2nd Edition of the Public Health and Midwifery World Conference 2026

Abstract

Contraceptive deserts (CDs) are geographical areas where women of reproductive age have little to no information or access to contraceptives, including prescription birth control, implants, and, most importantly, clinics that offer such services. Texas has one of the nation's largest numbers of CDs, housing around 1.7 million women in need, and mostly affecting rural communities. The primary explanations for the development of CDs are the existing systemic and physical barriers. Around 6 million Texans (<65 years old) live without health insurance, lack proper sexual education, are recipients of poor allocation of state and federal funding, and face implicit bias within healthcare, raising mistrust between providers and their patients. Utilizing data from the United States Census Bureau, county-based CD maps, and published research articles, we compared three Texas counties: Dallas, Starr, and Sabine. These counties have drastically varying access to contraceptives, regardless of them functioning under the same state legislation. We examined these counties’ varying legislation policies, demographics, budget allocation, and socioeconomic differences that contribute to limited access to birth control products. Consequently, we explored the intersection between maternity care and pharmacy desert prominence with CDs, as well as an overall correlation between CDs and rising STI rates. Our research showcases the importance of bridging the gap to address inequalities in CDs by expanding insurance coverage (Medicare, Medicaid, external state funding, and transportation reimbursement), rectifying healthcare-specific legislation, and, above all, significant need for healthcare provider reform that encourages the opening of medical practices in rural areas, as well as the improvement of patient-worker relationships. As demonstrated, contraceptive deserts are a symptom of systemic failures that not only foster an environment that inhibits this justice but also causes these deserts to thrive. It has been shown that the persistence of these deserts is the result of deliberate policy choices, and years of underinvestment in healthcare structure that heavily affect vulnerable and marginalized communities. In addition, several barriers often work together to exacerbate the issue, such as financial, logistical, demographic, and educational barriers. The financial burdens placed on low-income Texans illustrate a system where access to basic reproductive healthcare is more of a privilege, not a right. With one of the highest uninsured rates in the country, the state refuses to expand Medicaid and continues to aggressively target healthcare providers like Planned Parenthood which has proved to contribute to the growth of these contraceptive deserts. Without access to these affordable clinics, it was shown that many Texans were forced to choose between financial security or their reproductive healthcare, in most cases resulting in the termination of care. In counties such as Starr and Sabine, the absence of nearby clinics meant that individuals were required to travel farther distances to receive basic reproductive services. The issue is further exacerbated when these clinics lack funding due to policy restrictions causing severe operation issues or are forced shut down. However, when these clinics do exist, logistical barriers such as the requirement of parental consent for teens to access contraception, further inhibit populations from receiving care. Education barriers further amplify these challenges as abstinence-only education dominates the state's curriculum which withhold vital information on contraception and STIs from teenagers who would best benefit from it. Ultimately, solving the contraceptive desert epidemic in Texas requires an approach that calls for the expansion of Medicaid eligibility, a recruitment of the primary care workforce in understaffed areas, the expansion of the Trust Her initiative, and legislation reform. By prioritizing equitable reproductive healthcare, Texas can begin to close and decrease the number of deserts within the state while also creating a healthcare system that truly serves all its residents.