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In 2011, anti-abortion state lawmakers sought to shutter Planned Parenthood clinics and slashed state funding for family planning by 66 percent. As a result, more than 80 family planning clinics closed, and women across Texas suddenly found their birth control needs caught up amid the fight against abortion.

The impact was swift and widespread: Researchers found the number of women on the most effective forms of birth control -- IUDs, implants and injections -- plunged by a third and births by poor women on Medicaid increased 27 percent from 2011 to 2014.

In the aftermath, family planning clinics in Texas became almost entirely dependent on Title X federal funds. Now many administrators here and around the country are bracing for the Trump administration’s new rules.

Kathryn Hearn, community services director at Access Esperanza in McAllen, Texas, said clinics that offer the full range of FDA-approved birth control could be replaced by those like Obria.

“Today a woman can come into a Title X clinic, any clinic in the United States, in Texas, and be offered a wide range of contraceptive methods,” she said. “With these proposed rules, she could only be offered abstinence. Well, she says, I’m married. Or I’m in a relationship. That does not work for me. I need real contraceptive care.”

Ofelia Alonso, a 22-year-old community organizer, said that because of deceptive tactics and lack of comprehensive sex education, young women in Texas already find it difficult to discern between medical clinics and crisis pregnancy centers, offices where women are counseled against abortion.

“It’s like abstinence only, and then, crisis pregnancy centers, anti-abortion propaganda, defunding our family clinics. So what is left for us?” Alonso said. “We’re going to have these weird centers where you can’t get anything?”

But women seeking contraception have to go somewhere, and one alternative, she said, is to cross the nearby border into Mexico to buy birth control over the counter.

“It shouldn’t have to be that way,” she said. “We shouldn’t have to travel to another country to get what we need.”

Some uninsured patients in Texas do find alternative ways to get birth control.

Claire Hammons runs an historic hotel in Llano, a small city an hour and half west of Austin with no full-service women’s health clinic.

The vast geography combined with widespread clinic closures means that some 10 million Texans live at least half an hour from a clinic, a common standard used to determine health care shortages. It’s a phenomenon some call “contraception deserts.”

Hammons lives in one of these contraception deserts and when she could no longer afford health insurance, she turned to the internet for help. Now, she gets her birth control delivered every three months to her mailbox from a San Francisco-based company called Nurx. She pays about $15 a month and can message Dr. Jessica Rubino, a Nurx physician in Austin. Rubino can review her patients’ medical histories and renew their prescriptions without additional cost.

Rubino said she sees what happens to women who live in contraception deserts.

“I’m also an abortion provider, and I do that outside of Nurx at another facility,” she said. “I had one [patient] last week who drove five hours to see me. And the entire reason that she came to see me for the abortion is because she didn’t have any access to contraception.”

That lack of access worries Kami Geoffray, CEO of the Women’s Health and Family Planning Association of Texas, the nonprofit group that has coordinated the state’s application for Title X funds.

If the Trump administration’s overhaul of Title X succeeds, Geoffray said, it will undermine the goal of the program that the federal government has operated since the 1970s.

“We know that every dollar we spend on Title X saves $7 across other government programs, including Medicaid,” said Geoffray. “We avert Medicaid births very frequently by [getting contraception for] clients and preventing unplanned pregnancies.”

But back in suburban Atlanta at the Obria Medical Clinic, Bravo has declared it’s time for companies like hers to put a bigger mark on reproductive health care. The company is launching a $240 million capital campaign to open more clinics.

“Obria is a comprehensive primary care clinic for women that is an alternative model to Planned Parenthood,” said Bravo. “We put huge amounts of money into marketing our clinics, like all medical clinics do, to make sure that women know that we’re here in their city.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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