Program Spotlight: Houston Chronicle, Decrease in Birth Control Access

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Houston Chronicle Speaks with Texas Women’s Healthcare Coalition, A Healthy Futures of Texas Program, About the Decrease in Low-Income People Accessing Birth Control


Texas health programs report 21% drop in long-term birth control in runup to abortion ban

Jeremy Blackman, Austin Bureau

Aug. 4, 2022

The number of low-income people accessing highly effective forms of contraception in Texas health programs dropped for the second straight year, according to new data covering the fiscal period that ended last August, just as the state’s new six-week abortion ban took effect.

Use of intrauterine devices and contraceptive implants fell by 21 percent from the previous fiscal year in Healthy Texas Women and Family Planning, the two state-administered programs for reproductive health services. It was down about 30 percent overall from fiscal year 2019.

Any decline in access to long-acting contraception would make it harder to prevent unwanted pregnancies and came as lawmakers were working to cut off access to abortion for nearly seven million Texans of reproductive age. IUDs and implants are more likely to prevent pregnancy than condoms and other shorter-term forms of contraception.

“The drop off is definitely concerning,” said Diana Forester, the director of health policy at Texans Care for Children. “I imagine state leaders will want to figure out if this is a temporary decline due to the pandemic or if there’s a deeper problem they need to fix.”

Without abortion access, demand for long-acting contraception is only expected to grow. But the state has struggled for years to meet existing demand, according to research. Many women do not receive their preferred forms of contraception, and providers often can’t perform same-day insertions because of the high cost to stock the devices — IUDs can cost several hundred dollars apiece.

Health researchers said it is too soon to know exactly what was behind the drop, but that it does not necessarily mean fewer people were accessing those forms of contraception. Many women who became pregnant during the pandemic have remained on Medicaid under temporary federal protections, and are eligible to receive long-acting contraception through that coverage.

Still, Kari White, who heads the Texas Policy Evaluation Project at the University of Texas at Austin, said other data show similar declines at the beginning of the pandemic, when many providers were short-staffed or focused on other health responses.

Placements of IUDs and implants fell by about 22 percent in Medicaid in fiscal year 2020, which included the first months of the pandemic, according to data from the Texas Health and Human Services Commission. Data for the 2021 fiscal year is not yet available.

“All we know is what was happening with the numbers,” White said. “We don’t necessarily know from a patient perspective how much of this was people switching methods, people newly adopting a method, which I think could impact people’s chances of getting pregnant if they didn’t want to be.”

Martha Zuniga, who runs health clinics in and around Corpus Christi, said providers struggled with staff shortages at the beginning of the pandemic, and it took longer to coordinate in-person appointments. Health departments and hospitals were also forced to redirect resources toward treating COVID-19 patients.

A spokeswoman for the state health agency said the pandemic “continues to impact enrollment and utilization.”

Texas lawmakers passed a six-week abortion ban last spring; it took effect Sept. 1 after the U.S. Supreme Court declined to intervene. The high court has since overturned federal abortion protections, wiping out nearly all access in Texas.

Lawmakers responded in part last year to the challenges in accessing contraception by expanding Medicaid for new mothers to six months, up from two. Most other states have expanded the same coverage to a full year postpartum.

The number of pregnant patients and new mothers on Medicaid grew from 3.9 million to 5.4 million between March 2020 and May of this year. Health advocates said many of those patients will need to transition back to the state-run programs when the federal health emergency ends; it’s currently extended through October 13.

“We expect to see an influx of people getting back to getting their preventative services care, their primary care, their equal health care,” said Erika Ramirez, the policy and advocacy director at the Texas Women’s Healthcare Coalition. “So programs like Healthy Texas Women and Family Planning Program need to be ready to handle that uptick.”




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