News Abortion

Texas Birth Centers Face Increased Scrutiny From Lawmakers, Bureaucrats

Andrea Grimes

While the big reproductive health news out of Texas this summer centered around the regulation of abortion providers, the state's birthing centers are also coming under increased scrutiny from lawmakers and bureaucrats.

While the big reproductive health news out of Texas this summer centered around the regulation of abortion providers, the state’s birthing centers are also coming under increased scrutiny from lawmakers and bureaucrats.

Birthing centers in Texas must begin reporting data on their clients and practices to the state’s health agency this month, after lawmakers tasked the Department of State Health Services (DSHS) with collecting information on birth centers’ stillborn and live births, breech deliveries, and pregnancy complications resulting in hospital transfers, among other criteria.

Midwives and birthing center employees that Rewire spoke to said they were happy to report their data, much of which they already collect for internal review, though they expressed concern that data could be “taken out of context” by hospital industry stakeholders who want to steer pregnant people into hospital beds and away from birthing centers.

“We want people to know what a good job we’re doing,” said Jackie Griggs, a Houston-area certified nurse-midwife and leader of the Texas Birth Center Coalition.

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And Joan Doglio-Smith, a certified nurse-midwife and the staff development coordinator at the Austin Area Birthing Center, said she looked forward to showing state bureaucrats and lawmakers the high quality of care her center provides.

“We have to protect your pregnancy,” said Doglio-Smith, “because if we screw that up, then nobody gets the benefit [of birthing centers].”

Birthing centers are considerably more affordable than hospitals for low-risk pregnancies, said Doglio-Smith, who stressed that midwives carefully screen out clients who could be better served in a hospital environment—such as those with breech pregnancies or who are carrying multiples. A study published earlier this year in the Journal of Midwifery and Women’s Health highlights “the safety of birth centers and consistency in outcomes over time despite a national maternity care environment with increasing rates of intervention.”

Brielle Epstein, a certified professional midwife practicing in Austin, told Rewire that she’s been hoping the state would start collecting this kind of data, which she believes will “prove that out-of-hospital births are cost effective,” as well as safe.

(Certified professional midwives are accredited by the North American Registry of Midwives, and must attend midwifery school or complete an apprenticeship; certified nurse-midwives receive medical training to become nurses. Austin Area Birthing Center and Bay Area Birthing Center each employ both certified professional midwives and certified nurse-midwives.)

Though the Austin Area Birthing Center, which operates two homey facilities in Austin featuring themed birth rooms outfitted like studio apartments, has a large staff and the resources to collect the kinds of information DSHS requires, Doglio-Smith says she’s concerned that smaller birthing centers, particularly those located in the Rio Grande Valley, may have to stretch their already limited resources to make sure they comply with the new DSHS reporting requirements. And, says Doglio-Smith, the department hasn’t yet sent out a letter advising birth centers of the new requirements in Spanish, so the Texas Birth Center Coalition is currently working on a translation.

According to Susan Jenkins, legal counsel for the American Association of Birth Centers, precise language will be particularly important to ensure that the numbers produced by birth centers statewide aren’t misinterpreted.

“You need to have good questions to get good answers,” said Jenkins.

The Texas Birth Center Coalition, which was formed earlier this year in response to increased legislative interest in birthing centers, is currently focusing on making sure those “good questions” are asked by DSHS, said Doglio-Smith, to ensure that data reported isn’t “taken out of context.”

“I’m hoping [birth center reporting numbers] can be a benefit,” said Doglio-Smith. “And we’re hoping someone doesn’t try to twist them.”

Similar concerns were echoed by abortion providers earlier this year, when DSHS began collecting more data on abortion complications and Texans who seek abortions, despite the fact that the data collection was not required in statute but enacted at the behest of a single anti-choice lawmaker, Bill Zedler. The birth center data collection is part of a rider attached to DSHS’ funding appropriations, which means it is not without statutory basis, but it does reflect increased scrutiny, with minimal public input, on yet another aspect of Texans’ reproductive health choices.

Earlier this year, Texas Rep. John Zerwas, an anesthesiologist, proposed legislation that would enact new facility and operating requirements for birthing centers and require transfer agreements with nearby hospitals. His bill never made it out of committee hearings, but it’s precisely the kind of legislation that the Texas Birth Center Coalition hopes to counter in the future, if necessary, with the same enthusiasm that pro-choice supporters showed this summer against the omnibus anti-abortion bill that requires abortion facilities meet surgical center standards and abortion providers obtain hospital admitting privileges: “Lots of protesters hollered long and loud and stopped the bill from being passed before midnight. That is what we will need to do if this ever comes again against birth centers.”

CORRECTION: A version of this article incorrectly noted that Joan Doglio-Smith serves as the clinical director at the Austin Area Birthing Center. She is in fact the staff development coordinator at the center.

News Law and Policy

Texas Lawmaker’s ‘Coerced Abortion’ Campaign ‘Wildly Divorced From Reality’

Teddy Wilson

Anti-choice groups and lawmakers in Texas are charging that coerced abortion has reached epidemic levels, citing bogus research published by researchers who oppose legal abortion care.

A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”

Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.

White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy. 

“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.

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White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.

Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.

“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”

White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.

During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”

Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.

There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.

‘Extremely common but hidden’

“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”

Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.

“I believe the number is closer to 50 percent, in my opinion,” Parker said. 

There were 54,902 abortions in Texas in 2014, according to recently released statistics from the Texas Department of State Health Services (DSHS). The state does not collect data on the reasons people seek abortion care. 

White and Parker referenced an oft cited study on coerced abortion pushed by the anti-choice movement.

“According to one published study, sixty-four percent of American women who had abortions felt forced or unduly pressured by someone else to have an unwanted abortion,” White said in a statement.

This statistic is found in a 2004 study about abortion and traumatic stress that was co-authored by David Reardon, Vincent Rue, and Priscilla Coleman, all of whom are among the handful of doctors and scientists whose research is often promoted by anti-choice activists.

The study was cited in a report by the Elliot Institute for Social Sciences Research, an anti-choice organization founded by Reardon. 

Other research suggests far fewer pregnant people are coerced into having an abortion.

Less than 2 percent of women surveyed in 1987 and 2004 reported that a partner or parent wanting them to abort was the most important reason they sought the abortion, according to a report by the Guttmacher Institute.

That same report found that 24 percent of women surveyed in 1987 and 14 percent surveyed in 2004 listed “husband or partner wants me to have an abortion” as one of the reasons that “contributed to their decision to have an abortion.” Eight percent in 1987 and 6 percent in 2004 listed “parents want me to have an abortion” as a contributing factor.

‘Flawed research’ and ‘misinformation’  

Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.

“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.  

White sponsored or co-sponsored dozens of bills during the 2015 legislative session, including several anti-choice bills. The bills she sponsored included proposals to increase requirements for abortion clinics, restrict minors’ access to abortion care, and ban health insurance coverage of abortion services.

White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.

The bill was met by skepticism by both Republican lawmakers and anti-choice activists.

State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.

“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”

‘Very small piece of the puzzle of a much larger problem’

White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”

There is research that suggests a connection between coerced abortion and domestic and sexual violence.

Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.

“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”

A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.

Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.

‘Tactic to intimidate and coerce women into not choosing to have an abortion’

TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”

One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”

The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.

The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.

“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”

“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.

Among the other resources that TJF provides is a document produced by Life Dynamics, a prominent anti-choice organization based in Denton, Texas.

Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”

Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.

Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.

“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”

“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.

News Law and Policy

Lawsuit Challenges Anti-Choice Laws Passed by Louisiana Lawmakers

Teddy Wilson

The lawsuit comes in the wake of the U.S. Supreme Court’s landmark decision that struck down two provisions of Texas’ omnibus anti-choice law known as HB 2.

The Center for Reproductive Rights filed a lawsuit Friday in federal district court challenging abortion restrictions passed by Louisiana lawmakers this year.

Despite facing a budget crisis, lawmakers passed seven laws that restricted access to reproductive health care, including abortion services, which the Center for Reproductive Rights claims “individually, and cumulatively” unduly restrict the “constitutional right to abortion.”

Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement that the laws collectively create a “web of red tape” that restrict women’s ability to access reproductive health care.

“Louisiana politicians are trying to do what the U.S. Supreme Court just ruled decisively they cannot, burying women’s right to safe and legal abortion under an avalanche of unjustified and burdensome restrictions,” Northup said.

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The lawsuit comes in the wake of the U.S. Supreme Court’s landmark decision that struck down two provisions of Texas’ omnibus anti-choice law known as HB 2.

Stephen Griffin, a constitutional law professor at Tulane University, told the Times-Picayune that the Supreme Court’s ruling on HB 2 was a “strong rebuke” of the Fifth Circuit Court of Appeals that upheld the law.

“I think the Louisiana law and any similar laws are going to be struck down,” Griffin said. “[Justice Ruth Bader] Ginsburg filed a reminder to courts that the five-member majority is going to be looking very skeptically at targeted regulation of abortion providers.”

Among the laws challenged is a law similar to Texas’ HB 2.

HB 488 requires that physicians providing abortion care be licensed to practice medicine in Louisiana and that they be board-certified or board-eligible in obstetrics and gynecology or family medicine. Previously, the law required that a physician be licensed to practice medicine in Louisiana and be currently enrolled in or have completed a residency in obstetrics and gynecology or family medicine.

The bill was sponsored by Rep. Katrina Jackson (D-Monroe), who in 2014 authored the state’s Texas-style admitting privileges law. The law is the subject of another Center for Reproductive Rights lawsuit, and is currently blocked by a Supreme Court decision.

Ben Clapper, executive director of Louisiana Right to Life, told the Times-Picayune that the Supreme Court’s ruling on HB 2 “does not predict a favorable forecast” for a similar law passed in Louisiana.

“The sad thing here as we see it is that these judges are replacing the elected officials and the legislative process as the determiner of what is medically important or not,” Clapper said. “We don’t believe that’s how it should be.”

Among the other laws challenged include those that restrict abortion procedures, require a waiting period before an abortion, impose restrictions on the handling of fetal tissue, and ban public funding for organizations that provide abortion services.

HB 1081 targets a procedure known as dilation and evacuation (D and E), which is frequently used during second-trimester abortions. A growing number of states have passed laws to ban the procedure, while state courts have blocked such measures passed by GOP lawmakers in Oklahoma and Kansas.

HB 386 tripled the state’s waiting period for a pregnant patient seeking an abortion from 24 hours to 72 hours.

HB 1019 prohibits a person from intentionally performing or attempting to perform an abortion with knowledge that the pregnant patient is seeking the abortion solely because the “unborn child” has been diagnosed with either a genetic abnormality or a potential for a genetic abnormality.

HB 815 prohibits the buying, selling, and any other transfer of the “intact body of a human embryo or fetus” obtained from an induced abortion. The law also prohibits the buying, selling, and any other transfer of “organs, tissues, or cells obtained from a human embryo or fetus whose death was knowingly caused by an induced abortion.”

In addition, it “require[s] burial or cremation of remains resulting from abortion,” which acts as a de facto medication abortion ban, since an embryo miscarried at home, through medication abortion, cannot in practice be buried or cremated.

SB 33, similar to HB 815, prohibits the sale, receipt, and transport of fetal organs and body parts obtained from an induced abortion. Any person who violates this provision would be sentenced to a term of imprisonment at hard labor between ten to 50 years, at least ten years of which must be served without benefit of probation or suspension of sentence, and may, in addition, be required to pay a fine of not more than $50,000.

HB 606 prohibits entities that perform abortions from receiving public funding, unless the abortion was necessary to save the life of the pregnant patient, the pregnancy was a result of incest or rape, or the pregnancy was diagnosed as “medically futile.”

Most of the bills were passed with significant bipartisan support, and were signed into law by Gov. John Bel Edwards (D). Each of the laws is set to take effect on August 1. 

”We are asking the district court to immediately block these unconstitutional laws,” Northup said.