Texas Health and Human Services Commission officials listened to wide-ranging testimony about miscarriages, grief, loss and the need for human dignity Wednesday as they continue mulling a rule that would require cremation or interment of aborted or miscarried fetuses.

Attendance at the morning public hearing was sparse in the aftermath of Election Day, but 32 people gave short, emotionally charged speeches about the rule, which the department proposed in July. The agency received more than 12,000 comments in advance of an Aug. 4 public hearing. The rules were republished on Sept. 30 for another round of public comment that ended Oct. 31.

Several women tearfully shared stories of miscarriages, and of being forced to choose between abortion or risk of death trying to give birth. But the shared grief diverged: Some women said they were concerned about what happened to the dead fetuses and didn’t want them casually tossed away, while others said facing costs for cremation arrangements would have been emotionally taxing as they grieved.

Jim Bates, director of the Funeral Consumers Alliance of Texas, one of the first groups to come out against the proposed rule, suggested that two options be allowed; private burials or group burials. The goal, he said, is to “dispose of the fetus in the least harmful way.”

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“One year’s worth of fetuses would be smaller than the space of a refrigerator in the ground, so it would be very little,” Bates said. “What we see with at least these two choices is a very least cost way to do it, it gives the women choices to do the disposition and allow that fetus to just return to the earth in a very respectful, private manner.”

The proposed rule has bitterly divided reproductive rights advocates and anti-abortion advocates. Abortion supporters have said it would put unnecessary emotional burdens and financial costs on women. Anti-abortion groups point out that the rule would allow more care for fetuses and a more dignified way of disposing them. 

Joe Pojman, executive director for the Texas Alliance for Life, an anti-abortion group, said reproductive rights groups were “crying wolf” about the potential impacts on women. He said the costs would likely be minimal and partly why his group was suggesting abortion providers absorb the cost out of compassion for patients. He said the proposed rule was not about families being forced to have funerals.

“We’re talking about the difference between a landfill or cemetery for the final disposition of ashes,” Pojman said.

But agency officials have been mum about who would actually pay for the cremations and interment. The Funeral Consumers Alliance of Texas pointed out in a July 28 letter that the average funeral cost is $2,000, a cost number they say providers will likely try to pass on to women. The department has pointed out how nonprofits have said they would be willing to help with costs. But various providers, including doctors and hospitals, are concerned over whether it would be them or their patients who would pay for the cremations. The commission has not issued clear guidance on this yet. 

Aimee Arrambide, co-president of Fund Texas Choice, said in her public testimony that the proposed rule is an attempt to “stigmatize and shame women who seek abortion care.”

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“We’ve seen from the Supreme Court decision last summer, as well as the fact clinics have been closing over the past three years, that this does nothing to help women seek health care but shames, stigmatizes and makes it so abortion is out of reach,” Arrambide said.

Read related Tribune coverage here:

  • Despite intense outcry from the medical community and reproductive rights advocates, Texas isn't budging on a proposed rule to require the cremation or burial of fetal remains. 
  • In a new letter to the state, reproductive rights lawyers argue Texas' proposed rules requiring the cremation or burial of fetal remains "will almost certainly trigger costly litigation."