Texas providers have seen increased interest in birth control since the near-complete ban on abortion
In September, when the near-total abortion ban went into effect in Texas, the Planned Parenthood clinics in the Lone Star State began offering Senate Law 8 information, as well as emergency contraception, condoms, and two pregnancy tests, to every patient who walked in. This year, 22,000 “empowerment kits” are to be distributed.
“We felt it was very important that patients have so many tools on hand to help them comply with this really onerous law,” said Elizabeth Cardwell, senior clinician at Planned Parenthood of Greater Texas, which operates over 24 clinics in the northern and western regions central regions of Texas are owned by the state and serve tens of thousands of people annually.
Most of their patients – who are typically uninsured and have an annual household income of less than $ 25,000 – hadn’t known about SB 8 for the first few weeks after it was introduced, Cardwell said. But when they found out, patients seemed to be rushing to start birth control, she said.
SB 8 allows individuals in Texas or elsewhere to sue anyone who has an abortion in the state or has “assisted or aided” an abortion once fetal heart activity is detected. This usually takes about six weeks before most people know they are pregnant. It had a deterrent effect in Texas, where access to abortion was already restricted.
Medical staff are increasing patient education about birth control. They realize the strategy isn’t foolproof, but they are desperate to prevent unwanted pregnancies, nearly half of which nationwide end in abortion.
“It’s more important now than ever,” Cardwell said. “I’ve been in abortion care for over 30 years and my first choice was, ‘You have plenty of time. You don’t have to feel rushed. Talk to your partner. Talk to your family, ‘”she said. “Now we don’t have that luxury anymore.”
Patients also seem to feel a sense of urgency. According to data from Planned Parenthood of Greater Texas, medical staff provided patients with some form of contraception – such as pill packs, Depo-Provera syringes, or IUD implants – for more than 3,750 visits in September – for more than 3,750 visits, 5% more than in September 2020.
Dr. Jennifer Liedtke, a family doctor in West Texas, said she and her nurses explain SB 8 to every patient who comes to their private practice and see a 20 percent increase in requests for long-acting reversible birth control methods called LARCs. in September.
LARCs, a category that includes intrauterine devices and hormonal implants, are becoming increasingly attractive because they are 99% effective in preventing pregnancy and lasting for several years. They’re also simpler than the pill that has to be taken daily or the vaginal ring that has to be changed monthly.
However, LARCs are not everyone’s preferred method. For example, inserting an IUD can be painful.
A doctor’s office is one of the few options for reliable education about birth control. Texas law does not require schools to teach sex education, and if so, educators must emphasize abstinence as the preferred method of birth control. Some doctors choose to explain access to abortion in the state when naming birth control options.
Liedtke is used to having to explain new laws from the Texan legislature. “It happens all the time,” she says. But the controversy surrounding SB 8 confuses patients all the more as the law makes its way through the jurisdiction with different judgments, one of which temporarily blocked the measure. The US Supreme Court heard similar arguments on November 1st.
“People just don’t understand,” said Liedtke. “It was handcuffed for 48 hours, so they say, ‘It’s no longer a law?’ Well, no, technically it is. “
Not all providers can speak freely about access to abortion. In 2019, the Trump administration banned vendors participating in the state-funded Title X family planning program from mentioning abortion care to patients, even when patients ask questions themselves. In early October, the Biden government lifted this rule. The change will take effect this month. Planned Parenthood can discuss SB 8 in Texas as Texas Affiliates are not receiving Title X Dollars.
Dr. Lindsey Vasquez of Legacy Community Health, the largest state-qualified health center in Texas and a recipient of Title X dollars, said she and other staff members didn’t talk about abortion or SB 8 because they have to juggle a variety of other priorities as well. Legacy’s patients are underserved, she said. A majority live at or below the federal poverty line.
Almost two years after the Covid-19 pandemic, “we are literally maximizing these visits,” said Vasquez. Their tasks go beyond the provision of reproductive care. “We make sure they have food resources, that they have stable housing,” she said. “We really try to make sure that all of their needs are met because we know that for these types of populations – patients we care for – this may be the only time we can meet them.”
Specialized family planning clinics receiving Title X dollars are having proactive conversations about contraceptive methods, according to Every Body Texas, the state’s Title X grantee.
Discussions about long-acting reversible contraception need to be treated with sensitivity as these forms of contraception have a questionable history in certain populations, especially low-income patients. In the 1990s, lawmakers in several states, including Texas, introduced bills to provide financial incentives for cash benefit recipients to receive an implant, or to require the insertion of people with government benefits, a move seen as reproductive coercion.
“It’s important that a customer uses the contraceptive method of their choice,” said Mimi Garcia, communications director for Every Body Texas. “Some people will just say, ‘Let’s all put on IUDs’ or ‘Let’s all put on hormone implants,’ because these are the most effective methods. … This is not going to work [every] Individually. … Either they don’t philosophically agree with it or they don’t like the way their body feels because of it. “
It’s a nuanced topic that providers need to address, so some suggest starting the conversation by asking the patient about their future.
“The best question is: ‘When do you want another baby?'” Says Liedtke. And then when they say, ‘Oh God, I’m not even sure if I want to have more kids’ or ‘in five or six years,’ then we start talking about LARCs. … But when it says, ‘Man, I really want to start trying in a year,’ then I’m not talking to them about using one of them. “
The Biden government expected greater demand for birth control in Texas, so Secretary of State for Health and Human Services Xavier Becerra announced in mid-September that Every Body Texas would receive additional Title X funding, as would local providers due to SB. would see an influx of customers 8.
However, providers said improved access to contraception will not mitigate the effects of the law. It does not protect patients who want to get pregnant but ultimately choose to have an abortion because they are diagnosed with a serious complication, change their relationship status, or lose financial or social support, said Dr. Elissa Serapio, a gynecologist in the Rio Grande Valley and Fellow with Physicians for Reproductive Health.
“This is the best we can do,” said Cardwell of Planned Parenthood of Greater Texas. “There is no such thing as a 100% effective method of birth control.”
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