“They Just Don’t Care”: New Texas Abortion Law Could Be Worst Yet For Poor Women
Some 5,000 orange-clad men and women invaded the Texas capitol in Austin on Monday in an emotional and enthusiastic show of support for reproductive rights. They faced off with Republican lawmakers still resolved to pass SB 5, the very bill limiting abortion access that was defeated last week after Senator Wendy Davis’s 11-hour filibuster. Yesterday, nearly 2,000 people showed up to testify against the bill as it was considered by the Texas House Affairs Committee, which approved it 8-3.
This latest effort to roll back women’s rights in Texas has met fierce opposition and resolve from Texans and other Americans who recognize the value of women’s health care. “When you silence one of us, you give voice to the millions who will continue to demand our lives, our choices, our independence,” Ilyse Hogue, president of NARAL Pro-Choice America, reminded us at Monday’s rally.
It has also highlighted the deep gulf between the lived experiences of women in Texas, particularly low-income women, and lawmakers who have inserted themselves into decisions that should only be made by women and their physicians.
Monday’s protest took place as Texas lawmakers convened for a second special session called by Governor Rick Perry. The bill they’re considering would make abortion after 20 weeks illegal, impose onerous requirements on abortion providers, and demand that all clinics meet costly and burdensome building requirements. If passed, 37 of the state’s 42 abortion providers will be forced to close their doors. This despite the fact that 79 percent of Texans believe abortion should be available to a woman under varying circumstances, while only 16 percent believe abortion should never be permitted.
This is just the latest in a seemingly never-ending assault on Texas women. In 2011, lawmakers decimated the Texas family planning program with a two-thirds budget cut that closed nearly 60 family planning clinics across the state and left almost 150,000 women without care. Soon after, they also barred Planned Parenthood and other reproductive health clinics defined as “abortion affiliates” from the Women’s Health Program (WHP), a state Medicaid program on which thousands of poor women rely. Governor Perry insisted that former WHP patients could find new providers and claimed there were plenty to bridge the gap, but that simply is not the case. Clinics across Texas have reported a sharp drop in patients, and guess that former WHP clients are receiving no care at all.
To suggest so cavalierly that women simply find new providers is evidence that Republican lawmakers simply don’t understand – or don’t care about – the socioeconomic realities that shape women’s lives. Otherwise, they would recognize the absurdity of forcing women to navigate an increasingly complex health system to find new providers and then traverse hundreds of miles to receive basic care and services. This is a stark illustration of the privilege gap that exists between policymakers and the people they represent.
After it became clear that the warnings of public health experts – who testified that such policies would impose a heavy economic toll on the state, result in negative health outcomes, and increase the demand for abortion – were becoming reality, lawmakers last month restored family planning funding to the 2014 budget. While this is certainly good news, returning to pre-2011 funding levels still leaves nearly 700,000 women without access to care and so far has enabled only three of the nearly 60 shuttered clinics to re-open. And even before the 2011 budget cuts, only one-third of the state’s one million women in need of family planning services received them through the state program. A provider shortage will persist for the foreseeable future; it is no easy task to reopen a clinic once it has shuttered its facility, released its staff, sold all its equipment, and sent its patients’ files elsewhere.
If the current legislation were to pass, nearly all the state’s abortion providers would be forced to close. The majority of those are clinics that not only offer abortion services, but also provide contraception, STD testing, and cancer screenings for poor women. Many of those clinics are located in areas that are already bearing the brunt of family planning clinic closures (see map below). The few clinics that would remain open in Texas are located in urban areas, leaving women in rural Texas with even fewer health care options than they currently have.
What are women—especially poor women—to do? Women in Texas already face heavier burdens than women in many other states. Texas has one of the nation’s highest teen birth rates and percentages of women living in poverty. It has a lower percentage of pregnant women receiving prenatal care in their first trimester than any other state. It also has the highest percentage of uninsured children in the nation and provides the lowest monthly benefit for Women, Infants, and Children (WIC) recipients (an average of $26.86 compared to the national average of $41.52). And soon the majority of women may not have access to abortion care at any stage of their pregnancy.
Governor Perry’s policies have marginalized women who already bear the heavy weight of so many inequities. His latest efforts will only marginalize them further.
This anti-abortion legislation will not prevent women from getting abortions. It will simply push them across the border and into unsafe facilities like those operated by Kermit Gosnell. Its passage will add to the fury that has escalated over the past three years as women have lost access to breast exams, birth control, and abortion services while being told it is for their own good. These lawmakers fail to understand that the full range of reproductive health services, including the ability to access an abortion, is absolutely central to women’s ability to lead happy, healthy, and productive lives – an ability that is itself essential to the strength of families, communities, states, and our nation.
On Monday, Planned Parenthood president Cecile Richards reminded the crowd in Austin of the old adage that you can measure a country by how well it treats its women. The same is true for Texas. “We settled the prairie. We built this state. We raised our families,” said the ever-feisty daughter of former Texas governor and progressive icon Ann Richards. “We survived hurricanes and tornadoes, and we will survive the Texas legislature, too.”
By: Andrea Flynn, The National Memo, July 3, 2013
“Women’s Health Is In Danger”: A Fiercely Anti-Choice Ohio GOP Redefines “Pregnancy” To Mean “Not-Pregnancy”
Last night, Ohio Governor John Kasich took a little time from his weekend to sign a new $65 billion budget for the state. There are many moving parts to the law, including a $2.5 billion tax cut which—like most Republican tax cuts—is meant to help the rich at the expense of everyone else. But of those parts, the most relevant for discussion—given last week’s fiasco in the Texas Senate—are the new restrictions on all reproductive services.
In addition to slashing tax burdens on the wealthiest Ohioans, the budget measure signed yesterday would allocate federal funds away from Planned Parenthood—which uses them to provide contraception and other health services, not abortion—to crisis pregnancy centers, which claim to offer support, counseling and a full range of options for women who think they may be pregnant. In reality, they are overtly anti-abortion. “[A]ccording to personal accounts compiled by the National Abortion and Reproductive Rights Action League (NARAL),” notes the Guttmacher Institute, “once women are inside the office, counselors subject them to antiabortion propaganda, characterizing abortion as painful and life threatening, with long-lasting physical and psychological consequences.” While the psychological impact of abortion varies from woman to woman, in terms of medical safety, abortion ranks on the low end of risky procedures. CPC’s also discourage use of contraceptives like the morning-after pill, which are presented as abortion equivalents.
The Ohio law also requires doctors to give a verbal description of the ultrasound, including a fetal heartbeat if available. It compels abortion providers to tell patients that a fetus can feel pain and that a woman who has an abortion can increase her risk for breast cancer. This claim, touted frequently by anti-abortion activists, has little basis in fact. “The scientific evidence,” notes the American Cancer Society, “does not support the notion that abortion of any kind raises the risk of breast cancer or any other type of cancer.”
The law also redefines “pregnancy” and “fetus” in ways that could affect the availability of certain forms of birth control. Ohio Republicans have defined as “human offspring developing during pregnancy from the moment of conception and includes the embryonic stage of development,” and declared pregnancy as beginning with “fertilization.” Biological science, by contrast, defines pregnancy as beginning with the implantation of a fertilized egg in the uterine lining. Why? Because a fertilized egg isn’t guaranteed to become an embryo; it can fail to implant and be expelled by the body.
There are also explicit restrictions to abortion access, as well as new requirements for doctors who perform them. Abortion providers are banned from having transfer agreements with public hospitals. Given that clinics are required to have transfer agreements, this could cause the closure of some clinics, and otherwise hamper access to reproductive health services. What’s more, the waiting period for abortions is extended from 24 hours to 48 hours, and the law would also eliminate “medical necessity” as a reason to waive the waiting period, replacing it with a waiver for “medical emergency.”
The difference, as the Cleveland Plain Dealer notes, is that the former is defined “as a medical condition that complicates the pregnancy so that it warrants an immediate abortion,” while the latter is “a condition that would result in the woman’s death without an abortion.” In practical terms, a necessity is a state of urgency where you may need an abortion in the future, whereas an emergency is where you need one now. It doesn’t seem like a big change, but it could have major implications, especially when coupled with the new penalties for violating these restrictions.
A doctor who does could be charged with a first-degree felony and a fine of up to $1 million—penalties normally reserved for rape, murder, attempted murder, and aggravated robbery (among others). We have no idea how many doctors will hesitate or refuse to perform abortions under serious circumstances, but my guess is that it will be more than a few, with serious consequences for women’s health.
As with the proposed law in Texas, it’s hard to describe these measures as anything other than backdoor attempts at making abortion unavailable in Ohio, through harsh restrictions, new regulations, or the legal intimidation.
Yesterday, on Meet the Press, House Minority Leader Nancy Pelosi said that there was “currently an assault on women’s health” and that “women’s health was in danger.” She’s absolutely right. Since the 2010 midterm elections—when Republicans swept statehouses and governorships across the country—there’s been a concerted push to deny women access to the wide array of reproductive health services.
On one hand, there’s a refreshing clarity about these efforts. Conservative lawmakers have all but dispensed with attempts to sound moderate, arguing that rape exceptions are unnecessary, and pushing for proposals—like defunding Planned Parenthood and limiting sex education—that would increase the rate of unplanned pregnancies (and thus abortions).
Of course, the only reason Republicans have become so open about this is because—on the whole—they are winning this fight.
By: Jamelle Bouie, The American Prospect, July 1, 2013
“Practicing Without A License”: Iowa Governor Must Personally Decide Whether Each Poor Woman On Medicaid Deserves Abortion Coverage
Iowa Gov. Terry Branstad (R) has approved a measure to expand his state’s Medicaid program under Obamacare, which will extend health coverage to tens of thousands of his poor residents. But there’s a catch buried in the Medicaid expansion legislation that the governor signed last week. Now, when low-income women on Medicaid seek insurance coverage for medically-necessary abortions, they’ll have to get approval from Branstad himself.
State-level Medicaid programs often exclude abortion from the health services they will cover for low-income beneficiaries. Just like the Hyde Amendment prevents federal money from directly funding abortion care, over 35 states have decided they don’t want state dollars to pay for abortion, either. Just 17 states allow low-income women on Medicaid to receive insurance coverage for most abortion services — the others, like Iowa, will only permit those women to be reimbursed for the cost of their abortion in cases of rape, incest, and life endangerment.
But now Iowa is going a step further. If a woman who gets her health care through Medicaid has an abortion that falls under one of the exceptions in the state’s abortion coverage ban — if she has been a victim of rape or incest, if her fetus has fatal abnormalities that won’t allow it to survive outside the womb, or if her life will be put in danger unless she ends the pregnancy — she’ll need to have her case approved by the governor’s office. Presumably, Branstad will choose whether to approve or deny each woman’s request for insurance coverage for her abortion. It’s the first law of its kind in any state.
“This bill — now law — is outrageous on many different levels,” Ilyse Hogue, the president of NARAL Pro-Choice America, said in a recent statement. “Women in Iowa already face so many barriers in trying to get safe, legal abortion care. Now their governor will be deciding personally on a case-by-case basis, whether a woman’s doctor will be paid for providing a legal, medically appropriate, and constitutionally guaranteed procedure.”
Under Iowa’s current policy, a state agency already reviews claims for Medicaid funding of abortion services to make sure the billing is adhering to the law and doesn’t fall outside of the approved exceptions. As the Des Moines Register reports, that process will likely continue under the new law. But there’s a notable difference: “instead of the final call being rendered by the Medicaid medical director, the democratically elected and politically accountable governor will decide.”
Low-income women are unlikely to be able to afford bills for abortion care, which can exceed $1,000 dollars. If the governor decides that Medicaid won’t cover the cost of an abortion procedure, the medical providers will likely be forced to absorb the cost.
Ultimately, denying low-income women access to affordable abortion services simply exacerbates the economic divides that lead some desperate women to seek out illegal abortion providers. By passing a mounting number of state laws that prevent women from using their insurance coverage to pay for reproductive care — as well as by forcing abortion clinics out of business and driving up the cost of the abortion pill — lawmakers are essentially making abortion too expensive for low-income women to access at all.
By: Tara Culp-Ressler, Think Progress, June 25, 2013
“A Citizen Filibuster”: Fed Up And Determined, Progressive Activists Just Might Secure A Victory For Reproductive Rights In Texas
Two years ago, the Texas Legislature passed a law requiring that women seeking abortions first have a sonogram. If it’s early in a pregnancy, the law would require submitting to a transvaginal sonogram, with a wand inserted into the vagina. Even though a similar measure subsequently stirred national controversy in Virginia, prompting its defeat, progressives in Texas could barely mount a fight. Passage was inevitable, everyone knew, and the cause quixotic—because, after all, this was Texas.
That era may be over. For the past several days, activists have been waging a pitched battle in Austin against Senate Bill 5, a measure that would severely restrict abortions after 20 weeks and close most of the state’s abortion clinics. Since Thursday night, hundreds of activists have been protesting, packing galleries and committee hearings and every spare nook of the capitol. The intensity of the public outcry is notable in a state known for low voter turnout and a vastly outnumbered Democratic Party. With the session ending on Tuesday night, if lawmakers and activists can keep up the pressure, they may be able to kill the bill.
Texas’s regular legislative session ended last month, but governors can call special sessions to address specific “emergency” legislation. At first, Rick Perry called this one to approve new redistricting maps. It was only halfway through the month-long gathering that he added abortion restrictions to the agenda.
A hearing on Thursday in the House State Affairs Committee set off the clock-ticking drama. More than 600 pro-choice advocates arrived to voice their opposition to the clinic regulations and the 20-week ban. The activists made up 92 percent of those who signed up to testify; they called their effort a “citizen filibuster.” The chair began to get restless with the testimony, calling it “repetitive,” and eventually cut off debate—but not until 4 a.m. The committee approved the legislation and sent it to the floor.
By Sunday, when the House convened to debate and vote, the fight had reached a fever pitch. The House had multiple bills, but because of the time crunch decided to focus on Senate Bill 5. The measure requires that all abortions, including those performed by giving a woman a pill, be performed in clinics that meet surgical standards—a requirement normally reserved for surgical procedures that require incision. That requirement would prompt the closure of more than 30 clinics across the state; only five clinics in Texas currently meet the “surgical ambulatory care” standard. The measure also has an outsized impact on rural women, since it requires doctors performing abortions to have admitting privileges to a hospital within a 30-mile radius.
The House version of the bill adds a ban on all abortions after 20 weeks, unless the life of the mother is in danger or the fetus has birth defects so severe that it could die. The addition of the abortion ban means the bill must go back to the Senate for approval. With only two days left to complete all business, however, that gave House Democrats a chance to delay the bill and give their colleagues in the Senate a chance at a filibuster to kill it.
Activists flooded the capitol, most clad in burnt orange T-shirts, the color of the University of Texas, reading: “Stand with Texas Women.” They filled the House gallery, outnumbering pro-life advocates who were wearing blue. Allies from other states sent pizzas to keep them fed, and local shops began sending supplies of food and coffee.
Using parliamentary tactics, Democrats successfully delayed consideration of the bill for hours. They submitted more than two dozen amendments designed to showcase the absurdity of the bill. (One would have required a preponderance of peer-reviewed scientific evidence to justify the ban.) When questioned about the lack of support in the medical community for the bill, the sponsor, Republican Representative Jodie Laubenberg, explained that she knew a gynecologist who supported the bill. The Texas Medical Association and Texas Hospital Association, as well as the American Congress of Obstetricians and Gynecologists, all oppose the measure.
Points of order followed amendments as the hours ticked by. In perhaps the most notable exchange, Democratic Representative Senfronia Thompson offered an amendment to exempt rape and incest victims from the ban. She stood with a coat hanger in her hand, and asked her colleagues, “Do you want to return to the coat hanger? Or do you want to give them an option to terminate their pregnancy because they have been raped?”
Laubenberg responded with the latest in a Republican pantheon of spectacular misstatements on abortion: She implied that rape kits prevent pregnancy because “a woman can get cleaned out.” Her remark prompted widespread criticism and mockery from social media. After that, Laubenberg stopped directly responding to amendments. But her lack of knowledge about rape and pregnancy put her in company with a number of U.S. congressmen. During the 2012 election, Missouri’s Congressman Todd Akin argued that women’s bodies had ways of “shutting down” the possibility of pregnancy after a “legitimate rape”; more recently, Arizona’s Trent Franks noted that the odds of pregnancy after rape were “very low.”
The Texas bills are part of a larger national fight. Just last week, the U.S. Congress passed a similar 20-week abortion ban; though the measure has no chance of passing the Democratic-controlled Senate, it helped showcase the chasm between Democrats and Republicans on the issue. Earlier this year, North Dakota passed the most restrictive abortion ban in the country, outlawing all abortions after a fetal heartbeat can be detected, which usually occurs around six weeks into pregnancy. That law is currently making its way through litigation. Generally, such measures aren’t faring well in court. Idaho’s 20-week ban was found unconstitutional in March by the U.S. District Court for the District of Idaho, and in May, the Ninth Circuit Court of Appeals struck down Arizona’s 20-week ban.
The battle in Texas raged on until Republicans cut off debate around 4 a.m. Monday morning, finally passing the bill on the floor for the first time. They returned fewer than three hours later to vote it through again, as required by procedural rules. Later Monday morning, they passed a required “third reading,” which sends the bill to the Senate. However, there’s a 24-hour waiting period before the Senate can take up the bill and pass it in its turn.
That means the bill will reach the Texas Senate on Tuesday morning. Democrats have vowed a filibuster, which would block the bill’s passage. They will only have to hold out until midnight on Tuesday to give reproductive rights supporters a surprising victory in Texas.
By: Abby Rapoport, The American Prospect, June 24, 2013
“Safe And Effective”: All Women Should Have Quick, Confidential Access To Emergency Contraception
Earlier this week, the Food and Drug Administration took an important step for millions of women by moving emergency contraception out from behind the pharmacy counter and making it available to people ages 15 and older with valid identification.
As a doctor, I know that this is good news and a great first step. Emergency contraception is a safe and effective form of birth control that can prevent pregnancy if taken within five days of unprotected sex. By reducing barriers, this announcement will help more women prevent unintended pregnancy.
At the same time, the Obama administration said this week that it is appealing last month’s federal ruling that would have eliminated the age restriction completely. Citing scientific research and evidence, the judge removed the age and point of sale restrictions that made it harder for all women to access emergency contraception. That ruling should stand.
Unprotected sex sometimes happens – a condom breaks or non-consensual sex occurs. When it does, all women, regardless of their age, need access to emergency contraception quickly and confidentially.
Remember, emergency contraception prevents pregnancy. The sooner it is taken, the more effective it is (but if you are already pregnant, it won’t work). That’s why removing unnecessary barriers that delay access can help a woman prevent an unintended pregnancy.
The research shows that emergency contraception is safe for women of all ages, including young people. Research also indicates that teens understand how to use emergency contraception and understand it is not intended for ongoing, regular use. It doesn’t increase risky behavior either.
A recent study published in the medical journal Pediatrics found that sexual activity is exceedingly rare among the youngest adolescents. However, when sex does occur among teens under 14, it is often non-consensual and contraceptives are not used.
So despite some of the myths out there, emergency contraception is a safe, effective way to prevent pregnancy for all women, regardless of age (though, as someone who talks to parents everyday about health care, I also know it’s crucial that parents have conversations with their children about these issues).
The good news is that this week’s decision makes it a whole lot easier for women to get access to emergency contraception. More should be done to remove all barriers and unnecessary hurdles. While the teen birth rates have declined significantly in the last two decades, they are still high, including in states that lack access to medical providers and preventive health care.
That’s why, as a doctor, I know it makes good scientific and medical sense to expand access to emergency contraception to all women.
By: Deborah Nucatola, MD, Senior Director of Medical Services for Planned Parenthood Federation of America, Debate Club, U. S. News and World Report, May 3, 2013
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