Last week the Supreme Court decided to leave in place a Texas law that has essentially closed a third of the abortion providers in that state. On their own, the abortion restrictions are devastating. But in the context of three long years’ worth of family planning and women’s health cuts that violate the human rights of women in that state, they are catastrophic.
Over the summer Wendy Davis launched Texas into the national spotlight when she filibustered the same sweeping anti-abortion laws that were upheld by the Supreme Court. But long before that, women’s health advocates were sounding the alarm bells about the impact of massive family planning cuts that dismantled the state’s health infrastructure, on which millions of low-income women relied.
In order to understand the full implications of this week’s ruling, one must consider the current state of women’s health care – particularly that of low-income women – in Texas. The Center for Reproductive Rights (CRR) and the National Latina Institute for Reproductive Health (NLIRH) recently released a must-read report that illustrates the devastating human toll of family planning and reproductive health cuts on women living in Texas’s Rio Grande Valley.
The Valley is a marginalized region inside a state with some of the worst health disparities and the highest percentage of uninsured adults in the country. Many women in the Valley live in colonias, unincorporated communities along the U.S.-Mexico border, which often lack clean water, plumbing, electricity, and public transportation.
The report profiles women whose health and lives have changed along with the landscape of health infrastructures and systems in their communities. Women who detected lumps in their breasts four years ago but cannot afford the mammogram to determine if they are cancerous. Women who have received mammograms months ago but cannot get results because of exorbitant doctor’s fees. Women with ovarian cysts and cervical pain who risk their lives swimming across the river and traveling through towns rife with violence to access care in Mexico.
These women – and the thousands more they represent – must decide between paying rent, giving their children food and a roof over their heads, or having a mammogram, a Pap test, or contraceptives. “It’s one or the other, but not both,” they say. They live with a constant din of anxiety and fear, not knowing what disease is or might be growing in their bodies, where they will get care in emergency situations, or what will happen to their children if they become sick (or worse).
These women are living the consequences of calculated decisions made by conservative lawmakers to dismantle the state’s health safety net. Over the last two years, they cut the state’s family planning budget by two-thirds, from $111 million to $37.9 million. They established a tiered system and forfeited $30 million in federal funds so they could exclude Planned Parenthood and other organizations affiliated with abortion providers from receiving state or federal resources.
The 2011 policies shuttered 76 family planning clinics across the state (including 9 out of the Valley’s 32) and caused 55 more to reduce hours. Publicly funded clinics served 77 percent fewer patients in 2013 compared to 2011 (202,968 and 47,322, respectively). In the Valley public clinics went from serving 19,595 in 2011 to 5,470 in 2013. These trends are particularly troubling when you consider that even before the cuts, publicly funded family planning programs were providing care to less than 20 percent of the population in need.
As the CRR/NLIRH report describes, women in the Valley – particularly Latina women – experience the grave consequences of living at the intersections of race, class, gender, and immigration in the United States. They are 31 percent more likely to die of cervical cancer than women in non-border communities. In the rest of the country, rates of cervical cancer have been plummeting thanks to early detection and treatment, but among Latinas in the Valley the rate is increasing and cervical cancer deaths among Latinas is nearly twice that of non-Latina white women.
The report exposes the lesser-known consequences of the cuts and regulations on clinics that are still open. Remaining providers have reduced hours, laid off staff, increased fees, and stopped providing the most effective family planning methods all while managing a rapidly growing demand for their services. The average cost of a one-month supply of contraception and the fee for an annual exam has increased three- to four-fold since 2010. Ultrasounds and mammograms, once accessible thanks to subsidized rates, are no longer in reach of most women. Wait times often exceed several months.
For women living in areas where clinics have closed, reaching neighboring providers is often impossible due to transportation barriers. Buses are nonexistent, infrequent, or unreliable. Gas is too expensive. Childcare is hard to find. Taking time off work is not an option. For undocumented immigrants, traveling to other communities requires passing through internal checkpoints and risking deportation.
So what happens? Women purchase unregulated contraceptives off the black market, without consulting a doctor about which form of family planning is best for their bodies. They seek care in Mexico, taking the risk that they will not make it back across the border safely. Or, like many of the women described in the report, they forgo contraception and medical care because they simply cannot afford it.
This is the background upon which the most recent abortion restrictions have occurred. There is not a single abortion provider left in the Valley. At a minimum, women must travel three to five hours each way to access an abortion (and must make that trip multiple times thanks to ultrasound and counseling requirements). For most women, it might as well be outlawed.
Many of the women in the Valley do not reap the benefits of federal programs and policies meant to support low-income women. Undocumented immigrants are not eligible for public insurance programs. New immigrants must wait five years before becoming eligible for Medicaid. Texas is not expanding Medicaid under the Affordable Care Act, leaving those who aren’t poor enough for Medicaid but are too poor to qualify for subsidies out of luck.
Title X, the nation’s only program dedicated to family planning – which once provided effective and far reaching family planning care for the state’s low-income women – was seriously weakened by the above-mentioned regulations. (Luckily, the Obama administration recently took Title X out of the hands of the state government and endowed it to the Women’s Health and Family Planning Association of Texas, which has directed funding back to family planning clinics and even enabled a previously closed facility in the Valley to reopen.)
As the CRR/NLIRH report argues, the state of Texas has done more than just grievously neglect an underserved and marginalized community of women. It has violated the human rights of women in Texas, a duty it is legally obligated to respect, protect, and fulfill. American exceptionalism has relegated human rights to the international development sphere and deemed them unnecessary within our own borders. But for the health and lives of women in Texas and around the country, it is time we think about how we can use human rights to make America exceptional in ways we can be proud of.