Executive Summary
Women in Texas face hurdles when it comes to getting long-acting reversible contraceptive (LARC) methods following cuts to the state family planning budget by the 2011 Texas State Legislature.
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Research indicates that after giving birth, nearly 75% of women reported their ideal form of birth control for the postpartum period would be a LARC method or sterilization. However, six months after birth, only 27% of women were using those preferred methods.
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In 2011, the Texas state legislature reduced family planning funding by two-thirds and allocated the remaining funds through a three-tiered priority system.
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In 2013, the legislature took a critical step forward, restoring much of the public funding. However, much of the funding is only now beginning to replenish or start programs.
Women in Texas are facing hurdles when it comes to getting long-acting reversible contraceptive (LARC) methods following cuts to the state family planning budget by the 2011 Texas Legislature. Research by the Texas Policy Evaluation Project indicates that after giving birth, nearly 75% of women reported their ideal form of birth control for the postpartum period would be a LARC method or sterilization. However, six months after birth, only 27% of women were using those preferred methods, with the key factors linked with nonuse of preferred method being low income and not having health insurance.1
The research is based on interviews with more than 800 women ages 18-44 from Austin and El Paso who had just given birth and wanted to wait at least two years before having another child. The women had private or public insurance. Participants were asked about their current contraceptive use and the method they would prefer to use at six months after delivery.
At six months postpartum, 13% of women were using an intrauterine device or implant, and 17% were sterilized or had a partner who had had a vasectomy. Twenty-four percent were using hormonal methods, and 45% relied on less effective methods, such as condoms. However, 44% reported that they would prefer to use sterilization, while 34% said they would prefer to use LARC methods.1
The research is part of the evaluation project’s five-year, comprehensive effort to analyze the impact of the measures affecting reproductive health passed by the Texas Legislature. Team members include researchers from the University of Texas at Austin’s Population Research Center, Cambridge, MA-based Ibis Reproductive Health, and the University of Alabama — Birmingham.
"Because over half of unintended pregnancies in the U.S. occur in the two years following delivery, we are especially concerned that a large number of women who do not want to conceive rely on less effective methods such as condoms and withdrawal as late as six months after delivery," said Daniel Grossman, MD, vice president of research at Ibis Reproductive Health and a research co-author, in a press statement.
In 2011, the Texas Legislature reduced family planning funding by two-thirds and allocated the remaining funds through a three-tiered priority system. Public entities such as health departments were classified as Tier 1, and specialty family planning providers were placed in Tier 3. The remaining non-public entities that provided comprehensive preventive and primary care in addition to family planning were classified as Tier 2.
The funding changes affected all three tiers of facilities, according to the researchers. Organizations in all tiers closed clinics and reduced hours at other locations.2 Tier 3 clinics reported a higher percentage of clinics closed or reduced hours compared with Tier 1 and 2 organization clinics. While Tier 3 organizations accounted for a smaller number of total sites, researchers found they served about 40% of women seeking publicly funded family planning services.2
Nearly half of the organizations reported staff reductions between September 2011 and January 2012, with some organizations cutting total staff by more than 50%.2 Following the funding cuts, organizations reported more limited availability of nearly all methods. Fewer organizations widely offered long-acting methods, and more Tier 3 organizations reported limited or no availability of such methods, primarily due to the higher up-front costs.2
In 2013, the Legislature took a critical step forward and restored much of the public funding for family planning.1
"However, much of this funding is only now beginning to replenish or start programs, and it remains to be seen whether these efforts will substantially increase access to long-acting and permanent methods," the researchers state.
Colorado, Iowa, Georgia, Louisiana, New Mexico, New York, and South Carolina provide Medicaid coverage for immediate postpartum IUD and contraceptive implant placement outside of the global fee for delivery.3,4
"It is our hope that Texas Medicaid and the Department of State Health Services will consider this option to increase access to highly effective contraception for women in Texas," said Joseph Potter, PhD a demographer at the University of Texas at Austin and lead author of the study.
Project investigators will be following the women in the Austin part of the study for two years and will be assessing the number of unintended pregnancies that could have been prevented if the women being studied were using their preferred method of contraception. The telephone interviews are scheduled every three months, says Kristine Hopkins, PhD, research assistant professor in the Department of Sociology at the University of Texas at Austin and co-author of the current paper.
1. Potter JE, Hopkins K, Aiken AR, et al. Unmet demand for highly effective postpartum contraception in Texas. Contraception 2014; doi: 10.1016/j.contraception.2014.06.039.
2. Texas Policy Evaluation Project. Survey of Reproductive Health Clinics in Texas. Accessed at http://bit.ly/1BspJTu.
3. Kottke M. Georgia’s opportunity: immediate postpartum IUD and implant placement. OBGYN News 2014. Accessed at http://bit.ly/1p7CtWW.
4. New York City Department of Health and Mental Hygiene. Health officials announce new initiative to increase access to highly effective contraception immediately after childbirth. Press release. Accessed at http://on.nyc.gov/1risX7z.
