HORIZONS A Publication of Planned Parenthood South Texas
UNSTOPPABLE TOGETHER WE FIGHT FOR ALL
YOU CAN’T FIGHT BACK IF YOU DON’T KNOW THE THREATS. THE TRUMP-PENCE ADMINISTRATION IS TAKING DIRECT AIM AT OUR HEALTH, COMMUNITIES, AND RIGHTS. THAT’S WHY PLANNED PARENTHOOD IS TRACKING TRUMP AND MAKING SURE THAT YOU CAN, TOO.
2018 BOARD OF DIRECTORS Planned Parenthood South Texas Chair Kathy Armstrong Vice-Chair Elise Boyan Treasurer Merritt Clements Secretary Patricia Morales Immediate Past Chair Alison Boone
TrackingTrump.org is an innovative new tool to help everyone keep track of the growing number of ways the Trump-Pence administration has been stripping away people’s reproductive health and rights.
TrackingTrump.org includes an interactive website, browser notifications for alerts, and easy ways to share content with your friends.
Knowledge is power. Get the facts so you can join the fight.
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La Juana Chambers Cheryl Davis, DDS Ceci Goldstone Laurie Greenberg, MD Lupita Gutierrez Alison Kennamer Ellen Lake Rev. Jon Lowry Fernando Martinez, PhD Don McRee, PhD Amber Medina Sara Metersky Barbara Moschner Yvonne Pelayo Stuart Schlossberg Susan N. Smith Brian Steward President & CEO Jeffrey Hons Senior Vice President & COO Polin C. Barraza, RN
TABLE OF CONTENTS
Join the Fight Here’s how to speak up for Planned Parenthood
Increasing Access to LARCs Why these contraceptives are in high demand
Abortion is Health Care What gets lost in the national debate about abortion
California vs. Texas How these states differ in their approaches to reproductive health care
Lunch with Bill Nye The lunch raised more than $700,000 for health care
www.ppsouthtexas.org MISSION We provide and protect the health care and information people need to plan their families and their futures. 2018 Summer HORIZONS
COVER IMAGE BY: KALIM/BIGSTOCK.COM
better when I focus on the things I can control and where I can make something good happen. This is what I’m working on: Construction has begun on our new 5-exam room clinical space at 920 San Pedro, very near San Antonio College. This will become our premiere family planning space where we will provide birth control to more clients than we do currently at any site. It is an ideal, central location, and we have made plans that will allow us to continue a sliding fee scale at this site even after we lose the Title X funds. The other San Antonio locations (Perrin Beitel, Southcross, Marbach and the Medical Center) will be fixed fee, but those fees will be gentler than those in the for-profit medical marketplace.
President’s Message I
guess I could spend the next 1,000 words explaining what is happening with the impending loss of federal family planning funds (Title X), but I don’t want to do so. I have grown tired of writing, and reading, sentences that are some version of, “The Trump administration has recently announced . . . which will damage health care policy for women.” These sentences are, unfortunately, true, but when I focus on that sort of information for too long, it becomes nauseating and leaves me bereft of the energy I need for the work, and for the fight, ahead. Neither am I allowing myself to engage
in mental contortions imagining all the possible implications of Justice Kennedy’s retirement from the Supreme Court. What does this mean for a women’s ability to control her reproductive destiny? What about the vast array of other progressive issues that come to the High Court? What does this mean for Planned Parenthood South Texas and our health care operation?
Construction is almost complete at our Harlingen health center, where we were in need of a facelift and improved clinic flow. Remodeling a 3-exam room clinic while simultaneously serving clients has not been easy. Our General Manager, Cyndi Torres, and her team have made it work. This improved and fresh facility is an essential part of our work in the Rio Grande Valley. Both of our Valley clinics — Harlingen and Brownsville — will have a sliding fee scale just like the San Pedro location in San Antonio.
For now, I am asking all of us to slow down, muster our strength, and keep focused on the tasks at hand. We have a lot to do at PPST and we’re making great progress. Women and men and teens are coming through our doors today, just like always, and their care is our top priority. I can’t afford to get dragged down right now. I am much
We have New Marbach under contract. This health center was established by Emilie Chenault and her late husband, Dr. C. Brandon Chenault, in 2005. Over the years, the success of this clinic is undeniable, but it needs a new home. This relocation, like the others, is part of a multi-year plan to move out of rented spaces and into spaces that we
own. Doing so gives us greater control, improves our financial strength over time, and allows us to improve the aesthetics of our health centers. The new facility will also be larger than the first Chenault Center, and that will help because patient volume has been growing at Marbach. If you were at the Annual Luncheon on May 8 with Bill Nye (wasn’t he great?) you may remember that I began describing our new LARC Assistance Fund—that’s Long Acting Reversible Contraceptives. In case you missed it, there’s even more information about LARCS in an article that begins on page 6, which includes information about how the LARC Assistance Fund will work. I am heartened by your response to support this new project, and I believe we are once again on the vanguard of how to make a family planning program work even when government refuses to be a partner for women’s health. The LARC Assistance Fund will be available at all seven PP South Texas locations. Also, be sure to check out the open letter from Karen Lee Zachry, Luncheon Chair, whose electrifying remarks from the Luncheon are reprinted on page 15. (KLZ in 2020!) For some time I have indicated that we are planning to add abortion care to a second location. That location is our San Pedro location, and the service will begin later this year. Over the past several years, the number of places where a woman can find an abortion in Texas has dropped dramatically. The most direct way to change that is to make it happen ourselves. This central location will increase access to this health care service.
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We’re hiring — another physician, additional medical assistants and nurse clinicians. More is happening at PP South Texas, and just like any enterprise, it is your people who are the essential element to organizational success. We’re a hard-working team of dedicated professionals. We need a few more. Help us spread the word.
Trump’s decision to exclude us from Title X makes no sense. Nationally, Planned Parenthood as a collective operates only 13% of Title X funded health centers, but we provide services to 41% of all Title X funded patients. Why? Because women choose us to be their provider, and now Trump desperately wants to break up that relationship.
Finally, I will soon begin the budget building process for 2019. In that plan, I am incorporating the work described above and all of our regular health care operation, but without the $830,000 of Title X federal family planning funds that have appeared in our revenue mix previously.
This president has picked a fight on the wrong issue and with the wrong people. We are not the only ones who think so. The American Medical Association, American College of Obstetricians and Gynecologists, and the National Family Planning and Reproductive Health Association have all made strong public statements denouncing the president’s decisions on this matter for rejecting science, interfering with the patient-physician relationship, and reversing progress on women’s health. Our commitment to women, to family planning, and to sexual health care is longstanding and heartfelt. We’ve been doing this work long before he became president. And we will be here long after his time in office comes to a close.
— MAHATMA GANDHI
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THE RULE WOULD: • Block access to care at Planned Parenthood under Title X • Prohibit Title X providers from referring for abortion
Your support, especially during these difficult years, becomes all the more essential to the strength of Planned Parenthood South Texas. You help us punch well above our weight. I hope you will make plans for us to appear in your charitable giving as we fight forward together, providing and protecting the health care and information people need to plan their families and their futures.
• Remove existing Title X protections that ensure women have full, honest information about all of their pregnancy options, including abortion.
When I despair, I remember that all through history the way of truth and love have always won. There have been tyrants and murderers, and for a time, they can seem invincible, but in the end, they always fall. Think of it―always.”
he Trump-Pence administration recently issued a proposed rule that would fundamentally dismantle the Title X federal family planning program, which has helped low-income patients receive essential health services for 40 years.
WE’RE FIGHTING BACK. WILL YOU JOIN US?
This medically unethical Gag Rule is an ideological move to limit what a woman is allowed to learn from her doctor.
If you think women should be able to access medically accurate, honest information about their health, make your voice heard. Go to ppsouthtexas.org to find our Speak Up for Planned Parenthood DIY Toolkit. You will find information about the Gag Rule, how to contact your elected officials and local media, and social media suggestions. The official comment period for this proposed rule closes July 31.
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amount of the progestin hormone. It lasts four to six years. • The copper IUD is a hormone-free, T-shaped plastic device that has copper on it. The device is inserted into the uterus and lasts up to 12 years.
LARCs are inserted by a clinician during an office visit — a simple procedure that takes just a few minutes. Experts believe the increasing use of LARCs helped rates of unintended pregnancy drop to a 30-year low, according to an analysis from the Guttmacher Institute published in the New England Journal of Medicine in 2016.
WHEN IT COMES TO BIRTH CONTROL, IT’S HARD TO BEAT LARCs.
Best of all? They’re a “set it and forget it” method, so women don’t have to remember to take a pill every day, make trips to the pharmacy, or correctly use a contraceptive method every time they have sex. That means there’s little chance for user error. LARCs have the
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highest rates of user satisfaction, according to the American Congress of Obstetricians and Gynecologists, and they’re safe for most women.
While LARCs are pricey — the cost to patients ranges from $500 to $1,000, depending on the kind of device and whether the woman is eligible for patient assistance — they are cost-effective over time. For example, a copper IUD provides up to 12 years of protection, while the cost of oral contraceptives over that same time frame could easily exceed $4,000.
Planned Parenthood South Texas offers three kinds of LARCs: • The implant is a tiny, flexible rod inserted under the skin of the arm to release pregnancy-preventing hormones for up to three years. • The hormonal intrauterine device (IUD) is a plastic, T-shaped device inserted into the uterus, releasing a small
LARCs — long-acting reversible contraceptives — are the most effective form of reversible contraception available. They last between three and 12 years, are more than 99 percent effective at preventing pregnancy, and can be removed at any time if a woman decides to get pregnant,
LARCs have another advantage — no one but the patient and her health care team knows she has one. For some women, their male partners do not want them to use birth control — too often issues of control and abuse force women to hide their use of family planning. In other cases, young women, both minors and young adults, fear their parents’ knowledge that they are using birth control. These patients request LARCs because, unlike oral contraceptives or condoms, IUDs and implants are easily kept secret.
Even so, the high upfront cost of LARCs can be a barrier. As a result, many low-income women without
insurance who are interested in a LARC select birth control pills instead because the Pill feels more affordable at the time. Yet PPST’s provision of LARCs has been on the rise. In 2015 we provided only 79 LARCs. In 2017, that number increased nine-fold to 709 LARCs provided. Why? Much of the increase in providing LARCs is the result of our participation in Title X, which is the nation’s longstanding program that funds birth control and sexual health care for those living below the federal poverty level. Because we receive Title X federal family planning funds at four of our San Antonio locations, PPST is allowed to purchase LARCs at dramatically discounted prices to be used at those same four sites. This discounted price schedule is known as the 340B Drug Pricing Program.
I have never had to face anything that could overwhelm the native optimism and stubborn perseverance I was blessed with.” — SONIA SOTOMAYOR
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WE BELIEVE EVERY WOMAN SHOULD BE ABLE TO CHOOSE THE BIRTH CONTROL THAT’S THE BEST CHOICE FOR HER.
THE LARC ASSISTANCE FUND We believe every woman should be able to choose the birth control that’s the best choice for her. The politically motivated actions of lawmakers in Washington are unacceptable — bad public policy and bad medicine that threaten the public health gains we have made in family planning and exacerbate inequalities between the sexes. To mitigate political interference in women’s health care, we developed the LARC Assistance Fund to help women access these contraceptives, and we need your help. Here’s how it will work: When a woman
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wants a LARC, she’ll make a small upfront payment at her appointment, then PP South Texas will carry her balance without interest, and allow her to make small payments over time. Her initial payment, and every subsequent payment, will be matched with an equal amount from the LARC Assistance Fund. That’s your help; partnering with each woman to make her long-term birth control affordable.
This project is particularly important because it will increase access to LARCs in the Rio Grande Valley. Despite our best efforts, we have not received Title X funding at our sites in the Valley since August 2011, which means we have not been able to acquire LARCs at 340B pricing. Because of this, we provide very few LARCs to our Valley patients — just 16 in 2017. The new LARC Assistance Fund will increase LARC accessibility to our patients in the Valley for the first time in seven years, which will provide a huge public health benefit to the community.
At the Annual Luncheon with Bill Nye on May 8, we raised over $82,000 in same-day donations, which we are designating for the LARC Assistance Fund. We are piloting this project at the three clinics that do not receive Title X funds: our Babcock clinic in San Antonio and our clinics in Brownsville and Harlingen. We will fine-tune the program and be ready to roll it out at our other four sites when the Title X funds and 340B pricing end.
IN MAY, THE TRUMP ADMINISTRATION announced devastating changes to the Title X program. Our Title X contract is scheduled to end on August 31. Not only will we lose more than $800,000 in annual funding, but we will no longer be able to purchase LARCs at the discounted prices of the 340B program. On average, our acquisition price will increase by $453 per device.
Because we have long dealt with the vagaries of politics surrounding women’s health care in Texas, we know the importance of jumping in with creativity and an experimental mindset in order to develop new ways to serve our patients that blend generosity
and sustainability. We’re excited about the LARC Assistance Fund, and we hope you are, too. It’s because of your philanthropy and charitable investment in Planned Parenthood that we are able to try innovative methods to fulfill our mission. Thank you.
Great works are performed not by strength but by perseverance.” — MAYA ANGELOU
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higher risk of breast cancer, according to the American Cancer Society, the National Cancer Institute, the American College of Obstetricians and Gynecologists and Susan G. Komen.
THE FAC ABOUT A TS BORTION
As the Court’s swing vote in recent years, Kennedy provided tie-breaking votes protecting abortion access. President Trump now has the opportunity to appoint a second justice, who would no doubt move the court further to the right and potentially take away the constitutional right to safe, legal abortion established by Roe v. Wade. To understand the importance of defending access to this essential aspect of women’s health care, we must understand the facts about abortion. Abortion is health care — full stop. When the politics and vitriol of debate about a woman’s choice is muted, these facts stand clear. ABORTION IS SAFE Abortions in the United States
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WHO HAS ABORTIONS? While the abortion rate has declined, nearly 24 percent of women in the U. S. will have an abortion by age 45, according to an analysis published in the American Journal of Public Health in 2017.
are safe and have few complications, according to a landmark study by the National Academies of Sciences, Engineering and Medicine released in March. Major complications occur less than a quarter of a percent of the time, according to an analysis by the University of California San Francisco published in 2014. In fact, an abortion is less likely to result in complications than wisdom teeth removal. Medical advances have made abortion safer. Three-quarters of abortions at PPST are medication abortions, which use the medicines mifepristone and misoprostol to end a pregnancy. This eliminates the very small risk of uterine perforation in surgical abortion. Expanded availability of medication abortion in recent years has contributed to more procedures happening earlier, which also minimizes risk. However, Texas laws that mandate waiting periods and ultrasounds cause women to face greater risk of complications. FIND THE FACTS Women who choose abortion do not face
In some cases, women terminate pregnancies that, if carried to term, would jeopardize their own health. Others have become pregnant through sexual assault and are therefore seeking abortion care at a terrible time in their lives. Still others find themselves in abusive relationships and don’t wish to have a child in such a situation. REPRODUCTIVE HEALTH CARE Abortion must be viewed as a medical procedure like any other and an essential component of women’s reproductive health care. We believe it is important to provide abortion care in the context of family planning. Effective family planning is the best way to prevent future abortions. Every woman who has an abortion should be connected to full information about contraceptive options, If Texas were serious about preventing abortion, the state would insist that all women who have abortions receive contraceptive counseling and be offered a method of birth control, which is exactly what happens at Planned Parenthood.
ith Justice Anthony Kennedy’s announcement of his retirement from the Supreme Court, there is no doubt that abortion rights and access are on the line.
Abortions performed in the first trimester pose virtually no long-term risk of problems such as infertility, ectopic pregnancy, miscarriage or birth defects.
abortion care already have children.
It’s not possible to know the reasons for every woman’s abortion. Some choose abortion because they feel emotionally or financially unprepared to be a parent or to increase their family size. Some know parenthood never will be right for them, but many opt to have babies after achieving goals such as finishing school or launching careers. Six out of 10 women seeking
But health care providers who perform or work with an entity that performs abortion care can’t participate in Healthy Texas Women, the state’s subsidized health care program for low-income women. This means that Healthy Texas Women will not help provide birth control to women who have abortions. We must regard abortion care as the safe, common medical procedure it is. PPST is committed to protecting and providing this care for our patients. 2018 Summer HORIZONS
CALIFORNIA AND TEXAS MAY BE TWO STATES IN THE SAME NATION, BUT ON MATTERS OF ACCESS TO ABORTION CARE, THEY APPEAR TO BE DIFFERENT PLANETS IN THE SOLAR SYSTEM. In 2015 California passed the Reproductive FACT Act, requiring anti-abortion crises pregnancy centers to inform clients about free or low-cost abortion and contraception services. The law aimed to prevent crisis pregnancy centers from misleading women by providing inaccurate medical information or omitting information. Crisis pregnancy centers sued the state, arguing the act violated their right to free speech by forcing them to promote abortion. Unfortunately, the United States Supreme Court in June ruled in favor of fake clinics that lie to women. Still, it’s heartening to see a state that wants to equip women to make informed decisions about their pregnancies. Contrast California’s law with
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Texas’ Women’s Right to Know Act. This law requires women seeking an abortion to receive a booklet that is medically unsound and ideologically motivated. The booklet incorrectly suggests that abortion increases the risk of breast cancer, mental health issues and future infertility. The state also provides a resource directory that includes crisis pregnancy centers. Rather than providing women with unbiased, medically accurate information, Texas lawmakers push an ideological agenda under the guise of protecting and caring for women’s health. Those aren’t the only differences in the states’ approaches to abortion care. Texas is notorious for passing some of the strictest anti-abortion laws in the nation, and state legislatures across the country have been passing an increasing number of laws to reduce abortion access. Meanwhile, California is moving in the opposite direction.
In CALIFORNIA, nurse practitioners, certified nurse-midwives and physicians’ assistants are able to legally provide abortion, both surgical and medical. Increasing the number of trained providers increases access to abortion. In TEXAS, only physicians can provide abortion care, even medication abortions.
CALIFORNIA’S Medicaid program pays for elective abortions.
In TEXAS, Medicaid covers abortion only in cases of rape, incest, or lifethreatening conditions. Not only that, Texas forbids private insurers from covering abortion as part of an overall health insurance plan except in cases of life-threatening conditions (but not rape).
CALIFORNIA does not require abortion patients to undergo initial in-person counseling followed by a waiting period.
TEXAS requires women seeking abortions to receive a sonogram and counseling, then wait 24 hours before getting the abortion. They must see the same doctor for all visits. (In-person counseling is not required for women who live more than 100 miles from an abortion provider.)
In CALIFORNIA, a minor (younger than 18) can access abortion care without parental consent and without court permission. In TEXAS, a provider must notify the parent or guardian of a minor (younger than 18) before she can have an abortion. The parent or guardian must give consent for the abortion, unless she gets permission from a judge. 2018 Summer HORIZONS
Perseverance, secret of all triumphs.” — VICTOR HUGO
Thanks to those of you who were able to join us on May 8, we raised more than $700,000 for preventive health care. We estimate that before this year draws to a close, we will serve more than 19,000 women, men and teens in our health centers. Each and every visit will be facilitated in some way by the dollars contributed in support of the Luncheon. A visit to Planned Parenthood can change the world for a patient who is vulnerable, without resources and with no place to turn. Thank YOU for being that change.
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The work of Planned Parenthood is needed now more than ever. Please keep it up. We are living in extraordinary times. Together, we can improve the lives of families everywhere. Thanks again. Let’s change the world!” —BILL NYE
No matter who the speaker is, or what the topic, one of the main takeaways from our Annual Luncheon is always that we really are in this together, and together we are incredibly strong. (Just ask our opponents!) Planned Parenthood isn’t just an organization, isn’t just a collection of brick and mortar clinics. It’s you, along with hundreds of thousands of patients, volunteers, activists and donors — people united by a fierce commitment to equality, justice and compassion. It’s a movement begun back in 1908 that really has changed the world.
Nye with Medical Students for Choice
OPEN LETTER from
THE CHAIR OF THE 2018 ANNUAL LUNCHEON, KAREN LEE ZACHRY Dear Friends, I was asked recently why I support Planned Parenthood, and two posters from the Women’s March on Washington immediately came to mind — the first was the 90 year old woman’s poster that read, “I can’t believe I’m still protesting this s*%#.” The other had a quote from Angela Davis which read, “I am no longer accepting the things I cannot change. I am changing the things I cannot accept.” And that’s why I support Planned Parenthood — I suspect it’s why many of you do as well.
It is unacceptable to me that the maze of laws, regulations and restrictions surrounding women’s health care disrespect the ability and exclusive province of women to make health care decisions for themselves and to access true, reliable information in order to make those decisions. It is unacceptable to me that health care is increasingly a privilege for those who have full-time employment, not a basic human right — and that people of color, those with low incomes, and folks in rural areas are most affected by the limited access to health care. It is unacceptable to me that opponents of birth control cloak their opposition in a claim of religious freedom or base it on junk science. It is unacceptable to me that in our state and in 43 others, the law requires doctors to give women seeking an abortion misleading and outright false information or requires them to submit to medically unnecessary procedures, but also that medical providers may lose funding unless they agree not to refer, provide, or even mention abortion. It is unacceptable to me that the state of our laws is that I can walk into a store today and walk out with a handgun 30 minutes later, but a grown woman has to wait 24 hours to “think it over” before she can access a safe, legal medical procedure.
And finally, it is unacceptable to me that for the millions of women — and men — who rely on Planned Parenthood for Pap smears, birth control, HPV vaccines, breast cancer screenings, HIV testing, fertility treatments and more, the door to their SOLE source of basic health care is in jeopardy of being closed, for no reason other than that politicians don’t support one of the safe, legal medical services Planned Parenthood offers women. For almost 80 years, Planned Parenthood South Texas has been providing safe, sound, science-based health care to women, and has been fighting to make sure its doors stay open and its services remain available to all who need it. Years ago I learned a saying that people should give of their time, treasure or talent — whichever they have in greatest measure — to the causes they believe in. I hope all of you who believe in the values that Planned Parenthood stands for will continue to act on your beliefs with your voice, your vote, your philanthropy… through volunteerism, advocacy, and by staying informed. There is a role for all of us in this fight. In this together, Karen Lee Zachry
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