Planned Parenthood exclusion linked to decreased contraception provision, more births covered by Medicaid

Texas’ exclusion of Planned Parenthood affiliates from its state-funded Medicaid program was associated with decreases in the rate of contraception provision and continuation, and an increase in the rate of births among low-income mothers covered by Medicaid, according to data published in The New England Journal of Medicine.

“In 2011, the Texas legislature directed the [Women’s Health Program] to exclude Planned Parenthood affiliates,” Amanda J. Stevenson, MA, of the Population Research Center, at the University of Texas at Austin, and colleagues wrote. “ … Texas then replaced the federally funded program with a nearly identical, 100% state-funded program (the Texas Women’s Health Program) that excluded clinics affiliated with an abortion provider, effective Jan. 1, 2013. Effective 15 months earlier (on Sept. 1, 2011), Texas had cut family-planning grants (a separate funding system) by 66% and redistributed the remaining grant funding away from dedicated family-planning providers, such as, but not limited to, Planned Parenthood affiliates. … The 2011 reduction in grants and redistribution of funds were followed by the closure of 82 family-planning clinics, about a third of which were affiliated with Planned Parenthood.”

To assess changes in contraceptive acquisition and continuation, and the rate of childbirths covered by Medicaid, following the exclusion of Planned Parenthood in Texas, the researchers examined claims data from 2011 through 2014, including 2 years before and 2 years after the state cuts. Specifically, they observed continuation rates among women using injectable contraceptives and Medicaid-covered births. The researchers used the difference-in-differences method to compare outcomes in the 23 counties with Planned Parenthood affiliates to those without.

According to the researchers, the number of claims for long-acting, reversible contraceptives decreased 35.5%, from 1,042 to 672, and claims for injectable contraceptives fell 31.1%, from 6,832 to 4,708. The percentage of women in counties with Planned Parenthood affiliates using injectable contraceptives who returned for a follow-up injection decreased from 56.9% among those whose follow-up was due before the state cuts, to 37.7% among those who were scheduled for a subsequent injection after the exclusion. In counties without Planned Parenthood affiliates, the rate increased from 54.9% to 58.5%. In addition, the rate of Medicaid-covered births increased by 1.9 percentage points, or a relative increase of 27.1% from baseline, within 18 months after the claim in counties with Planned Parenthood affiliates.

“The implementation of the 2013 exclusion of Planned Parenthood affiliates from a Medicaid waiver program in Texas was associated with adverse changes in the rates of provision and continuation of contraception, and with increases in the rate of childbirth covered by Medicaid,” Stevenson and colleagues wrote. “These findings have implications regarding the likely consequences of proposals to exclude Planned Parenthood affiliates from public funding in other states or at the national level.” – by Jason Laday

Disclosure: Stevenson reports grant support from the Susan T. Buffett Foundation and the Eunice Kennedy Shriver National Institute of Child Health Development. See the full study to additional financial disclosures.