New England Journal of Medicine Says Texas’ Family Planning Cuts Are A Public Health Disaster

It’s been nearly a year since Texas legislators slashed the state’s family planning funding, diverting $73 million to a variety of other programs. That was about two-thirds of the total family planning budget, and the conservative lawmakers who orchestrated the cuts were vocal about why they’d done it: to harm Planned Parenthood and other “abortion providers.” That’s despite the fact that under state and federal law, this money has never gone toward abortion services.

“Of course this is a war on birth control and abortions and everything,” Rep. Wayne Christian told the Texas Tribune. “That’s what family planning is supposed to be about.”

Now, the New England Journal of Medicine has published the results of a three-year study on the impact of the family planning cuts and other changes to the state’s public reproductive-healthcare system. They call Texas’ family planning legislation “the most radical” in the United States, and warn that it is dismantling the social safety net.

Over the course of three years, the study’s authors interviewed 56 leaders of state organizations who received Title X and other public funding, both before and after the cuts went into effect. Title X is the money Texas receives from the federal government that’s earmarked for family planning and contraception.

What researchers found is that most of the clinics have stopped being able to provide more effective, long-term contraceptive methods, like IUDS, because of their higher costs. Women are being steered toward birth control pills, the authors found, but being provided with fewer pill packs per visit. It’s “a practice that has been shown to result in lower rates of continuation with the method and that may increase the likelihood of unintended pregnancy — and therefore that of abortion.”

Women who don’t qualify for the Medicaid Women’s Health Program are also affected by the lack of state funding, they found. Many clinics are now requiring those women to pay for services, where before they could have been covered by public funds. And the women who do pay the new fees are purchasing fewer packs of birth control pills and opting out of STD testing to save money. It’s not yet clear what will happen when the federally-funded WHP, in which Planned Parenthood previously saw almost half of all clients, disappears entirely, replaced by a state-run, Planned Parenthood-less alternative .

Before the cuts there were 76 funded family-planning organizations in the state; now there are 41. The 35 organizations who lost funding can no longer buy discount birth control pills through a special state program. The higher costs they pay are passed on to their patients. And because they no longer receive Title X money, they’re no longer eligible for the state law that lets Title X organizations provide confidential contraceptive services to teenagers. Teens who don’t want their parents notified that they’re seeking birth control will have to travel further to find an organization that will treat them — or will simply go without.

In making the cuts, lawmakers argued that public hospitals, Federally Qualified Healthcare Centers (FQHCs) and other organizations would step in to fill the gap. But the study’s authors found “considerable variation across Texas in terms of the willingness and ability of communities to cover the shortfall.” In one community, the main public hospital is relying on the county indigent care program to treat women, and running up a deficit in the process.

The authors are blunt: the cuts were meant to harm Planned Parenthood, but instead have hit every family planning provider. “We are witnessing the dismantling of a safety net that took decades to build and could not easily be recreated,” the authors write. “Even if funding were restored soon.”

Which it won’t be. That much we can count on.