Roe at Forty: Today in Texas, it is Yesterday


Tuesday was the much-celebrated 40th anniversary of the seminal Roe v. Wade decision that legalized abortion in America. But today, Texans are waiting 24 hours for mandatory, forced trans-vaginal sonograms. Today, Texans are being turned away from clinics they’ve relied on for years for contraceptive care. Today, Texans are crossing the border into Mexico in hopes of ending unintended pregnancies. Today, Texans are choosing between the possibility of losing their jobs and the possibility of raising a family they can’t support.

Today in Texas, it is yesterday. 

Texas is the future of the past; it is a place where regressive politics and backwards thinking have resulted not in strong families and healthy kids but in 6.3 million uninsured people—the highest percentage of any state—and a consistently rising poverty rate.

Our governor, Rick Perry, makes no bones about the fact that he’d like to make abortion a thing of the past, not by increasing access to contraceptives and thereby reducing the number of unintended pregnancies, but by increasing funding to religious, ideologically- driven crisis pregnancy centers, forcing women to get mandatory trans-vaginal ultrasounds and listen to or read about medically-unfounded claims linking abortion to breast cancer and infertility. 

“In Texas, we’ve worked hard to strengthen our abortion laws to the greatest extent possible under Roe v. Wade,” the governor said in a statement released on Tuesday. This is precisely the tactic, and an effective one, that conservative lawmakers and their religious-right backers have taken in Texas: if abortion can’t be made illegal, it can at least be made so difficult to get that only a very few people have access to it.
Perry claims that this reduction in access to abortion will “empower families and protect our children’s future.”

What it does, instead, is ensure that people have less control over the size of their families because the state government works to diminish access to both the means of preventing unintended pregnancies, and to the one safe, legal and common medical procedure available to women facing them. The result? A state where more and more people rely on public assistance every year. Texas has America’s highest number of citizens on food stamps, sees somewhere between a fifth and a quarter of its population living in poverty, and taxpayers here help fund 223,128 Medicaid-funded births per year (the second highest in the nation).

The state has dismantled its highly successful, money-saving Medicaid Women’s Health Program this year, preferring to shell out $40 million per year on a new, state-run program, all for the privilege of thumbing its nose at Planned Parenthood, with the ultimate result of vastly reducing access for low-income Texans to the free contraception and cancer screenings the WHP provided at a fractional cost to the state. In 2011, the state legislature cut family planning funds by two-thirds; as a result, numbers from the Texas Department of State Health Services show that the state is spending $37 more per family planning client to serve fewer than half the number of clients it saw two years ago. Paying more to do less.

In light of these facts, it is hard to see why reducing access to family planning and safe abortion care is anything but a step backwards. Abortion is, of course, technically legal in Texas. But if we want a preview of what a world without Roe v. Wade might look like, Texas is, sadly, a pretty good test case.

Because having the right to an abortion isn’t nearly the same thing as having access to one, RH Reality Check reached out to activists, non-profit leaders and abortion providers in Texas, asking the question: Who really has access to safe abortion care in Texas?

“Women living in the major urban areas who have insurance that covers abortion or access to the funds have the greatest access to abortion in Texas,” said Heather Busby, the executive director of NARAL Pro-Choice Texas. But “if you are a young woman, a low-income woman or a rural woman, your access is severely limited.”

Texas requires women seeking abortion to undergo trans-vaginal ultrasounds 24 hours before their procedures unless they can prove they live farther than 100 miles from an abortion provider. During the ultrasound, doctors must show and describe the image to their patient, who can look away or choose not to listen. (The state makes an exception to the law for those who are aborting non-viable fetuses.)

This means Texans must make two appointments, at least 24 hours apart. They must come up with the funds for their abortion in a matter of days, and the cost of an abortion goes up as a pregnancy advances. A $250 procedure at eight weeks becomes a $500 procedure just a couple of weeks later, and there are fewer doctors who provide later procedures. Cities with multiple providers will have overall lower abortion costs; in areas like Corpus Christi on the Gulf Coast, where there are fewer or perhaps only one provider, costs will be higher and appointments harder to make.

Shailey Gupta-Brietzke, who volunteers with the Lilith Fund, a non-profit organization that helps Texans fund their abortions, says that travel issues are a major barrier to Texans seeking abortions.

“There’s a lot of travel that’s required,” she says. Especially for Texans who live, say, 40 to 99 miles from their providers. They must take off work—if they have jobs that allow them to do so without fear of being fired—to drive or ride public transportation, an all-day affair when clinics aren’t just down the street.

And more than half of Americans who get abortions are already mothers, which means finding child care for the children already at home while they travel to and from their doctors.

Lilith Fund president Amelia Long hears frequently from these women: “A poor woman who works an hourly job, doesn’t have a car and can’t pay someone to take care of her children—she can’t take that time off and she doesn’t have the money to pay for it all.”

Because Texans of color tend to have fewer economic resources than whites, she says, “obtaining an abortion is a far greater financial strain on a black or Latino family than it is on a white family.”

And because of the swiftly rising cost of abortion with every week of pregnancy, a woman won’t “have months to set aside a few dollars here and there,” explains NARAL’s Heather Busbee. “We’re talking about mere days or weeks of coming up with what is likely the majority of her monthly income.”

The cost of the procedure is just one aspect of what it takes to fund an abortion; many women may need to stay overnight in a hotel and come up with bus fare or gas money to get to their clinic. What would be a $250 procedure for a woman in an urban area who already has, or can quickly access, the money in time for an abortion at eight weeks can turn into thousands of dollars for a woman who has to save or borrow before she can travel to her provider.

For undocumented women in Texas, the stakes are even higher. They fear that, in trying to access abortion, their information will be shared with government agencies.

“There are a lot of huge barriers in place for undocumented people,” says Gupta-Brietzke. “You have to show residency, a photo ID to show who you are, and where your address is to see if you’re within the hundred miles” of a provider. Women wonder, she says, “Is this something that’s going to be sent to other agencies? Is my confidentiality at risk?”

Those fears aren’t unfounded; new abortion reporting requirements enacted in 2013 mean the state is gathering more information than ever about Texans who seek abortion.

Minors in Texas also face challenges when they seek out contraception and abortions. The state requires parental consent for those under 18, or the alternative of a judicial bypass, something Jane’s Due Process, a non-profit legal hotline for pregnant minors, helps them obtain when their parents aren’t available to grant consent, or when abusive home situations make getting that consent dangerous.

“The majority of minors who call the hotline aren’t using any kind of birth control,” says Tina Hester, executive director at Jane’s Due Process. “Most of them tell us they thought they needed parental consent to get a prescription.”

But that isn’t true: clinics in Texas that receive federal Title X funding, says Hester, “are required to provide confidential family planning services for minors.” But a survey conducted by her organization last summer found “a number of clinics” that “gave misinformation, telling us parental consent is required.”

In Texas, misinformation, or a lack of information, for minors when it comes to sexual health is the norm; abstinence-only sex education is the government-endorsed default, and the result is the country’s fourth-highest teen birth rate.

The Texans who are in the least ideal financial and socio-economic position to provide for an unplanned-for child are the ones for whom abortion–and contraception–is hardest to access. This is by design; it isn’t an unfortunate accident or cruel happenstance of fate. And Texas lawmakers are doing all they can not to remedy the problem, but to make it worse.

This wouldn’t be a problem if Texas had a strong safety net for low-income people who want to grow their families, and who have every right in the world to do so. But Rick Perry has openly rejected the Affordable Care Act, which would make 1.7 million more Texans eligible for Medicaid. And conservative policymakers in Texas—from the governor to the attorney general to the executive commissioner of Texas Health And Human Services, Republicans hold most every high office and top bureaucratic position in the state—do not want to use the resources the state has to help break the cycle of poverty for its citizens.

At the opening of the 83rd Texas Legislature earlier this month, Gov. Perry touted what he sees as the state’s upcoming budget surplus—to the tune of about $8.8 billion—as an opportunity not to restore slashed education funds or family planning dollars, but an opportunity for more tax cuts. Lt. Governor David Dewhurst is excited about using some of the money to train teachers to carry handguns.

And of course, making abortion even harder to access is a top priority for the governor and the bureaucrats and lawmakers who share his views. State Senator Dan Patrick has proposed a bill that will increase restrictions on medical abortions. In a back-door deal made with the Texas Department of State Health Services, Rep. Bill Zedler has succeeded in his quest to gather more information, Big Brother-style, about abortion providers and people who seek abortions.

The big abortion-related legislative action on the horizon for the 2013 lawmaking session is a Perry-endorsed 20-week abortion ban; the details of the ban haven’t yet been worked out, and a bill hasn’t yet been filed. But when it is, Perry’s office told RH Reality Check, he’s going to let the legislators work out the appropriate punishment for abortion-seeking women.

If that happens, says the Lilith Fund’s Amelia Long, “a rich woman who wants or needs to terminate her pregnancy can still go out of state and get her abortion.” But low-income Texans, or Texans without the time and resources to travel out of state, will not have that luxury. And they will not necessarily be provided the resources they need to give birth to and raise an unplanned-for child even though, practically speaking, the state deliberately does all it can to give them no other choice.


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