News Politics

Goodbye, Texas Women’s Health Program

Andrea Grimes

Thanks to the tireless efforts of Texas lawmakers, as many as 400,000 Texas women will have no or greatly reduced access to basic preventative and reproductive health care beginning today.

For all our coverage of the cuts to the Texas Women’s Health Program, click here.

On March 14th, 2012, at least 300,000 low-income and uninsured Texas women will have no or greatly-reduced access to basic preventive and reproductive health care due to the loss of federal funding for the Medicaid Women’s Health Program in the state. The program has been under threat for months as lawmakers fight over whether it’s legal to exclude Planned Parenthood from the program.

On Friday, U.S. Health and Human Services Secretary Kathleen Sebelius told reporters in Houston that the federal government would not extend its waiver, which provided about 90 percent of the cost of the program. It is against federal law to exclude “qualified providers” from providing Medicaid care, and while the federal government considers Planned Parenthood “qualified,” the state of Texas does not. Since 2005, legislators in Texas have sought specifically to block Planned Parenthood from participating in the Women’s Health Program in Texas, when they voted into place a state law, only just now enforced, that bars “affiliates” of abortion providers from receiving funds. Planned Parenthood uses no taxpayer dollars to provide abortions and keeps its abortion services wholly financially separate from its non-abortion services.

In a statement released Friday, Governor Rick Perry’s office stuck the Obama administration with the blame for not renewing the Women’s Health Program, neglecting to mention that there would be no reason to defund the program had Perry and his conservative allies in Texas not sought to defy federal law in the first place. Perry has said that Texas will continue to fund what would very likely amount to a significantly stripped-down version of the program with state funds–despite the fact that state legislators already devastated the state family planning budget last year.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

“We’re questioning the governor saying he’s going to continue the funding with state money,” Planned Parenthood of North Texas representative Kelly Hart told Rewire, “and why the state would want to go forward to spend more money to provide care to fewer women.” Hart says Planned Parenthood expects to be able to provide WHP care until they’re phased out in late April so that “more women can have that last chance to get their annual exam.”

The Center for Public Policy Priorities, based in Austin, has issued a report urging the State of Texas not to make this unnecessary and less effective state-funded move in lieu of continuing to let the program work as it always has. Quite simply, family planning programs don’t need to be fixed because they were not broken.

“Our family planning programs are programs that have high ratings [because] they connect women that are uninsured with basic health care check-ups that go along with their family planning, and [in addition] the sometimes life-saving outcomes that go along with that,” CPPP Associate Director Anne Dunkelberg explained to Rewire.

She adds that, of course, family planning programs also “reduce unintended pregnancies dramatically.” Fewer unintended pregnancies mean fewer abortions.

By seeking to illegally exclude Planned Parenthood from the WHP, the State of Texas has effectively guaranteed a significant reduction in women’s access to basic reproductive care and an increase the number of unintended pregnancies, and thereby abortions.

“One thing about the Medicaid Women’s Health Program is that it promises to serve every qualifying woman who shows up,” said Dunkelberg. A state-funded program would “need to ensure there’s enough funding available to take care of all these women,” and it’s unlikely that Texas could or would do so, particularly because state legislators slashed family planning funds by two-thirds last year. 

The 2011 state family planning cuts left 180,000 women without access to contraception and reproductive health services like cancer screenings. The Women’s Health Program serves an additional 130,000 women, bringing the total number of women without access to basic reproductive health care to 310,000. Some estimates put the number closer to 400,000. The Texas Legislative Budget Board has estimated that this will result in up to 21,000 additional births in the state–children born to families who are already in need of government assistance and who would otherwise have sought to avoid an unintended and unwanted pregnancy.

It’s hard to argue that the Obama administration is to blame for denying health care to hundreds of thousands of Texas women when Gov. Perry and conservative Texas legislators already took these significant, cost-increasing steps last year, despite the widely-accepted reasoning that family planning in Texas saves taxpayers $3.74 for every $1 spent

Conservative lawmakers in Texas have argued that there are plenty of alternatives to Planned Parenthood in Texas, like Federally Qualified Health Centers and small-scale providers, though an Rewire investigation conducted by this author last year revealed that the “alternatives” only operate as such for a very small, very mobile group of women. Without Planned Parenthood, which has the resources to provide comprehensive reproductive health care to a large number of patients in many, many locations across the state, women are left with long waits, at non-specialized clinics and, if they don’t have cars or time off from work, difficulty accessing the care that may only be available counties away from their home and work.

Kelly Hart at Planned Parenthood of North Texas told us:

“Yes, there are a large number of providers that have been part of the Women’s Health Program that have been reimbursed for providing care, but the vast majority of them see less than 25 patients a year.”

A given Planned Parenthood clinic may see hundreds or thousands.

At a rally held for Planned Parenthood in Austin last week, interim CEO Sarah Wheat told Rewire that their patients in the WHP were upset, frightened and angry that they could lose their access to reproductive care–and this was before the official ruling.

One of those patients is Delia Henry, an Austin woman in nursing school. “I don’t know what my next step will be if the program is cut,” said Henry, a WHP who says she goes to Planned Parenthood for contraception, annual exams and screenings. She says she worries about women who rely on WHP who are already mothers.

“You’re taking a chance on kids’ moms, what are they going to do?” she asked. A non-traditional student, Henry says many of her classmates are just out of high school. “They work jobs but not enough hours to get insurance, what are they going to do? This is a great part of their life and they’re not going to have that education and that safety net,” that Planned Parenthood provides.

Facing the fact that her access to reproductive care may disappear, Henry made a joke that may be unfunny because it’s true: “If you talk to me at another time, I guess I’ll be pregnant.”

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.