Between 2011 and 2021, the state of Texas made multiple changes to the publicly funded reproductive healthcare programs it has administered. Legislative decisions aimed at excluding organizations that were affiliated with abortion providers, even though program funds could not be used for abortion care, adversely affected many specialized family planning organizations that served a high volume of clients. Newly created programs often invited participation by organizations that did not necessarily have the expertise to scale up or efficiently provide family planning services.
The reorganization of state-administered programs and funding fluctuations have contributed to shifts in the provider network over a 10-year period, and these shifts have been geographically uneven. The number of sites providing contraception and related reproductive healthcare decreased in the Panhandle and South Texas, while there were large increases in Southeast and Central Texas.
Geographic distribution of publicly funded family planning health centers
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Change in number of publicly funded family planning health centers 2011 – 2021
by health service region (HSR)
Over the 10-year period, the number of clients served through state-administered programs also decreased in half of Texas’ health service regions. The largest decreases were in West Texas and the Panhandle, where the number of publicly funded sites decreased by more than 25%.
In Southeast and North Central Texas, the state’s two largest health service regions, there were divergent patterns of change. The number of clients served increased by more than 33% in Southeast Texas, whereas the number of clients served decreased by 33% in North Central Texas, a region that lost many specialized family planning sites.
Within health service regions, increases in the number of clients served did not always correspond to growth in the overall population of women between the ages of 15 and 44 years.
Change in clients served at publicly funded family planning health centers
2011 – 2021 by health service region (HSR)
For this analysis, we used information on sources of funding and clients served in state-administered family planning programs, and aggregated funded organizations into health service regions (HSRs) by county. In 2011, this included organizations that received Titles V, X and/or Title XX funds during state fiscal year 2011. In 2021, we included organizations that received funds from the Family Planning Program and/or cost-reimbursement funds though the Healthy Texas Women program during state fiscal year 2021. In 2021, Title X funds were administered by Every Body Texas. There were 55 clinical sites in Texas’ Title X network that did not receive Family Planning Program and/or cost-reimbursement Healthy Texas Women funds and, therefore, are not represented on the map of health centers receiving state-administered family planning funds.
We used the Texas Demographic Center’s estimates for the population of women between 15 and 44 years of age in 2020, the most recent available.
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