As the first of the year again meant rules changes to the Texas Women’s Health Program by the Health and Human Services Commission, 50,000+ Texas women will need to scramble to find new providers. The State and HHSC promise that it will be provided for. But at what cost to quality and availability to these women and their families?
The Texas Women’s Health Progam (WHP) was initiated in 2005 as a joint federal and state service to provide checkups and birth control, to low-income, uninsured women who are not pregnant. The WHP covers preventive care and contraception, including a yearly examination with screening for breast and cervical cancer, diabetes, high blood pressure, high cholesterol, tuberculosis, and sexually transmitted diseases. It also covers education and counseling about family planning, including natural family planning and abstinence. In 2011, legislators adopted Texas Right to Life’s language to legally clarify that abortion providers and affiliates including Planned Parenthood were barred from participation in the program. Planned Parenthood lawyers looked to the courts for an injunction, but were denied allowing the State of Texas to proceed with the new rules.
Since the WHP’s inception, more than 235,000 Texas women have received family planning services. Previously a joint federal-state program, the federal funds had matched nine dollars to every one dollar doled out by the state before the new rules. The program had been expanded to agencies that provide a wide range of services, serve a broader population, and are not involved in pregnancy or abortion. Women are provided birth control and education about how to use it effectively. Preventive services through WHP cost much less than pregnancy-related services as mistimed pregnancies are costly in both human and economic terms. Among single young women, more than 70 percent of pregnancies in Texas are unplanned. The WHP actually helps Texas reduce the number of abortions by reducing the number of unplanned pregnancies, and helps women better plan and space their pregnancies which leads to healthier mothers and newborns.
Despite these successes, the WHP was always an underfunded, under-available program. Of the Texas women who qualify only one of six receives services leading it to be described as a ‘well kept secret’ and an ‘invisible program.’ The program never provided for any expense of pregnancy (or abortion) and for years its funds have been redirected through the Texas Alternatives to Abortion Program to non-medical ministerial centers. Texas, like many states, already has a shortage of primary care doctors, and has recently cut family planning funding by an additional two-thirds. As a result of such cuts, more than 50 clinics serving the low-income have closed. Many more medical providers will likely withdraw from the WHP because of undue burdens also created by the new rules. A proposal to restrict all doctors in the program from even mentioning the practice of abortion had to be withdrawn. Even HHSC President Perry Janek admitted that the original language was “a bit of a gag rule.” Participating doctors will be allowed to provide information to patients about abortion providers, as long as they do not work with said provider or ‘affiliate’.
The adding of stricter rules to the program was aimed at primarily at Planned Parenthood. While he rejected an injunction against new rules, District Judge Yelenosky agreed with arguments that Planned Parenthood’s exclusion from the WHP could endanger access to health services. The 51 Planned Parenthood clinics that participated in the previous version of the program provided 40 percent of the services such as cancer screenings, contraception and wellness exams for low-income women. In a study published in October by George Washington University, researchers conclude that some women may have problems accessing services if Planned Parenthood clinics are excluded from the program because “there is no evidence that [program providers] are prepared to sustain the very large caseload increases that would be required to fill the gaps left after Planned Parenthood affiliates are excluded.” More than half of the women enrolled in the WHP (50,000+) will have to switch providers.
The Texas Health and Human Services Commission (HHSC), which oversees the WHP, appears confident that it can find a sufficient number of providers to address the needs of all 115,000 Texans enrolled in the program. HHSC Director Perry Janek stated,“We’re going to make sure that every woman who qualifies for these services is able to get them.” This is some confidence considering only one of six women who qualified received the WHP’s assistance previously, 50+ clinics have closed and the 90% of the program’s funding provided by the federal government was rejected by the State. As proof, an HHCS survey states that current providers have the ability to serve 147,513 Texas Women’s Health Program patients in 2013. The key word is ‘provider’ which has been expanded to include non-medical pregnancy counseling centers. Women who qualify may likely be directed to a ‘provider’ without a doctor or nurse practitioner at an unlicensed facility that doesn’t actually provide health services. With state support and our tax dollars, the number of these centers is proliferating. Off to a predictably bad start with the new rules, the HHSC’s own website listing WHP providers was temporarily removed after surveys by the Dallas Morning News and others found the list of provided by the state so flawed that it may make it harder, not easier, for women to seek care. Out of hundreds of Dallas-area clinics recommended on a state-run website for the Women’s Health Program, just 51 had working phone numbers. The Waco Tribune-Herald “found many of the doctors aren’t actually participating or won’t take new patients through the program.” Included on the provider list are over-booked primary physicians and emergency rooms. Even a spokesperson for the HHSC acknowledged that the referral list has been misdirecting Texas women to wrong providers since it first went online three months ago. After dropping almost 1,000 more from the WHP provider list, it was still found to have errors including duplicate numbers in the Houston area. The commission has created an informational void for low-income women seeking health services and has wasted our tax dollars in the process.
The HHSC increasingly promotes Crisis Pregnancy Centers (CPC) as the provider solution at the expense of women’s health services and unregulated tax dollars. “They’re (CPCs) really the darlings of the pro-life movement,” says Jeanneane Maxon, vice-president for external affairs at Americans United for Life, an anti-abortion group. Unlike regulated and licensed health facilities, CPCs don’t have to account for state funds received, don’t have to be medically truthful, don’t provide birth control, contraceptive or abortion referrals, and can intentionally mislead women about their services. What’s more is that they do it with the legitimacy and encouragement of the State government. Since 2005, the state health department, at the direction of the Texas Legislature, has given public money to 50 CPCs for such work affecting 72,000+ women, and the money bankrolling these centers has been diverted from state health programs like the WHP. CPCs provided ideologically driven counseling to 17, 500 Texas women in 2012 at a cost to the state of 2.5 million dollars worth of advice. At $237 per client, this some expensive advice as it outpaces the costs to the WHP from other licensed medical providers with actual doctors. In the last legislative session, the Alternative to Abortion Program was the only ‘health’ service of any kind to see a rise in state funding. New state law now requires abortion clinics to provide patients with a list of crisis pregnancy centers at least 24 hours before an abortion can be performed, and callers to Texas’ state-funded 2-1-1 helpline seeking information about pre-abortion counseling will likely be directed to a CPC.
Crisis Pregnancy Centers have developed crises of their own. In addition to their crisis with medical sciences, they have developed an identity crisis. They have two very different public faces. To unsuspecting women and couples they represent themselves for all appearances as a legitimate clinic with receptionists and offers of free health services such as pregnancy tests, and sometimes ultrasound machines or STD screening. To potential donors however, CPCs are ministerial outreach centers working to end abortion, to deny women birth controls and contraception, and to promote an explicitly religious agenda. A leader in this industry, Care Net has built an expansive network of more than 1,100 pregnancy centers across North America. Unbeknownst to clients, their overtly religious agenda they don’t shy away from when courting anti-choice donors. In fact, Care Net’s seven-point Statement of Faith was adopted word for word from the National Association of Evangelicals – the very sponsors of Rick Perry’s August 2011 prayer vigil “The Response” in Houston.
To counter the deceptive practices of CPCs, cities like Austin, Baltimore and New York have tried regulating centers with ordinances requiring them to post signs stating that they do not provide abortions, referrals, birth control or contraceptive, and disclosing whether they are licensed or employ medical professionals on-site. Except for San Francisco’s, the laws were blocked by activist judges or softened after centers sued claiming free speech violations. The deliberate misinformation campaign protected as speech includes false health information concerning abortion, birth control and contraception, outright conspiracies and scare tactics. CPCs, with the state’s help, are allowed to make unsound claims tying abortion to cancers and suicide, and abortion providers to genocide. They doubly lie to minority women with claims that abortion providers target minority communities. Heartbeat International’s Urban Initiative Web page quotes John Piper, a minister: “O that the murderous effect of abortion in the Black and Latino communities, destroying tens of thousands at the hands of white abortionists, would explode with the same reprehensible reputation as lynching.”
The administration, functions and fundraisers of CPCs are littered with a who’s who of the anti-choice movement and always overtly Christian. As speakers are concerned, our Governor Rick Perry is well represented at functions and is a leading public advocate. He’s used the office of Governor to champion the defunding of Planned Parenthood on behalf of such ant-choice groups. Governor Perry was keynote speaker at a Source for Women’s Center dedication stating that “the Source for Women is already an important voice in the fight to make abortion a thing of the past… The Source for Women clinics, in fact, will be part of Texas’ own Women’s Health Program, and Planned Parenthood will not be.” Shortly after, the Governor chose yet another Source for Women center to announce “his support for Texas Right to Life’s priority legislation for 2013, the Preborn Pain Bill.”(TRL)
But it doesn’t stop there. State Senator Dan Patrick, who co-authored – with direct support of the Texas Right to Life lobby – the invasive and medically unnecessary sonogram bill, has made the CPC speaking tour rounds. Between the pats on the back, Dan Patrick courts anti-choice supporters as they provide the Senator with more legislative ideas. He has suggested using state dollars to pay women to deliver their unwanted pregnancies, and his 2013 priority (again with lobbyist help) is a bill that would make it more difficult for doctors to prescribe medications that induce abortions by adding a number of new and (again) medically unnecessary requirements. Also on the anti-choice watch is State Supreme Court Justice John Devine. A former board member of Texas Right to Life, Life Advocates of Houston and various crisis pregnancy centers, Justice Devine lists his numerous arrests protesting abortion clinics among his credentials and is currently a board member of the Tomball Pregnancy Center. Finding another solution for a nonexistent health concern is State Representative Allen Fisher’s (Houston) bill to end sex-selective abortions though no public health agency will suggest it’s a real problem.
As Attorney General, Greg Abbott has defended both the sonogram law and the ban on funding for Planned Parenthood – even comparing the service provider with terrorists. Seeing no conflict of interests, the attorney general was slated along with Gov. Perry to speak at the annual Texas Pro-Life Rally (Jan 26th). Texas Attorney General Greg Abbott has not only defended the restrictions to the WHP, he’s had a hand in creating some of his own. The “abortion affiliate” language was introduced to the program by state officials after it was suggested to the AG by State Senator Bob Deuell. Deuell enjoys an A++ rating from Texas Right to Life and is hailed by the Texas Alliance for Life as “One of the key players in the efforts to defund Planned Parenthood in Texas”. He’s got lots of company.
Texas Right to Life has reason to be confident heading into the 2013 legislative season, “… we were particularly proud that Governor Rick Perry mentioned Texas Right to Life’s priority legislation (fetal pain bill) in his inaugural speeches in both chambers.…we have a strong coalition of Republicans and Democrats on our side in Austin who will defend and advance the cause…” Any measure aimed at ‘fetal rights’ is a downgrade to women’s humanity reducing them to near incubator status. Nationally, laws aimed at protecting fetuses have already resulted in hundreds of arrests of pregnant women – overwhelmingly minority. Along with the ‘fetal pain bill’, the lobby will be pushing for more restrictions on abortion providers, to take away a judge’s authority to circumvent parental consent under certain circumstances, and a ban on abortion coverage in insurance plans offered under the Affordable Care Act. These new restrictions on reproductive health access will mount atop previous successes of the anti-choice lobby including waiting periods, mandated misinformation about abortion, the sonogram law, parental notification as well as the complete ban on public funding. Already fewer than 8 percent of Texas counties have an abortion provider, and, with recent clinic closures, whole cities the size of Abilene are left with only CPCs. Each new hurdle burdens the working poor, minority and rural women and families disproportionately and increasingly so.
Women’s health services join other public services under attack as lawmakers push to turn over state resources to private enterprises and the well connected. Mental health services, education, public works and university jobs are also all being parceled off to the benefit of profit making interests, but none enjoy such an aggressive, active and vocal public campaign as provided by the CPC industry. Through providing both campaign backing and language for law to anti-choice lawmakers and judges, the Crisis Pregnancy Center industry is booming. As 50+ health clinics have been denied funds and closed, 50+ unlicensed centers serving ‘clients’ have opened with the help of state dollars. In give and take fashion, CPCs and the anti-choice lobby offer an aggressive public campaign of deliberate misinformation to help cloak these attacks on women’s health services. Using unsound medicine and lies, this campaign is at a greater expense to public health, health access and the public dime. Conveniently without a paper trail as they aren’t required to account for expenses, it can better be described as medical fraud.
Already, 1.5 million Texas women are in need of publicly funded family planning services. Economically disadvantaged women and families are disproportionately affected by unintended pregnancy and its consequences. In absolutely no way will more restrictions to the WHP increase access to quality health services for women – even Texas Health and Human Services Commission projections expect a steep rise in unwanted pregnancies. Every new hurdle to abortion/reproductive health access artificially shrinks availability of women’s health providers and also unnecessarily restricts the quality of care. Increasing unwanted pregnancies and abortion demand while reducing providers means all Texas women and families will pay an increased price for the service. Pricing women out of abortions has long been a stated goal of the anti-choice community. The cost to families cannot be understated as most women seeking to end an unwanted pregnancy in Texas are already mothers. Encouraged by the inflammatory anti-choice rhetoric, street harassment, threats and violence against providers and women seeking access will rise. The percentage of pregnancies ending in abortion will likely go unchanged, but only at a greater monetary and health expense. There will be a measurable increase in injury and death due to lack of safe access. Disproportionately, that expense will be paid by working poor, minority and rural women and families – the very people the WHP was supposed to help.
Houston continues to show a willingness to defend women’s rights and reproductive health access. A successful clinic defense kept abortion facilities open as they were attacked by Operation Rescue during the 1992 Republican Convention. A renewal of pro-woman/ pro-choice activism in 2011 saw Houston’s Walk for Choice, SlutWalk and protest of a Heroic Media fundraiser featuring Dillard’s fashions. Filled buses were organized to both the Planned Parenthood Lobbying Day and the Texas We Are Women March on the Capitol. More recently, a NOW Houston Chapter has been re-organized taking a lead role in pro-choice actions and the Black Friday protest against discriminatory practices at Walmart. Houston NOW also maintains a weekly escort at an inner-city provider protecting vital women’s services. Pro-Choice Houston maintains maybe the only monthly picket of CPCs to warn unsuspecting women and families of their practices. The organizing meetings, sign making parties, fundraisers and the activities themselves provide lessons that will be ever more valuable tools as 2013 unfolds. The anti-choice agenda has been spelled out for us, and they are very well organized and focused. Their aim is to deny women reproductive choice. Without the right to choose abortion, women cannot exercise effective control of their life. It is an elementary precondition for women’s liberation, and, without it, a woman’s entire life is circumscribed by her reproductive capacities. The need for leadership presses on all of us all the more.
“If we lose the fight to liberate women we will have lost all right to hope for a positive transformation of our society into something superior… It is to wage this noble struggle that all of us, men and women, are summoned:” Thomas Sankara from WOMEN’S LIBERATION AND THE AFRICAN FREEDOM STRUGGLE
Bill Lambert, Pro-Choice Houston