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Women's Clinics Retreat As Finances Are Cut

For the state's social conservatives, forgoing family planning funding is a small price to pay to send a powerful message: They want Planned Parenthood out of Texas.

By Emily Ramshaw, The Texas Tribune, and Pam Belluck, The New York Times
Rosario Espriella (center) waits for her appointment at the Edinburg, Texas Planned Parenthood clinic on Tuesday, February 14 with her children L to R:  Edgar, 6, Eduardo, 12, Diego, 2 months and Victor, 10.

SAN CARLOS, Texas — Leticia Parra, a mother of five scraping by on income from her husband’s sporadic construction jobs, relied on the Planned Parenthood clinic in this impoverished South Texas town for breast cancer screenings, free birth control pills and pap smears for cervical cancer.  

But the clinic closed in October, along with more than a dozen others, after financing for women’s health was slashed by two-thirds by the Republican-controlled Legislature. 

The cuts, leaving many low-income women with inconvenient or costly options, stemmed from an effort to eliminate state support for Planned Parenthood. Although no clinic driven out of business performed abortions, and the cuts forced non-Planned Parenthood clinics to close too, supporters of the cutbacks say the abortion issue was behind them. 

“I don’t think anybody is against providing health care for women. What we’re opposed to are abortions,” said state Rep. Wayne Christian, R-Center. “Planned Parenthood is the main organization that does abortions, so we kind of blend being anti-abortion with being anti-Planned Parenthood.” 

Now anti-Planned Parenthood sentiment is likely to prompt the shutdown next week of another significant source of reproductive health care: the Medicaid Women’s Health Program, which serves 130,000 women with grants to many clinics, including Planned Parenthood ones. Gov. Rick Perry and Republican lawmakers have taken the position that they would forgo the $40 million program — which receives $9 for every $1 the state spends — rather than give Planned Parenthood any of it.

Although Texas already bars clinics that take such money from performing abortions, “Planned Parenthoods across the country provide abortions, are affiliated with abortion providers, or refer women to abortion providers,” said Lucy Nashed, a spokeswoman for Perry.

For some Texas conservatives, directing any state funds to any Planned Parenthood-affiliated clinics is akin to endorsing abortion. The arguments from influential religious organizations equating the morning-after pill, and in some cases birth control, with abortion resonate with some of them. And they brush off suggestions that cutting funding for Planned Parenthood could spur more abortions by limiting access to contraception, arguing that hundreds of non-abortion-affiliated health care agencies are eligible for state and federal support. 

For moderate Republicans, the situation is more nuanced. They believe that the lost services will be costly in a state where a quarter of the population does not have insurance, and taxpayers already foot the bill for more than half of all births. But some worry that if they do not support efforts to curtail funding for Planned Parenthood, fellow Republicans will not consider them to be sufficiently anti-abortion

“These were all votes focused on characterizing people as pro-life versus pro-choice. They really were not budgetary,” said state Rep. John Zerwas, R-Simonton, an anti-abortion anesthesiologist who voted with his party to cut the family planning dollars. “Although the causes the money was diverted to were worthy, I don’t know on balance that you can say they’re any more worthy than good quality women’s services.” 

Texas’ situation is mirrored in several states that have tried eliminating various funding for Planned Parenthood. Abortion also undergirds the Republican presidential candidates’ opposition to federal funding for Planned Parenthood. And critics of contraception coverage under the new federal health law assert that some birth control methods are essentially abortion drugs, something scientists largely dispute. As Texas illustrates, such battles are affecting broader women’s health services. In some areas women have lost the only clinic providing routine care. 

Nationally, the newest target is Title X, the main federal family planning program. All four Republican presidential candidates support eliminating Title X, created in 1970 with Republican support from President Richard Nixon and then-Congressman George H.W. Bush. 

Like other federal financing, Title X does not pay for abortions. Only some of it covers birth control. Title X also covers cervical and breast cancer screening, testing for HIV and other sexually transmitted diseases, adolescent abstinence counseling, infertility counseling and other services. 

Planned Parenthood receives about a quarter of Title X’s $300 million budget and sees about a third of Title X patients. The remaining money goes to county-run clinics, community health centers, hospitals and state agencies. 

Nonetheless, Mitt Romney’s fiscal plan proposes eliminating Title X because it “subsidizes family planning programs that benefit abortion groups like Planned Parenthood.”

Rick Santorum, in a recent debate, acknowledged, to boos, that in Congress he voted for appropriations bills that included Title X money. He pledged to rectify that if elected, saying, “I’ve always opposed Title X funding.”

President Obama supports Title X, which serves 5 million low-income people. 

“People think Planned Parenthood equals family planning the way Kleenex equals tissue, and it’s not true,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association, a nonprofit, nonpartisan organization of family planning providers. Title X supports many other providers, she said. “In a lot of states there is no state money for family planning. So Title X is the ballgame.” 

A 2009 Congressional Research Service report cited federal estimates that Title X helps prevent nearly a million unintended pregnancies annually. Reproductive health experts say that saves money, and that every dollar spent on family planning saves about four dollars in maternity and infant care. Some experts also say it helps prevent about 400,000 abortions annually.

“We were preventing abortions,” said Patricio Gonzales, the CEO of the Planned Parenthood Association of Hidalgo County, which watched its state family planning funding drop by nearly $3 million overnight. “Yet the politics of abortion took out those clinics, and with them, access for women.” 

Opponents of Title X and government family planning financing say these effects are exaggerated. 

“Eliminating Title X would not outlaw contraception,” said Gary Howard, a spokesman for Ron Paul. “People would simply have to pay for contraceptives with their own money or money donated by private sources.” 

The battle intensified last February when the U.S. House of Representatives voted to eliminate Title X and take federal dollars from Planned Parenthood. The Senate defeated the bill, but the issue remains alive. 

Several state legislatures recently voted to stop some Planned Parenthood financing: Title X money in Kansas and North Carolina, Medicaid in Indiana, other family planning and breast cancer screening funds in Wisconsin. In three states, judges blocked the laws, at least temporarily, ruling that Planned Parenthood was illegally excluded even if it was not named. Wisconsin’s cuts have not so far been challenged in court. 

New Hampshire canceled a state contract with Planned Parenthood last year, but the federal government awarded the organization a similar contract. Recently, the New Hampshire House voted to essentially strip Planned Parenthood of family planning money by creating a tiered system in which Planned Parenthood and other women’s clinics could receive financing only in the unlikely possibility the state could not give it to government-run clinics or to hospitals. The Senate has not voted on the bill.

Texas enacted a similar tiered system and also sliced its two-year family planning budget from $111 million to $38 million, cuts that the nonpartisan state Legislative Budget Board estimated would eliminate services for nearly 284,000 women, lead to 20,500 additional births and cost Medicaid about $230 million. The board had recommended expanding family planning as a cost-saver. 

In Texas’ abortion debate, this collision between passionate politics and facts and figures is nothing new. In 2003, lawmakers began requiring clinics to provide women seeking abortions “A Woman’s Right to Know,” a pamphlet that dedicates nine pages to the risks of abortion — including feeling “guilty, sad or empty,” having “suicidal thoughts,” and being at higher risk for breast cancer. Scientists have not found evidence for some of the information in the pamphlet. The American Psychological Association says studies show that women who have elective first-trimester abortions have no greater risk of mental health problems than women who deliver the baby; the National Cancer Institute says large studies have consistently shown no link between abortions and breast cancer risk.

In May, without the national commotion that has surrounded Virginia's recent abortion sonogram bill, Perry signed into law a bill requiring abortion doctors to conduct a sonogram at least 24 hours before terminating the pregnancy. Proponents maintained that the measure — which also directs the doctor to play the fetal heartbeat aloud, display the fetal image and describe it in detail — would give women as much information as possible about the decision they were making. Opponents argued that in addition to infringing on a doctor’s relationship with the patient, there was nothing medically necessary about a 24-hour waiting period, playing the heartbeat aloud or requiring the abortion doctor, as opposed to a technician, to perform a sonogram. 

Last spring, lawmakers slightly increased funding for the Alternatives to Abortion program, which now has an $8.3 million biennial budget that supports dozens of pregnancy resource centers, adoption agencies and maternity homes and thousands of low-income pregnant women through the non-profit Texas Pregnancy Care Network. Such organizations, like Care Net Pregnancy Centers of Central Texas, do not provide contraception or refer to abortion providers. Instead, they perform pregnancy tests and sonograms, subsidize STD tests at county health departments, counsel women as they try to decide how to proceed with their pregnancy, and provide everything from parenting and life skills classes to diapers and formula up to the baby’s first birthday.

“The goal is that a woman would never regret an uninformed decision,” said Deborah McGregor, the CEO of the Christian agency’s Waco affiliate. McGregor said that with all the options on the table, 85 to 90 percent of the clients who come through her doors choose to deliver their baby. “We have never had a client say they regret having a baby,” she said. “We hear clients say they regret having an abortion all the time.”  

The only reproductive health financing to make it out of the last legislative session intact — the Medicaid-funded Women’s Health Program — is in jeopardy. Texas signed regulations prohibiting clinics affiliated with organizations that provide abortions from receiving funds, even though the clinics do not perform abortions themselves. The federal government says excluding qualified providers in this way is illegal, requiring it to withhold $35 million, 90 percent of the program’s financing, if the regulations, which take effect March 14, are not rescinded. That would effectively end the program, increasing the number of women without services to about 400,000. 

Already, Planned Parenthood of Hidalgo County has closed four of eight clinics, including the one in San Carlos, and trimmed services elsewhere. At the closest clinic to San Carlos, 16 miles away in Edinburg, a receptionist in this neighborhood dotted with listing palm trees and corner hair salons informs plaintive callers that they won't get an appointment anytime soon. Wait times are up, from two or three days to three or four weeks. 

Many San Carlos patients struggle to reach Edinburg from makeshift homes in hardscrabble neighborhoods called colonias. Maria Romero, a house cleaner with four children who had a lump in her breast discovered at the San Carlos clinic, has no transportation. Parra, 33, the mother of five, tried for months before managing to borrow a car to get to Edinburg after a San Carlos pap smear indicated she might have cervical cancer. Further testing showed she was cancer-free. Both women worry about getting birth control pills; clinics are now likely to have to charge up to $20 for a month’s supply. 

"I will have to go without," said Parra, leaving an English class at a community center and walking to pick up her two youngest children from a Head Start program. "If I get pregnant again, God forbid." 

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Health care State government Abortion Health And Human Services Commission Medicaid Texas Legislature Women's Health Program