Texas Policy Evaluation Project
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The Consolidation and Expansion of Women's Health Programs at the Health and Human Services Commission

Prepared for the Texas Senate Health and Human Services Committee (September 13, 2016)

Testimony by Dr. Kari White

[Download a PDF of the testimony here]

My name is Kari White.  For the past five years, I have been a co-investigator on the “Texas Policy Evaluation Project,” a comprehensive effort to document and analyze the impact of measures affecting reproductive health passed by the Texas Legislature.  I am here today on my own behalf to speak on the consolidation and expansion of women's health programs at the Health and Human Services Commission.

Since 2012, the Texas Policy Evaluation Project has conducted interviews with administrators at organizations that have participated in state-funded family planning programs.  We have found that the 2011 family planning funding cuts and reallocation of funds to primary care organizations resulted in 82 clinics closing or eliminating family planning services and 54% fewer clients served.1,2 The funding cuts, in addition to the exclusion of Planned Parenthood from the Texas Women’s Health Program, also led to reduced access to intrauterine devices and contraceptive implants (known as long-acting reversible contraception, or LARC), which are the most effective at preventing pregnancy.2,3

Therefore, we appreciate the increase and consolidation of funding for family planning services into the new Healthy Texas Women’s program and are pleased that the network of providers has increased over the last several years.

Although the new program has strengths, our research shows that increasing funding and enrolling new providers is not sufficient to extend access to care for Texas women.  After creation of the Expanded Primary Health Care Program in 2013, many organizations that had not previously provided family planning services through state programs began doing so.  Our interviews with these new providers revealed it was difficult for them to start a family planning program from the ground up.  For example, in a community where the local Planned Parenthood clinic closed, the director of a public health organization explained to me, “There was a big learning curve there, and honestly, we got very, very little guidance... We were in the dark, and it was like okay, so now we’re going to start doing family planning… Where did you get the implantable birth control? Not that I expected a recipe manual, but it would have been a little helpful if there would have been an information sheet shared to contractors … instead of the administrator of the facility being the work horse on the ordering and learning.”

This administrator, like others we spoke to, commented that clinical staff initially lacked training to provide IUDs and implants.  This was because it was costly and logistically challenging to arrange provider training with the manufacturers, as required.  As a result, these methods were not widely available at clinics.  Also, new providers struggled to establish contracts with vendors did not serve the number of women they had anticipated.

We also learned that the new providers (as well as some of those that previously participated) did not routinely use evidence-based clinical protocols to provide women with contraception.  They required women to make multiple visits in order to undergo screening tests and wait for results that were not medically necessary to get their method of birth control.  This is concerning because it is burdensome to women and may keep them from obtaining timely access to highly effective contraception and prevent pregnancy.  Additional – and unnecessary – visits also are more costly to the program.

To summarize, the recent changes to family planning programs in Texas are a positive step toward rebuilding the reproductive health safety net for low-income women in the state.  But to ensure new programs like Healthy Texas Women serve the many Texas women in need, we conclude that the following would assist providers in achieving that goal:

1)     Provide technical assistance to new providers regarding vendors, purchasing and skills training to provide long-acting methods of contraception to facilitate their participation in these programs

2)     Require participating providers to document that they have continuing education in evidence-based guidelines for contraceptive and reproductive health care, such as those published by the American College of Obstetricians and Gynecologists.

Finally, the continued exclusion of Planned Parenthood clinics from participation in state programs will continue to limit the pool of qualified family planning providers in the state.

Kari White, PhD MPH
Co-Investigator, Texas Policy Evaluation Project
kariwhite@uab.edu

1. White K, Grossman D, Hopkins K, Potter JE. Cutting Family Planning in Texas. N Engl J Med. 2012;367(13):1179-1181.
2. White K, Hopkins K, Aiken ARA, et al. The impact of reproductive health legislation on family planning clinic services in Texas. Am J Public Health. 2015;105(5):851-858.
3. Stevenson AJ, Flores-Vazquez IM, Allgeyer RL, Schenkkan P, Potter JE. Effect of Removal of Planned Parenthood from the Texas Women’s Health Program. N Engl J Med. 2016;374(9):853-860.