Medicaid Births on the Rise in Texas

Photograph by Twenty20

A new report from the University of Texas at Austin shows that low-income women in that state—who benefit most from access to clinics, such as Planned Parenthood, that provide affordable, effective birth control—are having more babies and Medicaid is picking up the tab.

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The study from the Population Research Center at the University of Texas at Austin tracked the rate of births paid for by Medicaid against the rate of injectable contraceptive continuation between 2011 and 2014. They found that the number of women who used that method of birth control decreased, particularly in areas where there was less access to a family-planning clinic, and the number of Medicaid births went up at the same time.

In 2011, Texas cut state-funded, family-planning grants by two-thirds. Because of the dramatic financial resource cuts, 82 clinics—about one-third of which were affiliated with Planned Parenthood—had to close. The federal government and courts blocked the state from diverting or cutting off federally funded Medicaid programs related to Planned Parenthood services. But in 2013, Texas set up its own state-funded program called the Texas Women's Health Program and ditched federal funding in order to legally withhold funding from any clinic that had ties to abortion providers.

According to the Los Angeles Times, Planned Parenthood clinics served 60 percent of the state's low-income women of childbearing age—meaning the cuts and closures have made it much more difficult for these women to access birth control.

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The Texas study, published in the New England Journal of Medicine this month, focused only on injectable contraceptives because they require regular visits to a provider since they only remain effective for three months. The study does not include oral contraceptive pills, which can be prescribed for a little as one month and as many as 12 months at a time; it also did not include long-acting reversible contraception options such as IUDs or birth control implants, which can last for several years before a required visit may be necessary.

In the last decade, IUD and implant usage to prevent pregnancy have increased nearly five-fold; a CDC report from 2015 cited that just more than 7 percent of women ages 15 to 44 rely on these long-term contraceptive devices to prevent unwanted pregnancies. After Planned Parenthood was excluded from Texas' state-funded program, the number of women receiving long-acting, reversible contraceptives dropped by 35.5 percent in the state, and the number of women receiving injectable contraceptives dropped by more than 31 percent.

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A 2013 study from the George Washington University School of Public Health showed that nearly half of all births in the U.S. were paid for by Medicaid. At the time, researchers said the study would give them a baseline to determine how access to health services might change pregnancy and birth outcomes. In that study, Medicaid coverage by state varied; poorer, Southern states made up a higher percentage of Medicaid births. The lowest rate of Medicaid-funded births was Hawaii, with 25 percent; the highest rate was Louisiana at nearly 70 percent.

Researchers say what's happening in Texas is just a glimpse of what's to come in other states if clinics stop receiving state funding like they have in that state. Ohio, Arkansas, Alabama, New Hampshire, Louisiana, North Carolina and Utah are the states most at risk currently because lawmakers are actively defunding Planned Parenthood in all those states—meaning more women will have less access to affordable, safe reproductive health services and birth control options.

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