Changes to Title X mean contraception access for teens could worsen nationwide, study shows

Research demonstrates that lack of legal clarity and funding uncertainty led to confusion and loss of access to confidential services

AURORA, Colo. (Februrary 19, 2020) – Many teens lost access to confidential family planning services in Texas due to family planning budget cuts and loss of Title X funds, says a new study led by the University of Colorado College of Nursing just published in the Journal of Adolescent Health. Lack of clarity around parental consent laws, confusion among staff, and funding uncertainty made it more difficult for organizations to provide confidential, low-cost, and quality services to teens. This research suggests that contraception access for teens throughout the nation could worsen as new changes to Title X are implemented.

This study, based on three waves of interviews conducted between 2012 and 2015 at 47 organizations, was conducted after the Texas legislature reduced its family-planning budget by two-thirds in 2011, in an effort to exclude Planned Parenthood from receiving funds. However, this change impacted other organizations as well. Programs that had Title X funding but lost it, 79% of those in the study, consistently reported a decrease in the number of adolescent clients served and organizations’ ability to care for teens.

According to the study, these budgetary changes created confusion for teens, family planning organization staff, and providers. For example, teens that were covered by the federal Medicaid program could get confidential services at a clinic that did not have Title X funding, but teens that had different insurance could not. Furthermore, teens could access other reproductive health services, such as testing for sexually transmitted infections, without parental consent, but not birth control. Sometimes changes in funding occurred quickly, which made it challenging for organizations to understand and train staff in how to comply with the parental consent requirements.

“The loss of Title X funds meant that clinics had to suddenly start requiring parental consent or send adolescent clients elsewhere,” said lead author and CU Nursing Assistant Professor Kate Coleman-Minahan, PhD, RN. “This put a big strain on providers, both administratively and ethically. It was distressing for them to turn away teens seeking confidential care. They felt like they couldn’t meet their mission.”

Texas is one of 24 states that does not explicitly allow minors to consent for contraception. Federal Title X funding allows teens to access confidential family planning services, including free or reduced-cost contraceptives, even in states such as Texas that require parental consent. A major overhaul of the program by the current administration in 2019 includes policy changes that affect organizations across the country. A number of Title X-funded clinics have left the program since publication of the new policies, and a slate of legal battles challenging the changes are pending.

“Our research from Texas foreshadows the potential negative impact that the recently implemented Title X regulations will have on teens’ abilities to receive high quality sexual and reproductive services,” said study co-author Dr. Kari White, principal investigator of the Texas Policy Evaluation Project (TxPEP) and Associate Professor of Social Work and Sociology at The University of Texas at Austin.

“I am already seeing what we observed in Texas beginning to happen here,” says Coleman-Minahan, who provides family planning to teens in Colorado as a nurse practitioner. “Even though Colorado does not require parental consent for contraception, the new rules are already causing confusion and constrain our ability to provide high quality care.”

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The Society for Adolescent Health and Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists all recommend confidential low- or no-cost family-planning services for teens.

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