In September, when Texas’ near-total abortion ban took effect, Planned Parenthood clinics in the Lone Star State started offering every patient who walked in information on Senate Bill 8, as well as emergency contraception, condoms and two pregnancy tests. The plan is to distribute 22,000 “empowerment kits” this year.
“We felt it was very important for patients to have as many tools on hand to help them meet this really onerous law,” said Elizabeth Cardwell, lead clinician at Planned Parenthood of Greater Texas, which has 24 clinics across the northern and central regions of the state and provides care to tens of thousands of people annually.
Most of their patients—who tend to be uninsured and have annual household incomes under $25,000—had not known about S.B. Cardwell stated that it took 8 weeks for the program to fully take effect. She said that patients rushed to take birth control once they found out about the program.
S.B. 8 allows private citizens, in Texas or elsewhere, to sue anyone who performs an abortion in the state or who “aided or abetted” someone getting an abortion once fetal cardiac activity is detected. This is generally around six weeks, before most people know they’re pregnant. It’s had a chilling effect in Texas, where access to abortion was already limited.
Doctors and nurses are increasing their efforts to educate patients on birth control. They recognize the strategy isn’t foolproof but are desperate to prevent unintended pregnancies, nearly half of which nationwide end in abortion.
“It’s more important now than it ever has been,” said Cardwell. “I’ve been in abortion care 30-plus years, and my go-to line was, ‘You’ve got plenty of time. You don’t have to feel rushed. Talk to your partner. Talk with your family,’” she said. “Now we don’t have that luxury.”
Patients too feel a sense if urgency. During September, according to data from Planned Parenthood of Greater Texas, medical staff provided patients with some form of birth control—for example, pill packs, Depo-Provera shots or IUD implant insertions—in more than 3,750 visits. This was a 5 percent increase on September 2020.
Jennifer Liedtke (a West Texas family physician) said that she and her nurses explain S.B. Every patient who visits their private office is given 8 They saw an increase of 20% in the number of patients who sought long-acting, reversible contraceptive options, also known as LARCs (intrauterine devices, IUDs and hormonal implants) during September. They are effective in preventing pregnancy, and can last for many years. LARCs are becoming more popular. They’re also simpler than the pill, which needs to be taken daily, and the vaginal ring, which needs to be changed monthly. Still, LARCs aren’t everyone’s preferred method of birth control. It can also be very painful to insert an IUD.
A doctor’s office is one of the few opportunities for reliable birth control education. Texas law doesn’t require schools to teach sex education, and if they do, educators must stress abstinence as the preferred birth control method. When naming the birth control options, some doctors may opt to discuss abortion access in Texas.
Liedtke has become accustomed to explaining new Texas laws. “It happens all the time,” she said. The controversy around SB 8 is confusing patients more than it helps. It moves through court systems with different rulings. One of these was temporarily blocked. On November 1, the U.S. Supreme Court heard similar arguments. “People just don’t understand,” said Liedtke. “It was tied up for 48 hours, so they are like, ‘It’s not a law anymore?’ Well, no, technically it is.”
Some providers may not be able to freely discuss abortion access. Trump Administration in 2019 prohibited providers participating in Title X federally funded family planning program from mentioning the possibility of abortion to patients. This even if the patients raised questions. The Biden Administration reversed this rule in October. It will take effect this month. Planned Parenthood can discuss S.B. 8. Texas Affiliates are not eligible for Title X dollars.
Legacy Community Health’s Dr. Lindsey Vasquez, a federally-qualified health center that is the biggest in Texas, has stated that she and her staff have never discussed S.B. 8 as they must also manage multiple priorities. Legacy’s patients are underserved, she said. The majority of them live below the federal poverty line.
Nearly two years into the COVID-19 pandemic, “we’re literally maximizing those visits,” Vasquez said. There is more to their jobs than providing reproductive care. “We’re making sure they have food resources, that they have their housing stable,” she said. “We really are trying to make sure that all of their needs are met because we know for these types of populations—patients that we serve—this may be our only moment that we get to meet them.”
According to Every Body Texas (the state grantee), specialist family planning clinics receiving Title X dollars have initiated conversations about contraceptive methods.
Discussions about long-acting reversible contraception must be handled with sensitivity because these forms of birth control have a questionable history among certain populations—primarily lower-income patients. Texas and several other states introduced bills that offered cash assistance to people who were eligible for benefits.
“It’s important for a client to get on the contraceptive method of their choice,” said Mimi Garcia, communications director for Every Body Texas. “Some people will just say, ‘Let’s get everyone on IUDs’ or ‘Let’s get everybody on hormonal implants’ because those are the most effective methods. … That’s not something that’s going to work for [every]Individual. … Either they don’t agree with it philosophically or they don’t like how it makes their body feel.”
It’s a nuanced subject for providers to broach, so some suggest starting the conversation by asking the patient about their future.
“The best question to ask is, ‘When do you want to have another baby?’” said Liedtke. “And then if they say, ‘Oh, gosh, I’m not even sure I want to have more kids’ or ‘Five or six years from now,’ then we start talking LARCs. … But if it’s like, ‘Man, I really want to start trying in a year,’ then I don’t talk to them about putting one of those in.”
Biden’s Administration anticipated more Texas birth control demand, and Health and Human Services Secretary Xavier Becerra declared in September that Every Body Texas would get additional Title X funding. Additionally, providers in the area who are experiencing increased clientele as a consequence of S.B. would also receive Title X funding. 8.
But providers said improved access to contraception will not blunt the law’s effects. Patients who are trying to get pregnant, but decide against abortion, will not be protected by the law, according to Dr. Elissa Serasio, an OB/GYN from Rio Grande Valley, and a Fellow with Physicians for Reproductive Health.
“It’s the very best that we can do,” said Cardwell, of Planned Parenthood of Greater Texas. “There’s no 100% effective method of birth control.”
KHNKaiser Health News (Kaiser Health News), is a national newsroom that publishes in-depth reporting on health issues. KHN, along with Policy Analysis and Polling are the major three operating programs. KFF(Kaiser Family Foundation). KFF is an endowed, nonprofit organization which provides health information for the country.