Texas’s aggressive campaign to defund Planned Parenthood has led to a steep drop-off in access to popular forms of contraceptives for poor women, and, for some women, a 27% increase in births, a new study published in the New England Journal of Medicine has found.
The study, released on Wednesday, is the fullest exploration yet of the effects of eliminating Planned Parenthood from a safety net that tens of thousands of women rely on for reproductive healthcare screenings and family planning services. In January 2013, Texas became the first state to cut off almost all federal and state funds to Planned Parenthood.
Researchers found that Medicaid claims in Texas for IUDs and other implants that act as long-term contraceptives had dropped 35%, and claims for birth control injections had dropped 31% in the two years since Texas defunded Planned Parenthood affiliates. Among women who had been getting routine birth control shots from Planned Parenthood, pregnancy rates shot up 27%.
“Simply put, dedicated women’s health providers matter,” Joseph Potter, a sociology professor at the University of Texas at Austin and the lead author of the New England Journal of Medicine, said. “Providers who are mission-driven and have the requisite experience and knowledge appear to be critical for the delivery of the most effective methods of contraception.”
Along with Potter, who helps run a program to monitor the effects of the state’s drastic cuts in family planning funds, the authors are a fellow University of Texas professor, two members of the Texas Health and Human Services Commission, and an Austin attorney who served as a lawyer for Planned Parenthood.
This new data comes as Republican leaders in several states are attempting to follow in Texas’s footsteps. Last summer, anti-abortion activists released a series of sting videos purporting to show Planned Parenthood employees breaking federal abortion laws. The claims in the videos, which were heavily edited, have been disproved. But they have nevertheless motivated governors and lawmakers in nearly two dozen states to try to strip away hundreds of millions of dollars Planned Parenthood uses to provide free or low-cost STI and cancer screenings and contraceptives to low-income women. Without the funds, Planned Parenthood officials have said, most affiliates would have to charge for the services, putting them out of reach for poor women.
Supporters of those attempts have widely asserted that other publicly funded providers can absorb Planned Parenthood’s patients. This study, its authors say, throws those claims into doubt.
The study comes on the heels of another report , published in the journal Contraception, saying that only half of all women who were receiving contraception shots from Planned Parenthood received their first shot after the group was defunded at no cost and on time.
Since the release of the videos, two states, North Carolina and New Hampshire, have stripped family planning funds from Planned Parenthood. Several other states, including Arkansas, Utah, Alabama, and Louisiana, are fighting to sever Planned Parenthood’s Medicaid contracts. (None of the funds at stake are used to perform abortions.)
But Planned Parenthood has won several court fights to restore the Medicaid funds. States are generally prohibited from limiting a woman’s choice of qualified Medicaid provider, and defunding Planned Parenthood can lead the federal government to withhold a state’s Medicaid funds.
Texas is the only state to attempt a radical end-run around these rules. Under governor Rick Perry, a Republican who left office in 2015, the state completely forfeited the $9-to-$1 match in federal Medicaid dollars for women’s health. The move allowed Texas to exclude Planned Parenthood and other affiliates of abortion providers from its state-financed women’s health program. At the time, Planned Parenthood provided 40 percent of state-funded family planning services .
The new women’s health program enrolled about 20,000 fewer women after it excluded Planned Parenthood, according to an April 2015 report by the Texas Health and Human Services Commission.
The battle to defund Planned Parenthood in Texas has echoes in similar fights going on now. Texas had 23 counties with Planned Parenthood affiliates when it defunded the group. Nationwide, there are 491 counties where Planned Parenthood operates a reproductive health clinic, 332 counties where it provides the majority of safety net services, and 103 counties where it is the only safety net provider, according to the Guttmacher Institute, a think tank that supports abortion rights.
In order to justify defunding Planned Parenthood, Texas officials in 2013 drew up a list of alternative providers. But women’s health advocates found that the list included radiologists and anesthesiologists – not providers who routinely prescribe contraceptives. Likewise, officials in Louisiana and abortion opponents in Ohio have suggested food banks and dentist offices as alternatives 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,” said Cecile Richards, the president of Planned Parenthood, of the study released Wednesday. “Instead, women were left out in the cold. Texas is fast becoming a cautionary tale for politicians in Ohio, Utah, and other states targeting care at Planned Parenthood.”