ROBERT SIEGEL, HOST:
For the last five years, the Texas Legislature has done everything in its power to defund Planned Parenthood. Well, it's turned out that it hasn't been easy to target the organization without inflicting collateral damage to other family planning clinics around the state. NPR's Wade Goodwyn reports from Midland, Texas, that 82 clinics have closed, and of those, only a third were Planned Parenthood clinics.
WADE GOODWYN, BYLINE: At the Midland Community Healthcare Services Clinic in West Texas, every day, it's three lines deep as women file in for treatment.
GOODWYN: In an examination room, OB-GYN resident Dr. Jonathan Lugo studies his patient. Her two young children sit quietly in the room, eyes wide, watching the young doctor and their very pregnant mother.
JONATHAN LUGO: So this is not your first rodeo, right? So you kind of know what to expect.
UNIDENTIFIED WOMAN: Uh-huh.
LUGO: Let's listen to your baby.
GOODWYN: The clinic's 15 examination rooms go full throttle all day but can't come close to satisfying demand. The numbers are harsh. In Texas, just 22 percent of childbearing age women who qualify for subsidized preventive health care treatment actually get it.
The latest family-planning predicament began in 2011 when the Republican-dominated Texas Legislature decided it was done once and for all funding Planned Parenthood. It eliminated funding for any clinic associated with an abortion provider, even if the clinic itself didn't perform abortions. In the process, the legislature ended up slashing the state's family planning budget by two-thirds.
MOSS HAMPTON: And that turned everything on its head.
GOODWYN: Dr. Moss Hampton is a district chairman for the American Congress of Obstetricians and Gynecologists and a professor at the University Health Sciences Center in Midland. Hampton says the legislature's target was abortion, but the unintended consequence was that family planning clinics which had nothing to do with abortion, especially rural clinics, ran out of money.
HAMPTON: So you had programs that would help patients pay for physician visits, obstetrical care, gynecological care, pap smears. When all of that funding was removed and cut, a large number of women didn't have the means to pay for access to those services.
GOODWYN: By 2014, 82 family planning clinics across the state had closed, and the consequence was calamitous. In Midland, for example, when the Planned Parenthood clinic here closed, there were two aftereffects. Eight-thousand well women appointments a year vanished, and so did the last place a woman could get an abortion between Fort Worth and El Paso. Dr. Kari White is one of the lead researchers at the University of Texas's Texas Policy Evaluation Project. They've been investigating the statewide effects of the legislature's family planning cuts.
KARI WHITE: Teens, obviously - when they lose access, they don't have a lot of financial resources to go elsewhere for care, so they may go without. Women who are not legal residents are in disadvantaged positions in multiple ways, and even women who are making just a little bit over the cutoff for the Women's Health Program - $50 is still a lot of money out of your budget.
GOODWYN: The researchers found that two years after the cuts, Texas's Women's Health Program managed to serve less than half the number of women it had before. The legislature's own researchers predicted that more than 20,000 resulting unplanned births would cost taxpayers more than a quarter of a million dollars in federal and state Medicaid support. Dr. White says as the state has worked to rebuild its shattered network, the new providers don't necessarily have the same capacity to do cancer screenings, IUDs and birth-control implants.
WHITE: A lot of the funding that has been allocated has gone to organizations that do not necessarily have the expertise or the necessary training to provide the types of family planning contraceptive preventive reproductive health care that the Planned Parenthood clinics provided.
GOODWYN: The political backlash to the funding cuts was stout. So in 2013, the legislature essentially restored the money. But finding new providers, especially in the countryside, has been slow and difficult. Texas Health and Human Services Commissioner Leslie French runs the Women's Health Services Program.
LESLIE FRENCH: The legislature wanted to make sure that no one, even if they were accustomed to going to a certain provider that was no longer a part of the state plan - that there was another provider that was willing and able to take and serve women. That's never an overnight process.
GOODWYN: French says the state program is approaching the number of providers it had back in 2010. But in many regions of the state, there's been little or no decrease in the level of unserved need. Texas continues to grow vigorously, and a statewide doctor shortage compounds the problem. It's not like already inundated medical practices are chomping at the bit to take on thousands of orphaned Medicaid patients. Commissioner French says they're doing best they can under the circumstances.
FRENCH: I'm very cognizant of the needs, how the needs in one area of the state are not what the needs in the other area of the state are. And so what works in Houston or what works Dallas doesn't work for Midland.
GOODWYN: The state's newest rendition of its Women's Health Program debuts July 1. In the meantime, rural Texans still scramble to find family planning services and not just poor women. Aubrey, a student at Texas Tech, doesn't want her last name used for reasons we'll explain in a moment. But this last year, her senior year, her life changed.
AUBREY: Yes, I'd met a boy, and you know, I decided to go and seek out getting on birth control.
GOODWYN: About to become sexually active for the first time, Aubrey did not want her birth control showing up on her parents' insurance. So she went to the student health clinic, but there, the doctor was difficult.
AUBREY: I just wanted to talk to her and get some ideas on what would be best for me, and she was telling me that I needed to get on a certain one because that was my only option. It didn't really make sense. There wasn't a health issue, and it was kind of odd she was fighting me on this.
GOODWYN: The doctor told Aubrey it would take several weeks before she could get her birth control. When the young woman asked why, the doctor suggested Aubrey was lacking in moral fiber.
AUBREY: She actually asked me if I was in that big of a hurry to become sexually active.
GOODWYN: Furious and humiliated, Aubrey left, and she says this is where things got difficult. The Planned Parenthood clinics in Lubbock had recently closed. When she telephoned the county clinic, she discovered the next available appointment was in April. It was January. Determined, she next called to Fort Worth four-and-a-half hours away.
AUBREY: Planned Parenthood really changed my life, quite honestly. I don't know where I'd be right now if I hadn't been able to get in in Fort Worth. And so I'm glad I have the peace of mind now that I don't have to worry about getting pregnant when I'm not ready.
GOODWYN: And this is why Aubrey doesn't want her last name used because she's a Planned Parenthood supporter living in West Texas, which hadn't been a problem until three months ago when a gunman attacked a Planned Parenthood clinic in Colorado Springs a few hours to the Northwest. A police officer and two Planned Parenthood clients were killed.
In Texas, the legislature seems determined that its robust antiabortion politics will not further damage the state's Women's Health Programs. But its battle against Planned Parenthood continues unabated. The state has ousted the organization from its cancer screening programs, stripped it of state Medicaid money and is ending HIV prevention subsidies. Texas is becoming the model for other conservative states who'd like to defund all family planning clinics associated with abortion providers. Wade Goodwyn, NPR News, Midland.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.