Birth Control Access Is Under Threat After Texas Judge's Ruling Against Title X

Birth control pills in blister pack on pink background
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In this op-ed, researcher Dana Johnson and public health professor Laura Lindberg explore how birth control access is coming under fire after a Texas judge ruled against Title X.

Long before the Supreme Court ended nearly 50 years of precedent and reversed Roe v. Wade in the Dobbs v. Jackson Women’s Health Organization decision in June, experts warned that conservative lawmakers will target contraception next. Some have downplayed these concerns, claiming that limiting contraceptive access would be a far-off agenda item, or even a false alarm. But on December 20, 2022, U.S. District Judge Matthew Kacsmaryk confirmed these fears and became the first federal judge to rule against young people’s right to contraception since Roe fell.  

In Deanda v. Becerra, Judge Kacsmaryk ruled that the Title X Family Planning Program violates parental rights and state and federal law. The federal Title X program provides critical access to family planning services for over 1.5 million overwhelmingly low-income or uninsured people across the U.S. Created in 1972, Title X has been the country’s only federal program that provides affordable birth control and sexual and reproductive health care services. It now appears that Title X program officials can no longer mandate that providers protect minor clients’ confidentiality, though the ramifications of the case are so far unclear. The Deanda v. Becerra decision is a major threat to the reproductive autonomy of young people. 

In Texas, the implications of this ruling may be devastating. Texas teens already face multiple barriers to contraceptive care, including privacy, transportation, appointment accessibility, and cost. Title X clinics have been the only option in the state for access to contraception without explicitly informing a parent and obtaining their consent. With about 1 in 5 teens ages 15-17 reporting that they would not seek reproductive health services if there is a risk that their parents would find out, this discretion is an essential part of care. While officials are still seeking guidance on what the ruling will mean, Texas teens may soon have nowhere else to turn to for confidential access to prescription contraception

Even before this ruling, Texas high school students had rates of prescription contraceptive use far below the national average. On top of this, abortion is currently illegal in the state of Texas, and support for teen parents is sparse. In this extremely restrictive state-wide context, this decision thwarts young people’s power to make their own reproductive decisions.   

In the quest to end the legal right to contraception, the Deanda v. Becerra lawsuit may be the most threatening attempt yet, and the legal strategy behind it could be used to limit access to reproductive health services for young people nationwide. Although this case focused on Texas, the state often provides the road map for other states searching for strategies to limit sexual and reproductive health care. Judge Kacsmaryk, a Trump appointee and former religious liberty lawyer has previously worked on cases seeking to overturn contraceptive protections, and his December ruling is just the most recent development in a years-long effort from conservatives seeking to dismantle the Title X program. The U.S. Supreme Court — as evidenced by Justice Thomas’s writings about a need to reconsider contraceptive privacy as a constitutional right — may not only uphold the Deanda decision if it considers it, but rule in future decisions to limit access, tossing aside decades of existing policies protecting the right to contraception. 

Further court attacks on the Title X system will likely come, as well as attempts to overturn the mandate of ACA coverage for contraceptive care that would impact people of all ages. It is critical that teens have access to high-quality, confidential reproductive care, and there are concrete steps we can take to ensure that. Congress can move to secure the right to contraception and increase federal investment in the Title X program. We can advocate at the federal and state level for expanded access to over-the-counter birth control pills that are fully covered by most insurance, and available to people of all ages. We should also be watching state legislatures across the country, as lawmakers in Idaho, Arizona, and Missouri have already tried to ban access to some or all contraception. Finally, we must listen to young people. The overturning of Roe v. Wade has only intensified the political advocacy among teens, and teens across the country have mobilized to distribute emergency contraception on their college campuses. 

We know that these attacks on contraception will not stay within the borders of Texas. What this move tells us is that some conservatives appear to be committed to ending the right to contraception and stripping young people of their fundamental right to live healthy and safe lives, free of reproductive oppression and control. Texas has a long history of being the canary in the policy mine, with its most severe policies reverberating across the US. When Texas introduced Senate Bill 8 — the extreme early gestation abortion ban with a bounty hunter style enforcement mechanism — at least 15 states introduced copycat bills. The Supreme Court declined to halt Senate Bill 8 in a shadow docket ruling, and some believe Deanda v. Becerra could follow in these footsteps. Policies to stop access to contraception won’t end with targeting teens, and the reproductive autonomy of all pregnancy capable people is at risk. The year 2023 marks 50 years since the historic Roe v. Wade decision. We must make sure it does not also mark the end of the right to access contraception. 

Dana M. Johnson, MPAff, is a Doctoral Candidate at the University of Texas at Austin and Senior Associate Research Scientist at Ibis Reproductive Health. Laura Lindberg, PhD, is a Professor of Urban-Global Public Health at Rutgers School of Public Health

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