels like a full-on assault on women’s health, that’s because it is.” —Hillary Clinton, August 8, 2015
Kari White, PhD, MPH, Kristine Hopkins, PhD, Abigail R. A. Aiken, MD, PhD, Amanda Stevenson, MA, Celia Hubert, MA, Daniel Grossman, MD, and Joseph E. Potter, PhD published “The Impact of Reproductive Health Legislation on Family Planning Clinic Services in Texas” in the 105th volume of the American Journal of Public Health, May 2015.
Why the study? In 2011, Texas Governor Rick Perry announced significant funding cuts to women’s health care and family planning programs. Before Texas’ legislative cuts went into effect, Title X (Family Planning), Title V (Maternal and Child Health), and Title XX (Social Services) were funded by a federal block grant, which supported 72 qualified organizations in Texas (including Planned Parenthood and other non-profit affiliates). Funds also supported the WHP (Women’s Health Program), which provides Medicaid waivers to legal U.S. residents with poverty-level incomes.
In total, 336,967 women were served by these programs, 11,837 of them by PP specifically and 119,083 by the Medicaid waiver WHP program. This case study describes and analyzes the funding cut impacts and “provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services.”
Results of the study? In response to anti-abortion advocates, Texas’s family planning budget was cut by 76%, from $111 million to $37.9 million. Additionally, the legislature implemented a tiered system that prioritizes funding for public health departments over specialized providers (like PP and smaller affiliates and non-affiliates). Finally, the legislature reauthorized the WHP, also reauthorizing the ban on any organization affiliated with abortion providers.
Results of Texas’s legislation fell into 4 categories:
(1) Clinic closures and reduced hours: 82 clinics closed, 22 clinics stopped offering family planning services altogether, and 49 clinics significantly reduced hours.
(2) Changes in cost of services for providers and women: 67% of clinics lost their 340B drug discounts resulting in substantially increased contraceptive costs to women.
(3) Changes in contraceptive and clinical services: Fewer than 42% of clinics provide implants and IUDs, and female sterilization is provided by fewer than 15%. All 3 methods are considered the most effective in preventing unplanned pregnancies and, thus, are first-line options.
“There was no change in the availability of cervical cancer screening, annual chlamydia and gonorrhea screening for women aged 25 years and younger, and HIV testing between FY2011 and FY2012-2013,” which are offered onsite by clinics.
(4) Changes in client volume: Clients served dropped by 54%, which correlates with funding cuts across the board.
How was the study conducted? The study used general surveys and in-depth interviews with leaders (executive directors, medical directors, or program directors) of 72 family planning organizations to determine both pre-cuts service levels and post-cuts strategies to adapt. Both the surveys and interviews were conducted simultaneously, and 2 waves of each were conducted. State administrative data was analyzed to determine pre-cuts funding levels and client volume.
- Fewer women served and limited access to the most effective contraception will likely result in an upsurge of unintended pregnancies, costing the state in the form of Medicaid-paid births
- Undocumented women are suffering the most because they are ineligible for the WHP and are deemed a lower priority than adolescents and those with poverty-level incomes.
- New state funding to replace federal funds does not allow organizations to offer family planning services to adolescents without parental consent
- Public agencies, federally qualified health centers, and other organizations suffered significant funding losses, even though they were not the target of anti-abortion driven legislation
- Organizations with the most experience providing contraception are at a significant disadvantage in the tiered funding system, while less trained and experienced providers offer far fewer options to women.
- Organizations that have lost essential staff and infrastructure or closed altogether may not be able to function again even if funds were available now.
- In March 2012, the Centers for Medicare and Medicaid Services rejected Texas’s renewal application because women in Texas are not allowed to choose their own qualified provider under the state’s exclusion policy (which is a violation of federal law). Ultimately, federal funding for WHP — which provided 90% of the program’s support — was discontinued.
- On October 19, Texas cut off Medicaid funding to Planned Parenthood.
Who are the authors?
Kari White is with the Department of Health Care Organization & Policy, University of Alabama, Birmingham. At the time of the study, Kristine Hopkins, Abigail R. A. Aiken, Amanda Stevenson, Celia Hubert, and Joseph E. Potter were with the Population Research Center, University of Texas, Austin. Daniel Grossman is with Ibis Reproductive Health, Oakland, CA. Correspondence should be sent to Kari White, Department of Health Care Organization & Policy, University of Alabama at Birmingham, RPHB 320, 1720 2nd Ave S, Birmingham, AL 35294 (e-mail: firstname.lastname@example.org).
This study was approved by the institutional review boards at the University of Alabama, Birmingham, and University of Texas, Austin. All participants provided oral informed consent.
This study was funded by a grant from an anonymous foundation and the National Institute of Child Health and Human Development (NICHD) center (grant 5 R24 HD042849) awarded to the Population Research Center at the University of Texas, Austin. Abigail Aiken was supported by an NICHD predoctoral fellowship (F31 HD079182-01). Note. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Planned Parenthood Federation of America, Inc.