After Texas excluded Planned Parenthood from a state-funded Medicaid plan in 2013, women covered by the health plan used long-acting contraceptives less frequently and gave birth to more babies, according to a new study in the New England Journal of Medicine.

Additionally, the number of claims for long-acting contraception fell by more than one-third. The number of low-income women using injectable contraceptives who continued treatment after the exclusion also dropped: while 56.9% of women in counties with Planned Parenthood sites returned for an on-time appointment before the exclusion, that portion dropped to 37.7% a year later.

And even though the percentage of women giving birth in areas without Planned Parenthood dropped in the 18 months after the exclusion, there was an increase in childbirth in counties that had Planned Parenthood affiliates. Within the 18 months after the exclusion, the percentage of Medicaid-covered women who gave birth jumped from 7% to 8.4%, according to the study.

“Although data are lacking on intendedness of pregnancy, it is likely that many of these pregnancies were unintended, since the rates of childbirth among these women increased in the counties that were affected by the exclusion and decreased in the rest of the state,” the authors wrote.

The debate in Texas over completely defunding Planned Parenthood re-emerged last year, when a series of videos was publicized that purported to show Planned Parenthood employees talking about the sale of fetal tissue. While a Texas grand jury cleared Planned Parenthood, it indicted the videographers who posed as potential buyers of the tissue.