The future of family planning in Texas: Are family physicians ready?
Abortion, Contraception
Awarded 2014
Complex Family Planning Fellowship Research
Bhavik Kumar, MD
Albert Einstein College of Medicine

Background: In 2011, Texas cut its family planning budget, resulting in a patchwork system of access to family planning services, and increased contraception costs for many patients. Although much of this budget was restored in 2013, multiple barriers to care still exist, including a decreased number of clinics providing contraceptive services and the exclusion of some clinics from public family planning funding. Much of the restored budget is allocated to expand a Primary Health Care program. Providing family planning would be a new role for many primary care providers in Texas. Little is known about Texas family physicians’ readiness to provide family planning services.
Objectives: To assess participants’ knowledge of evidence-based contraceptive provision (per CDC guidelines), the extent of contraceptive care they currently provide, attitudes about the provision of family planning care, and to identify areas of family planning care that require further training.
Methods: This quantitative study utilized a self-administered survey available on paper and online. Recruitment occurred in-person at Texas Academy of Family Physicians (TAFP) conferences, via an e-mailed TAFP newsletter, and through a paper mailing to the 4,700 TAFP members.
Preliminary results: A total of 632 surveys were completed with an average response rate of 15% of conference attendees and a response rate of 10% for mailed surveys. Almost all respondents (97%) agree that comprehensive contraceptive care is within the scope of family medicine and most (86%) feel prepared to address the contraceptive needs of their patients. However, most respondents (74%) scored ≤30 on a 40-point scale designed to assess contraceptive knowledge. Generally, respondents did not consider IUDs safe for teens (80%) or for those with >1 sexual partner (67%). Most respondents prescribe or dispense non-LARC methods, with COCPs (90%) and DMPA (71%) being the most common. A minority of respondents provide IUDs (17%) and contraceptive implants (11%). Many respondents (38%) require a pelvic exam before initiating non-IUD hormonal contraception, and only 33% routinely include elective abortion as an option when counseling patients with an undesired pregnancy.
Preliminary conclusion: Provision of contraception among Texas family physicians is variable and mostly excludes LARC provision. Although most Texas family physicians feel prepared to address the contraceptive needs of their patients, knowledge gaps about evidence-based contraceptive provision could impact the quality of patient care. More education and training is needed among this group so they can provide contraceptive services as the landscape of healthcare changes.