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The impact of dramatic budget cuts on women's experiences seeking affordable family planning services in Texas
Abstracts / Contraception 88 (2013) 433–473
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preventive screening, and women not getting the method they want; only some of these consequences are the direct result of recent budget cuts. Conclusions: The funding cuts have exacerbated the challenges lowincome women in Texas already faced when trying to meet their reproductive health needs.
White K University of Alabama at Birmingham, Birmingham, AL, USA
P23 Hopkins K, Aiken A, Stevenson A, Hubert Lopez C, Grossman D, Potter JE Objectives: Several state legislatures recently have proposed legislation to cut family planning budgets or exclude specialty family planning providers from receiving public funding. We examine the initial impact of such actions on the delivery of publicly funded family planning services in Texas, which in 2011 both dramatically cut, and restricted participation in, their family planning program. Methods: Between February and June 2012, we contacted executive directors of the 76 organizations that received state-administered funding to provide family planning in Texas in 2010. Fifty-four completed a survey about changes in service delivery at their organization as a result of the 2011 changes. We also conducted in-depth interviews with leaders at 28 organizations about strategies they adopted in response. Results: Of the 76 funded organizations in 2010, 34 received less funding in 2012, and 35 organizations (13 of which were specialty family planning providers) lost all funding. Among organizations completing the survey, 37% closed clinics, 27% reduced service hours and 46% laid off staff. Availability of nearly all contraceptive methods declined; only 55% of organizations widely offered long-acting reversible contraception, compared with 69% in 2010. The most common strategy that organizations adopted was charging women for services if they did not qualify for another public program. Many organizations also expanded fundraising or drew upon funding reserves to continue providing services, but this was not viewed as sustainable. Conclusions: Although Texas presents a unique case, it provides insight into the potential effects that provisions proposed elsewhere may have on lowincome women's access to family planning services.
P22 THE IMPACT OF DRAMATIC BUDGET CUTS ON WOMEN'S EXPERIENCES SEEKING AFFORDABLE FAMILY PLANNING SERVICES IN TEXAS Hopkins K University of Texas at Austin, Austin, TX, USA White K, Linkin F, Hubert Lopez C, Grossman D, Potter JE Objectives: The 2011 Texas Legislature cut its budget for family planning services by two-thirds, from approximately $50 million to just $15 million per year. This study explores low-income women's and teens' experiences obtaining affordable family planning services following the budget cuts. Methods: We conducted 11 focus groups with women and teens throughout Texas: nine adult groups (six conducted in English and three in Spanish) and two teen groups (both in English). Participants were recruited through organizations that serve low-income populations. Overall, 92 adults and 15 teens participated in the groups. Recordings were transcribed, and at least two researchers independently coded each transcript. Results: Women reported that affordable family planning services are very difficult to access, unless one qualifies for Medicaid. In addition, previously free services now require payment, leaving some to forgo care. Nearly all women expressed very strong support for government assistance for family planning, and many were frustrated that it is easier to access government help for pregnancy and childbirth than for the prevention of pregnancy. Teens reported difficulties obtaining services due to state parental consent requirements, but this appears unrelated to the funding cuts. Finally, many negative consequences exist because of a history of limited coverage for family planning, such as unplanned pregnancies, inability to access
SPATIAL VARIATION IN THE IMPACT OF FAMILY PLANNING CUTS IN TEXAS Stevenson AJ University of Texas at Austin, Austin, TX, USA White K, Hubert Lopez C, Hopkins K, Aiken A, Grossman D, Potter JE Objectives: Measuring the local impacts of state family planning budgets cuts requires concise statistical descriptions of the provision of services and their impact at multiple levels of geographic aggregation. We developed local estimates of demographic characteristics, volume and cost of services provided, and impacts, and made them easily accessible through a mobile application. Methods: Each site receiving public funding for family planning services delivery was geocoded and associated with its county, senate district, house district, and public health region. Women served and funds spent were associated with each site. American Community Survey data were used to estimate women in need in each geographical area. For each area, before and after the cuts, we estimated unintended pregnancies averted and Medicaid costs saved, unmet need for subsidized contraception, and open and closed family planning clinics. Results: There is substantial geographic variation in the impact of the reductions in family planning funding in Texas. Rural areas were already more underserved than urban areas, but the disparity grew with the cuts. For example, rural counties were about 1.5 times as likely as urban counties to transition from having at least one family planning provider to having no providers. There was wide variation in impact across more urban counties: In El Paso County, savings rose from $3.74 million to $4.53 million, while in Lubbock County, savings fell from $4.53 million to $173,952. Conclusions: Mobile technology is an effective way to investigate and display spatial variation in family planning policy impacts at varying levels of geographic aggregation.
P24 THE FACTORS UNDERLYING THE 82ND TEXAS LEGISLATURE’S DECISION TO RESTRICT ACCESS TO FAMILY PLANNING IN TEXAS Aiken A University of Texas at Austin, Austin, TX, USA Garrette D Objectives: The 2011 Texas Legislature enacted a series of laws restricting access to family planning. Such legislation is rising nationally, yet we have little understanding of the factors associated with legislators’ voting behavior on reproductive health issues. We address three main questions: (1) What is the trend in reproductive health legislation in Texas from 1991– 2011? (2) To what extent is the passage of bills that restrict access to reproductive health attributable to partisanship, both in 2011 and over time? (3) What is the relative influence of other factors? Methods: Our dataset combines roll-call record votes for the Texas house from 1991–2011 with legislator and constituency characteristics. We employ a Bayesian factor probit model to identify correlations between legislators’ votes and candidate explanatory factors. Results: Reproductive health legislation has increased dramatically over the past 20 years in Texas. Bayesian analysis of variance for the 2003 and 2011
P21 THE IMPACT OF REPRODUCTIVE HEALTH LEGISLATION ON FAMILY PLANNING CLINIC SERVICES IN TEXAS
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preventive screening, and women not getting the method they want; only some of these consequences are the direct result of recent budget cuts. Conclusions: The funding cuts have exacerbated the challenges lowincome women in Texas already faced when trying to meet their reproductive health needs.
White K University of Alabama at Birmingham, Birmingham, AL, USA
P23 Hopkins K, Aiken A, Stevenson A, Hubert Lopez C, Grossman D, Potter JE Objectives: Several state legislatures recently have proposed legislation to cut family planning budgets or exclude specialty family planning providers from receiving public funding. We examine the initial impact of such actions on the delivery of publicly funded family planning services in Texas, which in 2011 both dramatically cut, and restricted participation in, their family planning program. Methods: Between February and June 2012, we contacted executive directors of the 76 organizations that received state-administered funding to provide family planning in Texas in 2010. Fifty-four completed a survey about changes in service delivery at their organization as a result of the 2011 changes. We also conducted in-depth interviews with leaders at 28 organizations about strategies they adopted in response. Results: Of the 76 funded organizations in 2010, 34 received less funding in 2012, and 35 organizations (13 of which were specialty family planning providers) lost all funding. Among organizations completing the survey, 37% closed clinics, 27% reduced service hours and 46% laid off staff. Availability of nearly all contraceptive methods declined; only 55% of organizations widely offered long-acting reversible contraception, compared with 69% in 2010. The most common strategy that organizations adopted was charging women for services if they did not qualify for another public program. Many organizations also expanded fundraising or drew upon funding reserves to continue providing services, but this was not viewed as sustainable. Conclusions: Although Texas presents a unique case, it provides insight into the potential effects that provisions proposed elsewhere may have on lowincome women's access to family planning services.
P22 THE IMPACT OF DRAMATIC BUDGET CUTS ON WOMEN'S EXPERIENCES SEEKING AFFORDABLE FAMILY PLANNING SERVICES IN TEXAS Hopkins K University of Texas at Austin, Austin, TX, USA White K, Linkin F, Hubert Lopez C, Grossman D, Potter JE Objectives: The 2011 Texas Legislature cut its budget for family planning services by two-thirds, from approximately $50 million to just $15 million per year. This study explores low-income women's and teens' experiences obtaining affordable family planning services following the budget cuts. Methods: We conducted 11 focus groups with women and teens throughout Texas: nine adult groups (six conducted in English and three in Spanish) and two teen groups (both in English). Participants were recruited through organizations that serve low-income populations. Overall, 92 adults and 15 teens participated in the groups. Recordings were transcribed, and at least two researchers independently coded each transcript. Results: Women reported that affordable family planning services are very difficult to access, unless one qualifies for Medicaid. In addition, previously free services now require payment, leaving some to forgo care. Nearly all women expressed very strong support for government assistance for family planning, and many were frustrated that it is easier to access government help for pregnancy and childbirth than for the prevention of pregnancy. Teens reported difficulties obtaining services due to state parental consent requirements, but this appears unrelated to the funding cuts. Finally, many negative consequences exist because of a history of limited coverage for family planning, such as unplanned pregnancies, inability to access
SPATIAL VARIATION IN THE IMPACT OF FAMILY PLANNING CUTS IN TEXAS Stevenson AJ University of Texas at Austin, Austin, TX, USA White K, Hubert Lopez C, Hopkins K, Aiken A, Grossman D, Potter JE Objectives: Measuring the local impacts of state family planning budgets cuts requires concise statistical descriptions of the provision of services and their impact at multiple levels of geographic aggregation. We developed local estimates of demographic characteristics, volume and cost of services provided, and impacts, and made them easily accessible through a mobile application. Methods: Each site receiving public funding for family planning services delivery was geocoded and associated with its county, senate district, house district, and public health region. Women served and funds spent were associated with each site. American Community Survey data were used to estimate women in need in each geographical area. For each area, before and after the cuts, we estimated unintended pregnancies averted and Medicaid costs saved, unmet need for subsidized contraception, and open and closed family planning clinics. Results: There is substantial geographic variation in the impact of the reductions in family planning funding in Texas. Rural areas were already more underserved than urban areas, but the disparity grew with the cuts. For example, rural counties were about 1.5 times as likely as urban counties to transition from having at least one family planning provider to having no providers. There was wide variation in impact across more urban counties: In El Paso County, savings rose from $3.74 million to $4.53 million, while in Lubbock County, savings fell from $4.53 million to $173,952. Conclusions: Mobile technology is an effective way to investigate and display spatial variation in family planning policy impacts at varying levels of geographic aggregation.
P24 THE FACTORS UNDERLYING THE 82ND TEXAS LEGISLATURE’S DECISION TO RESTRICT ACCESS TO FAMILY PLANNING IN TEXAS Aiken A University of Texas at Austin, Austin, TX, USA Garrette D Objectives: The 2011 Texas Legislature enacted a series of laws restricting access to family planning. Such legislation is rising nationally, yet we have little understanding of the factors associated with legislators’ voting behavior on reproductive health issues. We address three main questions: (1) What is the trend in reproductive health legislation in Texas from 1991– 2011? (2) To what extent is the passage of bills that restrict access to reproductive health attributable to partisanship, both in 2011 and over time? (3) What is the relative influence of other factors? Methods: Our dataset combines roll-call record votes for the Texas house from 1991–2011 with legislator and constituency characteristics. We employ a Bayesian factor probit model to identify correlations between legislators’ votes and candidate explanatory factors. Results: Reproductive health legislation has increased dramatically over the past 20 years in Texas. Bayesian analysis of variance for the 2003 and 2011