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Dr. Jen Gunter

Dr. Jennifer Gunter is a nationally and internationally renowned obstetrician/gynecologist.

May 3rd, 2012 11:20 PM

Messing with reproductive health, Texas style

The Texas Women’s Health Program provides uninsured low income women between the ages of 18 and 44 with Pap smears, STD screening, breast exams, and contraception. Under a rule adopted March 14, 2012 WHP providers must certify they do not “perform or affiliate with an entity that performs or promotes elective abortions.” As the Federal Government provides 90% of the operating budget and this new rule violates the conditions for the federal money, the Obama administration pulled the funds leaving Texas, a state where 31% of women are uninsured (the highest in the country), to make up the $36 million a year short fall.


According to the Texas Attorney General the WHP is “designed to encourage preventative birth control and discourage abortion” (although the "discourage abortion" part of the mission isn't listed on the web site). It is a ludicrous and insulting argument that any kind of association, no matter how remote, with someone who performs abortion encourages a woman to have one. Pregnant women don’t enter a clinic seeking prenatal care and then get coerced by a stealth abortion provider lurking in the hallway. Women who have abortions know exactly why they are making that choice and it is almost always socioeconomic.


If Texas lawmakers actually did a little research and used some common sense (both apparently too much to ask) they would learn that the domino effect of this rule will likely increase abortions as well as cost taxpayers millions and millions of dollars. Here’s why:

  • Fewer Planned Parenthood clinics. This law prevents Planned Parenthood from offering care in WHP network. The reduction in clientele (many of the more than 130,000 women who use this program get care at Planned Parenthood) will result in some clinic closures throughout the state. Now the almost 2.9 million uninsured Texas women between the ages of 18 and 64 will have fewer low cost options for reproductive health care. Less access to contraception means more unplanned pregnancies because it is unplanned pregnancies that have a 50% rate of ending in abortion, not the planned ones. It also means a more difficult time access Pap smears and breast screening, so more later stage cancers. 
  • Women who rely on the WHP will have a harder time finding a provider. No provider who performs abortions, works in a facility where abortions are provided, or is a member of a large medical practice where one member does abortions can participate in the WHP plan under this new rule. While this seems directed at Planned Parenthood, many private doctors quietly do first trimester medical and surgical abortions in their offices. It may also exclude teaching programs as abortion training is part of OB/GYN residency. At the end of the day, considering the paltry reimbursement and this new hurdle, many providers may simply decide it’s not worth the hassle. Again, fewer providers translates into difficulty accessing care and thus more unplanned pregnancies.
  • More women and children on Medicaid. Medicaid pays for 64% of births that result from unintended pregnancies and many of the babies from these pregnancies will also be Medicaid eligible. A study from California tells us that every dollar spent on family planning for women at or below 200% of the federal poverty limit saves $2.76 within 2 years and $5.33 within 5 years. This is, of course, the reason programs like WHP exist.
  • The $36 million has to come from somewhere…or not. To find $36 million (as Rick Perry has promised) some other state program will have to be cut, Texas will start a state income tax, or the Governor will demonstrate his new skill of spinning straw into gold. Or the money won’t come from anywhere and the WHP will be decimated (I’m betting on this outcome, not the Rumplestiltskin project).
  • Texas has to pay for the legal costs of fighting this is court. Planned Parenthood filed suit in Federal Court. On Monday, April 30 a federal judge issued an injunction preventing Texas from implementing the new restrictions; however, on Tuesday, Judge Jerry Smith of the 5th Circuit Court stayed the injunction. Planned Parenthood responded, but regardless how the 5th Circuit ultimately rules it is almost certain this case will continue in the court system consuming tax dollars. Tax dollars that could otherwise go to funding health care. 

This rule is clearly a back door approach to undermine Roe v. Wade, but restrictive laws don't reduce abortion. The only legislation that reduces abortion is publicly funded, easily accessible family planning. And while the GOP in Texas flouts uterine rattling anti-abortion dogma to shore up right wing fundraisers, the people who suffer are the almost three million uninsured women in Texas. 

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