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Research Suggests Mexico’s Family Planning Initiative Could Serve as Template for Texas

TxPEP Study Shows Unmet Demand for Postpartum Contraception Among Mexican-Born Women in Texas

AUSTIN, Texas—New research from the Texas Policy Evaluation Project (TxPEP) shows unmet demand for postpartum long-acting reversible contraception (LARC) among Mexican-born women in Texas. Mexico’s family-planning initiative, launched in the 1980s, made postpartum LARC—including the Intra-Uterine Device (IUD)—widely available to women at no cost. Recently, there has been considerable interest in the United States for postpartum access to highly effective contraception such as the IUD. The research, based on a 2013 survey of postpartum Mexican-born women in Austin and El Paso, as well as reanalysis of surveys conducted in Mexico between 1987 and 2014, was recently published online in Maternal and Child Health Journal.

The study points to the vast difference between the proportion of women in Mexico and the U.S. who use LARC in the first several months following delivery. In 2014, 19 percent of women in Mexico had an IUD or implant placed immediately following delivery, whereas less than 0.1 percent of women in the U.S. began using these methods before they left the hospital.

“The transformative impact of Mexico’s national family-planning initiative is not well known,” Dr. Joseph Potter, TxPEP lead investigator and lead author of the study, said. “Some of the strategies used by Mexico’s health authorities in the 1980s, including training physicians in immediate postpartum insertion of IUDs and subsidizing the cost of devices, provided widespread access to postpartum LARC among women throughout the public healthcare system.” 

The TxPEP study revealed that while over half of Mexican-born women in Texas preferred to use an IUD or implant after delivery, less than 10 percent were actually using these methods. Nearly half were relying on less effective methods such as condoms or withdrawal, or no method at all, but very few had a preference for these methods. 

The study underscores the contrast for Mexican women living in the U.S. between the highly effective types of contraception they would like to use and could easily access if they were living in Mexico, and the less effective methods they are actually able to access in the U.S. Immediate postpartum LARC is not yet available in either Austin or El Paso, although it has been in Mexico for more than 30 years.

Only recently, Texas revised its Medicaid policy to reimburse hospitals for the cost of devices and postpartum insertion, effective January 1, 2016. The extent to which Medicaid policy changes will increase women’s access to LARC following delivery depends on future efforts to facilitate counseling and provision of immediate postpartum LARC.

Dr. Kari White, co-author of the study and an assistant professor at the University of Alabama at Birmingham, said, “The U.S. lacks national policies that ensure women have affordable access to their method of choice, which Mexico was able to achieve more than three decades ago. By leaving it up to the states to create their own policies, the U.S. has created an incomplete patchwork of coverage for women.”

The situation in Texas was especially dire at the time the study was conducted, just one year after the state Legislature slashed family-planning funding by two-thirds. Texas is now in a better position to make access to highly effective contraception a reality. In the last two legislative sessions, the state has increased funding for family planning services through new programs. However, there is still much work to be done to ensure organizations and healthcare providers have the training and resources they need to meet the large demand for contraceptive methods and to guarantee access for all women in Texas.

About the Texas Policy Evaluation Project

The Texas Policy Evaluation Project, or TxPEP, is a comprehensive effort to document and analyze the impact of the measures affecting reproductive health passed by the Texas Legislature. The project team includes researchers at the University of Texas Population Research Center, the University of California San Francisco, Ibis Reproductive Health, and the University of Alabama-Birmingham. The project is supported by grants from the Susan Thompson Buffett Foundation and the Society of Family Planning. Infrastructure support for the Population Research Center is provided by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Funders of the Texas Policy Evaluation Project have no role in the design and conduct of the research, interpretation of the data, approval of the final manuscript or decision to publish.

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