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Texas Policy Evaluation Project

Why are so many pregnant women dying in Texas?

Better yet, what are we going to do about it?

The rate of Texas women dying of pregnancy-related causes nearly doubled from 2010 to 2014, with the state seeing more than 600 such deaths in the four-year span.

In a new study, set to be published in the September issue of Obstetrics and Gynecology, researchers found that Texas experienced a dramatic increase in pregnancy-related deaths from 2010 to 2012. While the rest of the country also experienced an increase, no other state saw the rate nearly double like it did in Texas.

Some health experts complain that the state has been slow to respond to the problem. A state task force on the issue is nearly three years into its work and has released no recommendations.

“We’re really seeing this is a serious problem with maternal mortality,” said Dr. Daniel Grossman, an OB-GYN who studies the effects of recent reproductive health legislation in Texas with the Texas Policy Evaluation Project at the University of Texas at Austin. “It really seems like that’s where the state officials should be focusing on trying to improve health and safety.”

From 2006 to 2010, the rate of Texas women who died while pregnant or within 42 days of being pregnant due to causes related to their pregnancies fluctuated between 18.1 and 18.6 deaths per 100,000 live births, according to the study. In 2011, the rate jumped to 33, and by 2014, it was 35.8.

In 2012, 148 women died from such causes, up from 72 deaths two years before.

The findings stumped the national researchers and have prompted them to begin a further study into maternal mortality in Texas. Vital statistics officials on both state and national levels “did not identify” any change in the data recording processes that could have resulted in the dramatic increase, according to the study.

The Texas Legislature created a task force in 2013 to study pregnancy-related deaths and severe complications in the state. It’s set to release its first report to lawmakers on Sept. 1.

[…]

The rise in pregnancy-related deaths in 2011 coincided with the beginning of major budget cuts in Texas. In September of that year, health care providers across the state began to feel the effects of a family planning budget reduced by two-thirds.

Sarah Wheat, a spokeswoman for Planned Parenthood of Greater Texas, said many of the family planning clinics that lost funding or closed were an “entry point into the health care system” for women.

“Chances are they’re going to have a harder time finding somewhere to go to get that first appointment,” Wheat said. “They may be delayed in getting that initial pregnancy test and then a prenatal referral.”

The study mentioned changes to women’s health services and clinic closures but didn’t go so far as to suggest there was a correlation between that and the uptick in pregnancy-related deaths.

“Still, in the absence of war, natural disaster, or severe economic upheaval, the doubling of a mortality rate within a two year period in a state with almost 400,000 annual births seems unlikely,” the study said.

I’m going to wait and see what that task force finally says on September 1. It took them three years to come up with something, so one hopes it will be worth the wait. In the meantime, I wonder why we haven’t heard more from the “pro-life” forces in this state, whom we know are legion and not at all the quiet types. One would certainly think that a sharp, unexplained rise in the rate of pregnant women dying would be the sort of thing that might attract their attention and at least some of their energy. Wouldn’t one? The Current has more.

Use of abortion pill rises

Until the Lege reconvenes, anyway.

Misoprostol

There’s been a sharp increase in the number of Texas women who are using the abortion pill to end their pregnancies now that federal officials have eased restrictions on the drug, according to officials at Planned Parenthood of Greater Texas.

Until recently, the number of women seeking medically induced abortions at Texas’ Planned Parenthood facilities had dipped to about 1 percent because of stringent guidelines put in place by state lawmakers, officials say.

That changed in late March, when the U.S. Food and Drug Administration relaxed guidelinesfor women taking mifepristone, a pill geared to induce abortion early in a pregnancy.

“We have seen a fourfold increase in the number of our patients choosing medication abortion since the FDA updated its protocol,” said Sarah J. Wheat, chief external affairs officer at Planned Parenthood. “From our perspective, it’s restoring options for women.

“It’s putting decisions back in the hands of women instead of politicians at the Capitol.”

No firm numbers are available yet, but Texas researchers and abortion providers say they see the increase and hope to have better estimates in the coming months.

[…]

Planned Parenthood continues to run clinics statewide, including the Southwest Fort Worth Health Center, a privately funded $6.5 million licensed ambulatory surgical center that opened in 2013.

A medical abortion has remained an option for patients at these facilities, but fewer women have used it because Texas law required them to visit the clinic four times for it, said Daniel Grossman, an investigator with the Texas Policy Evaluation Project and a professor at the University of California, San Francisco.

“In the six months after HB 2 went into effect, there was a 70 percent decline in medication abortions performed statewide,” said Grossman, who is working with researchers at the University of Texas at Austin to determine the impact of legislation on abortions. “Interviews with women … [showed they were] incredibly frustrated when they had a preference for medication abortion” and couldn’t get it.

Wheat said some women have had to travel 100 miles or more to reach a Planned Parenthood clinic, which put a hardship on them for multiple visits.

“That requirement alone created huge barriers for our patients,” she said.

Now that the FDA change has loosened restrictions in Texas — requiring a lower dose, 200 milligrams instead of 600 milligrams; fewer doctor visits; and allowing the medication up to 10 weeks in a pregnancy instead of seven weeks — more women are choosing the medical abortion option, Wheat and Grossman say.

Exact numbers won’t be available for weeks or months, but “many of the independent abortion providers who have already started using the new FDA regimen are saying their numbers are back up,” Grossman said. “Many women have a preference and prefer this.”

[…]

Now the question is whether Texas lawmakers will weigh in on the issue when they return to work in January.

Planned Parenthood officials say they hope not.

“The restrictions the Legislature put in place were not based in science,” Wheat said. “The FDA is the national expert in how medications are provided, and they approved these updates.

See here for the background. I’d laugh at the futility of hoping that science and rationality would prevail if it weren’t so painful. The best hope as I see it is for HB2 to be sufficiently gutted by the Supreme Court. That will surely only slow down the zealots, but it’s probably the best we can expect until we start electing different leaders.

How much more “undue” does it need to be?

HB2 is doing exactly what it was intended to do.

A new report released Thursday shows Texas abortion patients traveled farther for services and experienced higher out-of-pocket costs following the closure of more than half of the state’s legal abortion providers in 2014. The closures came after the implementation of parts of Texas’ omnibus anti-abortion law, HB 2, which is currently being challenged at the U.S. Supreme Court.

Thursday’s is the latest report from the Texas Policy Evaluation Project (TxPEP), a University of Texas research group that studies the long-term effects of Texas’ omnibus anti-abortion law and other changes to reproductive health funding and policies. TxPEP surveyed 398 women who sought abortions between May and August of 2014, when all but 19 abortion clinics in Texas were closed. Researchers then compared the experiences of two groups: women whose nearest clinic closed after HB 2’s admitting privileges requirement first took effect, and those whose nearest clinic didn’t close.

Women whose nearest clinic closed (38 percent of the 398 surveyed) ended up traveling an average of 85 miles for their abortion, while those whose nearest clinic stayed open (62 percent) traveled 22 miles. According to the Guttmacher Institute, the national average distance traveled to an abortion clinic is 30 miles.

[…]

Researchers found that 32 percent of women whose nearest clinic closed reported spending more than $100 in out-of-pocket expenses to access abortion because of extra necessities, such as transportation, overnight accommodations, child care, and also lost wages from taking time off work. Those expenses were added to the cost of the procedure itself.

Either the “undue burden” standard – which Anthony Kennedy authored – means something, or it doesn’t. If this law doesn’t violate that standard, then we may as well admit that it means nothing. I continue to hope that the good Anthony Kennedy will be there for this one. Newsdesk and Think Progress have more.

The easily predicted results of de-funding Planned Parenthood have resulted as predicted

Who’d a thunk it?

Right there with them

Right there with them

A new study released Wednesday reports that after anti-abortion Texas lawmakers blocked Planned Parenthood from participating in the Texas Women’s Health Program (TWHP) in 2013, fewer low-income women received the most effective kinds of contraception. The study, published in the New England Journal of Medicine, is also the first to analyze the subsequent significant rise in some Medicaid-covered deliveries after the provider’s ouster.

Comparing quarterly medical and pharmaceutical claims from 2011 to 2014, researchers with the Texas Policy Evaluation Project (TxPEP) found that 35 percent fewer patients received highly effective intrauterine devices (IUDs) and implants — known as long-acting, reversible contraception (LARC) — over the four-year period. Claims for the injectable Depo shot, which requires follow up every three months, decreased by 31 percent. Researchers found that the rate of Medicaid-covered deliveries among women in the Depo group then increased by 27 percent.

The reduction in claims, said lead author Amanda Stevenson, highlights the fact that despite recent state efforts to recruit more providers, and claims of successwithout Planned Parenthood, patients have lost services.

“The reproductive health safety net cannot just absorb all of the demand for highly effective contraception when you remove Planned Parenthood from the network,” Stevenson told the Observer. TxPEP’s findings, she said, “directly contradict” claims “that Planned Parenthood can be removed from federally-funded healthcare programs and other providers will just step up to pick up the slack.”

[…]

For this study, TxPEP focused on patient claims that reflect the eligibility criteria for enrollees in the TWHP: legal Texas residents between the ages of 18 and 44 and who live at or below 185 percent of the federal poverty line (an annual income of approximately $44,000 for a family of four). They also compared services in counties with and without a Planned Parenthood health center.

The study found that contraceptive claims decreased most dramatically in counties with Planned Parenthood clinics, while counties without a Planned Parenthood clinic were largely unaffected.

The percentage of women who returned for their birth control shot every three months illustrates the long-term impact of losing Planned Parenthood as a program provider. Before the exclusion, 56.9 percent of patients living in counties with a Planned Parenthood clinic received their follow-up injections. After the exclusion, just 37.7 percent of patients got their subsequent shots.

In addition to cutting family planning funding by more than $70 million, the 2011 Legislature also funneled what remained of the state’s available family planning dollars away from specialty reproductive health providers, including Planned Parenthood. That, compounded by the cuts, led to the closure of 82 family planning clinics statewide; about one third of those were Planned Parenthood health centers.

I don’t even know what else to say, so I’m just going to let this speak for itself. Just repeat after me: Nothing will change until our electoral results change.

A reduction in funding for women’s health leads to fewer women getting health care

Shocking, I know.

Right there with them

Right there with them

The number of claims filed for medical and family planning services in the new state-run Texas Women’s Health Program has dropped since the state ousted Planned Parenthood from it and set up its own program without federal financing, according to figures from the Health and Human Services Commission.

Stephanie Goodman, a spokeswoman for the commission, wrote in an email that the program is “running at about 77 percent of the number of claims this year compared to last year.” She added that the agency expects to “see a similar trend with the number of women served,” though those numbers are more difficult to calculate.

“We expected to see a drop-off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” Goodman said. “We’ve been able to find new doctors for women who call us, and we’ve got the capacity to increase the number of women we’re serving in the state program.”

[…]

While Planned Parenthood continues to provide services with community donations and other revenue, Danielle Wells, a spokeswoman with Planned Parenthood of Greater Texas, said many patients have expressed frustration “that politicians are telling them where they should and should not go for their health care.”

“We’re still hearing from patients who were in the program and were unable to locate a provider or schedule services in a timely manner,” she said. The exclusion of Planned Parenthood requires many women to travel farther to find an available provider, she said, and to make “tough decisions about paying out of pocket for care or simply putting off vital care that could potentially save lives.”

Amanda Stevenson, a research associate at the University of Texas at Austin’s Texas Policy Evaluation Project, a three-year study evaluating the impact of the 2011 women’s health policy changes, said determining whether women still have adequate access to care is complicated. While the health commission is working hard to enroll new providers to replace Planned Parenthood, she said women may delay care because they do not know which providers are available or end up paying out of pocket costs by continuing to seek services at a Planned Parenthood clinic.

“We’re seeing obviously that access is diminishing in places, particularly [those] that rely heavily on Planned Parenthood providers,” she said. But other areas of the state have not been as affected by the policy changes, she added, referencing a data application created by the researchers that shows how the 2011 policy changes and funding cuts have affected women’s health services regionally.

She also noted that more data is necessary to determine whether the percent reduction in claims represents a persistent trend.

“If things were getting better then we would expect consistent reduction in that proportion, but it’s not happening,” Stevenson said. “There might be a trend, and we might see it, but it’s not enough here to say that it is.”

To be as fair as I can to something that doesn’t deserve fair treatment, Planned Parenthood had previously served forty percent of the Women’s Health Program clients, but the decline in participation is now only about 23% of the pre-cutoff total, which means that at least some of the women who were directly affected by this bit of ideological bloodletting have since found an acceptable alternative. Hooray for small victories. Of course, they were all still forced to change doctors, and we have no way of knowing how much less convenient or more expensive these new arrangements are for them. And Lord knows the people that brought you this little catastrophe aren’t interested in finding out the answer to that. But again, as I said before, even if you could reasonably claim that access to health care is no worse than it was before, hundreds of thousands of women had their access to health care disrupted, for no good reason. And a lot of legislators plus our state leaders count that as a victory.

In related news, that ballyhooed restoration of family planning funds this session is less than meets the eye.

The Texas Women’s Healthcare Coalition has raised concerns that a bipartisan effort to restore access to family planning services by expanding a state-run primary care program isn’t shaping up as planned.

During hearings in the regular legislative session, David Lakey, the commissioner of the Department of State Health Services, told lawmakers that 60 percent of the $100 million allotted to expand the primary care program for women’s health care in the 2014-15 biennium would be used to provide family planning services and contraception. But the forms created by DSHS for health providers to apply to take part in the program do not explicitly state that 60 percent of providers’ services must go toward family planning.

In a letter sent Monday to DSHS and lawmakers, the coalition — which counts the Texas Medical Association, Texas Academy of Family Physicians and Texas Association of Community Health Centers among its 39 members — argued that the proposed rules don’t ensure that the program will achieve lawmakers’ intent of restoring access to family planning services.

“We’re concerned that this was really like a bait and switch,” Dr. Janet Realini, chairwoman of the coalition, said in an interview. Although she does not believe DSHS has intentionally disregarded the legislative intent to increase family planning services, she said, “the system to do that is missing an essential piece of direction for the contractors.”

Carrie Williams, a spokeswoman for DSHS, said the department received the coalition’s letter and is working to clear up misunderstandings about the program.

“We’ve been very open in developing and talking about this program, so it was disappointing to see these inaccuracies being promoted as fact,” Williams said in an email to the Tribune.

She added that family planning services are emphasized throughout the department’s materials on the program, but that the program does not exclusively provide family planning services.

“The 60 percent target for family planning was what we have been proposing all along. While that threshold is not explicitly stated in the materials, it has long been the plan and we have never indicated otherwise,” said Williams.

In its letter, the coalition recommended that the department explicitly prioritize family planning services by setting specific targets and performance measures for contractors. The state could save money and avert unintended pregnancies, the coalition argues, by setting performance targets for family planning services and giving funding priority to contractors that have demonstrated the ability to provide these types of services.

“I think putting it in the materials to let contractors know what you’re looking for is important,” said Realini.

In the private sector, we call that setting metrics. Metrics reflect goals and values. You can draw your own conclusions.