A recent New England Journal of Medicine study has the mainstream media swooning. Ever since Texas excluded Planned Parenthood from its state health-care program in 2011, countless media outlets have been eager to find evidence of negative public-health consequences. At first glance, the NEJM study appears to serve that purpose nicely. It purportedly shows that after Texas defunded Planned Parenthood in 2011, contraceptive claims went down and Medicaid births went up. The study was released this Wednesday and has already received overwhelmingly positive coverage from a number of mainstream-media outlets, including the Dallas Morning News, Vox, and the Los Angeles Times.
That said, a closer look at the study indicates that the results are considerably more nuanced. Most importantly, the study analyzes Medicaid births only among a specific subset of Texas women — those receiving injectable contraceptives through the Texas Women’s Health Program (TWHP). It did not consider Medicaid births among Texas women receiving other kinds of contraceptives though the TWHP. It also did not consider data on either unintended pregnancies or abortions — both of which would be useful in evaluating the impact of the state’s decision to defund Planned Parenthood.
This New England Journal of Medicine study begins by analyzing claims for three types of contraceptives covered by the state-funded TWHP: 1) long-acting reversible contraceptive (LARC) methods, 2) injectable contraceptives, and 3) short-acting hormonal methods (pills, patches, and the like). After Planned Parenthood was excluded from the state health-care program, claims for both LARC methods and injectable contraceptives went down. Interestingly, however, the authors acknowledge that there was no statistically significant decline in claims for short-acting hormonal methods of contraception.
All in all, the data here is uncontroversial. A number of other analyses have shown a reduction in contraceptive claims among women participating in the TWHP since 2011. What is getting the most attention is the finding that Medicaid births increased after Planned Parenthood was excluded from the state health program. That said, this finding is being misreported, and there is much less here than meets the eye. There are three problems with how this finding is being spun.
(1) No evidence of overall Medicaid births’ going up.
Again, the New England Journal of Medicine authors looked at Medicaid births only among a particular subset of Texas women — those who lived in a county with a Planned Parenthood affiliate and received injectable contraceptives though a state program. Contrary to what is being reported by some media outlets, the report did not analyze data on overall Medicaid births. It fails to provide data on Medicaid births among women receiving other kinds of contraceptives (LARCs or hormonal contraceptives).
(2) No data on either abortions or unintended pregnancies.
The study does not provide any information on trends in either abortion or unintended pregnancies among women receiving injectable contraceptives. If abortion numbers declined among this group of women, it is possible that the unintended pregnancy rate would have remained the same even as births to Medicaid-eligible women rose.
(3) Only a slight increase in Medicaid births.
In 2011, 529 women who resided in a county with a Planned Parenthood affiliate and received injectable contraceptives had a Medicaid-covered childbirth. In 2012, after Planned Parenthood was defunded, that number increased to 566. This is an increase of about 7 percent, hardly a dramatic spike upwards. Overall, the study finds that 37 additional women in one state-funded contraceptive program had a Medicaid funded birth. This is not evidence of a public-health crisis.
The media and the academic community have worked tirelessly to generate some evidence of negative public-health consequences after Texas excluded Planned Parenthood from the state health-care program in 2011. They have not found much. Last September, New York Times columnist Gail Collins cited George Washington University law professor Sara Rosenbaum as her source for a claim that unintended pregnancies increased in Texas after Planned Parenthood was defunded. However, Rosenbaum had not done any research that found an increase in unintended pregnancies in Texas. She wrote an analysis that predicted an increase in unintended pregnancies, but provided no data indicating an actual increase. When I brought this to the attention of both Collins and Rosenbaum, neither took steps to issue a correction.
It is disappointing to see the New England Journal of Medicine once again use its prestige and influence in such a partisan manner. The release of this study was doubtless timed to coincide with oral arguments in Zubik v. Burwell on the Department of Health and Human Services contraception mandate. Unfortunately, this has become standard operating procedure for the New England Journal of Medicine. During the debate over the Affordable Care Act in 2010, it published a very superficial analysis of abortion trends in Massachusetts to make the case that wider health-care coverage could reduce the abortion rate. In reality, abortion numbers in Massachusetts had been falling for a long time, as they are virtually everywhere, and the enactment of Commonwealth Care in 2006 had little impact on the trend.
Overall good public-health data from Texas indicates that since Planned Parenthood was defunded, abortions have gone down significantly. Additionally, the overall birth rate has gone down slightly. Most importantly, there is no evidence that the unintended-pregnancy rate has gone up. Sadly, but unsurprisingly, these important statistics have gone largely unreported by the mainstream media.