More than half of Texans who were surveyed in a new university study said that they have faced at least one barrier to accessing cervical cancer screenings, family planning care, or other reproductive health services. The results follow years of drastic cuts and structural changes to publicly funded reproductive health care programs in the Republican-held legislature.

“Poor, Spanish-speaking women with low educational attainment report the most barriers to effective contraception use and being unable to use their contraceptive method of choice,” according to researchers at the University of Texas’ Texas Policy Evaluation Project (TxPEP), which on Monday released a research brief on the survey.

Texas’ GOP-controlled legislature in 2011 cut family planning program funds by two-thirds. In 2013, lawmakers attempted to restore some of that funding through a restructured program that privileged general practitioners over family planning providers, though the effectiveness of that retooling has yet to be proven.

The TxPEP research suggests that Texans continue to struggle to access the care they need.

The most commonly reported barrier to accessing reproductive health care generally was cost, with 38 percent of respondents saying they “can’t pay for services.” The next most-reported barrier was “don’t feel comfortable with healthcare providers,” followed by an inability to get time off from work or school.

TxPEP researchers found that about a third of Texas women using a contraception method other than sterilization “would like to be using a more effective method,” and that the most common barrier to obtaining that preferred method was cost, followed by “their insurance would not cover it.”

The research brief’s release came the same day as the federal government released guidance about contraception coverage under the Affordable Care Act, emphasizing that insurance companies “must cover without cost sharing at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide.”

Researchers concluded that the use of long-acting reversible contraceptive methods (like the IUD or implant) or sterilization for both men and women “would increase if all methods were available at no out-of-pocket cost.”

Most of the women TxPEP surveyed were Hispanic, at 44 percent of respondents, with white women making up 36 percent and Black women making up 13 percent of respondents. Half were married, and 56 percent were employed or self-employed. Sixty-four percent had private health insurance, 23 percent paid for care out-of-pocket, while 13 percent used the Texas Women’s Health Program, Medicaid, or a county-based health program to access care.