This Is a Very Bleak Preview of Reproductive Health Access After the Gag Rule

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After Texas defunded Planned Parenthood in 2011, the state poured millions of dollars into a network of anti-abortion Christian pregnancy centers—a decision that could offer a glimpse of what’s to come in other states after the Trump administration announced a plan to block federal grant funding for reproductive health organizations that offer abortion services and counseling.

The Houston Chronicle reports that in 2016, the state of Texas awarded Christian pregnancy center the Heidi Group, founded by abortion opponent Carol Everett, nearly $40 million in family planning funds. In an email to a network of anti-abortion activists, Everett called it “the greatest possibility for expansion of pro-life care for the poor ever.” As the Chronicle notes, Everett, a well known anti-abortion activist, had neither clinical experience nor experience contracting with the state, and many of the pregnancy centers she cited did not even provide contraception.

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Yet the state funneled money to her network anyway, which mostly included clinics that didn’t offer core services patients need when seeking comprehensive family planning services:

By May, Everett had persuaded more than two dozen clinics to join her new network, and said it could support 111,000 patients annually across 60 counties, including 67,000 in Healthy Texas Women. Even in its best years with the state, Planned Parenthood had served about 50,000 in a comparable program.

There were problems, though. Only seven of the Heidi Group’s clinics were licensed to distribute birth control pills and other prescriptions, as typically required by the health commission. Without it, they would be forced to refer patients to outside pharmacies, decreasing the likelihood that women would actually receive the contraception, and receive it in quantities that would serve them for months to come.

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Everett has said that having sex with multiple partners is akin to rape, supports legislation to cremate fetal remains on the basis that aborted fetuses could spread HIV and contaminate drinking water, and has alleged that abortions are “unnatural,” “painful,” and are often performed on “women who were not pregnant.” A current website for the Heidi Group, last updated in 2017, does not mention any affiliation with Christianity, Everett, or anti-abortion views, but, according to an older version hosted by church website hosting service Clover Sites, the Heidi Group aims “to make certain that a girl or woman in unplanned pregnancy explores all her choices and recognizes the full picture of the resource community to embrace her and her unborn baby.”

A page about Everett claims that: “Our ultimate goal is to lead women and families to secure lives in Christ and economic stability.”

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The rise of anti-abortion centers like the Heidi Group wasn’t an accident; it happened precisely because of Texas’s war against Planned Parenthood: In 2011, in an effort to defund Planned Parenthood, the Texas state legislature slashed the two-year budget for funding family planning services from $111 million to $38 million. As the Washington Post notes, “after these cuts, 82 Texas family planning clinics—one out of every four in the state—closed or stopped providing family planning services. An unintended consequence of the law was that two-thirds of the clinics that closed were not even Planned Parenthood clinics.” In an effort to attempt to return some of the services the state decimated, in 2016, the state legislature launched two programs: Healthy Texas Women, which offers services like birth control, immunizations, and pregnancy testing tied to the Medicaid program, and the Family Planning Program, which offers similar services and would, according to the Houston Chronicle “take in anyone remaining, including men and undocumented immigrants.”

The Heidi Group received funds under both programs, contracts that were renewed despite the organization failing to meet its target client goals: the Texas Tribune reported that during the 2017 fiscal year, the group served fewer than five percent of the patients they said they would.

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But the Texas Department of Health and Human Services was undeterred, per the Chronicle. In fact, “state health officials gave [Everett] much of the money anyway, ignoring warning signs and overruling staff who recommended millions less in funding.”

“When Everett’s clinics began failing,” the report notes, “the state delayed for months in shifting money to higher performing clinics, instead devoting vast amounts of time to support Everett and her small, understaffed team.” Meanwhile, the Heidi Group diverted precious resources away from family planning organizations serving low-income women.

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In late 2018, after the group faced numerous criminal complaints alleging mismanagement of taxpayer funds, the Texas Health and Human Services Commission finally canceled its health contracts with the Heidi Group, saying in an email to the Texas Tribune that “it has become clear that the Heidi Group is unable to come into compliance.”

The Heidi Group’s rise in Texas, facilitated by anti-abortion legislators, illustrates challenges that other states are increasingly likely to face in light of the Trump administration’s new restrictions on the Title X Family Planning Program, the only federal grant program dedicated to offering family planning services in the country. Though Title X does not directly fund abortion services, the new guidelines prohibit health care providers from receiving Title X funding if they refer patients to abortion care.

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This bars Planned Parenthood, the nation’s leading family planning provider of low-income women, from Title X funds. “Forty-one percent of people in the program are going to be left without care as a result of the rule,” Emily Stewart, the Vice President of Public Policy at Planned Parenthood Federation of America, told Jezebel. “The vast majority of people in this program have incomes below 150 percent of the federal poverty level. For decades, it has been part of our nation’s healthcare safety net. And so this is one of the most dangerous, if not the most dangerous things this administration has done to attack peoples’ access to affordable healthcare.”

In the absence of vetted providers like Planned Parenthood, scammers move in and patient needs go unmet. If Texas is any indication, and the gag rule goes into effect unchallenged, there’s suffering on the horizon.

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Prachi Gupta

Prachi Gupta is a senior reporter at Jezebel.

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