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Texas women's clinic restrictions increased fertility rate for unmarried women, study finds

Tuesday, April 17, 2018


LAWRENCE — Recent restrictions and funding limitations on women's health organizations in Texas increased driving distance to women's health centers and led to a 2.4 percent increase in the fertility rate for unmarried women, according to a study co-authored by a University of Kansas economist. The researchers found no statistically significant change in the birth rate among married mothers.

"These clinics were really helping unmarried women avoid unplanned children," said David Slusky, assistant professor of economics. "Removing funding for them and causing them to close had a much stronger effect on unmarried mothers."

The article "The Impact of Women's Health Clinic Closures on Fertility" is forthcoming in the American Journal of Health Economics, one of the country's top health economics academic journals. Slusky's co-author is Yao Lu, manager at Analysis Group Inc. in Boston.

In an action aimed at preventing abortions, the Texas state legislature in 2011 instituted broad cuts to family planning services that resulted in closure or reduced hours at more than 80 clinics, about one-third of which were affiliated the national network Planned Parenthood. Other researchers estimated as a result there were almost 50 percent fewer organizations to help poor women plan their pregnancies.

The specialized clinics had offered contraceptive and sometimes abortion services in addition to often serving as a primary point of access to the health care system for women.

Unlike previous research that examined county-level data, Lu and Slusky calculated the driving distance to the nearest clinic in that network for each ZIP code. They also calculated fertility rates for each ZIP code, using restricted geotagged data of all Texas birth certificates from 2008 to 2013.

They found the increase in driving distance to the nearest clinic over this time period led to a statistically significant increase in fertility rates concentrated among unmarried women.

Clinic closures could have affected fertility rates through a lack of access to contraception, leading more women to have unplanned pregnancies, the researchers said. The changes in access to contraception appear to be the driver of the change in fertility rates in Texas because the vast majority of clinics that closed during the time period of the analysis only provided non-abortion family planning services, they added.

One potential unintended consequence of the funding cuts is that they would not result in a net savings of public funds because researchers have found that children born to unmarried mothers are more likely to experience worse economic conditions, including being more likely to grow up in unstable living arrangements, be in poverty and receive less education, he said.

"The majority of children of unmarried mothers grow up in more dire economic circumstances," Slusky said.

He said this policy change could cost the state of Texas in other ways through Medicaid funds or other social or institutional costs.

The findings could be significant given attitudes in a majority-Republican Congress, for example, that could seek to enact previous state-level funding cuts to women's health and family planning services nationwide, Slusky said. Or the study could be useful information for policymakers in other states considering similar cuts to funding for women's health and family planning services because it could show them potential unintended consequences.

"Those consequences need to be taken into account in future decisions," Slusky said.

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