Is birth control accessible in Texas? New study ranks state policies

When it comes to access to contraception, Texas is not the most restrictive but it's also not a state with many protective laws.

In new policy analysis by the nonprofit group PRB (which used to stand for Population Research Bureau), Texas ranked in the bottom six, tied with Tennessee, in the group of 16 most restrictive states. Kansas was the most restrictive, followed by Mississippi, Florida, Wyoming and Alabama.

Washington state and California tied for first place among states with the most laws protecting contraception, followed by Connecticut, New York, New Mexico, Maryland and Oregon.

Policies varied widely among states, with some states not even having official policies on some elements of contraception access.

PRB is hoping this study will be a useful tool for lawmakers and advocates to compare their state's policies to other states. It did not study abortion laws, but Cathryn Streifel, senior program director at PRB, said "there is definitely an association" between contraception access and abortion access.

Why did Texas rank the way it did?

"Texas has some significant room for progress," said Christine Power, a senior policy advisor with PRB, but it didn't have many policy voids. Instead, about half of its laws are restrictive and half have some protections along with restrictions.

The scorecard looked at nine key areas:

Medicaid expansion: Restrictive. Texas is one of 10 states without Medicaid expansion. That means that people who have lower incomes, but not the lowest incomes, do not qualify for health care under Medicaid, which means contraception might not be affordable.

Family planning Medicaid expansion: Mixed. Using a waiver funding, Texas does provide contraceptive coverage through the Healthy Texas Women program for women making up to 204% of the federal poverty level. This coverage does not apply to people younger than 18 or to men.

Contraceptive coverage: Mixed. Texas does require health insurance companies to cover contraception if they cover any prescription benefits. However, it does not require that coverage to make contraception free or at an affordable cost.

Prescriptive authority: Restrictive. Texas does not allow nurse midwives or nurse practitioners of pharmacists to directly prescribe contraception.

Extended supply of contraception: Mixed. Private insurance companies and Medicaid must offer a 12-month supply, but only after offering an initial three-month supply.

Emergency contraception: Mixed. While nothing in the law says emergency rooms have to provide emergency contraception to patients in crisis situations such as after an assault, there has been some guidance from the Texas attorney general that they should. Emergency contraception is covered under the Healthy Texas Women program.

Minor consent: Restrictive. Texas requires parental or guardian approval before a person younger than 18 can be prescribed contraception unless that person is married.

Sex education: Restrictive. Schools do not have to provide this class and parents have to give consent for students to take the class. The class also doesn't have to provide medically accurate information and is abstinence-only.

Refusal clauses: Mixed. Pharmacists may refuse to fill birth control prescriptions for religious or moral reasons. There is no such provision for other providers or health facilities.

Why this matters?

Many of the semi-protections or semi-restrictions create health equity problems, Power said, because they make accessing birth control harder for people in lower income brackets.

In a 2024 KFF study, 82% of U.S. women ages 18 to 49 said they used some form of contraception in the past year, and 85% of those were using it to prevent pregnancy.

In this study, among women of reproductive age, 69% said it was important to avoid becoming pregnant in the next month.

When it came to access, 20% of uninsured women said they had to stop using a birth control method because they couldn’t afford it.