Defunding Planned Parenthood May Lead to Less Contraception

In 2011, Planned Parenthood affiliates in Texas were excluded from a state-funded replacement for a Medicaid fee-for-service program. Researchers now report that the exclusion was followed by a decrease in provision of contraception in the state and an increase in the rate of childbirth covered by Medicaid.

Amanda J. Stevenson, MA, from the University of Texas at Austin, and colleagues published their analysis of program claims online February 3 in the New England Journal of Medicine. The study was prompted by the abrupt decision by the Texas legislature on September 1, 2011, to exclude Planned Parenthood affiliates from its fee-for-service family-planning program. The researchers focused on the 2 years immediately after the exclusion.

After the exclusion, claims for long-acting, reversible contraceptives (LARCs) decreased 35.5%, from 1042 to 672 (P < .0001). Claims for injectable contraceptives decreased by 31.1%, or 6832 to 4708 (P < .001). In the 18 months after the legislation was passed, the rate of childbirth covered by Medicaid increased by 1.9%, which represented a 27.1% increase from baseline (P = .01).

Moreover, counties with Planned Parenthood affiliates at the time of exclusion had a reduction in the number of claims for LARC methods, which reversed the trend toward an increased number of claims for LARC methods that had been seen before the exclusion.

There was also a difference in on-time LARC continuation rates before and after the change in counties with Planned Parenthood affiliates (56.9% before vs 37.7% after) compared with counties that did not have affected clinics (54.9% before vs 58.5% after; P < .001).

The authors suggest that the data from Texas would likely be generalizable to other states or to the nation, should Planned Parenthood affiliates be excluded from public funding elsewhere.

"Our data are observational and cannot prove causality," the authors write. "However, our analyses suggest that the exclusion of Planned Parenthood affiliates from the Texas Women's Health Program had an adverse effect on low-income women in Texas by reducing the provision of highly effective methods of contraception, interrupting contraceptive continuation, and increasing the rate of childbirth covered by Medicaid. Although our data do not capture specific barriers that Planned Parenthood clients encountered after the exclusion, another study that was based on interviews with women using injectable contraceptives that were paid for by the Women's Health Program before the exclusion of Planned Parenthood affiliates in two Texas cities (Houston and Midland) revealed obstacles that these clients faced after exclusion."

In particular, the authors note that before the Planned Parenthood exclusion, funding cuts had, in general, reduced access to LARC methods.

This research was supported by a grant from the Susan T. Buffett Foundation for the Texas Policy Evaluation Project and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to the Population Research Center, University of Texas at Austin. The authors have disclosed no relevant financial relationships.

N Engl J Med. Published online February 3, 2016. Full text