Texas Policy Evaluation Project
RESEARCH BRIEF
May 2015
Barriers to Family Planning Access in Texas
Evidence from a Statewide Representative Survey
This research brief highlights women’s experiences accessing reproductive health care, as well
as satisfaction with their current contraceptive method following major changes in funding and
coverage of family planning services occurring in Texas between 2011 and 2014. FINDINGS
Barriers to Care
• 55% of women reported at least one barrier
to accessing reproductive health care
services, including cervical cancer screening
or family planning services. • Women reported that they were not able
to: pay for services, find a place where
they feel comfortable with the health care
providers, get time off of work or school,
find a place that accepted their insurance,
or find a place in their community offering
these services.
• 37% of women reported two or more
barriers and 25% reported three or more
barriers. Women reporting three or more
barriers to accessing regular reproductive
health care services were more often
young (ages 18-29), poor, less educated,
unmarried, Spanish-speaking Hispanic
women born and educated in Mexico, and
without access to internet in their homes.
Figure#1.#Barriers#to#ReproducEve#Health#Care#
Figure 1. Barriers to Reproductive Health Care
Can't#pay#for#services#
Don't#feel#comfortable#with#healthcare#providers#
Can't#get#Eme#off#work/school#
Insurance#issues#
No#services#in#community#
No#childcare#
No#transportaEon#
Language#barriers#with#healthcare#providers#
Don't#have#partner/family#support#
38%#
30%#
23%#
20%#
15%#
11%#
10%#
7%#
5%#
0%#
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5%#
10%#
15%#
20%#
25%#
30%#
35%#
40%#
Women are not using the birth control method they want
• 31% of women using contraception other
than sterilization in Texas would like to be
using a more effective method. • 20% of hormonal method users would
prefer a more effective method like female
sterilization, vasectomy, LARC. • 43% of women using contraception other
•
than sterilization who had no insurance
or were using TWHP or state or county
programs to pay for care would like to be
using a more
effective
method. Contraceptive
Figure
2. Current
Women not currently using their preferred
method of birth control were more often
ages 30-44, poor, less educated, married,
Spanish-speaking Hispanic women, born
and
educated
in
Mexico, and
without access
Method
ofWomen
Women
Using
Figure 2. Current Contraceptive Method
of
Using
to
internet
in their
homes.
Otherthan
thanSterilization
Sterilizationby
by
Source
ofPayment
Payment
(N=224)
ContraceptionOther
Source
of
(N=224)
Contraception
• 61% of all women using less effective
methods would prefer more effective
• The top barriers cited among women not
Figure
2.
Current
Contraceptive
Method
of Women
methods such as hormonal methods, female
using
their preferred
methodUsing
were financial: TWHP,
Medicaid,
&
Other
than
Sterilization
by
Source
of
Payment
(N=224)
Contraception
Medicaid, &
sterilization, vasectomy, or TWHP,
long-acting
they could
not afford it (36%) and their
NoInsurance
Insurance
No
Private
Insurance
County
Programs
Private Insurance
County Programs
reversible methods (LARC). insurance would not cover it (23%).
Less Effective
Figure 2. Current Contraceptive Method of Women Using ContraceptionLess
Other
than
Effective
Methods
Methods
Sterilization
by
Source
of
Payment
(N=224)
16% TWHP, Medicaid, &
18% 16% 18% 23% No Insurance
23% Hormonal
Private Insurance
33% 30% County
Programs
36% Hormonal
33% 30% 36% Private Insurance
61% 61% 16% 23% TWHP, Medicaid, &
County Programs
34% 34% 36% 61% 30% 34% No Insurance
Long-acting
Long-acting
Less Effective
Effective
Reversible
Reversible
Methods
Contraception
Contraception
49% 49% 18% 33% Hormonal
Hormornal
Long-acting
Long-acting
Reversible
Reversible
Contraception
Contraception
49% Figure3.3. Preferred
PreferredContraceptive
ContraceptiveMethod
Methodof
ofWomen
WomenCurrently
CurrentlyUsing
Using
Figure
by Source of Payment (N=224)
Otherthan
thanSterilization
Sterilization
ContraceptionOther
by Source of Payment (N=224)
Contraception
Figure 3. Preferred Contraceptive Method of Women Currently Using Contraception
Other than Sterilization by Source
of Payment (N=224)
TWHP,
Medicaid,
PrivateInsurance
Insurance
TWHP,
Medicaid,
TWHP,
Medicaid,
&&&Method of Women
Private
No Insurance
Figure
3.
Preferred
Contraceptive
Currently
No
LessUsing
Effective
County
Programs
Private Insurance
NoInsurance
Insurance
County
Programs
County
Programs
Methods
Other than Sterilization by Source of Payment Less
(N=224)
Contraception
Effective
7% 7% 9% 9% 4% 3% 4%
3%
4% 3% 18% 18% Private Insurance
20% 20% 7% 9% 46% 46% 20% 20% TWHP,
Medicaid, &
County Programs
54% 19% 54% 19% 4% 3% 14% 18% 14% 18% 14% 14% Hormonal
Hormonal
No Insurance
35% 35% 19% 19% 14% 18% Less Effective
Methods
Methods
Hormornal
18% 20% 14% Note: Less effective methods refer to withdrawal, condoms, calendar or rhythm method, spermicide;
20% Long-acting
reversible contraception refers to intrauterine device (IUD) and implant
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46% 19% 54% 19% 35% Long-acting
Reversible
Contraception
Long-acting
Long-acting
Reversible
Reversible
Contraception
Female
Contraception
Less Effective
Sterilization
Female
Female Methods
Sterilization
Sterilization
Vasectomy
Hormonal
Vasectomy
Vasectomy
Long-acting
Reversible
Contraception
Female
Sterilization
METHODS
Table 1. Survey Respondents’ Characteristics*
Age
%
18-29
37
30-44
47
45-49
16
Race/ethnicity
%
White, Non-Hispanic
36
Black, Non-Hispanic
13
Other, Non-Hispanic
7
Hispanic
44
Employment status
%
Employed or self-employed
56
Unemployed or not in labor force
44
Marital status
%
Married
50
Widowed/Divorced/Separated
10
Never married-not living with partner
28
Living with partner
12
Parity
%
0
38
CONCLUSIONS
1
18
2 or more
44
Texas women face barriers to accessing
effective contraceptive methods and report
desire to use more effective methods. In
particular, poor, Spanish-speaking women
with low educational attainment report the
most barriers to effective contraception use
and being unable to use their contraceptive
method of choice. Country of education
%
US
84
Mexico
12
Other country
3
Education
%
Less than high school
13
High school
27
Some college
34
Bachelor’s degree or higher
26
Nativity of Hispanic women
%
Our findings suggest that use of more effective
contraceptive methods (LARC, female and
male sterilization) would increase if all methods
were available at no out-of-pocket cost.
US-born
54
Foreign-born
46
Data for this report are from a study
commissioned by TxPEP and conducted by GfK
using its KnowledgePanel. KnowledgePanel
is a nationally representative, probabilitybased online non-volunteer access panel. GfK
sampled households in the KnowledgePanel
and then invited 1,397 non-institutionalized
Texas-resident women between the ages of 18
and 49 to participate in the survey; 779 women
completed it. Data collection took place over 5
weeks from December 2014 to January 2015.
Table 1 shows the socioeconomic
characteristics of the women who completed
the survey.
Language proficiency
English dominant
10
Bilingual
19
Spanish dominant
15
Non-Hispanic
56
Family planning payment source
%
Private insurance
64
TWHP, Medicaid, or County program
13
Out of pocket (with and without discounts)
23
* Weighted Percentages
TxPEP is a five-year comprehensive effort to document and analyze the impact
of the measures affecting reproductive health passed by the 82nd and 83rd
Texas Legislatures. The project team includes researchers at The University of
Texas Population Research Center, Ibis Reproductive Health, and the University of
Alabama-Birmingham.
http://www.utexas.edu/cola/orgs/txpep
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