Two years ago, if a Texan needed an abortion, they’d have to travel an average of 44 miles to get one. Today, that number is 497.
Even before the fall of Roe last summer, Texas had one of the most restrictive abortion laws in the country. During the 87th legislative session, Texas Republicans passed Senate Bill 8, which prohibited abortions after the first six weeks of pregnancy. The overturn of Roe v. Wade in June 2022 led to a near-total statewide ban on abortion at any point during a pregnancy, except in cases where providing an abortion could save the life of the mother. The ban does not include an exception for victims of rape or incest, and doctors stress that the law’s harsh penalties and vague language make the medical exception hard to interpret.
In the two years since our state’s last legislative session, millions of Texans have lost access to abortion care. But those restrictive laws have also caused ripple effects, and obstructed doctors’ ability to care for patients experiencing pregnancy complications. As the Texas Legislature returns for its first session post Roe, state Representative Donna Howard, the Austin Democrat who chairs the Women’s Health Caucus, says her number-one priority is access to healthcare and damage control. She recently spoke with the Texas Observer’s Sara Hutchinson.
Our state’s draconian abortion laws have outlawed abortion at any point in a pregnancy with very few exceptions, even in the case of rape and incest. The laws have also had an impact on access to care for pregnancy complications. What are you hoping to do to mitigate those impacts?
Recognizing that we have a Republican majority, we are not going to be able to repeal what has been put in place, but we want to put exceptions in place that will allow us to deliver the best care possible. One exception is for victims of rape and incest. Of course, you should not have to be assaulted to have access to abortion healthcare and we’re going to keep pushing back on that. So, in regards to the rape and incest exception, we have legislation that we’ve worked on with the Texas Association Against Sexual Assault and the Children’s Advocacy Center, and they’ve stressed that we should not retraumatize survivors by requiring them to report to law enforcement. The majority of assaults are perpetrated by someone the victims knows and oftentimes that means family members. A victim may choose not to use the criminal justice system in that case. We want them to still be able to access healthcare regardless. Part of the legislation that we have drafted clarifies that if you are a victim of rape or incest you do not have to have your case reported to law enforcement in order to access abortion. I think that’s an important distinction.
What about access to abortion care for Texans experiencing pregnancy complications? Doctors sometimes provide a surgical abortion or prescribe abortion medication to patients who are miscarrying, but physicians now say these laws are preventing them from providing that care.
We need to address the issue of physicians having a lack of clarity about when they can intervene with pregnant patients who experience medical complications. Right now, doctors feel like their hands are tied. It’s not clear to them at what point they can intervene without risking their medical license or their livelihood and even going to jail. It’s a horrendous position we’ve put them in. We have been working to come up with language that would give doctors more clarity. We want to protect the doctor-patient relationship and ensure doctors feel safe to use their medical judgment.
“Doctors feel like their hands are tied. It’s not clear to them at what point they can intervene.”
Do you see this damage control as being something that Republicans would be interested in?
It’s hard to say. I haven’t had a lot of opportunities to have in-depth discussions with them. I have been on a few panels that give insight. Specifically, they’ve pushed back on: If there’s been an assault, they would want that to be reported and the assailant to be prosecuted. And then in terms of the medical complications in the same panel, one senator actually read the verbiage out of the current statute regarding medical exceptions for abortions and said, “It sounds clear to me.” I mean, great. It sounds clear to legislators. We’re talking about what the physicians are saying. It’s not clear to them and we’ve got to listen.
Texas has one of the highest teen birth rates in the country. It’s hard to imagine things improving now that abortion is banned, but what can be done to improve young people’s access to quality sex education and birth control?
It’s extremely disappointing. We have one of the highest rates of teen pregnancy and also one of the highest rates of repeat teen pregnancy. And we know that pregnant teens have many more challenges in completing their education and finding employment. In terms of STIs, we also have one of the highest rates of chlamydia. These students need to know about sexually transmitted infections and how to avoid them, but they’re not getting that information. It’s just irresponsible to not pass this information along.
I’ve proposed a bill for several sessions that would reimburse for contraceptives for young people who are on CHIP, a program that provides healthcare coverage for children whose families don’t qualify for Medicaid, but don’t have enough money for insurance. We are one of only two states that does not reimburse for contraceptives for CHIP plans. All the red states are doing this, yet we have chosen not to. And it’s not only the right thing to do in terms of the public health of these young people, but it’s fiscally the right thing to do, because right now we have a 90-to-10 match from the federal government. So if we’re talking about being fiscally conservative and fiscally responsible, providing contraceptive coverage when we have a significant federal match is absolutely the right direction.
Let’s talk about our state’s data on maternal morbidity and mortality. The latest report, released in December, found that 90 percent of pregnancy-related deaths in Texas were preventable. What should the Legislature do?
The bottom line is that we still have a higher rate of maternal mortality than the national average and we are still seeing disproportionate impacts on Black moms. We also have a huge issue of near-death complications and/or chronic diseases that occur as a result of pregnancy even a year postpartum. We’ve got to ensure that Texas moms have access to the healthcare they need. In the last legislative session, the House, in a bipartisan fashion, voted to extend postpartum coverage for Texas moms from two months to 12 months under Medicaid. That’s what most of the states already have been doing. Over half of our births in Texas are Medicaid births. But the Senate balked and would only go to six months. So we’re coming back this session with the same recommendation: Extend postpartum Medicaid coverage to 12 months. The Speaker of the House Dade Phelan is fully supportive. It’s one of his highest priorities. So, I know what’s going to happen on the House side. I still don’t know what the Senate is going to do.
Now, if we would just expand Medicaid, this would be a moot point. The best thing we could do for Texas moms and babies is to expand Medicaid so that these Texas moms can have the care they need preconception throughout their pregnancy postpartum [and] in between pregnancies.
“The best thing we could do for Texas moms and babies is to expand Medicaid.”
Thinking about big picture strategy, now that elective abortion is banned, what role do you think you and other Texans can play in the larger movement for reproductive justice?
We have regular conversations with the White House and with other states’ legislators. I just had a meeting last week with two legislators from Illinois, where abortion is legal. We’re exchanging information so they can see what’s happening in Texas so they can prepare for what to block if necessary. Also, how do we ensure that Texans who need abortion healthcare can get to other states to get that care? Which means we have to look at how we can help [other states] with their capacity, because they’re now not only addressing their own needs, they’re addressing the needs of the rest of us as well.
We’re strategizing, but clearly this is going to require changes in Washington, D.C. We need to make sure that the federal government can prevent states from denying access to care, denying us being able to cross state lines, [and] denying the mailing of abortion medication. The federal government has got to find ways to preempt what states are doing to trap people within their state from having access to healthcare. We’ll keep pushing. It’s never going to be about saying: we’re giving up. It’s always going to be about balancing pushing with protection. Pushing for what needs to be done and needs to be reinstated, but protecting those within the constraints that we have and doing everything we can to ensure as many people as possible can still access healthcare.
This interview has been edited for length and clarity.
