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Commentary: Why Texas should reject proposed changes to Title X

Access to contraception is one of the nation’s most important public health achievements over the past 100 years, contributing to better-timed and spaced pregnancies, which tend to be healthier and safer for mothers and babies and improves the economic status of women and their families.

But if newly proposed federal regulations take effect, millions of low-income people — including nearly 200,000 Texans — will find it much harder to obtain affordable contraception. Such a development would be unhealthy for them and for Texas in general.

On May 22, the U.S. Department of Health and Human Services (HHS) announced dramatic changes to the Title X, the only federal program dedicated to supporting family planning services. Since 1971, Title X has awarded grants to states and community entities to provide low-income, uninsured people — mostly women — access to preventive health care, including contraceptives.

UPDATE: Texas women’s health program makes gains amid declining participation.

Title X has benefited Texas families. Since its inception, Title X grant recipients have had to provide eligible women and men access to high-quality, client-centered care designed to help them plan their families. In 2016 alone, Title X served 183,000 Texans, preventing an estimated 41,090 unintended pregnancies, which means fewer unplanned births and fewer abortions.

Planned pregnancies are healthier for both mother and child, with earlier prenatal care and fewer low-birth-weight and pre-term births. Title X also has saved Texas taxpayers money — more than $7 in medical costs for every dollar spent on family planning.

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The proposed revisions to Title X regulations and funding deeply trouble maternal health advocates. Among major concerns, instead of providing women access to a comprehensive array of family planning options, Title X grantees would emphasize “natural family planning” and abstinence. While both are valid choices, they should not make more effective methods less available. Title X clinics should offer women a wide array of choices, including highly effective methods like implants and intrauterine devices.

Also under these new guidelines, HHS would no longer require clinics to provide “medically approved” forms of contraception. This decision could displace community clinics from the program in favor of “crisis pregnancy centers” — also known as “pregnancy resource centers” — with limited medical services, inaccurate reproductive health information, and limited or no contraception at all.

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Rather, clinics that specialize in family planning are more likely to ensure patients have access to the full range of contraceptive methods and medical technology — while serving a higher volume of patients, often at lower cost per patient.

In Texas, we already have seen that diverting funds away from clinics that focus on family planning means fewer women are served.

In 2011, the Texas Legislature cut funding for women’s preventive health care services by two-thirds, which had devastating consequences: 82 preventive health clinics closed, and tens of thousands of women lost services. Thankfully, Texas lawmakers substantially restored funding, but the system still has not fully recovered.

We urge HHS to learn from Texas’ earlier mistake and reject the proposed changes to Title X. If enacted, these changes will erode important gains in Texas’ efforts to improve the lives of women and their families. We have come too far to turn back the clock.

Realini is chair of the Texas Women’s Healthcare Coalition.

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