How Did Planned Parenthood Defunding Affect Women in Texas?

Contraceptive use was interrupted and more Medicaid-covered births occurred after Texas excluded Planned Parenthood from its fee-for-service family planning program.

A new study published in The New England Journal of Medicine examined data from all pharmacy and medical claims made between January 1, 2011, and December 31, 2014, under public fee-for-service family planning insurance programs in Texas.

Of the state’s 254 counties, 23 had clinics affiliated with Planned Parenthood. These 23 counties alone comprised 60% of women in Texas living at or below 185% of the federal poverty level.

The study authors’ objective was to examine the effects of the 2013 exclusion of Planned Parenthood affiliates from a Medicaid waiver program in Texas.

One of the factors that the researchers considered was contraceptive use, which was broken down into 3 categories:

1. Long-acting reversible contraception (LARC), which includes contraceptive implants and intrauterine devices.

• The American College of Obstetricians and Gynecologists (ACOG) has stated that LARC is the most effective method of reversible birth control. In the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring, according to ACOG.

2. An injectable contraceptive (depot medroxyprogesterone acetate).

3. Short-acting hormonal methods such as the pill, transdermal contraceptive patches, and contraceptive rings.

After Texas blocked Planned Parenthood patients from accessing care through the state’s Women’s Health Program, there was a 35% decline in LARC use and a 27% increase in births among women who had previously been using injectable contraception, the researchers discovered. In the first quarter after the exclusion, LARC claims saw a “sharp decrease” in counties with Planned Parenthood clinics, but not in those lacking clinics affiliated with Planned Parenthood.

The Planned Parenthood exclusion was also linked with reductions in the number of claims for both LARC (from 1042 to 672, a relative reduction of 35.5%) and injectable contraceptives (from 6832 to 4708, a relative reduction of 31.1%).

“[This] represents a divergence from the trend toward an increased number of claims for LARC methods in counties with Planned Parenthood affiliates in the years preceding the exclusion—a trend that has also been observed nationally,” the researchers stated.

In counties with Planned Parenthood affiliates, the percentage of women using injectable contraceptives who returned for a subsequent on-time injection decreased from 56.9% to 37.7% following the exclusion. Meanwhile, in counties without Planned Parenthood affiliates, there was an increase in on-time injections from 54.9% to 58.5%.

Furthermore, the percentage of women who had a Medicaid-covered birth within 18 months increased from 7% to 8.4% in counties with Planned Parenthood affiliates and decreased from 6.4% to 5.9% in counties without the affiliates. This resulted in a relative increase of 27.1% from baseline in the proportion of women who had previously been using injectable contraceptives but had a Medicaid-covered birth within 18 months of the claim.

“…[O]ur analyses suggest that the exclusion of Planned Parenthood affiliates from the Texas Women’s Health Program had an adverse effect on low-income women in Texas by reducing the provision of highly effective methods of contraception, interrupting contraceptive continuation, and increasing the rate of childbirth covered by Medicaid,” the researchers concluded.

The researchers also cited another study that found women who went to Planned Parenthood clinics following the exclusion were required to pay a fee of $60 or more for a contraceptive injection.

“These findings have implications regarding the likely consequences of proposals to exclude Planned Parenthood affiliates from public funding in other states or at the national level,” the study authors argued.

Cecile Richards, president of Planned Parenthood Federation of America, wrote in a press release that this research demonstrated the “devastating consequences” of efforts to block access to Planned Parenthood.

“Politicians have claimed time and again that our patients can simply go to other health care providers — and tragically that’s not the case,” Richards said in the press release. “…Texas is fast becoming a cautionary tale for politicians in Ohio, Utah, and other states targeting care at Planned Parenthood.”

Planned Parenthood critic National Right to Life did not respond to requests for comment.

On February 19, 2016, The Associated Press reported that study author Rick Allgeyer was stepping down from his position as director of research at the Texas Health and Human Services Commission next month.

Allgeyer faces accusations that he wrote the study on taxpayer time. He has also been criticized by Republican leaders for what the study implied regarding disrupted access to contraceptives for Texas women.

One of the critics is Republican state Sen. Jane Nelson, who dismissed the research in part because it was funded by the Susan T. Buffet Foundation, which supports Planned Parenthood. Sen. Nelson also argued that there were other state health services available for women, but the study neglected to mention them.

"Critical evaluation is essential to good government, but women should not be misled into thinking the services they need are not available to them," Sen. Nelson said, according to The Associated Press.