Recent news coverage on the increase in maternal mortality in the U.S. overall has highlighted the spike in deaths among pregnant women in Texas. It went from 19 deaths per 100,000 live births in 2010 to 33 deaths per 100,000 in 2011-2012.
Although all the reasons for this increase are not clear, one thing is clear: It is partially a consequence of the severe cuts to family planning services by the 2011 Texas Legislature.
As a result of reduced access to contraception, some Texas women have been more likely to experience an unplanned pregnancy, with potentially adverse outcomes occurring among women at high risk for pregnancy-related complications. And with the closure of many of the abortion clinics in the state after implementation of Texas House Bill 2, women faced greater challenges accessing abortion care if they had an unplanned pregnancy or developed a medical complication during pregnancy.
The State abortion statistics for 2014, recently released by the Department of State Health Services, show new evidence that the family planning funding cuts in 2011 made it difficult for low-income women to prevent unplanned pregnancies. In fact, the county-level data show dramatic increases in abortions and demonstrate a connection between cuts to family planning, reductions in contraceptive services, and unintended pregnancy.
Take Gregg County in East Texas, for example. The federally qualified health center in the county lost more than 60% of its family planning funding and, as a result, served fewer clients than in previous years. In 2012, there were 59 abortions among Gregg County residents. In 2014, there were 172, a whopping 191% increase.
Neighboring counties such as Harrison and Upshur also had considerable increases during the same period. There were also sharp increases in Bowie and Nacogdoches, as well as bordering counties.
The increase in the number of abortions in these East Texas counties is in contrast to the overall trend in abortion for the state as a whole. According to the 2014 statistics, the number of abortions in Texas decreased by 14% since 2013. But this decline was uneven across the state. For instance, in Lubbock and Hidalgo counties where women had to travel more than 100 miles to reach the nearest health facility, the number of abortions dropped by more than 50% between 2012 and 2014.
The changes in abortion in these selected counties illustrate the competing forces shaping women’s reproductive health in Texas. On one hand, the decrease in access to family planning services increased unintended pregnancy and women’s demand for abortion. On the other, women had significantly reduced access to abortion. This was the dominant force operating in the majority of Texas counties where either abortion clinics closed or the distance to the nearest clinic dramatically increased.
There is reason to believe that the impact of decreased access to reproductive care on the total number of abortions in Texas would have been considerably larger had there not been a simultaneous increase in demand for abortion.
Since 2013, the Legislature, the Department of State Health Services, and the Health and Human Services Commission have attempted to rebuild the safety net for family planning services. Some of the major changes include increasing state funding for services, reorganizing the Family Planning Program, launching the new Healthy Texas Women program, and expanding access to highly effective contraception immediately after delivery for low-income women. These are good steps, but their effectiveness has been limited by excluding Planned Parenthood clinics and politically motivated grants to less than fully qualified providers.
But the statewide increase in maternal mortality and likely increases in unintended pregnancy – as evidenced by increase in the number of abortions in some counties – points a bright light on the harm done by the 2011 cuts to the reproductive healthcare safety net.
Moving forward, the Texas Legislature must make a long-term and comprehensive investment to restore the family planning infrastructure, and public health leaders need to be committed to ensuring women have timely access to high-quality preventive reproductive health care regardless of their income and where they reside in the state. Given the damage that has been done and the program limitations now in place, it may be a long time before we see the results from these commitments.
This op-ed was originally published by UT News. For more op-eds from Texas Perspectives, click here and follow on Facebook.
Top image: A pregnant woman holds her belly. Photo via Flickr user summerbl4ck.
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Thanks for this very informative article. Every “right to life” Texan needs to be hit over the head with this sentence: If you want to reduce the need for abortion, then you must (MUST!) offer free contraception to all Texans. Yes, FREE — if abortion is so despicable to some Texans (some consider abortion “murder,” which is a debatable stance), then isn’t funding full free access to all forms of contraception (to be clear, “contraception” means PREVENTING fertilization thereby PREVENTING pregnancy; ain’t no “baby killing” involved, folks) a small price to pay to avoid the need for abortion. Abortion should remain legal and be made widely accessible, as other research on the shows that teenage pregnancy and teenage abortion rates are significantly DOWN nationally due to increased access to contraceptives. Oh, and as for that ol’ abstinence approach, research (and Sarah Palin’s grandchildren) have proven that it is ineffective.
If you hate abortion, then ya gotta LOVE contraception. There should be buckets of free condoms all over the place — big box stores, liquor stores, beauty/barber shops, movie theatres, BARS, etc. I challenge the TX Lege to TRY such a relatively inexpensive program of statewide free access to condoms and other contraceptives (IUds, pills, etc.) and see what happens — or doesn’t happen (unwanted pregnancies!).
PS to my previous post (below): And while the TX lege is at it, how about funding a comprehensive sex ed curriculum including contraception measures so our kids LEARN what causes pregnancy and how to prevent unwanted pregnancy. A responsibly sex-educated person can decide what to do if he/she does not want to be a parent. For many Texans, public school is their last exposure to formal education; there is no other mandated source of sex ed to many young Texans after high school.
Correlation something something causation, etc.
Women’s health advocates should thank Texas for forcing Planned Parenthood to divorce itself from abortion. Texas ripped the mask off that beast. How, you ask? PP can still provide all the women’s health services it claims to provide, it can still prescribe contraception, it can still provide prenatal care. But if PP can’t do abortions, they close up shop and move out—why? Because it’s their money-maker. It’s the only service the actually care about! If PP cared about doing anything other selling abortions, they would still be in business in all those closed locations.
But, hey, can’t let this crisis go to waste. We’ve got to blame an inexplicably complicated observed spike in maternal deaths on Texas’s crusade against a fake women’s health business. The Texas Tribune‘s article on this same subject concludes: “Political commentators and news media have focused on the timing of the spike in maternal mortality reported in a national study published in the journal Obstetrics and Gynecology. The study found that while maternal mortality rates around the country were steadily rising, the rate in Texas alone nearly doubled in 2011 — the same year, the study’s authors noted, that Texas lawmakers made significant cuts to the state’s women’s health program. The researchers stopped short of saying whether the policy change had any effect on the numbers.”
Hm, whom to trust? The media and Planned Parenthood, or the researchers who did the study being used by the media and PP? My money’s on the science.
Jason C., aren’t you overlooking that Gov. Perry refused the Medicaid expansion program, which would have enabled low-income folks to utilize ALL of PP’s services, not just abortion. Admittedly, an abortion procedure costs more than counseling a 20-year-old on birth control and providing him/her materials, prescriptions, devices. It’s all part of the same cloth — sexual health!
Some folks claim that “most” of PP’s money comes from abortions. That percentage can be calculated in different ways. While a good number of Republican politicians contend that 94% of PP’s “business” is abortions, impartial fact-checking sources agree that only 3% of PPs caseload is abortion-related. If providing a young woman birth control prevents her from unwanted pregnancy (which might have involved abortion[s]), isn’t that wildly more cost-effective than closing down a clinic? Yes, it is obvious that you are “pro-life” and I am “pro-choice,” but the bottom line is both of us are in favor of reducing abortion rates. I am not sure if you are willing to promote fee/low-cost contraceptive programs to achieve that goal, though. As I said in my other post, if you want to reduce abortion incidence, then you must embrace increased access to contraception methods. And I consider effective sex education for Texas school kids a contraception method. Let’s try to find common ground here to achieve the outcome we share.
NB on the concept of “pro-life”: With the government’s sneaky sanction of reduced access to abortion services in Texas, there is now significant incidence in women dying from pregnancy terminations obtained in illegal, non-medical settings. Is that “pro-life”? At this point, I will repeat what has been said over and over since Roe v. Wade: Women don’t wan’t abortions; they need them. (Just as you or I wouldn’t want, say, prostate surgery, but there is a time when one — if not both of us — may need it.)
Thanks for this very informative article. Every “right to life” Texan needs to be hit over the head with this sentence: If you want to reduce the need for abortion, then you must (MUST!) offer free contraception to all Texans. Yes, FREE — if abortion is so despicable to some Texans (some consider abortion “murder,” which is a debatable stance), then isn’t funding full free access to all forms of contraception (to be clear, “contraception” means PREVENTING fertilization thereby PREVENTING pregnancy; ain’t no “baby killing” involved, folks) a small price to pay to avoid the need for abortion. Abortion should remain legal and be made widely accessible, as other research shows that teenage pregnancy and teenage abortion rates are significantly DOWN nationally due to increased access to contraceptives. Oh, and as for that ol’ abstinence approach, research (and Sarah Palin’s grandchildren) have proven that it is ineffective.
If you hate abortion, then ya gotta LOVE contraception. There should be buckets of free condoms all over the place — big box stores, liquor stores, beauty/barber shops, movie theatres, BARS, etc. I challenge the TX Lege to TRY such a relatively inexpensive program of statewide free access to condoms and other contraceptives (IUds, pills, etc.) and see what happens — or doesn’t happen (unwanted pregnancies!).