Texas birth control demand is set to grow. Is the state

“With the economy and everything going up, I just can’t afford to have two pregnancies,” she said.

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Ramírez’s situation reflects an immense need in the country: 21 million women of reproductive age needed publicly funded contraceptive care as of 2016, according the Guttmacher Institute. Demand is expected to increase in states like Texas, where strict abortion laws mean many people, mostly in poor communities of color, now will have to carry pregnancies to term.

But Texas is ill prepared, healthcare advocates and policy experts warn. Significant policy changes and funding cuts over the last decade make it more difficult for low-income patients to access contraceptives, threatening to worsen the already poor maternal health outcomes in the state.

“A lot of this (new) legislation is focused on protecting the rights of the unborn, but we need to be equally focused on protecting the rights of women and their ability to make decisions about their health,” said Dr. Rola El-Serag, director of the Baker Institute’s Center for Health and Biosciences at Rice University and former expert educator in women’s health with the Department of Veterans Affairs.

Increasing demand

Originally from Mexico City, Ramírez moved to Houston when she was 9 years old. She became a citizen at around 12 and enlisted in the Texas National Guard at 17. Her contract expired last year, she said, just as she became pregnant. Debt mounted, so she turned to Door Dash. Her fiancé, a contractor who installs HVAC systems, also helped support them.

Now a new mother, she continues to pursue a career as a Realtor with Keller Williams while family members help at home with the baby. She stresses over breastfeeding and struggles with postpartum depression. Groceries, car payments and credit card bills remain a constant concern.

With an IUD, she will not have to worry about another pregnancy adding to her burden. Abortion laws did not factor into her decision, she said, but demand for contraceptives has already increased at some Houston-area clinics since the Supreme Court struck down Roe v. Wade three weeks ago.

Planned Parenthood Gulf Coast, which covers eight clinics in the greater Houston region, has seen a 67 percent increase in patients seeking long-term reversible contraceptives, such as IUDs and implants, according to a spokesperson.

Legacy Community Health, the largest federally qualified health center in Texas, and the four family planning clinics operated by the Houston Health Department also have experienced a surge of interest in long-acting contraceptives, officials told the Chronicle. Other news outlets have reported similar trends elsewhere in the state.

“Anecdotally, I can tell you, now women are taking family planning a lot more seriously, because they know an unplanned pregnancy is not going to be something that they can easily mitigate,” said Dr. Devanshi Somaiya, chief of family planning for the Houston Health Department.

Health care gaps

Clinics are facing this growing interest after a decade of significant changes to the state’s family planning programs. Family planning includes contraceptive access as well as pregnancy testing, counseling and STD testing.

In 2011, the legislature slashed the family planning budget dramatically, from $111 million to $38 million, and made it harder for Planned Parenthood and other specialized family planning organizations to access the remaining funds, according to the researchers at the Texas Policy Evaluation Project based at the University of Texas at Austin.

As a result, 82 clinics across Texas closed or stopped providing family planning services, and fewer organizations provided IUDs, implants and female sterilization and vasectomy due to high costs.

Lawmakers reinstated funding over the next several years, which helped some providers rebuild services, while continuing to steer money away from Planned Parenthood, which serves a disproportionately high share of family planning patients. Even as funding stabilized, the state has struggled to fill coverage gaps and has consistently declined to expand Medicaid coverage.

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Uninsured and publicly insured women commonly report issues paying for care, finding a provider that accepts their insurance and locating providers that offer the services they need, according to the policy evaluation project. Research also shows most women in that population are not using their preferred birth control method. Meanwhile, the state continues to boost funding for an anti-abortion program that supports faith-based pregnancy centers, which generally do not offer contraceptives.

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The loss of critical safety net providers, coupled with the growing shortage of healthcare workers and pandemic-related job losses, likely have contributed to longer wait times at some clinics, said Dr. Anna Chatillon, a researcher with the policy evaluation project. A typical wait for a family planning visit could be a month or more at Houston Health Department and Legacy clinics, officials say.

Somaiya said she could use more money at health department clinics to offer competitive salaries for a shrinking pool of healthcare workers. She would like to build out infrastructure, including mobile clinics, to dispense birth control to communities most in need.

At Legacy, funds are needed to meet the steadily growing number of patients seeking family planning services. The number has ballooned from 46,562 in 2018 to 67,896 last year at all of its Houston-area clinics, according to data provided by organization. Already, in the firsts six months of 2022, Legacy has nearly surpassed the 2018 total.

“What we’ve received from the state and the federal government has been very minimal compared to the amount of patients that we see on a normal day,” said Lindsay Lanagan, vice president of government relations and public affairs at Legacy.

‘Something for myself’

It’s not just money that providers and patients need, said Dr. Vian Nguyen, an OB-GYN and chief medical officer at Legacy.

Cutting down on the logistical hurdles of applying for government funding might encourage more patients to seek out healthcare, she said. It takes more than an hour for some patients to work through different eligibility criteria and complete the paperwork, she said.

“Funding is great, but if

we don’t make it easy for people, the reality is, that’s just not their number one priority in certain patient population groups,” she said. “It’s not what they’re thinking about.”

Ensuring better access to women’s healthcare is especially critical in a state with the highest uninsured rate in the country and one of the worst maternal death rates nationwide, experts say.

Ramírez is grateful to have access to doctors who, in the midst of her busy life, can answer all of her questions.

On Monday, she saw Nguyen at the bustling Legacy clinic on Mapleridge street, where they talked about what Ramírez described as mild depression. The doctor also helped her identify the type of birth control she preferred. The IUD will be free with Medicaid, she said.

Ramírez is eager to work with the goal of one day owning rental properties in Mexico.

“I want to support my daughter,” she said. “And I want to do something for myself.”