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The Consolidation and Expansion of Women's Health Programs at the Health and Human Services Commission

Prepared for Texas Senate Health and Human Services Committee (Sept. 13, 2016)

Testimony by Chloe Dillaway on behalf of Dr. Joseph Potter.

[Download a PDF of the testimony]

Hi, my name is Chloe Dillaway, and I am here on behalf of Dr. Joseph Potter. We’re part of the “Texas Policy Evaluation Project,” an investigation of the impact of reproductive health legislation in Texas. Today, I will be speaking on the consolidation and expansion of women's health programs.

In 2014, we began a study of 1,700 women from 8 hospitals across Texas who just had a baby. We interview them about their experiences getting the birth control method they want. A typical woman in our study had her delivery paid for by Medicaid or CHIP, doesn’t want another baby for at least 2 years, and is looking for a birth control method she can rely on.

We conducted a similar study in two Texas cities soon after the 2011 funding cuts to women’s health services. In that study, we found that the majority of women desired highly effective methods like sterilization, IUD’s and implants. However, women could not access these methods. As a result, 20% of women became pregnant within 2 years, the vast majority of which were unintended pregnancies [1], [2].

The current study began following the legislature’s 2013 consolidation and expansion of women’s health programs. Unfortunately, the results of the new study are no different. Today the picture for women looks much the same as it did following the 2011 cuts. We continue to see great demand for highly effective methods. However, 3 months after delivering their babies, nearly half of women are relying on less effective methods, such as condoms and withdrawal (see figure 1 below), while nearly 90% of them want to be using something more effective.

So why is effective contraception inaccessible?  First, the majority of women leave the hospital with no contraception. This is a problem because a quarter of women don’t make it back for any check-up after delivery. Second, women who do return face many barriers getting birth control, including high cost and multiple appointments.

Although the picture is dim overall, the outlook is much more promising at one of the hospitals in our study. This hospital provides immediate insertion of IUD’s and implants after delivery. At 3 months, 60% of women are using long-term or permanent methods, which is much higher than at any other hospital in our study.  

The January 2016 Medicaid rule change allowing reimbursement for IUD and implant insertions immediately after delivery has great potential to increase access to highly effective methods for women who want them. However, its success will depend on more than just money. It will involve counseling pregnant women on birth control options prior to delivery, actively disseminating information about the policy change to hospitals across Texas, training clinicians to provide contraception immediately after delivery, and ensuring that procedures are in place for hospitals to stock and bill Medicaid for these methods. 

In closing, women who already have children account for a large fraction of the unintended pregnancies in our state. Improving access to highly effective contraception for this group will require a dramatic shift in medical practice and hospital and clinic administration. This is an historic opportunity for Texas to improve the health of mothers and their children while establishing programs that will result in long-term cost savings for the state.

Fig. 1
             Fig. 2

[1] Potter, J. E. et al. Unmet demand for highly effective postpartum contraception in Texas. Contraception 90, 488–95 (2014).

[2] Potter, J. E. et al. Barriers to postpartum contraception in Texas and pregnancy within 2 years of delivery: Obstet. Gynecol. 127, 289–296 (2016).

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