Signing a petition outside the Southwestern Women's Surgery Center in Dallas in November, after a federal appeals court ruled that the state's new abortion restrictions could take effect.Rex C. Curry/AP
AUSTIN, Texas — Betsy Garcia hovers nervously outside an abortion clinic in McAllen, Texas. After accepting a pamphlet from someone on the street, she goes to a different building where a woman in a white coat greets her with warmth. The woman offers to show Betsy a graphic video about abortion, then the two pray in front of a crucifix before the teen exposes her belly for an ultrasound. "God is going to bless you in a tremendous way with this child," says the woman as she presses a rosary into the girl's hands. The final scene shows a radiant Betsy dandling her 6-month-old daughter on her lap.
So goes the promotional video for the McAllen Pregnancy Center, a crisis-pregnancy facility established in 2008 to dissuade women from having abortions. The video was released in April, when there was still an abortion clinic to lure women from.
Today there’s a major change in town. While the McAllen Pregnancy Center continues to operate, Whole Woman’s Health, the only abortion provider in McAllen, stopped being able to provide abortions. A controversial Texas law that went into effect in November requiring abortion physicians to have admitting privileges at nearby hospitals has caused a third of the abortion clinics in the state to close. Abortion opponents say the law makes abortion safer, while providers and medical groups, like the American College of Obstetricians and Gynecologists (ACOG), counter that admitting privileges have no impact on the safety of the procedure.
Regardless, women in McAllen seeking to terminate unplanned pregnancies must now travel 170 miles to the nearest clinic. Alternatively, they could walk the two blocks to the McAllen Pregnancy Center for help. But that could prove risky.
A laissez-faire climate
While center staffers donning white coats and offering sonograms could easily be mistaken for health professionals, there’s nothing medical about the services they provide.
A McAllen Pregnancy Center counselor reached by phone told Al Jazeera that the center does not employ a doctor because the ultrasounds it conducts aren’t for diagnostic purposes but for “seeing the baby.” Medical experts, like the American Institute of Ultrasound in Medicine and the ACOG, take a dim view of such practices. They warn that women could be falsely reassured about their health or that of their fetus, and if abnormalities are discovered, there’s no guarantee that pregnant women will receive the follow-up care they need.
Though it might not be obvious to Betsy that she isn’t receiving medical treatment, the McAllen Pregnancy Center isn’t behaving like a rogue operator. Unlike abortion clinics, sandwich shops and nail salons, crisis-pregnancy centers in Texas don’t have to comply with state or federal safety standards. The state health department does not inspect the clinics, not even the ones that offer ultrasounds and call themselves pregnancy medical clinics. (The McAllen Pregnancy Center doesn’t call itself a medical clinic because it says its ultrasounds are nondiagnostic.) Even the Texas Medical Board, which is responsible for the good conduct of licensed physicians, shrugs at its doctors’ activities. It doesn’t require physicians to report where they serve as medical directors, and it investigates only if someone files a complaint. So far, no one has.
Such a laissez-faire climate means that anyone can set up shop and call it a pregnancy medical clinic. The anti-abortion powerhouse National Institute of Family and Life Advocates (NIFLA) sees this as a ripe business opportunity. As NIFLA says on its website, “Ultrasound opens a window to the womb where the mother is first introduced to her unborn child. By allowing this connection to happen, medical (clinics) experience dramatic increases in the percentages of their patients that choose life.”
NIFLA advises would-be medical clinics that only California, New Jersey, Massachusetts and New York have rigorous regulatory requirements for medical clinics. In any other state, a crisis-pregnancy center needs to have only a licensed physician to serve as medical director. Accordingly, NIFLA provides legal advice and staff training for crisis-pregnancy centers that want to “go medical,” advising that ultrasounds be performed only by physicians, sonographers or nurses because “the provision of ultrasound services is the practice of medicine.” The group reassures members that the extra effort to become a medical clinic is worthwhile because the ability to confirm pregnancies and establish viability will increase their client loads. Accordingly, more than 70 crisis-pregnancy centers in Texas have gone medical.
Feted by Texas politicians
These unregulated medical clinics operate in every corner of Texas. In Dallas, where two abortion clinics closed in November, there are seven NIFLA-affiliated pregnancy medical clinics. In Fort Worth, four medical clinics exist, while two abortion clinics recently ceased operations. There are no abortion providers in the Texas Panhandle, but there are at least four pregnancy medical clinics there. Two pregnancy clinics remain in San Antonio after three abortion clinics recently ended operations. In Waco, both abortion clinics closed, but two pregnancy medical clinics flourish nearby.
All these clinics offer free pregnancy tests and ultrasounds — which can be attractive to low-income women whose access to regulated health providers was severely curtailed by state-mandated budget cuts in 2011.
Growing concerned about the lack of information available to vulnerable women entering such clinics, the city of Austin passed an ordinance in 2010 requiring local centers to display a sign stating whether they provide medical services, if they do so under medical supervision and if they are inspected. Almost immediately, the centers filed a lawsuit, saying such signage was both forced speech and a violation of their freedom of religion. While a federal judge deliberates on the case (the hearing was almost two years ago), the ordinance is not being enforced.
Meanwhile, crisis-pregnancy centers continue to be feted by Texas’ political establishment. Since 2005, the state health department has rerouted $30 million from family-planning coffers toward crisis-pregnancy centers so that they might persuade pregnant women to choose parenting or adoption over abortion. Those centers in receipt of state money under the Texas Alternatives to Abortion program are self-inspected and paid by the state to distribute scientifically inaccurate information about abortion risks.
In Houston, a crisis-pregnancy center network called the Source for Women runs four NIFLA-affiliated clinics that are part of the Alternatives to Abortion program. The state health department recently certified the Source to provide the kind of women’s health services that Planned Parenthood clinics were barred from providing two years ago. At a ribbon-cutting ceremony in 2012, Gov. Rick Perry unveiled one of the Source’s sonogram rooms and said, “The opening of this latest medical center will enable you to spread your message and do your vital work on a significantly larger scale in the years to come … The Source gives women with unexpected pregnancies the information and the support they need to make the right choice, the choice of life.”
Indeed, crisis-pregnancy centers are feeling optimistic about the new health landscape in Texas. In response to a question by a local news station about the closure of abortion clinics after the passage of the state’s anti-abortion law, Cynthia Wenz, head of the Source for Women, was upbeat. She explained that the Source offers women exams and STD and STI treatments but no abortions.
“We feel like there’s now a diversification of care because additional providers have stepped up,” she said. “We’re one of those providers. We’re a pregnancy medical clinic.”