Finding contraception in Texas: How planned parenthood patients on injectable contraception fared after legislative changes

In 2013, Texas\u27s single largest reproductive healthcare provider was barred from a state-funded family planning program. We performed a telephone questionnaire from July through October 2014 of 224 program clients who previously received injectable contraception at the large healthcare provider in fall 2012. Clients were selected from two sites: a major metropolis and a remote, smaller city. In spring 2013, 295 of 2,045 major metropolitan clients (14.4%) and 35 of 54 other clients (64.8%) returned to the healthcare provider for injectable contraception, a significant difference (p = .000) that likely reflects lack of alternative providers in the remote area at that time. Statewide, of surveyed women who wished to continue injectable contraception, only half (50.4%) were able to do so both free and on time. Almost 1 in 4 women (24%) missed their doses because of barriers, most commonly finding a provider and affording the injection. While the program is intended to provide contraception without cost, 11.2% of covered women reported paying something for the dose. Almost 60% of women were required to undergo a physical examination, contrary to evidence-based practice guidelines. Among 30 women who cited barriers as a reason for discontinuing the injection, seven (23%) became pregnant in 2013. Given the effectiveness of the contraceptive injection, up to six of these pregnancies were preventable, if those women had wished to continue the injection all year and had done so (p = .0006). While this study\u27s scope was limited, our findings suggest that injectable contraception use was disrupted during the rollout of the state-funded family planning program. Women living outside major metropolises may have been disproportionately affected. Unintended pregnancies in Texas may have increased at least temporarily as a result. We recommend that the state annually survey program participants about barriers to care; use results to publicly grade providers; offer providers an incentive to stock depot medroxyprogesterone; encourage evidence-based screening practices; and facilitate telemedicine for reproductive healthcare in West Texas and rural areas