Access Denied

Prodded By Religious Right Extremists, State Officials Are Increasingly Decimating Reproductive Care Options For Women

On Oct. 22, Texas health investigators raided Planned Parenthood clinics across the state. Representatives of the Texas Office of the Inspector General demanded patient and billing records from clinics in Dallas, Austin, Houston and San Antonio and gave them 24 hours to comply.

Advocates for women’s health swiftly condemned the raids.

“The breadth and depth of what was requested this morning was unprecedented. Today’s visits were clear­ly politically motivated. We’re all pretty surprised by how far the (state) is willing to go to try to shut down Planned Parenthood health centers,” Sarah Wheat, a spokeswoman for Plan­­ned Parenthood’s Austin locations, told the Austin Statesman.

Ken Lambrecht, CEO of Planned Parenthood of Greater Texas, called the demands a “politically motivated fishing expedition” and told Mother Jones magazine the group would try to protect patient confidentiality as it attempted to cooperate with the state’s demands. The reproductive health care provider eventually convinced the state to allow them a full week to respond to records requests, but its representatives insist it has not broken the law.

State Inspector General Steve Bow­en told reporters the raids occurred in response to a whistleblower report of Medicaid billing fraud. But in a letter to Planned Parenthood, he also cited a series of videos released by the Center for Medical Progress (CMP), a group with significant ties to the Religious Right.

CMP’s videos purportedly show Planned Parenthood staffers organizing the sale of fetal tissue for profit in violation of federal law. Fusion GPS, a research and corporate intelligence company, disagrees; they informed Con­­­­­gress in August that CMP had deceptively edited the videos to depict wrong-doing.

But that revelation hasn’t deterred Bowen. He has asked specifically for the records of women who donated fetal tissue after their abortions. According to Jezebel, a women’s news website, his extensive request covers “physician orders, progress notes, personal clinic notes, nurses’ notes, procedure reports” and more. The move came just three days after the Texas legislature voted to defund Planned Parenthood.

Texas is the only state to raid clinics, but it isn’t the only state to defund Planned Parenthood. Alabama, Ark­ansas, Louisiana and Utah voted to do the same, although federal courts have thus far ruled the states have no constitutional authority to strip Medicaid funds from the organization.

Planned Parenthood’s opponents may lack evidence and legal justification for their attempts to shut the provider down. But according to their critics, the fight against Planned Parenthood – and against comprehensive reproductive health care more generally – is ultimately based in fundamentalist or traditionalist religious views.

This is not a new phenomenon. Anti-abortion sentiment is the original glue that bound conservative Protestants and Catholics together to create the contemporary Religious Right. In a process documented by former activists like Frank Schaeffer, social conservatives successfully popularized the notion that support for abortion access was incompatible with an orthodox Christian identity.

That marked a distinct departure from pre-Roe v. Wade America, when a band of clergy, horrified by deadly botched abortions, formed the Clergy Consultation Service on Abortion to connect women to reputable providers.

Now, decades later, the strength of a person’s religious affiliation strongly indicates opposition to abortion.

According to Pew Research Center, 75 percent of self-identified white evangelical Protestants oppose abortion. Catholics are more ambivalent on the issue, but for members of both groups, a higher rate of church attendance positively correlates to strong opposition to abortion.

They also constitute a formidable voting bloc. Marshalled by groups like the Southern Baptist Convention, the U.S. Conference of Catholic Bishops and an array of “pro-life” organizations with religious overtones, abortion opponents have successfully packed the U.S. Congress and state legislatures with ideological allies.

The result: 42 years after Roe, the Religious Right has succeeded in making abortion nearly inaccessible for women in many areas of the country. In the process, they are methodically curtailing women’s access to a range of health-care services.

This is particularly evident in Texas, where women in rural areas have watched their access to abortion clinics steadily erode since 2013. Reproductive-rights advocates say that’s largely due to strategic alliances between legislators and the state’s powerful Religious Right groups.

Dan Quinn, director of communications for the Texas Freedom Network, told Church & State that abortion is a “huge” priority for extremist groups.

“It is the thing they care about the most,” Quinn said. “Abortion has long been the dominant issue for our Religious Righters.”

In the Lone Star State, major players include the Texas Alliance for Life, Texas Right to Life and the Texans for Life Coalition. To these religious fundamentalists, access to abortion, contraception and other reproductive health services is tied directly to socially conservative views on sex.

Quinn noted that abortion opponents also tend to oppose comprehensive sex education in public schools, and many worked to defeat an anti-discrimination ordinance in Houston that was intended in part to protect LGBT people.

They don’t lack official support.

During his tenure in office, former Texas Gov. Rick Perry (R) proved a reliable ally for the Religious Right and its war on access to reproductive health care.

“I feel like I am in the garrison of an army that has devoted itself to the defense of the unborn, here in this state and across the country, and am proud to be counted in the ranks,” Perry said in 2010.

He consistently framed his opposition to abortion in spiritual terms as a resistance to supernaturally evil forces. Sarah Posner, a reporter for the site Religion Dispatches, reported that Perry quoted Ephesians 6:12 during the same gala speech: “For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms.”

Perry’s successor, Greg Abbott, is equally opposed to abortion – for equally religious reasons.

Abbot repeatedly touted his Cath­olic faith and pro-life credentials during his campaign, and his wife, Cecilia, keynoted the Diocese of Fort Worth’s Respect Life Gala in October. As state attorney general, Abbot also tied his religious convictions to his personal experiences as a quadriplegic.

“As I laid there motionless on the ground, gripped with pain, as helpless as a child in the womb, I knew my life had changed forever,” Abbott told the National Right to Life Convention in 2013. “Some people think it’s easy to write off the lives of the disabled or the different. But every day, God reminds us that all life has value, no matter the form.”

Texas’ current lieutenant governor, Dan Patrick, made similar statements – and legislative commitments – during his tenure as state senator. He sponsored a successful 2011 bill that requires doctors to show women sonograms before terminating their pregnancies, and he wasn’t shy about his motivation.

“Standing for life isn’t a partisan issue. It’s a God issue,” Patrick said in defense of the measure. “The good news is through the blood of Jesus Christ he forgives, and women who have aborted children need to know that message…I believe this can be the beginning of the end of 75,000 abortions we have every year in Texas.”

Perry, Abbott, Patrick and their numerous allies in the Texas legislature have created a state in which religious extremists wield real political power over a constitutional right.

They also pushed for HB2, an omnibus bill that included several strict abortion restrictions. Passed in 2013 on Perry’s watch, it requires abortion providers to have admitting privileges at a hospital located within 30 miles of the clinic and to adhere to standards set for ambulatory surgical centers, even if surgical abortions are not performed at the facility. The bill also set restrictions on the medicines used during abortions.

Whole Woman’s Health, an Austin-based abortion provider, filed suit to challenge some of the law’s provisions. According to the clinic, legislators placed an undue burden on women seeking abortions in the state. The clinic and its allies say these provisions are also unnecessary and out of date. Those criticisms are supported by mainstream professional bodies like the American College of Obstetricians and Gynecologists (ACOG).

Whole Woman’s Health v. Cole has now made its way to the U.S. Sup­reme Court; at press time, the justices had just announced that they will hear the case.

If a majority rules that HB2 does not place an undue burden on the right to access abortion, the effects will be drastic. In a recent profile and photo essay, MSNBC’s Irin Carmon noted that a mere 10 Texas clinics would remain open to serve roughly 13.5 million women.

Providers like Amy Hagstrom Miller, who owns Whole Woman’s Health, say this would put abortion out of reach for most women.

“I think we have to ask: Do we want the rest of the country to look like Texas?” Miller told MSNBC.

To the Religious Right, it seems, the answer is yes.

Texas is no longer much of an outlier. Reproductive-rights opponents in other states across the country have adopted similar tactics to curtail reproductive options. So-called “targeted regulation of abortion providers,” or TRAP laws, are among the most popular – and the most successful. The Guttmacher Institute reports that 28 states now have some version of the law on the books; Texas’ HB2 contained a TRAP provision. TRAP laws typically require clinics to adhere to the same standards as ambulatory surgical centers.

Not only is that condition unnecessary, according to ACOG, it can also put clinics out of business: The cost to upgrade the average abortion clinic to a surgical center can run in the millions.

Another HB2 provision – requiring abortion providers to have admitting privileges at a local hospital – has spread far outside Texas. In 2013, Ohio legislators passed a law requiring providers to have admitting privileges. They subsequently banned publicly-funded hospitals from entering into these agreements, and private hospitals have been reluctant to fill the void. The Huffington Post website reported in September that anti-abortion activists had urged hospitals to refuse to extend admitting privileges to abortion providers.

Two clinics are challenging the requirements. But if they fail, the state will be down to seven clinics. The city of Cincinnati will be without a clinic at all.

In Missouri, activists and legislators have resorted to similar tactics. Lawmakers launched repeated investigations into the state’s Planned Parenthood clinics in response to CMP’s alleged exposé. Missouri legislators found no evidence of wrongdoing.

The scrutiny, however, proved too controversial for the University of Missouri. Its medical school severed its ties with Planned Parenthood and revoked “follow and refer” privileges to a local abortion provider.

The St. Louis Review recently reported that the Missouri Catholic Conference (MCC) contacted Pathology Services, Inc., to urge it to sever its relationship with Planned Parenthood, which happens to operate the state’s last abortion clinic.

“Whether they fully appreciate it or not, your lab workers are part of the assembly line of the abortion industry,” MCC executive director Mike Hoey wrote. “By agreeing, in advance, to take the human remains of these children aborted while in utero, you are facilitating this taking of innocent human life. Knowing this, your only moral recourse is to say ‘NO, we will no longer cooperate, we will no longer help kill unborn babies.’”

By press time, the lab had not agreed to Hoey’s suggestion. But the matter isn’t likely to disappear. As Robin Marty recently reported for Dame magazine, the Missouri legislature is poised to debate a bill that would subject pathology labs to the same stringent requirements as abortion clinics.

“Since Pathology Services Inc. serves many clients besides Planned Parenthood, the obvious mission is to make them conclude working with the abortion clinic is too risky to continue,” Marty wrote. “If the legislature is successful, that could be the action that would close the St. Louis clinic and make the state abortion-free.”

But the Religious Right’s activism isn’t restricted to abortion. The movement has also made it significantly more difficult for women to access a full range of reproductive health care services, including contraception and sterilization, and in many cases, they’ve accomplished this without the aid of legislation.

Jessica Mann discovered that earlier this year. She suffers from brain tumors, and her doctor recommended sterilization to prevent another potentially life-threatening pregnancy. But when Mann attempted to schedule a tubal ligation after her scheduled C-section at Genesys Regional Medical Center in Grand Blanc, Mich., hospital administrators told her they wouldn’t perform the procedure.

Genesys is a Catholic hospital, which means that it’s governed by the Ethical and Religious Directives produced by the United States Conference of Catholic Bishops (USCCB). Those directives prohibit abortion and sterilization as well as the prescription of hormonal contraceptives in most cases.

“I was surprised and upset,” Mann told The Washington Post. “And there was anger at the fact that they can disregard medical issues for their religious beliefs.”

In an op-ed for The Daily Beast, a news site, Mann explained that Genesys waited so late to inform her that it would not perform the tubal ligation that she was forced to attempt to find another doctor and hospital a mere seven weeks before her high-risk birth. Further complicating the matter: Genesys approved a similar request last year. The hospital offered no explanation for the apparent discrepancy.

The ACLU of Michigan sent a legal demand letter to the hospital on Mann’s behalf. When Genesys refused to budge, the ACLU announced that it had decided to sue its Catholic-affiliated parent group, Trinity Health Corporation.

“We’re taking a stand today to fight for pregnant women who are denied potentially life-saving care because doctors are forced to follow religious directives rather than best medical practices,” ACLU of Michigan Staff Attorney Brooke A. Tucker said in a statement. “Catholic bishops are not licensed medical professionals and have no place dictating how doctors practice medicine, especially when it violates federal law.”

According to the ACLU, one in nine hospital beds are now located in Catholic hospitals. That’s largely due to mergers between Catholic hospitals and secular ones. In practice, this means it’s difficult for many patients to access care that isn’t influenced by Catholic doctrine.

The ACLU’s California affiliate had to threaten a lawsuit to persuade a Redding Catholic hospital to perform a tubal ligation. Rachel Miller had decided to undergo the procedure after her second C-section, but the hospital refused.

“I was shocked to learn from my doctor that the hospital was telling me no and that the only basis for that was a religious doctrine,” she said. “I have no problem with people practicing their religion, but because there are so many Catholic hospitals, especially in the north state where I live, it leaves women with very little choice.”

Miller told The San Francisco Chronicle that the nearest secular hospital is located more than two hours away in Sacramento. That’s an increasingly common scenario for patients.

“Ten of the 25 largest hospital systems in the U.S. are Catholic. In the past decade mergers have led to a 16 percent increase in the number of Catholic-sponsored hospitals. In some communities there is no other option for emergency care,” ethicist Arthur Caplan wrote in an op-ed for NBC News. “They took in $115 billion in 2011 alone from Medicare and Medicaid. They also get tax exemptions and other public money.”

Catholic hospitals often refuse to perform certain services. They are religious institutions, and most operate according to doctrinal dictates. But according to Americans United Senior Litigation Counsel Greg Lipper, the First Amendment does not guarantee a blanket religious exemption from offering comprehensive reproductive health care.

“Like all hospitals, Catholic hospitals are required to meet the standard of care,” Lipper said. “If a particular procedure is called for in order to save the patient’s life or protect her health, then the hospital cannot withhold that procedure on religious grounds. There is no free exercise right to commit medical malpractice. “A merger between a religious hospital and a secular hospital is not necessarily a problem,” Lipper added. “But it does become an issue when the religious hospital is the only hospital in town. Because state governments typically limit the number of hospitals that can open in a particular area, they have an obligation to ensure that meaningful secular alternatives are available and that everyone in a particular area has access to comprehensive medical care without religious restrictions.”

The USCCB might not agree. On its website, it characterizes its health care work as a “ministry” of the church. It also condemns the Affordable Care Act’s contraception regulations for insurance providers as “coerced abortion payments.” These regulations, it claims, violate its religious freedom.

Religious freedom looms large in the national conversation about reproductive rights. The USCCB is not the only religious group pushing for restrictions on reproductive health care while vaunting its defense of religious freedom; activists say this tactic is common to Religious Right groups.

“Religious freedom has become a political weapon that they use to push a political agenda,” Quinn said. “They use religious freedom as a general catchall for social conservatives to push everything from laws that harm gay, lesbian and transgender Americans to anti-abortion laws.”

But it’s a weapon that some people of faith refuse to use.

Dr. Willie Parker, an Alabama-based abortion provider who identifies as a devout Christian, criticized the Religious Right’s tendency to combine anti-abortion activism with its pleas for religious freedom.

“When they [anti-abortion activists] frame issues as matters of religion, it puts them beyond question and debate,” Parker told Church & State. Parker said it’s the “irony of ironies” that abortion opponents brand themselves religious freedom advocates.

“They aren’t talking about freedom of religion or from religion. They mean the freedom for you to believe what they believe,” he noted. “It’s a real abuse of the privilege of living in a country where matters of conscience are protected.”