In 2011, Texas passed legislation that effectively defunded Planned Parenthood in the state and made its services unavailable for the majority of lower-income earning women who depended on the organization for reproductive health care. Seven years later, as politicians insist that the needs of these women can be met through the Healthy Texas Women program, a new report from Texas Observer finds that almost half of the providers in the network did not actually see any patients last year.

When Texas cut the budget for funding family planning from $111 million to $38 million in 2011, it was an intentional effort to defund Planned Parenthood. After these cuts, 82 Texas family planning clinics—one out of every four in the state—closed or stopped providing family planning services. “An unintended consequence of the law was that two-thirds of the clinics that closed were not even Planned Parenthood clinics,” reported The Washington Post last year.

The same legislation that slashed the budget also stated that any provider who performed abortions could not be in the Women’s Health Program, the predecessor of Healthy Texas Women, the state’s Medicaid fee-for-service family planning program. This meant Planned Parenthood—which provided care for 40 percent of the people who used Women’s Health Program—was excluded from participating. By 2013, 31 of Planned Parenthood’s 74 Texas clinics had closed, with the others staying open through payments from private insurance plans and patients paying out-of-pocket for services. Today, only 35 remain open.

Texas Healthy Women writes on its website that it “provides women’s health and family planning services at no cost to eligible, low-income Texas women.” Last year, it cost a reported $62 million to run. But Texas Observer reports that there are approximately 5,400 providers in Texas Healthy Women and, according to data from the Texas Health and Human Services Commission (HHSC), nearly half of them did not see a single patient last year. Of those who did, more than 700 saw just one person, and only 1,500 worked with more than five. In addition, 27 of the providers listed as having more than 1,000 patients are actually labs, which do not provide contraception or many other reproductive health services.

Reports Texas Observer:

Meanwhile, less than a quarter of the nearly two million Texas women who need publicly funded contraception and preventive care are getting it—a gap advocates say can’t be filled by providers that see one or two (or zero) patients. Research has found that non-specialty doctors and clinics don’t see as many family planning patients as those dedicated to women’s health, which tend to have personnel with specialized training and a range of contraceptive options. Before it was kicked out, Planned Parenthood served more than 40,000 patients annually in the state’s women’s health program.

In response, HHSC spokesperson Christine Mann wrote in an email to the Observer that “HHSC encourages all providers who want to provide women’s health services to enroll as a [Healthy Texas Women] provider, and expects provider participation in the program to grow over time.”

Records kept by HHSC did not list the race of the women seeing providers for reproductive health services. However, The Guardian reported,[Public health experts in Texas] say the loss of Planned Parenthood [imperils] the health of thousands of women who already face high barriers for care.” The publication also concluded that a disproportionate number of Planned Parenthood’s patients were Medicaid beneficiaries and women of color. The article notes there has been a rise in STIs and unplanned pregnancies in the state since 2013.

A 2017 study from the Population Research Center of the University of Texas-Austin focused on women who received the injectable contraceptive Depo Provera at Planned Parenthood locations in Midland County, Texas and Houston. Researchers examined how many women missed their next dose when their local Planned Parenthood locations stopped accepting Medicaid—either because they were unable to get to another provider that took Medicaid or they could not afford to pay out-of-pocket. The results: about half of the people who missed them were African American, 28 percent were Latinx, 20 percent were White and 5 percent were identified as “other.” “About 25 percent became pregnant—versus just 8 percent of the women who didn’t miss their next dose,” reported The Guardian.

As Texas continues to ineffectively fill the gap left by stripping Planned Parenthood of funding, reproductive health experts warn that the people who will continue to be affected most are the ones who were already disproportionately at risk for reproductive health crises.