Long waiting lists for intrauterine devices, higher fees for STD screenings and reduced hours of operation at women's health clinics are just a few of the real consequences women in Texas are now facing since Gov. Rick Perry (R) and the Republican state legislature slashed family-planning funds, according to a report released Wednesday by the New England Journal of Medicine (NEJM).
Perry signed a bill in 2011 that reduced state funding for family-planning services from $111 million to $37.9 million for the following two years. He also approved legislation that excludes women's health clinics that affiliate with abortion providers, such as Planned Parenthood, from the state's Women's Health Program.
To survey the damage from the cuts, researchers at the NEJM interviewed 56 leaders of reproductive health organizations throughout the state that had previously received Title X and other public funding. More than 60 women's health clinics have been forced to close due to the loss of funding, and the NEJM study found that even some of the organizations that continue to receive family-planning funds lost up to 75 percent of their budgets.
The organizations interviewed by NEJM said they have had to cope with the budget cuts in ways that transfer the cost burden to patients, many of whom are low-income, uninsured, and live in rural communities that are medically under-served. Some clinics reported that they have had to limit the methods of contraception they offer. Instead of offering the $250 intrauterine device or a subdermal implant, for instance, some clinics now only offer oral contraception, and women are being provided with fewer pill packs per session. The clinics that still offer alternative methods of contraception are reporting long waiting lists for those devices, and they can only dispense them to women whose bodies react poorly to oral contraception.
Many clinics are also keeping shorter hours and having to charge women more for certain services, such as contraception, well-woman visits or STD screenings. If the women can't pay for those services, the clinics now have to turn the patients away instead of being able to cover them with public family-planning funds.
"The organizational leaders we spoke to reported that women who can pay the newly instated fees are choosing less effective methods, purchasing fewer pill packs, and opting out of testing for sexually transmitted infections to save money," the researchers wrote.
Moreover, the 35 family-planning providers that lost all public funding no longer qualify for a federal exemption to Texas' state parental consent law for teens under 18 that seek contraception. Previously, those clinics could dispense birth control to a 17-year-old with no questions asked; now that teen may have to travel further to find a publicly-funded clinic.
"Time will reveal the full effect of these budget cuts on the rates of unintended pregnancies and induced abortions and on state and federal health care costs," the report concludes. "Already, the legislation has created circumstances that force clinics and women in Texas to make sacrifices that jeopardize reproductive health and well-being."