As former President George W. Bush prepares for his first post-White House journey to Africa to promote efforts to combat cervical and breast cancer among women there, his home state is struggling to provide the same services to low-income women.
“It’s a contradiction and it’s ironic,” said Fran Hagerty, the CEO of the Women’s Health and Family Planning Association of Texas, an advocacy group that represents more than 60 clinics, hospitals and medical schools around the state.
Bush and former first lady Laura Bush are scheduled to leave their Dallas home to visit Tanzania, Zambia and Ethiopia on a weeklong tour beginning Dec. 1. The trip will emphasize the work of the Southern Methodist University-based George W. Bush Institute’s Global Health program, which has continued outreach efforts to Africans that began in 2003 when Bush created the President’s Emergency Plan for AIDS Relief, or PEPFAR. In 2010, the program provided life-saving medications to 4.2 million Africans living with AIDS.
In a Nov. 22 interview with The Associated Press, Bush said, “We believe it’s in our nation’s interest to deal with disease and set priorities and save lives.’’
The former president is spearheading a health issue abroad that has brought some negative attention to his successor in Texas, Gov. Rick Perry. On the presidential campaign trail, Perry has shrugged off criticism of his 2006 effort to make the HPV vaccine mandatory for girls by saying that he hates the cervical cancer it causes and will “always err on the side of savings lives.”
At the same time, though, Perry proudly points out that he signed a budget that defunds Planned Parenthood. That decision slashed the state’s family planning budget by two-thirds — from $111.5 million last biennium to $37.9 million over the next two years. That means a major reduction in the services family-planning providers in Texas can offer, including the kinds of tests that Bush is promoting in Africa that help prevent cancer in women.
Since he left office, Bush has made global health one of his main legacy projects. In September, the Bush Center joined forces with the U.S. Department of State, PEPFAR, Susan G. Komen for the Cure and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to create the Pink Ribbon Red Ribbon initiative.
Dr. Eric Bing, the senior fellow and director of the Bush Center’s Global Health initiative, said the Bushes are focusing on Sub-Saharan Africa for several reasons. HIV is an epidemic in the region, and cervical cancer is four to five times more likely to be diagnosed among women also diagnosed with HIV. Pap smears are not readily available in developing countries, but a new visual inspection using vinegar can detect abnormal cell formations in a woman's cervix, allowing pre-cancerous lesions to be frozen and removed before they develop into cancer.
“Our goal is to help countries reduce death to cervical cancer, and the way we do this is the country has to want it, commit to it and put policies in place to support that,” Bing said.
For Hagerty, at the Women’s Health and Family Planning Association of Texas, learning that the former president is going overseas to advocate for services that will be harder to access in his home state was “hard to swallow.”
In Texas, budget cuts to state-funded family-planning services mean drastic slashes to things like STD testing, breast cancer exams and pap smears that screen for HPV, the virus that can lead to cervical cancer. Last year, state family-planning funds paid for 133,691 women to receive cervical cancer screenings. According to health reports, 12,787 women had abnormal test results that merited follow-up treatment.
Perry spokeswoman Lucy Nashed told The Texas Tribune in an email that the Legislature "strengthened controls to further ensure state funds aren’t used for abortions. Breast and cervical cancer screening services are available to low-income Texas women."
But state law already prevented family planning funds from being used for abortions, and Nashed did not address concerns that thousands of women could lose access to cancer testing. Instead, she pointed to Perry's work to establish the Cancer Prevention Research Institute of Texas and use of the Texas Emerging Technology Fund to "bring research from the lab room to the marketplace." On Monday, Perry helped announce the creation of the Institute for Applied Cancer Science at MD Anderson.
"Gov. Perry has been abundantly clear in his belief that Texas has the potential to be a worldwide leader in finding life-saving cures for cancer and other debilitating diseases," Nashed wrote.
But Hagerty said Perry misses the point. While investment in finding a cancer cure is laudable, she said, the state budget cuts that took effect Sept. 1 gut the services that prevent women from getting cancer in the first place. Many health providers are “hanging by a thread,” she said.
Family-planning providers are laying off staff and preparing to shutter clinics due to budget cuts. Hagerty fears the result could lead to tough choices for thousands of poor women who would likely choose to feed their families instead of paying for cancer screenings. Bush's influence when it comes to women's health care, she said, is a missed opportunity for Texas.
"I’d really like to see just as much effort put into Texas," Hagerty said. "Texas has been really good to him, and he’s a man who has a large sphere of influence and could use that for such good — and does — but I’d like to see somebody have the guts to step out on this one and be the voice of reason. We need a champion. We need it bad.”