In 2011, Texas legislators slashed the state’s family planning budget by 67 percent. The justification? To reduce abortions by defunding clinics associated with an abortion provider (read: Planned Parenthood). Now, it turns out Texas legislators actually accomplished the opposite: narrowing access to family planning services only led to more unplanned pregnancies and more abortions.
In a study that will soon be published in the Journal of Health Economics, researcher Analisa Packham found that in the years following the 2011 funding cuts, Texas’ teen birth rate went up by 3.4 percent, which suggests that nearly 2,200 teens would not have given birth if funding hadn’t been cut. Also in the three years after the cut, Texas’ teen abortion rate went up by about 3 percent. Those numbers mean that because teen childbearing often comes at significant cost to taxpayers, the budget cut likely ended up costing Texas taxpayers more than the millions that legislators claimed they “saved” by slashing family planning.
“Just seeing the increase in raw data is striking because you don’t see this mirrored in other states,” Packham, an assistant professor of economics at Miami University Farmer School of Business, told me. “The increase in teen pregnancy is a costly unintended consequence of attempting to close down these clinic sites, which don’t even provide abortion.”
Back in 2011, Texas lawmakers decided to remake the state’s family planning landscape. They cut the state’s family planning budget from $111 per biennium to $37.9 million and put in a three-tiered system that favored clinics with comprehensive health services over clinics that primarily provided family planning services (read: Planned Parenthood). That meant family planning clinics would absorb the brunt of the budget cut. The result: By 2012, 25 percent of family planning clinics had shuttered, 18 percent reduced service hours, and about half had to fire staff. By the end of 2013, according to the study, more than 160 clinics had lost all funding, included 82 clinics that were forced to shut their doors. The number of publically funded family planning clinics went from 287 to 126 in two years. (Also important to note: At the time of the budget cut, it was already illegal for clinics to provide an abortion if they accepted public money.)
In analyzing state health data, Packham found that the funding cuts resulted in higher teen birth rates among those ages 16, 17, 18 and 19, but she did not find an impact on 15-year-olds. The birth rate in Texas counties with a Planned Parenthood clinic increased by 3.2 percent in the four years following the funding cut, though Packham said a 2013 measure to bar Planned Parenthood from the Texas Women’s Health Program could have contributed as well. Overall, 11 Planned Parenthood clinics closed after the 2011 cuts. Teens in richer Texas counties seemed to be less affected by the budget cuts than their peers in lower-income counties.
So, how is Packham able to confidently attribute increases in teen births to the state’s funding cut? After all, teen pregnancy is a complex issue with many contributing factors. To help isolate the effects of the funding cut, Packham used something called the synthetic control design, which is a technical way of saying she compared birth rates in Texas to rates in other states that have a similar teen birth pattern. Then, if Texas experienced a sharp break from its peers after 2011, Packham could more confidently attribute the birth increase to the funding cut. (And as we know now, the state did experience a spike after 2011.)
Packham said as far as she knows, her study is the first to examine the impact of family planning funding cuts on childbearing. It’s a critical policy issue, she told me, because research shows that teen pregnancy is often associated with a host of adverse outcomes, such as living in poverty, fewer educational opportunities, lower wages and greater dependence on public assistance. The kids of teen parents are also more likely to live in poverty.
“If we care about reducing teen pregnancy, one way to do that is to increase access to contraception,” she said. “It’s essentially an investment in women and children. No matter what side of the aisle you’re on, (family planning) should be something that everyone supports.”
In recent years, Texas lawmakers did restore a portion of the eliminated family planning funds. But rebuilding lost infrastructure isn’t that easy. Packham writes:
In the past two years, the Texas state legislature has simultaneously restored funding for family planning services by 19 percent and implemented new restrictions on abortion providers and clinics affiliated with abortion providers. Given the high fixed costs of establishing a network of health care facilities, few publicly funded clinics have been able to rebuild and achieve funding comparable to previous levels. Moreover, several Texas abortion clinics and other affiliated clinics have closed since the 2013 regulations. It is unclear how these policies will affect childbearing and reproductive health in the years to come, and future work should consider the impacts of the fluctuation of funding on teen health outcomes.
Packham noted that many of the Texas clinics forced to shutter served a particularly important role for low-income women, with many clinics being the only source in the community where women could access contraception at low or no cost.
“One of the big issues here is that the stated policy goal (of the Texas funding cut) was to reduce abortion,” she told me. “But by cutting funding for publically funded family planning clinics that don’t provide abortion, it’s unlikely that we’d see that policy goal met.”
Right now in Congress, the GOP is considering a health care bill that would kick Planned Parenthood out of the Medicaid program and scrap mandates to cover contraception as an essential health benefit. And news just broke this past week that the Trump administration has cut more than $213 million in teen pregnancy prevention programs and research, even though family planning efforts have been shown to yield a significant return on investment. Packham said if Republicans succeed in defunding Planned Parenthood, she wouldn’t be surprised to see higher rates of unintended pregnancy across the nation.
“Funding for family planning is a smart long-term investment,” she told me. “At the end of the day, this funding pays back benefits in kind.”
To download a full copy of the Texas study, go here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.
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