By Bhavik Kumar, MD, MPH
In 2011, the Texas legislature cut its family planning budget by more than $70 million, resulting in a patchwork system of access to family planning services. Although much of this budget was restored in 2013, multiple barriers to care still exist. For example, abortion-affiliated family planning clinics that have commonly provided a significant amount of family planning and other preventive care are now specifically excluded from state funding programs like the Texas Women’s Health Program. Instead, much of the restored budget is being directed to primary care providers rather than specialized family planning providers.1 While Texas family physicians are well distributed throughout the state and provide care to a large volume of patients, it is likely a new role for many primary care providers who previously relied on family planning clinics that are now either cut off from state funds or have closed due to funding restrictions.
The recent changes have also had an impact on Texans trying to access health care services. The restructuring has resulted in confusion and complexity for patients accessing family planning care. Notably, the decreased funding has limited coverage for preventive care, such as cervical cancer screening, as well as long-acting reversible contraception like the intrauterine device and contraceptive implant. Unfortunately, the changes have been most harmful for low-income women who rely on state-funded programs for much of their health care needs.2, 3
Given this evolving landscape, researchers at the Albert Einstein College of Medicine, in partnership with the Texas Academy of Family Physicians, sought to explore Texas family physicians’ knowledge of evidence-informed contraceptive provision (per CDC guidelines), the extent of contraceptive care they currently provide, attitudes about the provision of family planning care, and to identify areas of family planning care that could require further training. Self-administered surveys were completed through TAFP regional conferences, Academy newsletters, and mailed to TAFP members. A total of 693, 15 percent of TAFP’s membership, eligible surveys were included in the final analysis.
Findings show that most respondents were not aware of recent changes to the state family planning budget and had not heard of funding structures like TWHP that prioritize funds for primary health care providers. Provision of contraception among these Texas family physicians is variable and very few offer LARCs. Some respondents cited funding and reimbursement as limitations to providing family planning care. Although most felt prepared to address the contraceptive needs of their patients, they also desired further training in at least one aspect of providing comprehensive family planning care. Addressing the need for training and helping providers access available funding could help more Texans access family planning services.
Bhavik Kumar, MD MPH is a second-year fellow in the Fellowship in Family Planning at the Albert Einstein College of Medicine, Department of Family and Social Medicine, in the Bronx, NY. Bhavik completed his medical school training at Texas Tech HSC in Lubbock and will be returning to Texas upon completion of fellowship.
Hopkins K, White K, Linkin F, Hubert C, Grossman D, Potter JE. Women’s experiences seeking publicly funded family planning services in Texas. Perspectives on Sexual and Reproductive Health. 2015; 47(2):63-70.