Off the Kuff Rotating Header Image

Texas Public Policy Evaluation Project

The Mexican abortion option, part 3

Stop me if you’ve heard this one before.

Misoprostol

Between 100,000 and 240,000 Texans have attempted to terminate their pregnancies without medical assistance, according to new research released Tuesday. Based on interviews and a statewide survey, the unprecedented study by the Texas Policy Evaluation Project (TxPEP) estimates that between 1.7 and 4.1 percent of Texas women between the ages of 18 and 49 have attempted to end their own pregnancies outside of a clinical setting.

According to TxPEP’s interviews with Texans who’ve attempted self-induction, the top four reasons they tried to end their pregnancies on their own fall into four categories: financial constraints for the cost of the procedure or travel to the nearest clinic, clinic closures, recommendation from a family member or friend, or an intention to avoid shame or stigma of going to an abortion clinic, especially if they had had an abortion before.

“I didn’t have any money to go to San Antonio or Corpus,” one woman living in the lower Rio Grande Valley told researchers. “I didn’t even have any money to get across town. Like I was just dirt broke. I was poor.”

The study also found that Latina women living near the Texas-Mexico border are more likely to have attempted to induce their own abortions, or know someone who has, than non-Latina Texans.

[…]

Researchers believe the likelihood of self-induced abortion in Texas is higher than elsewhere. According to a 2008 national study by the Guttmacher Institute, less than 2 percent of American women reported taking something to terminate their pregnancies on their own. In 2012, TxPEP conducted a survey of Texans seeking abortions and found that 7 percent of women interviewed spoke to reported taking something to induce their own abortion.

Lead TxPEP researcher Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco, warned that clinic closures after HB 2 may lead to an increase in self-inductions.

“This is the latest body of evidence demonstrating the negative implications of laws like HB 2 that pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk,” Grossman said in a press release. “As clinic-based care becomes harder to access in Texas, we can expect more women to feel that they have no other option and take matters into their own hands.”

The most common method women reported using to induce their own abortion was a medication called misoprostol, also called by its brand name, Cytotec.

Spoiler alert: we have heard this before. I have often heard it said that trying to ban or regulate something – guns, drugs, gambling, what have you – doesn’t work and can’t work because people will still want those things, so the net effect is to push the activity in question underground and thus make it more dangerous for everyone involved. Funny how that never seems to be applied to abortions, especially by those who so piously intone that they’re just making them safer because they care so much about women’s health. Thankfully, at least some federal judges have been willing to point out the dangerous absurdity of the recent spate of anti-abortion laws; whether SCOTUS follows suit or not remains to be seen. The AusChron, the Press, and ThinkProgress have more.

It’s about much more than abortion

Yet another reminder that even if the Legislature had taken no action on abortion since 2011, it still grievously damaged women’s access to healthcare.

The closure of nine of 32 family planning clinics in the Rio Grande Valley — a result of the state Legislature’s decision to cut family planning financing in 2011 — has compounded the struggles of low-income, Latina women trying to access reproductive health services, according to a report released Tuesday by the Center for Reproductive Rights and the National Latina Institute for Reproductive Health.

“Profound barriers to reproductive health, including cost, lack of transportation, immigration status and lack of accessible clinics, mean that Latinas in Texas are systemically barred from the care they need to live with health and dignity,” Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, said in a statement. “These conditions are dangerous to the health of Latinas and immigrant women.”

The Legislature’s decision in 2011 to cut two-thirds of the state’s two-year family planning budget — to $37.9 million from $111 million for 2012-13 — has caused 76 medical facilities across the state to close or stop providing family planning services as a result of lost public financing, according to the Texas Policy Evaluation Project (TxPEP), a three-year study at the University of Texas evaluating the impact of the cuts to family planning services.

The enactment of stricter abortion regulation in November — the constitutionality of which is currently being debated in federal courts — has also caused a third of state’s nearly 40 licensed abortion facilities, including the only two abortion clinics in the Valley, to stop performing abortions. The Center has provided legal assistance to the abortion providers involved in that lawsuit.

Although the report released Tuesday focuses on the Valley, TxPEP researchers have found women across Texas have lost access to trusted providers, experienced longer wait times for services and paid higher rates for contraception and other health services, as a result of the 2011 cuts to family planning services.

In its 2013 session, the Legislature sought to mitigate the impact of the 2011 cuts with the largest financial package for women’s health services in state history, increasing spending to $214 million in the 2014-15 budget from $109 million. Texas’ 2014-15 budget includes a $100 million expansion of a primary care program to provide services for an additional 170,000 women; $71 million to operate the Texas Women’s Health Program; and $43 million to replace family planning grants that the federal government awarded to another organization to distribute.

The efforts to rebuild access to reproductive health care is slow moving, as the state is still in the process of contracting providers to participate in the expanded primary care program. Texas Women’s Health Program, which replaced the federally-financed Medicaid Women’s Health Program in January after the state violated federal rules by ousting Planned Parenthood clinics, has fewer women enrolled and has processed fewer claims so far this year than during the same time period last year.

See here for some background. As I said before, even if a sufficient number of new clinics eventually opens and the state’s replacement Women’s Health Program matches the reach and breadth of the Planned Parenthood-anchored network that the Lege and Rick Perry killed off, you can’t undo the damage and disruption that the original cuts caused. Tens of thousands of women were left in the lurch, often to the detriment of their health, and most if not all of them will wind up with a different doctor than who they had before. All of this was done in the service of ideology. When we talk about a war on women, when Wendy Davis talks about truly being “pro-life”, this is what we’re talking about.

Senate begins omnibus abortion bill hearings

Remember, it’s all about women’s health.

Senate Bill 1, and its companion, House Bill 2, would ban abortion at 20 weeks post-fertilization and recognize that the state has a compelling interest to protect fetuses from pain; require doctors performing abortions to have hospital admitting privileges within 30 miles of the facility; require doctors to administer the abortion-inducing drug RU-486 in person, rather than allow the woman to take it at home; and require abortions — including drug-induced ones — to be performed in ambulatory surgical centers.

[…]

The House will consider HB 2 on Tuesday. Senate Health and Human Services Committee Chairwoman Jane Nelson, R-Flower Mound, indicated that the committee would wait to vote on that version of the legislation, which means, it’s likely that the legislation would reach the Senate floor for debate on Thursday. If the House and Senate approve the same version of the legislation, it could reach Gov. Rick Perry’s desk for final approval by the end of this week.

Nelson said that every person who registered to give oral testimony before 11 a.m. would get to speak for two minutes. But if there were any outbursts from the public, one warning would be given before she would ask public safety officers to clear the committee room and end the hearing. Senators debated the bill among one another for roughly an hour before they began listening to public input.

Sen. Judith Zaffirini, D-Laredo, pressed SB 1 author Glenn Hegar, R-Katy, on amending the bill to include an exemption from the 20-week ban for women with pre-existing psychological conditions and redefining the “substantial medical evidence” the bill cites to “some medical evidence” or just “medical evidence.” Hegar rejected all of those changes.

Sen. Carlos Uresti, D-San Antonio, asked about including an exception for cases of rape and incest. Hegar responded that there is no exception after 24 weeks, so he did not see the need to have one at 20 weeks.

Zaffirini also asked Hegar what the bill did to reduce levels of unwanted pregnancy and inquired why it did not specifically address sex education. Hegar said the bill is not “a funding mechanism for women’s health” and that sex education is not on the call for this special session.

Sen. Royce West, D-Dallas, debated with Hegar over whether it is realistic to require that abortion providers have admitting privileges at hospitals within 30 miles of the clinic.

[…]

Ellen Cooper, an expert witness from the Department of State Health Services, said that abortion clinics are inspected at least once a year, while ambulatory surgical centers are inspected every three to six years.

“Generally speaking, compared with the other facility types, I have not been aware of any particular concerns” associated with abortion clinics, she said, and later added, “there’s no reason for me to believe that one is safer than the other.”

Researchers with the Texas Public Policy Evaluation Project — a three-year study at the University of Texas at Austin evaluating the impact of the 2011 cuts to family planning financing in Texas — issued a policy brief detailing the impact of the legislation on five areas of the state that do not have an abortion clinic that meets the ambulatory surgical facility standards.

In the Rio Grande Valley, more than 2,634 women received an abortion in 2011 at one of two medical clinics, according to the policy brief, but if the law were to pass, those women would have to travel to San Antonio at least two times, adding 16 hours of travel to obtain the procedure.

Because only six of the state’s 42 existing abortion facilities meet the existing ambulatory surgical center standards, the policy brief states that women in the metropolitan areas near Beaumont-Port Arthur, Corpus Christi-Kingsville, El Paso, Midland-Odessa, and the Rio Grande Valley would have to travel on average more than 16 hours for two round-trip visits to obtain an abortion. That would increase the costs of obtaining an abortion, and require women to take more time off from work or school, according to the researchers. If there are fewer facilities, women will also be forced to wait longer for an appointment, the researchers add, and later-term abortions are associated with a higher risk of complications.

“Faced with these obstacles, some women may instead choose to try to self-induce their abortion, a phenomenon that we are already observing in the state,” states the policy brief. “We do not doubt that the proposed restrictions would reduce the number of legal abortions carried out in these regions, but we are deeply concerned about the increase in self-induced abortions and increase in later abortion that will almost certainly follow in the wake of these restrictions.”

Yes, the concern for women’s health just warms your heart, doesn’t it? As with the House committee hearing last week, testimony will go well into the night, or until the Chair gets tired of it all and arbitrarily cuts it off. I don’t know if the committee plans to vote on SB1 after the hearing or if it will wait till later, but as the story notes the whole thing could be wrapped up by the end of the week, since neither author is likely to accept any amendments. They have a political mission to accomplish, and they are focused on that. See BOR’s liveblogging for more.

On a side note, for those of you in Houston, the Stand With Texas Women bus tour is coming to Discovery Green tonight, July 9, at 6 PM. I have it on good authority that Sen. Wendy Davis will be one of the speakers. You can also buy one of those orange “Stand with Texas women” T-shirts for $15. I can’t be there, but if you can you should be. Stace, dKos, Texas Politics, and Trail Blazers.