Service delivery at Title X sites in Texas during the COVID-19 pandemic

Publicly Funded Family Planning Organizations' Response to the Coronavirus Disease 2019 Pandemic in Texas

INTRODUCTION

After the onset of the coronavirus disease 2019 pandemic, the use of family planning services decreased, but there are limited data on how safety net providers were affected.

METHODS

Between November 2020 and March 2021, we conducted in-depth interviews with administrators at health departments, federally qualified health centers and specialized family planning organizations across Texas about pandemic-related changes in family planning services. We analyzed interview transcripts using an inductive thematic approach.

RESULTS

Administrators at the 19 participating organizations described pervasive service disruptions. Some organizations closed for 6-8 weeks at the pandemic's onset owing to safety uncertainties and difficulty interpreting Texas' March 2020 executive order prohibiting "nonessential" medical services; others later suspended services after staff exposures. Health departments and federally qualified health centers commonly decreased family planning services to focus on coronavirus disease 2019 response, leaving specialized family planning organizations to absorb displaced reproductive health care clients. Some of the advantages of service delivery modifications-including telehealth, curbside and drive-through prescription pickup, and medication by mail-were difficult to realize; barriers included low reimbursement, necessary patient examinations, and clients' confidentiality concerns and lack of technological resources.

CONCLUSIONS

Texas' diverse network of family planning organizations illustrated a range of responses to the pandemic, and organizations often focused on their core missions-public health, primary care, or family planning.