Texas Governor Rick Perry is knee deep in litigation as he fights the Obama Administration over the exclusion of Planned Parenthood affiliates from the state’s Women’s Health Program.
But he still finds the time to take a moment to pray for the President.
May 3rd is National Day of Prayer, and Perry has declared it Texas Day of Prayer as well. And what is the governor of one of the largest states in the country, with one of the highest teen pregnancy rates, highest rates of unintended pregnancy, and largest uninsured population praying for?
Oh, yes. That the President will start taking away women’s reproductive rights.
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According to the Associated Press, “Perry, who opposes abortion, said he hoped Obama ‘truly understand God’s will to protect innocent life. I pray for his true understanding of God’s will for this country.'”
Less in need of protection? The hundreds of thousands of Texas women who will be without preventive reproductive health care and even basic contraception, all in the name of his ideological quest to “end abortion.”
Neither of those observations bode well for Texas patients.
The battle over HB 2 may be the most high-profile abortion rights fight currently in this country. Beginning with Wendy Davis’ epic filibuster and the protests that followed, the hollow and unsupported claims by conservatives that restricting access to reproductive health care advances patient safety, Texas’ struggle has for good or for bad come to symbolize the plight of reproductive rights in this country. The Supreme Court has already intervened twice in the fight over HB 2’s constitutionality, so smart money is on Whole Woman’s Health v. Cole being the next big abortion rights case on the Court’s docket.
Meanwhile, abortion rights jurisprudence has slid dramatically rightward since Roe v. Wade and Planned Parenthood v. Casey, so much so that the Roberts Court, should it take up the fight over TRAP laws, would be considering the question of whether or not states can constitutionally close all the abortion clinics within their borders. In other words, does closing every clinic in a state, or maybe leaving just one clinic open, create an undue burden on a patient’s right to terminate their pregnancy?
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The answer to that question seems obvious, right? How can a patient exercise their right to terminate a pregnancy if they cannot access a provider or a facility to do so? But, does your right to vote mean anything if there are no polling places for you to cast it?
One partial answer in the context of abortion rights is to self-terminate a pregnancy. I’ll get back to that terrifying prospect in a moment.
With such a fundamentally important question before the Roberts Court, and the significant likelihood the justices will take up the case, you would think the Texas Attorney General’s Office could muster up a little zing in its brief defending HB 2 and the Fifth Circuit’s decision to allow it to take effect. Instead, what the State of Texas offered up is a collective shrug, or a non-statement, at the state of abortion rights access in their state, especially for poor people.
“While some abortion providers may choose to close rather than comply,” the state’s brief reads, “petitioners [Whole Woman’s Health] did not even attempt to prove that remaining facilities will lack the capacity to perform the number of abortions sought—or that some of the other 423 ambulatory surgical centers in Texas will not begin performing abortions.”
The bulk of Texas’ defense of HB 2’s admitting privileges and ambulatory surgical center requirements is that, after two years and countless court hearings later, there is no evidence that patient care is harmed with these requirements in effect. That’s it. In its brief, there is no recounting of the purported health benefits forcing doctors to have admitting privileges extends to patients. There is no data presented discussing the benefit of ambulatory surgical center requirements on patient care. And there is certainly no information to support the State of Texas’ claims that patient health has improved since HB 2’s implementation.
An amicus brief filed by the National Abortion Federation (NAF) in support of the petition to the Roberts Court to take up the case puts that lack of evidence claim in context.
“Texas is the second-largest state in the U.S., both by population and geographic area, and home to approximately 5.4 million women of reproductive age,” the NAF brief reads. “Texas also has the highest proportion of citizens without medical insurance of any state in the nation, and consistently rates near the bottom of national health care access rankings.”
The brief continues:
The state’s abysmal health care record has led to poor outcomes for pregnant women and staggering racial disparities in care. For example, the State Task Force on Maternal Mortality and Morbidity reported last year that while there were 24.4 pregnancy-related deaths per 100,000 overall births in Texas in 2011, among African-American women there were 67.3 such deaths per 100,000 live births. The Task Force concluded that pregnancy- related deaths are on the rise, and that between 20% and 50% are preventable.
In other words, what the State of Texas describes as “no evidence of harm” is, really, a refusal to see the individuals being harmed by HB 2.
According to the legal record from the lower court proceedings in the fight over HB 2 cited by NAF, in the six months after the admitting privileges requirement of HB 2 was implemented, 13.9 percent of abortion procedures in Texas were provided at 12 weeks of pregnancy or later, compared to 10.7 percent in 2012. One clinic informed NAF that some patients were waiting for three weeks just to obtain a first visit, with many forced to travel out-of-state to Louisiana to seek care.
The same day the State of Texas submitted its brief to the Roberts Court, the Texas Policy Evaluation Project at the University of Texas at Austin released a report on the growing wait times for patients needing abortion care in the state. Since HB 2’s enactment, approximately half the abortion clinics have closed. The report measured wait times in major metropolitan areas in the state from November 2014 to present. In Dallas, the wait time to schedule a procedure grew from about five days to more than 20. Wait times in Ft. Worth grew to more than 25 days to schedule an abortion. “The long wait time at some of the [abortion clinics that meet ambulatory surgical center standards] suggests that these facilities are not meeting the existing demand for services,” the researchers wrote in the report.
The result of the increased wait time means patients are being pushed into more expensive, later abortion procedures or going without care. (HB 2 also bans abortions at 20 weeks, a provision that so far has gone unchallenged by advocates.)
Monday’s report is not part of the legal record challenging HB 2, but it does help highlight how the State of Texas’ argument—that those abortion providers remaining in the state could meet the demand of all Texas patients—ten providers to accommodate millions of patients “strains credulity,” as NAF argued.
There is also the possibility that some patients will be forced into self-terminating pregnancies. The evidence exists that this is already happening at alarming rates, especially for poor patients and those who do not live in urban centers and/or cannot travel the distance to get a provider.
Those patients are nowhere to be found in the State of Texas’ brief.
The Supreme Court will decide later this fall if it will take up the HB 2 challenge. If it does, and I believe it will, it will be the first time the Roberts Court has heard a challenge to an abortion restriction since it upheld the so-called federal Partial Birth Abortion Ban in 2007’s Gonzales v. Carhart. By the looks of the State of Texas’ brief, Attorney General Ken Paxton’s office doesn’t seem to care one way or another if they do.
The fight to open a Planned Parenthood health-care clinic in El Centro, California, shows that national anti-choice groups are intent on rolling back reproductive health care gains in even the most progressive parts of the country.
California may be traditionally progressive with a history of protecting reproductive rights, but Imperial County has become a new front in the anti-choice movement’s effort to erode abortion access well outside the confines of GOP-controlled red states.
Imperial County sits on California’s southeastern corner, bordering Arizona and Mexico. Go west and you’ll hit San Diego; north, and you’ll hit Palm Springs. About 80 percent of the county’s households identify as Latino and 65 percent speak predominately Spanish at home, according to the last census.
Despite its desert landscape, Imperial County has wide swaths of farmland thanks to irrigation fields fed by the Colorado River on its eastern border and the Hoover Dam. Jobs in agriculture account for about a quarter of all employment in the county, and even though the state is in a historic drought, water for the area is all but guaranteed because of local politics.
The same cannot be said for reproductive health care, as national anti-choice activists have focused their attentions on a Planned Parenthood health-care facility opening in the valley’s El Centro, California.
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“Imperial Valley statistically is now rated fourth highest in the state for teen births,” Tracy Skadden, general counsel for Planned Parenthood of Pacific Southwest, told Rewire in an interview. “It has one of the highest rates of unemployment in California; the high schools sometimes have day care centers.”
Skadden said Planned Parenthood agency members spent about five years on the ground in Imperial Valley meeting with members of the community and local organizations to get an understanding of the area’s unique health-care needs before putting together the effort required to open a new facility.
“We know that they don’t have any reproductive health-care access specifically as it relates to abortion services,” Skadden said. “We know that they have very long waits to get in to see a doctor. A lot of the men and women who come to see us, because they don’t have any insurance coverage they really don’t go to doctors very often.”
“Some of the women in their 30s and 40s who come to see us have never had a pap smear,” she continued. Through the Planned Parenthood facility, “they get wellness checks, they get their cholesterol checked, possibly they get screened for diabetes. We don’t treat those things, but we do refer them to other health-care clinics that can.”
The El Centro facility is the only one to provide abortion care anywhere in Imperial County. Still, despite a chronically underserved population in need of comprehensive reproductive health care, Planned Parenthood faced what Skadden described as opposition that was “unprecedented for California” in opening the new facility in El Centro, the heart of Imperial Valley.
After funds for the new facility had been raised, architectural plans were approved by government officials, and all necessary permits were obtained, Planned Parenthood broke ground and finished building the facility this spring.
Then the protests started.
“The thing that triggered the protesters from the very beginning was our ‘now hiring’ sign that we put up under our logo,” Cita Walsh, vice president of marketing and communication, said in an interview with Rewire. “When we put the sign up we had hundreds of people apply for jobs at our health center.”
While the facility applied for a standard transfer agreement for patients with the city-owned El Centro Regional Medical Center, an area church organized about 500 protesters to come to the hospital’s board meeting and complain that by signing the transfer agreement, local officials were “authorizing abortions to occur in Imperial Valley.”
The city, in response to the anti-choice backlash, agreed to hire a third-party law firm to review the transfer agreement. That law firm told the city council the transfer agreement was legal and there was no reason the center should not open.
Walsh said that harassment escalated after the transfer agreement was complete, with more than 2,000 anti-choice protesters complaining to the El Centro city council about the opening of the health-care center.
“The National Right to Life Movement inserted themselves as outsiders into the Imperial Valley in an attempt to embed Imperial County and ignite the local churches and help them organize,” Walsh said.
National anti-choice activists, from former Minnesota Rep. Michele Bachmann (R) to Alveda King, came to the Valley to raise funds for efforts to stop the clinic’s opening.
“They brought in people from out of state to try and get the Imperial Valley Coalition for Life funded in order to teach them how to use the Texas playbook,” Walsh said. The Texas playbook, as described by Walsh, is centered on pressuring local officials into endorsing TRAP (targeted regulations of abortion providers) measures.
“It starts with you try to stop them with transfer agreements and then you have a lot of protesters,” Walsh said. “It felt a little like Mississippi or Texas, but right here in California.”
Days before the facility was set to open, after city officials had told Planned Parenthood of the Pacific Southwest to invite trained staff in to begin setting up, El Centro city officials denied Planned Parenthood of the Pacific Southwest its occupancy permit on the grounds that the building had been improperly classified and would need significant, additional upgrades before opening.
No other comparable facility in California is subject to the more burdensome requirements city officials want to impose on the El Centro facility.
The decision to reclassify the building just prior to its opening was made by El Centro Fire Chief Kenneth Herbert. Herbert explained to Rewire in an email that architects made the initial occupancy classification, but that “[b]ased upon conditions observed,” he decided the building needed more stringent requirements and denied fire clearance.
Herbert declined to elaborate on what conditions he observed that prompted his decision that the facility needed a more stringent classification. He told Rewire that since the initial permit denial, there have been changes made to the building in an attempt to comply with the “occupancy classification B requirements.” After a five-week delay, the city issued the facility a temporary certificate of occupancy.
In other words, the state-of-the-art health-care facility meets all the health and safety requirements it was required to all along.
In signing the licensing document, however, Herbert put in special conditions for their license to remain in place, Skadden said. One condition provides the fire chief with the authority to revoke the document pending a review of the building code by the state’s Fire Marshall Department. Herbert has requested from the State Fire Marshall’s office “a formal interpretation of the occupancy based on the use of the building.” That process could take up to 90 days.
“We complied with all the building, fire, and safety requirements for licensure, but the City of El Centro fire chief made an arbitrary and unilateral decision to deny our final documentation,” Skadden said. “The dispute is over a California building code. But it was clear this was about our abortion services.”
Planned Parenthood of the Pacific Southwest successfully fought back this round of challenges to providing reproductive health care in Imperial County, but more challenges lie ahead. The Imperial Valley Coalition for Life reported on its Facebook page that “friends” of its organization purchased the property right next to the new Planned Parenthood clinic.
The anti-choice group charged that the property is now “available to our prayer warriors from the 365 days for life to park and to pray and it will be available for sidewalk counseling also.”
Meanwhile, those opposed to legal abortion care continue to protest outside the El Centro facility. “We’ve had some vandalism already, but we are very vigilant with our security and our number-one priority is to the safety of our patients and staff,” Skadden said. “California has a long history of protecting reproductive rights, which, thankfully, we were able to rely on our safety and health codes and our California Constitution and other laws that do protect reproductive health care.”
The hope for Planned Parenthood of the Pacific Southwest is that the political fight to provide reproductive health care in Imperial Valley is over. “We intend [to] provide health care in Imperial Valley and to work with the city,” Skadden said. “We all have a mutual goal of increasing the health outcomes of the community in Imperial Valley.”