At the beginning of 2013, Texas—a state that has made abortion care virtually impossible to receive in many counties—excluded Planned Parenthood from its Medicaid family planning program. As a result, far fewer low-income women in the state received contraception, according to a new study published in the New England Journal of Medicine. And many more had babies.

The study revealed that after the exclusion, prescriptions for long-acting reversible birth control, like IUDs and implants—which have been proven more reliable than short-term birth control methods like condoms or the pill—dropped by a startling 36 percent.

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Similarly, prescriptions for injectable birth control like Depo Provera dropped by 31 percent, and the study found that after the change, 20 percent of women who had previously relied on Planned Parenthood for their Depo Provera injections failed to return for their follow-up injections, despite the fact that Depo Provera shots must be received every three months in order to be effective.

Without insurance or Medicaid coverage, an IUD can cost up to $1,000, and a single Depo Provera shot can cost up to $100. The study found no significant decrease in the use of short-term contraception, which is generally less expensive, but also has significantly higher rates of failure.

"20 percent of women who had previously relied on Planned Parenthood for their Depo Provera injections failed to return for their follow-up injections."

At the same time, the rate of childbirth among the same group of women rose by 27 percent. Although the study looked at four years of data, this dramatic increase in Medicaid-covered births was observed within 18 months of the exclusion of Planned Parenthood affiliates from the state’s Medicaid program.

Planned Parenthood has clinics in 23 counties in Texas, and 60 percent of low-income women who qualify for Medicaid live in those counties. Access to abortion care in Texas has become so sparse that large numbers of women in the state have resorted to seeking out “DIY abortions.”

But this phenomenon isn’t a threat to women’s health just in Texas. Overall, it’s estimated that more than half of all pregnancies in the U.S. are unplanned. Pete Schenkkan, a Texas attorney and co-author of the study, pointed out that “Initiatives to exclude medically qualified providers of family planning and other women’s health services if they are affiliated in any way with abortion providers have been adopted or proposed in 17 U.S. states and both houses of the U.S. Congress.”

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“Supporters of these proposals claim that other providers can meet the needs of women served by Planned Parenthood clinics,” Schenkkan continued. “Until now, this claim had not been empirically tested. On January 1, 2013, Texas became the first state to enforce such a law, and the study analyzes the results of this real world test.”

The study’s findings suggest that when low-income Texas women lost access to Planned Parenthood’s services, they didn’t actually find alternative sources of contraceptive care—they just received less of it. The authors of the study are hopeful that their findings could have an impact on other proposals to exclude Planned Parenthood affiliates from public funding at both the state and national level.

Another recent study, published by the journal Contraception, revealed that following the enactment of the 2013 law, Texas women who’d previously turned to Planned Parenthood for family planning and contraceptive care encountered roadblocks like unnecessary exams, multiple visits, and additional costs when they were forced to seek out a new provider after Planned Parenthood clinics were excluded from Medicaid programs.

"The study’s findings suggest that when low-income Texas women lost access to Planned Parenthood’s services, they didn’t actually find alternative sources of contraceptive care—they just received less of it." 

“The U.S. continues to have higher rates of unintended pregnancies than most rich nations,” Amanda Jean Stevenson, the study’s lead author, said. “And we know that U.S. and Texas women face barriers as they try to access preventative services. It’s a public health issue that Texas women struggle to achieve their reproductive goals.”