Analysis Law and Policy

Rick Perry: Ideological Crisis Pregnancy Center Is the Future of the Texas Women’s Health Program

Andrea Grimes

On Tuesday, Texas Governor Rick Perry stopped by to lend a little good-old-boy masculinity to the opening of a branch of Houston's The Source For Women, a crisis pregnancy center that Perry touted as the future of Texas' new Women's Health Program--a program explicitly designed and intended to serve women who are not, and don't want to be, pregnant.

On Tuesday, Texas Governor Rick Perry stopped by to lend a little good-old-boy masculinity to the opening of a branch of Houston’s The Source For Women, a crisis pregnancy center that Perry touted as the future of Texas’s new Women’s Health Program—a program explicitly designed and intended to serve women who are not, and don’t want to be, pregnant.

“The Source for Women clinics, in fact, will be part of Texas’s own Women’s Health Program, and Planned Parenthood will not be,” Perry told the crowd at the pink-ified clinic, at which Texas Observer’s Emily DePrang reports he cut a giant hot pink bow “with an actual pair of oversized scissors.”

Problem is, currently, there is no overlap between the services provided by The Source and the services provided by the federally-funded Medicaid Women’s Health Program, which is being phased out so that Texas can exclude Planned Parenthood from participating and create a new, state-funded Texas Women’s Health Program.

And therein lies the core issue: The WHP does not serve pregnant women. By definition. But crisis pregnancy centers don’t like to provide contraception nor are their services evidence-based. So if the future of the Texas WHP is a crisis pregnancy center, then the future of low-income women in Texas will be pregnant, like it or not.

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The Source claims to provide well-woman exams, for example, but at the same time, doesn’t even offer an integral part of that exam: pap smears. (Either that, or they don’t know what a pap smear is, and they’re providing them without knowing it; plenty troubling, that.) According to its own website, the Source for Women also does not prescribe contraceptives. Neither does it presently provide mammograms or employ any OB-GYNs.

Sound familiar? It should—anti-choice folks love to spread lies that Planned Parenthood doesn’t practice real medicine and to confuse breast exams with mammograms—you’ll remember that from the whole Susan G. Komen Foundation dust-up earlier this year. (Planned Parenthood provides breast exams and refers for mammograms.) Despite the fact that the Source currently provides only limited, pregnancy-related medical care and STI screenings, Gov. Perry is holding up the ideologically-motivated crisis pregnancy center as the future of comprehensive reproductive medical care for low-income Texas women. He even told the crowd gathered on Tuesday that Texas is excited about helping them spread their beliefs.

“The opening of this latest medical center will enable you to spread your message,” he said, “and do your vital work, on a significantly larger scale in the years to come.”

To be fair to The Source, its CEO Cynthia Wenz told Rewire that they will eventually provide pap smears and some contraceptives. In order to be enrolled in the WHP, they’ll have to.

“Obviously, we can’t qualify for the WHP if we’re not doing all of the above,” she said in a phone interview. Right now, says Wenz, she’s looking to hire OB-GYNs and is talking with her board members about which contraceptives they feel comfortable making available to patients.

“It is still on the table at the board level as to which contraceptives will be provided,” she said, adding that no “abortifacients” will be available. That’s a term that has very specific meaning to crisis pregnancy centers and anti-choice activists, and it goes well beyond what the word might mean medically and biologically and to a layperson who assumes it deals with the termination of an existing pregnancy. Instead, anti-choice activists and crisis pregnancy centers consider almost all forms of hormonal contraception and even IUD’s to be “abortifacients,” asserting that the pill can cause a “very early abortion,” and that “the pill kills.” Same goes for Depo-Provera, Norplant, and the morning-after pill. So that basically eliminates all effective contraception.

Fact is, a place like The Source has no interest—indeed, a demonstrated disinterest—in women not being pregnant. What the Source does have an interest in is dictating to women, using sketchy non-science and thinly-veiled religious dogma, what it believes they should do with their bodies and what kind of medical care it is appropriate for them to receive. Why should a board of directors—a group of total strangers—decide what kind of contraception is appropriate for any woman to use?

Of course, abortion-related posturing is wholly unnecessary when it comes to the Women’s Health Program, again because the WHP does not cover pregnancy or pregnant women. According to a spokesperson for Texas’ Health And Human Services Department, it is “not making any changes to who the program serves,” meaning the program will continue to enroll only non-pregnant women.

No one in the WHP needs “life-affirming” pregnancy care, because no one in the WHP is pregnant—that is, if the new Texas WHP works the way it should. But if women’s contraceptive choices are limited to those dictated by the whims of a group of total strangers, and they’re counseled by nurses and doctors who consider hormonal contraception to be “abortifacients,” they may very well need pregnancy-related services.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

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