"You need any condoms today, honey?" asks clinic manager Kristi Guerra, whose country-fried cheerfulness warms the otherwise drab clinical feel of the waiting room. "Nobody who needs them gets out of here without a sack full of condoms." To her, it's simply a matter of practicing safer sex: less chance of contracting STDs or HIV/AIDS or an unwanted pregnancy that might result in an abortion. And teen-agers in small towns--they tend to get more sexually active in the summer, she says. "What else is there to do?"
A young patient, her hair short and strawberry blond, enters the clinic, surprising Guerra with her promptness. "You called me yesterday and said my Pap smear was abnormal," she says. "I came for my medication."
"Got it right over here," says Guerra, who recommends a follow-up pap smear within six months, another precaution against cervical cancer. No attempt is made to collect money. This is a publicly funded clinic serving the family-planning and reproductive health-care needs of the poor and marginally poor, those who have no health insurance because they lost their job or never found one.
Those needs include annual gynecological exams, breast and cervical cancer screenings and birth control--including the controversial "morning after" pill, an anathema to religious conservatives who believe it's still abortion. Those same conservatives are none too happy with the clinic's sex education counseling, which goes far beyond the "abstinence only" agenda endorsed by the Bush administration. Pregnancy tests are also offered, and when one returns positive, the patient consults with a family-planning assistant who is trained to discuss every available option--prenatal care, adoption and abortion, which may include referrals to the nearest abortion provider, Dallas' Planned Parenthood.
What the clinic doesn't do is abortions, yet this rural family-planning clinic, which serves approximately 250 patients a month, soon may be the latest casualty in the decades-long cultural war over abortion. The Texas Legislature has added a rider to its appropriations bill that denies public funding for family planning to any abortion provider, even if it performs abortions with private funds. And even though Corsicana Health Services does not perform abortions itself, the fact that it is an affiliate of Planned Parenthood of North Texas, which does provide abortions, will be enough to deny it family-planning funds.
Six of Planned Parenthood's regional affiliates, including North Texas, have taken this rider personally and filed a federal lawsuit claiming that this legislation amounts to the state levying an unlawful penalty on a woman's constitutionally protected right to choose. Because the state also is placing greater restrictions on the use of the federal government's money than the federal government is, Planned Parenthood alleges these restrictions (no family-planning funds if the organization performs abortions) are also unconstitutional. Its petition has received some favorable play from an Austin federal judge, who has granted a restraining order preventing the state from requiring Planned Parenthood affiliates to either sign a pledge to stop providing abortions or be disqualified from the state family-planning program. He will consider extending the injunction at a hearing scheduled for July 25.
The legislation is far too sweeping, argues Kathryn Allen, senior vice president for community relations for Planned Parenthood of North Texas, and "risks depriving 115,000 low-income women of their health-care needs at 33 clinics across the state." The $13 million in federal dollars helps fund family planning and reproductive health services, not abortions, which are offered at only seven clinics and account for only 2.3 percent of the medical visits to its 85 clinics in Texas.
The legislative sponsors of the rider--Senate Republicans Steve Ogden from Bryan and Tommy Williams from The Woodlands--say their legislation was not meant to target Planned Parenthood in particular or family planning in general. They just want government out of the business of subsidizing abortion providers, whether that means directly for the procedure itself or indirectly for the expenses--staff, rent, utilities--of its family-planning clinics or services.
At the risk of sounding paranoid, Planned Parenthood also believes that this rider is part of a "pernicious web of assault" that is bent on destroying its organization--as well as family planning. "Abortion is just the ideological tip of the iceberg," says Gloria Feldt, president of the Planned Parenthood Federation of America. "The hard right--which has found a spokesperson in President Bush--has long been opposed to reproductive health care and is making an orchestrated attack on family planning and sex education."
More mainstream anti-abortion groups deny this rider is a concerted effort at anything but banning public dollars for abortion. "The problem with family-planning funds is that they are fungible--easy to move around and indirectly fund abortions," says Joe Pojman, executive director of Texas Alliance for Life. "Texas is not the only state concerned about abortion providers using family-planning funds to promote abortion as a method of birth control."
Truth is, ever since Roe v. Wade, those opposed to abortion rights have been searching for ways to ban both direct and indirect public funding for abortions. The direct came easy enough, with the passage of the federal Hyde amendment in 1976. But prohibiting indirect government funding of abortions--those family-planning dollars allocated to local Planned Parenthood clinics that provide abortions through private donations (justice funds, as they are called)--has been more problematic.
Besides the "fungibility theory," which justifies a ban on public family-planning money because it might "free up" private funds that may be used for abortion, anti-abortion groups argue that taxpayers should not be required to pay for what they consider immoral. At the extreme, other groups believe that family-planning clinics are just out to build a strong customer base by promoting promiscuity through sex education and condom distribution, and then steering these patients to the same abortion clinics in which they have a vested financial interest.
Time and again, various states have attempted to put restrictions on federal money appropriated under Title X of the Public Health Services Act (family planning for the poor). But Title X regulations require that a woman facing an unintended pregnancy receive "nondirective counseling" and referrals upon request for each of her legal choices: prenatal care, adoption and abortion. States that have attempted to impose a so-called "gag rule" prohibiting Title X family-planning providers from engaging in abortion counseling and referrals have met with little success in court. The Texas rider does not go that far, but it does ban family-planning clinics from receiving Title X funds if those clinics are affiliated with abortion providers (i.e. Planned Parenthood). Historically, only those clinics that have failed to meet the stringent federal regulations for keeping the family-planning and abortion-providing aspects of their services "separate and distinct" have been cut off from public funding.
"We [Planned Parenthood affiliates in Texas] have never violated these regulations and never done anything to jeopardize our family-planning funds," says Danielle Tierney, director of public affairs for Planned Parenthood of Texas Capitol Region. But the Legislature didn't need any evidence of impropriety, not with the anti-abortion bias that underscored its agenda. Between enacting a statute that required women to wait 24 hours before obtaining an abortion so they could be informed (or misled, some argue) about the risks of pregnancy termination, and elevating the fetus to the status of a person for purposes of protection under criminal law, the move to "defund" Planned Parenthood, the arch-nemesis of social conservatives, seemed like easy pickings.
Tierney and others within the pro-choice movement fought hard to appeal to the anti-abortion instincts of lawmakers. "If their goal is to reduce the number of abortions, pro-life legislators should fully fund family-planning programs instead of jeopardizing the very services that prevent unintended pregnancies to begin with."
The first two riders introduced in the House, one of which contained a gag rule, unraveled because they went too far. Only in the Senate Finance Committee was defunding able to gain any traction. "What we had on the Senate side was a deadly combination of Senators Ogden and Williams," Tierney says. Williams was Senate sponsor of numerous anti-abortion bills. Ogden, on the other hand, had a fervent anti-abortion constituency represented by the Coalition for Life, which pushed him to take action against Planned Parenthood in Bryan, where abortions have been performed since 1998.
"We needed to find a way to diminish their revenue," says David Bereit, executive director of Coalition for Life. "Planned Parenthood is a corrupt corporate entity, because it destroys human life. The organization is the problem, not what the funding is used for."
A spokesman for Senator Ogden claims he has no philosophical problems with family planning, which is why he supported the waiver provision within the rider. If the Texas Department of Health determines that defunding will result in a "significant reduction" of family-planning services in a particular region, the department can waive the rider for one year until it can contract with another family-planning provider that does not offer abortions.
Planned Parenthood of North Texas finds this an unlikely scenario. "County health departments are just not going to be able to pick up the slack," says Kathryn Allen. "They don't do fund raising. They will just tell patients, 'See you in six weeks.' But our patients need the services right now."
When TDH informed Planned Parenthood in June that it must sign a pledge to stop performing abortions or be dropped from the state family-planning program, Planned Parenthood sued. Although each side seems confident it will prevail in court, staffers at Corsicana Heath Services must contemplate what will happen to them if they lose their funding.
"The better question," Guerra says, "is what will happen to our patients."
