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 Abortion

Anti-Choice Group Wants National Abortion Data Reporting Law

Teddy Wilson

Anti-choice activists claim that despite the evidence, the number of complications from abortion is higher than is being reported. States that track abortion care data have shown the procedure to be exceedingly safe.

A leading anti-choice organization is calling for a national database of abortion statistics and increased reporting requirements for states—proposals seen as part of a strategy to justify laws restricting access to abortion care.

The U.S. Supreme Court in June struck down provisions of Texas’ omnibus anti-choice law known as HB 2. The ruling relied heavily on research that showed abortion care was a safe and well regulated procedure. Anti-choice activists have long disputed those claims.

Clarke Forsythe, acting president of Americans United for Life (AUL), told Politico that there is not enough data on abortion. “The abortion advocates like to talk in vague terms about abortion but we need specifics,” Forsythe said. “We don’t have a national abortion data collection and reporting law.”

The Centers for Disease Control and Prevention (CDC) has collected “abortion surveillance” data since 1969. The CDC published the most recent report on abortion statistics in 2012.

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Abortion surveillance reports are created by compiling data from health agencies, provided voluntarily to the CDC, in all 50 states as well as the District of Columbia and New York City. The data includes deaths from abortion related complications, but does not include the number of complications that don’t result in deaths.

Reporting requirements for abortion statistics vary from state to state, with 46 states requiring that abortion providers submit regular reports, according to the Guttmacher Institute. Most states report the number of abortion procedures performed as well as the type of procedure, the gestation of the pregnancy, and demographic data of the patient.

There are 27 states that require providers to report the number of complications from abortion procedures.

The self-described “legal architect” of the anti-choice movement, AUL has been heavily involved in lobbying for state and federal laws that restrict access to abortion. The organization creates copycat legislation and distributes anti-choice proposals to state lawmakers, who then push the measures through legislatures.

Forsythe took a victory lap Monday for the organization’s role in promoting bills from the AUL’s “playbook of pro-life legislation” that were introduced this year in state legislatures. “AUL continued to assist states considering health and safety standards to protect women in abortion clinics,” Forsythe said in a statement.

Dozens of bills to increase reporting requirements have been introduced in state legislatures over the past several years. These proposals include several types of reporting requirements for abortion providers, and many of the provisions are similar to those found in AUL model legislation.

Arizona legislators in 2010 passed SB 1304, which required abortion providers to submit annual reports to the state and required the state Department of Health Services (DHS) to publish an annual report.

The Republican-backed legislation is similar to copycat legislation drafted that same year by AUL.

Since the law’s passage there have been very few complications resulting from abortion procedures reported in the state: from 2011-2014, less than 1 percent of abortions procedures in the state resulted in complications.

Arizona reported that 137 patients experienced complications out of 12,747 abortion procedures in 2014; 102 patients experienced complications out of 13,254 abortion procedures in 2013; 76 patients had complications out of 13,129 abortion procedures in 2012; 60 patients experienced complications out of 14,401 abortion procedures in 2011.

Dr. Daniel Grossman, a physician at the University of California, San Francisco who studied the impact of HB 2 for the Texas Policy Evaluation Project (TxPEP), told Politico that abortion has been shown to be exceptionally safe medical procedure.

“There’s already a lot of data that have been published documenting how safe abortion is in the U.S.,” Grossman said.“The abortion complication rate is exceedingly low.”

Anti-choice activists claim that despite the evidence, the number of complications from abortion is higher than is being reported. Joe Pojman, the executive director of the Texas Alliance for Life, told Politico that “better data” is needed.

Texas has required reporting of the number of complications from abortion procedures since 2013, and the data has shown that abortion complications are exceedingly rare. There were 447 complications out of 63,849 procedures in 2013 and 777 complications out of 54,902 procedures in 2014.

Pojman said that the Texas data “defies common sense” and that the complications are “are much smaller than what one would expect.”

The Texas abortion statistics reveal that it is safer to have an abortion than to carry a pregnancy to term in the state. Between 2008 and 2013, the most recent years for which data is available, there were 691 maternal deaths in Texas, compared to one death due to abortion complications between 2008 and 2014.

“There’s no sign that there’s a hidden safety problem happening in Texas,” Grossman said.

News Health Systems

Texas Anti-Choice Group Gets $1.6 Million Windfall From State

Teddy Wilson

“Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services," Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement.

A Texas anti-choice organization will receive more than $1.6 million in state funds from a reproductive health-care program designed by legislators to exclude Planned Parenthood

The Heidi Group was awarded the second largest grant ever provided for services through the Healthy Texas Women program, according to the Associated Press.

Carol Everett, the founder and CEO of the group and a prominent anti-choice activist and speaker, told the AP her organization’s contract with the state “is about filling gaps, not about ideology.”

“I did not see quality health care offered to women in rural areas,” Everett said.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement that it was “inappropriate” for the state to award a contract to an organization for services that it has never performed.

“The Heidi Group is an anti-abortion organization, it is not a healthcare provider,” Busby said.

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State lawmakers in 2011 sought to exclude Planned Parenthood from the Texas Women’s Health Program, which was jointly funded through federal and state dollars. Texas launched a state-funded version in 2013, and this year lawmakers announced the Healthy Texas Women program.

Healthy Texas Women is designed help women between the ages of 18 and 44 with a household income at or below 200 percent of the federal poverty level, and includes $285 million in funding and 5,000 providers across the state.

Bubsy said the contract to the Heidi Group was “especially troubling” in light of claims made by Everett in response to a recent policy requiring abortion providers to cremate or bury fetal remains. Everett has argued that methods of disposal of fetal remains could contaminate the water supply.

“There’s several health concerns. What if the woman had HIV? What if she had a sexually transmitted disease? What if those germs went through and got into our water supply,” Everett told an Austin Fox News affiliate.

The transmission of HIV or other sexually transmitted infections through water systems or similar means is not supported by scientific evidence.

“The state has no business contracting with an entity, or an individual, that perpetuates such absurd, inaccurate claims,” Busby said. “Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services.”

According to a previous iteration of the Heidi Group’s website, the organization worked to help “girls and women in unplanned pregnancies make positive, life-affirming choices.”

Texas Health and Human Services Commission spokesperson Bryan Black told the Texas Tribune that the Heidi Group had “changed its focus.”

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” Black said in an email to the Tribune.

Its current site reads: “The Heidi Group exists to ensure that all Texas women have access to quality health care by coordinating services in a statewide network of full-service medical providers.”

Everett told the American-Statesman the organization will distribute the state funds to 25 clinics and physicians across the state, but she has yet to disclose which clinics or physicians will receive the funds or what its selection process will entail.

She also disputed the criticism that her opposition to abortion would affect how her organization would distribute the state funds.

“As a woman, I am never going to tell another woman what to tell to do,” Everett said. “Our goal is to find out what she wants to do. We want her to have fully informed decision on what she wants to do.”

“I want to find health care for that woman who can’t afford it. She is the one in my thoughts,” she continued.

The address listed on the Heidi Group’s award is the same as an anti-choice clinic, commonly referred to as a crisis pregnancy center, in San Antonio, the Texas Observer reported.

Life Choices Medical Clinic offers services including pregnancy testing, ultrasounds, and well-woman exams. However, the clinic does not provide abortion referrals or any contraception, birth control, or family planning services.

The organization’s mission is to “save the lives of unborn children, minister to women and men facing decisions involving pregnancy and sexual health, and touch each life with the love of Christ.”

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